The Effect of Dietician Education Program on Nutritional Knowledge, Dietary Intake and Phosphate Control in Patients with Renal Failure

Document Type: Original Article

Authors

1 Hemodialysis Service, Institute of Clinical Surgery, Catholic University of the Sacred Heart Rome Italy, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

2 Division of Nephrology, Catholic University of the Sacred Heart Rome Italy, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

3 Institute of Biochemistry and Clinical Biochemistry, Catholic University of the Sacred Heart Rome Italy, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy

4 Division of Clinical Nutrition Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

Abstract

Background: Limited fluid and electrolyte intake are part of standard diet of patients with renal failure on maintenance hemodialysis (MHD). However, non-adherence is common and may be explained by patients’ insufficient nutritional knowledge. Therefore, we investigated the influence of a dietary counseling on MHD patients’ knowledge about nutrients and their subsequent consumed diet, with particular attention to the intake of phosphates and the phosphorus to protein intake ratio
(i.e., the phosphorus content per gram of dietary protein intake per day).
Methods: Forty-five MHD patients participated in this experimental study. At baseline, participants were interviewed by a dietician to assess their dietary habits and knowledge about nutrients and health-related consequences of electrolyte imbalances. In addition, they completed a nutrient intake diary during three consecutive days. Subsequently, individual dietary counseling, by means of personal advice was reinforced with the use of printed tables addressing the composition of food products and the phosphorus to protein intake ratio. Dietary counseling was repeated at three, six and nine months of follow-up. The interview with the dietician was repeated after one year.
Results: Forty-five MHD patients completed the study. Their knowledge about nutrients and their dietary habits and food preparation mode improved significantly after the counseling program. Especially, caloric intake and dietary composition became more adequate and balanced, respectively. Moreover, the phosphorus to protein intake ratio improved, as well as patients’ intake of phosphate binders.
Conclusion: This study showed that nutritional counseling improved MHD patients’ knowledge about nutrients and subsequently diet composition and phosphate intake.

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