EVALUATION OF DIETARY PROTEIN AND PHOSPHATE INTAKE AMONG THE HEMODIALYSIS PATIENTS WITH HYPERPHOSPHATEMIA IN PENANG, MALAYSIA
Objective: High serum phosphate level and malnutrition are among the key factors that elevate the risk of mortality among hemodialysis patients. The objective of this study was to evaluate the total dietary protein and phosphate intake by hemodialysis patients with hyperphosphatemia in Penang state, Malaysia. Methods: This was a cross sectional study conducted between September to November 2015 which involved hemodialysis patients from eight dialysis centers in Penang. The inclusion criteria were hemodialysis patients aged more than 18 years old with serum phosphate more than 1.8 mmol/L. Patients’ two days’ unscheduled diet recall that included one weekday and one weekend diet intake were recorded. Results: A total of 117 eligible hemodialysis patients were approached and 98 patients agreed to participate in this study. The mean age of the patients was 52.6±14.1 years. The patients’ mean serum phosphate and albumin level were 2.18±0.24 mmol/L and 38.28±3.94 g/L respectively. The mean total dietary calorie intake was 1411.2±248.3 kcal/day. Whereas, the mean dietary protein intake was 43.7±7.6 g/day and phosphate intake were 940.2±150.8 mg/day. Conclusion: The dietary calories and protein intake for the hemodialysis patients were relatively low, indicating that the patients were at risk of malnutrition and mortality. The patients’ dietary phosphate intake was within the recommended range, but the target serum phosphate level was not achieved.
Keywords:Hemodialysis, Hyperphosphatemia, Dietary protein, Phosphate
Arenas, M. D., Malek, T., Gil, M. T., Moledous, A., Alvarez-Ude, F. & Reig-Ferrer, A. (2010) 'Challenge of phosphorus control in hemodialysis patients: a problem of adherence?', Journal of Nephrology, 23(5) pp- 525-534.
Benini, O., D'Alessandro, C., Gianfaldoni, D. & Cupisti, A. (2011) 'Extra-phosphate load from food additives in commonly eaten foods: a real and insidious danger for renal patients', Journal of Renal Nutrition, 21(4) pp 303-308.
Block, G. A., Hulbert-Shearon, T. E., Levin, N. W., & Port, F. K. (1998) 'Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study.', American Journal of Kidney Diseases, 31(4) pp-607-617.
Cannata-Andia, J. B. & Rodriguez-Garcia, M. (2002) 'Hyperphosphataemia as a cardiovascular risk factor -- how to manage the problem. ', Nephrology, Dialysis, Transplantation, 17(11), pp-16-19.
Chironda, G. & Bhengu, B. (2016) 'Contributing Factors to Non-Adherence among Chronic Kidney Disease (CKD) Patients: A Systematic Review of Literature', Medical and Clinical Reviews, 2(4).
Denomme, J. & Cui, W. (2013) 'The barriers surrounding hemodialysis for patients with ESRD: improving access since 1945', University of Western Ontario Medical Journal, 82(1), pp 31-32.
European Food Safety Authority (2013) 'Assessment of one published review on health risks associated with phosphate additives in food', EFSA Journal, 11(11), pp- 3444.
Fouque, D., Pelletier, S. & Guebre-Egziabher, F. (2011) 'Have Recommended Protein and Phosphate Intake Recently Changed in Maintenance Hemodialysis?', Journal of Renal Nutrition, 21(1) pp 35-38.
Gafor, A. H. A., Koh, K. H., Karupaiah, T. & Chee, W. S. S. (2014) 22nd Report of the Malaysian Dialysis and Transplant Registry 2014, Kuala Lumpur, Malaysia: Malaysian Nephrology Society.
Goh, B. L., Ching, C. H., Kok, L. S., Liew, Y. F. & Ganeshadeva, Y. M. (2014) 22nd Report of the Malaysian Dialysis and Transplant Registry Kuala Lumpur,Malaysia: Malaysian Nephrology Society.
González-Parra, E., Gracia-Iguacel, C., Egido, J. & Orti, A. (2012) 'Phosphorus and Nutrition in Chronic Kidney Disease', International Journal of Nephrology, 2012.
Gutiérrez, O. M. & Wolf, M. (2010) 'Dietary Phosphorus Restriction in Advanced Chronic Kidney Disease: Merits, Challenges, and Emerging Strategies', Seminars in Dialysis, 23(4), pp 401-406.
Hruska, K. A., Mathew, S., Lund, R., Qiu, P. & Pratt, R. (2008) 'Hyperphosphatemia of chronic kidney disease', Kidney International 74(2), pp 148-157.
Ikizler, T. A. & Hakim, R. M. (1996) 'Nutrition in end-stage renal disease', Kidney International 50(2), pp 343- 57.
Kalantar-Zadeh, K., Gutekunst, L., Mehrotra, R., Kovesdy, C. P., Bross, R., Shinaberger, C. S. & Kopple, J. D. (2010) 'Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease', Clinical Journal of the American Society of Nephrology, 5(3), pp 519-530.
Karavetian, M., Vries, N., Rizk, R. & Elzein, H. (2014) 'Dietary educational interventions for management of hyperphosphatemia in hemodialysis patients: a systematic review and meta-analysis', Nutrition Reviews, 72(7), pp 471-482.
Karkar, A. (2012) 'Modalities of hemodialysis: quality improvement', Saudi Journal of Kidney Diseases and Transplantation, 23(6), pp 1145-1161.
Kaysen, G. A., Dubin, J. A., Müller, H. G., Rosales, L. M. & Levin, N. W. (2000) 'The acute-phase response varies with time and predicts serum albumin levels in hemodialysis patients.', Kidney international, 58(1), pp 346-352.
KDIGO CKD-MBD Work Group (2009) 'KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD)', Kidney International. Supplement, 113, pp. S1-S130.
Kok, L. S., Ghazalli, R. B., Ching, C. H., Fan, K. S. & Liew, Y. F. (2013) 21th Report of the Malaysian Dialysis & Transplant Registry, Kuala Lumpur, Malaysia: Malaysia Society of Nephrology.
Lee, R. D. & Nieman, D. C. (2007) 'Measuring Diet', Nutritional Assessment. 6th ed. New York: McGraw-Hill, pp. 80.
Lowrie, E. G. & Lew, N. L. (1990) 'Death Risk in Hemodialysis Patients: The Predictive Value of Commonly Measured Variables and an Evaluation of Death Rate Differences Between Facilities', American Journal of Kidney Diseases, 15(5), pp 458-482.
Lynch, K. E., Lynch, R., Curhan, G. C. & Brunelli, S. M. (2011) 'Prescribed dietary phosphate restriction and survival among hemodialysis patients', Clinical Journal of the American Society of Nephrology, 6(3), pp 620-629.
Ma, Y., Olendzki, B. C., Pagoto, S. L., Hurley, T. G., Magner, R. P., Ockene, I. S., Schneider, K. L., Merriam,P. A. & Hebert, J. R. (2009) 'Number of 24-hour diet recalls needed to estimate energy intake', Annals of Epidemiology, 19(8), pp 553-559.
Moe, S. M., Zidehsarai, M. P., Chambers, M. A., Jackman, L. A., Radcliff, J. S. & Trevino, L. L. (2011) 'Vegetarian compared with meat dietary protein source and phosphorus homeostasis in chronic kidney disease.', Clinical Journal of the American Society of Nephrology, 6(2), pp 257-264.
National Kidney Foundation (2000) 'NKF-DOQI - clinical practice guidelines for nutrition in chronic renal failure.',American Journal of Kidney Diseases, 35(Suppl 2), pp 17-103.
Noori, N., Sims, J. J., Kopple, J. D., Shah, A., Colman, S., Shinaberger, C. S., Bross, R., Kovesdy, C. P. & Kalantar-Zadeh, K. (2010) 'Organic and inorganic dietary phosphorus and its management in chronic kidney disease', Iranian Journal of Kidney Diseases, 4(2), pp 89-100.
Owen, W. F. Jr, Lew, N. L., Liu, Y., Lowrie, E. G. & Lazarus, J. M. (1993) 'The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis', The New England Journal of Medicine, 329(14), pp 1001-1006.
Phelan, P. J., O'Kelly, P., Walshe, J. J. & Conlon, P. J. (2008) 'The importance of serum albumin and phosphorous as predictors of mortality in ESRD patients.', Renal Failure, 30(4), pp 423-429.
Pinto, D. E., Ullmann, L. S., Burmeister, M. M., Antonello, I. & Pizzato, A. (2009) 'Associations between energy, protein, and phosphorus intakes in patients with chronic kidney disease on hemodialysis', Brazilian Journal of Nephrology, 31(4), pp 269-276.
Shinaberger, C. S., Kilpatrick, R. D., Regidor, D. L., McAllister, C. J., Greenland, S., Kopple, J. D. & Kalantar- Zadeh, K. (2006) 'Longitudinal associations between dietary protein intake and survival in hemodialysis patients', American Journal of Kidney Diseases 48(1), pp 37-49.
Sridhar, N. R. & Josyula, S. (2013) 'Hypoalbuminemia in hemodialyzed end stage renal disease patients: risk factors and relationships--a 2 year single center study', BMC Nephrology, 14, pp 242.
Tee, E. S. (1997) Nutrient Composition of Malaysian Foods (4th ed.). Kuala Lumpur: Institute for Medical Research.
Waheed, A. A., Pedraza, F., Lenz, O. & Isakova, T. (2013) 'Phosphate control in end-stage renal disease: barriers and opportunities', Nephrology, Dialysis, Transplantation, 28(12), pp 2961-2968.
Wolfson, M. (1999) 'Management of protein and energy intake in dialysis patients', Journal of the American Society of Nephrology, 10(10), pp 2244-2247.
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