Nutritional intervention for management of osteodystrophy (nimo) program in hemodialysis patients, lebanon and baseline data

Abstract

Hyperphosphatemia in hemodialysis (HD) patients is considered to be the silent killer. Adherence to phosphorus restricted diets by HD patients is too low in the literature. This study aims to reveal the NIMO trial plan and the baseline characteristics of the study sample Adult stable patients (n=750) were selected from 12 hospital-based HD units. Baseline patient characteristics were assessed during the 6 months prior to study initiation. HD units were randomly assigned to the study clusters: Cluster 1 (6 units, 370 patients) was divided into full intervention (A) and control groups (B) (as per shifts); where the full intervention received medical nutritional therapy (MNT) for 6 months as 2 hours/patient/month, delivered by externally recruited dietitians, fully dedicated to the unit. The hospital dietitian (blinded to study protocol) continued providing dietetic services as per existing practice to all patients. As for cluster 2 (6 units, 380 patients): partial intervention (C), where the MNT was delivered by the hospital dietitian after HD-specific nutritional training. It was not possible to have a control in cluster 2 for ethical reasons. Dietitians delivering the study protocol in group A and C received the same training by study coordinator based on the nutritional guidelines of Kidney Disease Outcomes Quality Initiative and trans-theoretical model. Key results at baseline were: Nutritional knowledge (%) of Group A, B, C was 40.14±12.39, 38.2±12, 38.92±12.74 respectively. Serum P (mg/dl) of Group A, B, C was 5.58±1.53, 5.39±1.5, 5.17±1.44 respectively. The serum P of Group A was significantly higher than the other groups. Actual consumption of protein compared to needs (%/d) of Group A, B, C was 59, 64, 58 respectively. Frequency of hospital dietitian’s visits was <1 time/patient/6 months for all the 3 groups. The low protein intake and the inadequate frequency of dietetic consultation highlights the need of a nutritional program that would empower dietitians to get integrated the HD unit’s health care team and thus improve the quality of life of the Lebanese HD patients.