Knowledge of the hyperphosphatemia treatment and adhesion to the nutritional orientations after intervention in individuals in hemodialysis
DOI:
https://doi.org/10.34019/1982-8047.2019.v45.26123Keywords:
Food and Nutritional Education, Renal Dialysis, Hyperphosphatemia, Renal Insufficiency, ChronicAbstract
Introduction: Hyperphosphatemia control is a challenge in the treatment of patients in hemodialysis, which is one of the main objectives to be reached. Nutritional accompaniment and practice of educational activities contribute to the success in the adhesion to the treatment. Objective: Describe, in individuals in hemodialysis, the knowledge of the treatment of hyperphosphatemia, as well as to evaluate the possible impact of nutritional orientations on phosphorus levels after nutritional intervention in participants of the program HD at the University Hospital in the city of Juiz de Fora, MG. Material e methods: Quasi-experimental study, of the before and after kind with 35 patients in hemodialysis treatment, with 18 years or more, of both sexes, in dialysis for, at least, two months and who have had, at least, one appointment with the nutritionist in this division. Sociodemographic and clinical data was collected from patient records and adapted reminder questionnaires of food frequency in the last 24 hours were applied for assessment of food intake, as well as multiple-choice questions about the knowledge of the causes of hyperphosphatemia, phosphorus-rich food and use of binders. The intervention was made through the use of an educational leaflet. After the intervention, phosphorus serum levels were verified, taking into consideration hyperphosphatemia values >5,5 mg/dL. Results: In the sample, 57.1% (n=20) were male, with mean age of 61.8 ± 14.3 years and mean time in dialysis of 61.1 ± 68.9 months. The prevalence of hyperphosphatemia before the intervention had been of 60% (n=21) and at the end of the intervention there was a reduction to 25.7% (n=9). There was difference in the reduction of phosphorus serum levels when compared to the medians before and after the intervention [(5.9 ± 1.3 mg/dL; 4.9 ± 1.7 mg/dL; p<0,001)]. Conclusion: The results showed that the educational intervention possibly contributed to a better understanding and treatment adherence, having a complementary role in the management of hyperphosphatemia in dialysis patients.
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National Kidney Foundation. K/DOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD. Am J Kidney Dis. 2014; 63(5):713-35. doi: https://doi.org/10.1053/j.ajkd.2014.01.416
Cuppari L. Nutrição clínica no adulto: guias de medicina ambulatorial e hospitalar UNIFESP/Escola Paulista de Medicina. 3ª ed. São Paulo: Ed. Manole; 2014.
Sesso RC, Lopes AA, Thomé FS, Lugon JR, Martins CT. Inquérito brasileiro de diálise crônica 2016. J Bras Nefrol. 2017; 39(3):261-6. doi: 10.5935/0101-2800.20170049
Brito ACD, França AKTC, Hortegal EV, Dias RSC, Costa RCO, Lima DP. Conhecimento de hiperfosfatemia e quelante de fósforo em hemodialíticos. BRASPEN J. 2016; 31(4):322-8.
Caldeira D, Amaral T, David C, Sampaio C. Educational strategies to reduce serum phosphorus in hyperphosphatemic patients with chronic kidney disease: systematic review with meta-analysis. J Ren Nutr. 2011; 21(4):285-94. doi: 10.1053/j.jrn.2010.11.006
Sherman RA. Hyperphosphatemia in dialysis patients: beyond nonadherence to diet and binders. Am J Kidney Dis. 2016; 67(2):182-6. doi: 10.1053/j.ajkd.2015.07.035
Elliott JO, Ortman C, Almaani S, Lee YH, Jordan K. Understanding the associations between modifying factors, individual health beliefs, and hemodialysis patients’ adherence to a low-phosphorus diet. J Ren Nutr. 2015; 25(2):111-20. doi: 10.1053/j.jrn.2014.08.006
Taketani Y, Koiwa F, Yokoyama K. Management of phosphorus load in CKD patients. J Clin Exp Nephrol. 2017; 21(S1):27-36. doi: 10.1007/s10157-016-1360-y
Nerbass FB, Morais JG, Santos RG, Krüger TS, Koene TT, Filho HAL. Adesão e conhecimento sobre o tratamento da hiperfosfatemia de pacientes hiperfosfatêmicos em hemodiálise. J Bras Nefrol. 2010; 32(2):149-55. doi: http://dx.doi.org/10.1590/S0101-28002010000200003
Pinto DE, Ullmann LS, Burmeister MM, Antonello ICF, Pizzato A. Associações entre ingestão energética, proteica e de fósforo em pacientes portadores de doença renal crônica em tratamento hemodialítico. J Bras Nefrol. 2009; 31(4):269-76. doi: http://dx.doi.org/10.1590/S0101-28002009000400005.
D'Alessandro C, Piccoli GB, Cupisti A. The "phosphorus pyramid": a visual tool for dietary phosphate management in dialysis and CKD patients. BMC Nephrol. 2015; 20(16):9. doi: 10.1186/1471-2369-16-9.
Pascoal BA, Paula MR, Maniglia FP. Educação nutricional como estratégia no controle da hiperfosfatemia e hipercalemia em pacientes em hemodiálise. BRASPEN J. 2017; 32(3):221-5.
World Health Organization (WHO). Obesity: preventing and managing the global epidemic. Geneva: World Health Organization; 1997.
Tabela Brasileira de Composição de Alimentos (TACO). NEPA-UNICAMP. 4. ed. rev. e ampl. Campinas: NEPA/UNICAMP; 2011.
Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de orçamentos familiares: tabela de composição nutricional dos alimentos consumidos no Brasil. Rio de Janeiro: IBGE; 2011.
Philippi ST. Tabela de Composição de Alimentos: Suporte para decisão nutricional. 2ª ed. São Paulo: Coronário; 2002.
Schieri R, Everhart JE. Validity of a Brazilian food frequency questionnaire against dietary recalls and estimated energy intake. Nutrition. 1998; 18(10):1649-59. doi: https://doi.org/10.1016/S0271-5317(98)00151-1
National Kidney Foundation. K/DOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 update. Am J Kidney Dis. 2015; 66(5):884-930. doi: https://doi.org/10.1053/j.ajkd.2015.07.015
Vaz IMF, Freitas ATVS, Peixoto MRG, Ferraz SF, Campos MIVA. A ingestão energética de pacientes em hemodiálise é subrelatada? J Bras Nefrol 2015;37(3):359-66. doi: http://dx.doi.org/10.5935/0101-2800.20150056.
Hoover H. Compliance in hemodialysis patients: a review of the literature. J Am Diet Assoc. 1989; 89(7):957-9.
National Kidney Foundation. KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD). Am J Kidney Dis. 2017; 70(6):737-51. doi: 10.1053/j.ajkd.2017.07.019.
National Kidney Foundation. K/DOQI Clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis. 2001; 37(1 Suppl 2):S66-70.
National Kidney Foundation. K/DOQI Clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003; 42(4 Suppl 3):S1-201.
Machado AD, Bazanelli AP, Simony RF. Avaliação do consumo alimentar de pacientes com doença renal crônica em hemodiálise. Rev Ciênc. Saúde. 2014; 7(2):76-84. doi: http://dx.doi.org/10.15448/1983-652X.2014.2.17758.
Guida B, Parolisi S, Coco M, Ruoppo T, Veccia R, di Maro M et al. The impact of a nutritional intervention based on egg white for phosphorus control in hemodialyis patients. Nutr Metab Cardiovasc Dis. 2019; 29(1):45-50. doi: 10.1016/j.numecd.2018.09.010
Danelon B, Andrade MM, Alvarenga L, Nascimento R, Mendes LL, Aguiar A. Efeitos a curto e longo prazos de ações de educação alimentar e nutricional no perfil nutricional de pacientes em hemodiálise. Nutr clín diet hosp. 2018; 38(4):131-6. doi: 10.12873/384danelon.
Nisio JM, Bazanelli AP, Kamimura MA, Lopes MGG, Ribeiro FSM, Vasselai P et al. Impacto de um programa de educação nutricional no controle da hiperfosfatemia de pacientes em hemodiálise. J Bras Nefrol. 2007; 29(3):152-57.
Baraz S, Zarea K, Dashtbozorgi B. Comparing the effect of two educational programs on the quality of life of hemodialysis patients in Iran. Iran Red Crescent Med J. 2014. 16(8):e19368. doi: 10.5812/ircmj.19368.
Ebrahimi H, Sadeghi M, Amanpour F, Dadgari A. Influence of nutritional education on hemodialysis patients’ knowledge and quality of life. Saudi J Kidney Dis Transpl. 2016; 27(2):250-5. doi: 10.4103/1319-2442.178253.
Karavetian M, de Vries N, Rizk R, Elzein H. Dietary educational interventions for management of hyperphosphatemia in hemodialysis patients: a systematic review and meta-analysis. Nutr Rev. 2014 Jul; 72(7):471-82. doi: 10.1111/nure.12115. Epub 2014 Jun 11.
Casas J, Rodrigues CIS, D’Avila R. Educação nutricional para pacientes renais crônicos em programa de hemodiálise. Nutrire. 2015; 40(1):36-44.
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