Objective: To assess knowledge of phosphorus compared with other nutrients in patient undergoing maintenance dialysis (MD). Design:We compared knowledge of phosphorus versus other nutrients important to the MD diet (potassium, sodium, protein) in hemodialysis (HD) and peritoneal dialysis (PD) patients. We further measured gender, age, education level and functional health literacy to assess correlations in patient nutrient knowledge. Nutrient knowledge was measured using a 25-item chronic kidney disease knowledge assessment tool for nutrition (CKDKAT-N), and functional health literacy was measured using the short-form of the test of functional health literacy in adults (STOFHLA). Results: Forty-seven MD patients participated in the study (29 HD, 18 PD, 30 males and 17 females, average age 58.6 (SD 13.8) years, average grade level 1.4 (SD 2.6) years of post-secondary education). 35 participants had adequate, 4 marginal and 8 inadequate health literacy. CKDKAT-N scores ranged from 6 to 21 of 25 items, mean score of 13 (SD 2.91). Knowledge of phosphorus compared with knowledge of other nutrients was poor (0.38 versus 0.72, p = 0.003). Comparing HD to PD patient knowledge, both phosphorus (0.37 versus 0.42, p=0.231) and other nutrients (0.69 versus 0.80, p=0.115) were the same. Conclusion:Despite regular dietary instruction, patients undergoing MD have a poor knowledge of dietary phosphorus content, compared with knowledge of other nutrients important in chronic kidney disease. Interestingly, there was no difference in nutrition knowledge when comparing PD and HD patients, despite differences in education level and health literacy between the groups.

Background. Hypomagnesaemia is a common side effect of cyclosporin A (CsA) therapy. Animal studies suggest that magnesium (Mg) supplementation inhibits chronic CsA nephropathy. Methods. To determine if low Mg levels correlate with true CsA-induced nephrotoxicity in humans, we examined kidney transplant biopsy records at our centre for all transplant biopsies performed between 1990 and 2002. We simultaneously reviewed the medical records to determine whether serum Mg levels were checked at the time of biopsy. Those individuals with histologically proven CsA nephrotoxicity were studied. Results. Serum total Mg levels were available for 320 patients, 60 of whom were diagnosed with chronic CsA-mediated nephropathy. Patients were divided in two groups, a low Mg [n ¼ 29, 1.8 (1.67-1.9) mg/dl or 0.74 (0.68-0.78) mmol/l] and a normal Mg group [n ¼ 31, 2.2 (2.0-2.4) mg/dl or 0.9 (0.82-0.98) mmol/l, P<0.05] based on the median Mg level in the entire cohort (2 mg/dl or 0.82 mmol/l). Both groups were analysed for disease progression and graft loss using the slope of creatinine clearance (CCR) and multivariate analyses. Although the CCR at the time of biopsy was greater in the low Mg group [44.3 (36.3-64.3) ml/min vs 37.8 (25.2-47.3) ml/min, P<0.05), the decline in graft function was faster in this group (À8.9±3.5 vs 1±2.7 ml/min/year; P ¼ 0.02) compared with the normal Mg cohort. Using Cox proportional hazards analyses, the adjusted graft survival was significantly reduced in the low Mg group 5 years after biopsy. Conclusions. Our study demonstrates that low serum Mg levels were associated with a faster rate of decline in kidney allograft function and increased rates of graft loss in renal transplant recipients with chronic CsA nephropathy. This suggests that hypomagnesaemia could potentiate CsA-mediated nephropathy.

No abstract

No abstract

No abstract