Daily dietary phosphorus intake variability and hemodialysis patient adherence to phosphate binder therapy

Abstract

Introduction: Phosphate balance could be reached only by an optimized combination of dietary restriction and the careful use of phosphate binders for patients receiving standard hemodialysis treatment. Little is known about individual variability of phosphorus intake and phosphate binder use in hemodialysis patients. The purposes of this study were to quantify phosphorus intake and to describe individual phosphate‐binder use in hemodialysis patients. Methods: This was a cross‐sectional study. The dietary phosphorus intake was assessed using a 3‐day duplicate portion sampling method combined with chemical analysis. Patients' adherence to phosphate binders was evaluated by the Morisky Medication Adherence Scale, with a score of <6 being considered as an indicator of inadequate adherence. Findings: A total of 101 food samples from 36 patients were collected and analyzed. The mean daily phosphorus, protein, and energy intake was 15.1 mg/kg/d, 1.0 g/kg/d, and 28.9 kcal/kg/d, respectively. There was a higher consumption of phosphorus on dialysis days (DDs) than on non‐dialysis days (NDDs) (16.2 mg/kg/d vs. 14.0 mg/kg/d, P = 0.035); however, such a trend was not observed for dietary protein and energy intake (1.1 g/kg/d vs. 1.0 g/kg/d, P = 0.706; 30.3 kcal/kg/d vs. 27.6 kcal/kg/d, P = 0.225). A significantly higher percentage of patients on low phosphorus intake (<1000 mg/d) reported inadequate phosphate‐binding adherence than those on high phosphorus intake (60% vs. 18%, P = 0.031). Discussion: Patients receiving hemodialysis had a higher consumption of phosphorus on DDs than on NDDs; such a pattern was not obviously observed for protein and energy intake. For patients achieving phosphorus intake recommendation, medication nonadherence that possibly being attributed to the patient's necessity beliefs may pose extra hurdles for phosphate control.

Muscle Strength and Biochemical Markers as Predictors of Depression in Hemodialysis Patients: A Cross-Sectional Study

“…Lack of energy and protein intake is a common nutritional problem in these patients. Other studies carried out in Iran [ 32 ] and other countries [ 33 34 ] have shown similar results. It is important to consider that inadequate energy and protein intake in hemodialysis patients worsens malnutrition and increases the risk of mortality [ 34 35 ].…”

“…Other studies carried out in Iran [ 32 ] and other countries [ 33 34 ] have shown similar results. It is important to consider that inadequate energy and protein intake in hemodialysis patients worsens malnutrition and increases the risk of mortality [ 34 35 ]. The most important reason for lack of energy and protein intake in these patients is anorexia, which is the result of different factors, such as inflammation, the accumulation of toxic products, changes in hormones levels (ghrelin and leptin), neural mediators affecting appetite and underlying diseases like infection, and mental disorders.…”

“…The most important reason for lack of energy and protein intake in these patients is anorexia, which is the result of different factors, such as inflammation, the accumulation of toxic products, changes in hormones levels (ghrelin and leptin), neural mediators affecting appetite and underlying diseases like infection, and mental disorders. All these factors can not only affect the appetite of patients but can also affect the nutritional status, quality of life, and vitality [ 33 34 36 ].…”

Dietary Daily Sodium Intake Lower than 1500 mg Is Associated with Inadequately Low Intake of Calorie, Protein, Iron, Zinc and Vitamin B1 in Patients on Chronic Hemodialysis

“…We used a 3-day food diary to assess sodium intake, a method that may imply inherent errors of dietary assessment and can be the cause of under-and over-reporting. Nevertheless, there is large recent evidence that the 3-day diet diary is a simple, useful, and effective method to measure the intake of macro-and micro-nutrients in patients on chronic hemodialysis [43][44][45][46][47]. The strength is that we included patients of different towns of Italy and consequently the data can be considered representative of the Italian population of patients on chronic hemodialysis.…”

Development of a Predictive Nomogram for Estimating Medication Nonadherence in Hemodialysis Patients

“…This figure includes chronic hemodialysis patients [ 1 ]. Recent studies of medication compliance in hemodialysis patients have mainly assessed the relationship between patients’ preferences, such as dietary intake, and chelating agents [ 9 , 10 ]. Our study analyzed clinical data related to hemodialysis patients, discussed the factors influencing patient medication compliance, and established a nomogram model to predict poor medication compliance in patients undergoing hemodialysis; this nomogram provides a simple and effective tool for identifying high-risk hemodialysis patients with poor medication compliance.…”