Intensive Nutritional Counseling and Education for Management of Hyperphosphatemia in Hemodialysis Patients at Al-Khor Hospital- Hamad Medical Corporation - State of Qatar

Abstract

Objectives: To assess the dietary phosphate intake of hemodialysis patients with hyperphosphatemia and the effects of a dietetic intervention focused on limiting dietary phosphate load. Design: Cross-sectional dietary phosphate intake assessment and prospective intervention study. Setting: Hospital hemodialysis units of AL-Khor hospital – Hamad Medical Corporation, Qatar. Subjects: sixteen stable adult hemodialysis patients, who had phosphorus serum levels ≥1.6 mmol/L. Intervention: Analysis of dietary composition and of the effects of individual dietetic counseling to reduce phosphorus intake while preserving the same or improving protein intake. Main outcome measures: Differences in nutrient intake between pre and post-dietary intervention among hyperphosphatemia patients, and changes in phosphorus–protein ratio, and serum phosphate, after the dietetic intervention. Results: Significant differences in nutrient intake including energy, protein, and phosphorus were detected after the intervention. After dietetic intervention in the hyperphosphatemia patients, a decrease in the dietary phosphate–protein ratio (28.9 -13.4 mg/g, P <0.05) also occurred. Serum phosphate showed a trend of a significant decrease after the dietary intervention (2.2mmol/L-1.68mmol/L), P < 0.05). Conclusion: Individual intensive nutritional education and counseling may be useful in reducing phosphate load and improving serum phosphorus with a positive effect on nutrient intake. A phosphate-controlled diet has a role in an integrated therapeutic approach to hyperphosphatemia and positive calcium-phosphorus balance in hemodialysis patients.