Adherence to Mediterranean Diet in Individuals on Renal Replacement Therapy

Abstract

Patients on renal replacement therapy are typically subject to several dietary restrictions; however, this approach has been questioned in recent years, with some suggesting that the Mediterranean diet might be beneficial. Data on the adherence to this diet and factors that influence it are scarce. We conducted a web survey among individuals on renal replacement therapy (dialysis or kidney transplant, KT) using the MEDI-LITE questionnaire to assess adherence to the Mediterranean diet and dietary habits in this population. Adherence to the Mediterranean diet was generally low, and significantly lower among participants on dialysis versus KT recipients (19.4% vs. 44.7%, p < 0.001). Being on dialysis, adopting fluid restrictions, and having a basic level of education were predictors of low adherence to the Mediterranean diet. Consumption of foods typically included in the Mediterranean diet, including fruit, legumes, fish, and vegetables, was generally low, particularly among those on dialysis. There is a need for strategies to improve both the adherence to and the quality of the diet among individuals on renal replacement therapy. This should be a shared responsibility between registered dietitians, physicians, and the patient.

Keywords: Mediterranean diet; dialysis; kidney transplant.

Figure 1

Weight change since the start of dialysis or KT. * p < 0.05.

Figure 2

Proportion of participants reporting restrictions in fluid, potassium, salt, or phosphate intake. ** p < 0.001 vs. the dialysis group. KT, kidney transplant.

Figure 3

MEDI-LITE score by age category, body mass index (BMI) category, geographical area, level of education, working status, and physical activity level in participants on dialysis. UW, underweight; NW, normal weigh; OW, overweight; OB, obesity; Adv, advanced; Interm., intermediate.

Figure 4

MEDI-LITE score by age category, body mass index (BMI) category, geographical area, level of education, working status and physical activity level in KT recipients. UW, underweight; NW, normal weigh; OW, overweight; OB, obesity; Adv, advanced; Interm., intermediate. ^a p = 0.031 vs. central Italy; ^b p = 0.016 vs. intermediate; ^c p = 0.006 vs. advanced level of education.

Figure 5

Proportion of participants reporting optimal (2 points), intermediate (1 point), or inadequate (0 points) intake of each food category included in the MEDI-LITE questionnaire. * p < 0.05 vs. the corresponding category in the dialysis group.