Nutritional Intake and Diet Quality in Hemodialysis Patients: Scope for Improvement

Abstract

Objective: Hemodialysis (HD) patients face challenges in upholding dietary compliance. This study aimed to compare dietary intake against disease-specific guidelines. Secondary, to assess the overall diet quality and to explore the association between dietary potassium intake and serum potassium concentrations.

Methods: In this cross-sectional multicenter study, nutrient intake of Dutch adult HD patients was assessed using food frequency questionnaires and diet quality with the Dutch Healthy Diet 15-index. Intake and diet quality were compared to disease-specific dietary recommendations or Dutch Dietary Guidelines. Insufficient intake was defined as <90% of the requirement, sufficient as 90-100%, and excessive as >110%. The association between serum potassium concentration and dietary potassium intake was modeled with linear regression analysis.

Results: The study population consisted of 248 participants (60% male) from 21 dialysis centers. Energy intake (1789 [872] kcal/day) was insufficient for 45% of the participants, while protein intake (1 [0.5] g/kg/d) was insufficient for 50%. Despite 67% of participants managing to align their energy intake below 110% of the recommended level, a high prevalence of overweight (61%) was observed in this cohort. Saturated fat intake was excessive for 87% of participants, while only 15% met the recommended fiber intake. Overall diet quality was low (74 [20] maximum score of 150). No association was observed between serum potassium and dietary potassium intake after adjusting for relevant confounders (r = 0.163, P = .261).

Conclusions: A considerable proportion of Dutch HD patients were unable to meet disease-specific dietary guidelines. Diet quality was shown to be poor.

Keywords: chronic kidney disease; diet quality; nutrition; potassium.