Effectiveness of adherence to nutritional therapy in type 2 diabetics on hemodialysis
DOI:
https://doi.org/10.36097/rgcs.v2i2.3174Keywords:
nutritional status, adherence, diet, hemodialysis, type 2 diabetes mellitusAbstract
Type 2 diabetes is one of the leading causes of chronic kidney disease, and its treatment through hemodialysis requires strict adherence to nutritional therapy. This study evaluated anthropometric and biochemical parameters, as well as the degree of dietary adherence, in 87 patients with diabetic nephropathy undergoing hemodialysis in Ecuador. Serial measurements were conducted over a six-month period, and the DDFQ questionnaire was used to assess adherence to dietary and fluid restrictions. Significant sex-based differences were observed in waist, arm, and calf circumferences (p<0.001), as well as in phosphorus and potassium levels (p≤0.05). A total of 48% of patients showed a moderate deviation from the diet, and 34% a severe deviation. Significant correlations were found between the degree of dietary non-adherence and levels of albumin, creatinine, phosphorus, and potassium, suggesting that these biochemical markers may reflect nutritional adherence. No significant correlations were found between fluid restriction adherence and any other variables. These findings underscore the importance of enhancing nutritional education among hemodialysis patients and support the use of the DDFQ as a valuable tool for monitoring adherence to nutritional therapy.
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References
American Diabetes Association (2021). 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care, 44(Suppl 1), S15-S33. https://doi.org/10.2337/dc21-S002
Angulo, A. A., Rodríguez, D., & García, M. A. (2024). Estado nutricional y calidad de vida del adulto mayor: revisión sistemática. Revista Gregoriana de Ciencias de la Salud, 1(2), 165-177. https://doi.org/10.36097/rgcs.v1i2.3149
Bakkal H., Dizdar OS., Erdem S., Kulakoğlu S., Akcakaya B., Katırcılar Y., & Uludag K. (2020). The Relationship Between Hand Grip Strength and Nutritional Status Determined by Malnutrition Inflammation Score and Biochemical Parameters in Hemodialysis Patients. Journal of Renal Nutrition, 30(6), 548-555. https://doi.org/10.1053/j.jrn.2020.01.026
Beerendrakumar N., Ramamoorthy L., & Haridasan S. (2018). Dietary and Fluid Regime Adherence in Chronic Kidney Disease Patients. Journal of Caring Sciences, 7(1), 17-20. https://doi.org/10.15171/jcs.2018.003
Brennan, A. M., Coen, P. M., Mau, T., Hetherington-Rauth, M., Toledo, F. G. S., Kershaw, E. E., Cawthon, P. M., Kramer, P. A., Ramos, S. V., Newman, A. B., Cummings, S. R., Forman, D. E., Yeo, R. X., Distefano, G., Miljkovic, I., Justice, J. N., Molina, A. J. A., Jurczak, M. J., Sparks, L. M., Kritchevsky, S. B., & Goodpaster, B. H. (2024). Associations between regional adipose tissue distribution and skeletal muscle bioenergetics in older men and women. Obesity, 32(6), 1125-1135. https://doi.org/10.1002/oby.24008
Contreras, F., Espinosa, J. C., & Esguerra, G. A. (2008). Calidad de vida, autoeficacia, estrategias de afrontamiento y adhesión al tratamiento en pacientes con insuficiencia renal crónica sometidos a hemodiálisis. Psicología y Salud, 18(2), 165-179. https://psicologiaysalud.uv.mx/index.php/psicysalud/article/view/659
Cui, L., Zhang, L., Li, J., Li, Y., Hao, X., Xu, Y., & Li, C. (2024). Correlation between ultrafiltration rate and hemoglobin level and erythropoietin response in hemodialysis patients. Renal Failure, 46(1), 2296609. https://doi.org/10.1080/0886022X.2023.2296609
De las Heras, M. T., & Martínez, C. (2015). Conocimiento y percepción nutricional en diálisis: su influencia en la transgresión y adherencia: estudio inicial. Nutrición Hospitalaria, 31(3), 1366-1375. https://dx.doi.org/10.3305/nh.2015.31.3.7942
Forbes-Hernández, T. Y., Betancourt, G., Rodríguez, D., & García, M. A. (2020). Capacidad antioxidante total de la dieta vs. balance redox. QhaliKay. 4(1), 35-48. https://doi.org/10.33936/qkrcs.v4i1.2711
Gallardo, W. D., & García, M. A. (2024). Junk food: analysis of risks, benefits, and social perception. Journal of Food Science and Gastronomy, 2(1), 26-34. https://doi.org/10.5281/zenodo.13996283
García, F. W., Fajardo, C., Guevara, R., Gonzáles, V., & Hurtado, A. (2002). Mala adherencia a la dieta en hemodiálisis: papel de los síntomas ansiosos y depresivos. Nefrología, XXII(3), 244-252. https://www.revistanefrologia.com/es-pdf-X0211699502014870
GBD - Chronic Kidney Disease Collaboration. (2020). Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 395(10225), 709-733. https://doi.org/10.1016/S0140-6736(20)30045-3
Gupta, S., Domínguez, M., & Golestaneh, L. (2023). Diabetic Kidney Disease: An Update. Medical Clinics of North America, 107(4), 689-705. https://doi.org/10.1016/j.mcna.2023.03.004
Halle, M. P., Nelson, M., Kaze, F. F., Jean Pierre, N. M., Denis, T., Fouda, H., & Ashuntantang, E. G. (2020). Non-adherence to hemodialysis regimens among patients on maintenance hemodialysis in sub-Saharan Africa: an example from Cameroon. Renal Failure, 42(1), 1022-1028. https://doi.org/10.1080/0886022X.2020.1826965
Iborra, C., López-Roig, S., & Pastor, M. de los Á. (2012). Prevalencia de la adhesión a la restricción de líquidos en pacientes renales en hemodiálisis: indicador objetivo y adhesión percibida. Nefrología, 32(4), 477-485. https://doi.org/10.3265/Nefrologia.pre2012.Feb.11236
Jampour L., Dehzad, M. J., Eftekhari, M. H., & Akbarzadeh, M. (2018). The Evaluation of Adherence to Dietary and Liquid Intake Recommendations in Hemodialysis Patients. Intternational Journal Nutrition Sciences, 3(2), 92-98. https://ijns.sums.ac.ir/article_43447.html
Kugler, C., Vlaminck, H., Haverich, A., & Maes, B. (2005). Nonadherence with diet and fluid restrictions among adults having hemodialysis. Journal of Nursing Scholarship, 37(1), 25-29. https://doi.org/10.1111/j.1547-5069.2005.00009.x
Li, X., Qureshi, A. R., Suliman, M. E., Heimburger, O., Barany, P., Stenvinkel, P., & Lindholm, B. (2023). Interleukin-6-to-Albumin Ratio as a Superior Predictor of Mortality in End-Stage Kidney Disease Patients. American Journal of Nephrology, 54(7-8), 268-274. https://doi.org/10.1159/000531191
Ministerio de Salud del Ecuador. (2018). Prevención, diagnóstico y tratamiento de la enfermedad renal crónica: Guía de práctica clínica. Quito: Ministerio de Salud del Ecuador, Dirección Nacional de Normatización. Available in: http://bit.ly/3IEDqfz
Nadri, A., Khanoussi, A., Hssaine, Y., Chettati, M., Fadili, W., & Laouad, I. (2020). Impact de l’éducation du patient en hémodialyse sur le respect des mesures diététiques et sur la restriction aux liquides [Effect of a hemodialysis patient education on fluid control and dietary]. Nephrologie & Therapeutique, 16(6), 353-358. https://doi.org/10.1016/j.nephro.2020.03.011
Park, C., Obi, Y., Streja, E., Rhee, C. M., Catabay, C. J., Vaziri, N. D., Kovesdy, C. P., & Kalantar-Zadeh, K. (2017). Serum uric acid, protein intake and mortality in hemodialysis patients. Nephrology Dialysis Transplantation, 32(10), 1750-1757. https://doi.org/10.1093/ndt/gfw419
Patel, S. S., Molnar, M. Z., Tayek, J. A., Ix, J. H., Noori, N., Benner, D., Heymsfield, S., Kopple, J. D., Kovesdy, C. P., & Kalantar-Zadeh, K. (2013). Serum creatinine as a marker of muscle mass in chronic kidney disease: results of a cross-sectional study and review of literature. Journal of Cachexia, Sarcopenia and Muscle, 4(1), 19-29. https://doi.org/10.1007/s13539-012-0079-1
Peng, H., Aoieong, C., Tou, T., Tsai, T., & Wu, J. (2021). Clinical assessment of nutritional status using the modified quantified subjective global assessment and anthropometric and biochemical parameters in patients undergoing hemodialysis in Macao. Journal of International Medical Research, 49(9), 3000605211045517. https://doi.org/10.1177/03000605211045517
Qian, G., Zhu, Y., Tao, S., Li, X., Liu, Z., Bai, Y., & Wang, D. (2022). Increased hemoglobin concentration and related factors in maintenance hemodialysis patients in Anhui, China. Medicine, 101(46), e31397. https://doi.org/10.1097/MD.0000000000031397
Rodríguez, D., & García, M. A. (2025). Assessment of the nutritional status of institutionalized older adults in two residences. Salud, Ciencia y Tecnología, 5, 1271. https://doi.org/10.56294/saludcyt20251271
Saeedi, P., Petersohn, I., Salpea, P., Malanda, B., Karuranga, S., Unwin, N., Colagiuri, S., Guariguata, L., Motala, A. A., Ogurtsova, K., Shaw, J. E., Bright, D., Williams, R., & IDF Diabetes Atlas Committee (2019). Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Research and Clinical Practice, 157, 107843. https://doi.org/10.1016/j.diabres.2019.107843
Sohrabi, Z., Eftekhari, M. H., Eskandari, M. H., Rezaeianzadeh, A., & Sagheb, M. M. (2015). Malnutrition-inflammation score and quality of life in hemodialysis patients: is there any correlation? Nephro-urology Monthly, 7(3), e27445. https://doi.org/10.5812/numonthly.7(3)2015.27445
St-Jules, D. E., Goldfarb, D. S., Pompeii, M. L., Liebman, S. E., & Sherman, R. A. (2018). Assessment and misassessment of potassium, phosphorus, and protein in the hemodialysis diet. Seminars in Dialysis, 31(5), 479-486. https://doi.org/10.1111/sdi.12713
Torres, I., Sippy, R., Bardosh, K. L., Bhargava, R., Lotto-Batista, M., Bideaux, A. E., Garcia-Trabanino, R., Goldsmith, A., Narsipur, S. S., & Stewart-Ibarra, A. M. (2022). Chronic kidney disease in Ecuador: An epidemiological and health system analysis of an emerging public health crisis. PloS One, 17(3), e0265395. https://doi.org/10.1371/journal.pone.0265395
Valente, A., Caetano, C., Oliveira, T., & Garagarza, C. (2019). Evaluating haemodialysis patient's nutritional status: Body mass index or body cell mass index? Nephrology, 24(9), 967-974. https://doi.org/10.1111/nep.13527
Vlaminck, H., Maes, B., Jacobs, A., Reyntjens, S., & Evers, G. (2001). The dialysis diet and fluid non-adherence questionnaire: validity testing of a self-report instrument for clinical practice. Journal of Clinical Nursing, 10(5), 707-715. https://doi.org/10.1046/j.1365-2702.2001.00537.x
Yoshida, S., Nakayama, Y., Nakayama, J., Chijiiwa, N., & Ogawa, T. (2022). Assessment of sarcopenia and malnutrition using estimated GFR ratio (eGFRcys/eGFR) in hospitalised adult patients. Clinical Nutrition ESPEN, 48, 456-463. https://doi.org/10.1016/j.clnesp.2021.12.027
Zheng, C. M., Wu, C. C., Lu, C. L., Hou, Y. C., Wu, M. S., Hsu, Y. H., Chen, R., Chang, T. J., Shyu, J. F., Lin, Y. F., & Lu, K. C. (2019). Hypoalbuminemia differently affects the serum bone turnover markers in hemodialysis patients. International Journal of Medical Sciences, 16(12), 1583-1592. https://doi.org/10.7150/ijms.39158
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