Nutritional Education for Management of Osteodystrophy (NEMO) Trial: Design and Patient Characteristics, Lebanon

Overview

Journal Nutr Res Pract

Specialty Nutritional Sciences

Date 2014 Mar 11

PMID 24611112

Citations 6

Authors

Mirey Karavetian

Saade Abboud

Hafez Elzein

Sarah Haydar

Nanne de Vries

Affiliations

Soon will be listed here.

Abstract

THIS STUDY AIMS TO DETERMINE THE EFFECT OF A TRAINED DEDICATED DIETITIAN ON CLINICAL OUTCOMES AMONG LEBANESE HEMODIALYSIS (HD) PATIENTS: and thus demonstrate a viable developing country model. This paper describes the study protocol and baseline data. The study was a multicenter randomized controlled trial with parallel-group design involving 12 HD units: assigned to cluster A (n = 6) or B (n = 6). A total of 570 patients met the inclusion criteria. Patients in cluster A were randomly assigned as per dialysis shift to the following: Dedicated Dietitian (DD) (n = 133) and Existing Practice (EP) (n = 138) protocols. Cluster B patients (n = 299) received Trained Hospital Dietitian (THD) protocol. Dietitians of the DD and THD groups were trained by the research team on Kidney Disease Outcomes Quality Initiative nutrition guidelines. DD protocol included: individualized nutrition education for 2 hours/month/HD patient for 6 months focusing on renal osteodystrophy and using the Trans-theoretical theory for behavioral change. EP protocol included nutrition education given to patients by hospital dietitians who were blinded to the study. The THD protocol included nutrition education to patients given by hospital dietitian as per the training received but within hospital responsibilities, with no set educational protocol or tools. Baseline data revealed that 40% of patients were hyperphosphatemics (> 5.5 mg/dl) with low dietary adherence and knowledge of dietary P restriction in addition to inadequate daily protein intake (58.86%± 33.87% of needs) yet adequate dietary P intake (795.52 ± 366.94 mg/day). Quality of life (QOL) ranged from 48-75% of full health. Baseline differences between the 3 groups revealed significant differences in serum P, malnutrition status, adherence to diet and P chelators and in 2 factors of the QOL: physical and social functioning. The data show room for improvement in the nutritional status of the patients. The NEMO trial may be able to demonstrate a better nutritional management of HD patients.

Citing Articles

Interventions for improving health literacy in people with chronic kidney disease.

Campbell Z, Dawson J, Kirkendall S, McCaffery K, Jansen J, Campbell K Cochrane Database Syst Rev. 2022; 12:CD012026.

PMID: 36472416 PMC: 9724196. DOI: 10.1002/14651858.CD012026.pub2.

Dietary advice with or without oral nutritional supplements for disease-related malnutrition in adults.

Baldwin C, de van der Schueren M, Kruizenga H, Weekes C Cochrane Database Syst Rev. 2021; 12:CD002008.

PMID: 34931696 PMC: 8691169. DOI: 10.1002/14651858.CD002008.pub5.

Adequate Management of Phosphorus in Patients Undergoing Hemodialysis Using a Dietary Smartphone App: Prospective Pilot Study.

Khoury C, Crutzen R, Schols J, Halfens R, Karavetian M JMIR Form Res. 2021; 5(6):e17858.

PMID: 34061034 PMC: 8207257. DOI: 10.2196/17858.

Poor Sleep Quality, Depression and Social Support Are Determinants of Serum Phosphate Level among Hemodialysis Patients in Malaysia.

Ng E, Wong P, Kamaruddin A, Lim C, Chan Y Int J Environ Res Public Health. 2020; 17(14).

PMID: 32708766 PMC: 7400380. DOI: 10.3390/ijerph17145144.

An integrative review of the methodology and findings regarding dietary adherence in end stage kidney disease.

Lambert K, Mullan J, Mansfield K BMC Nephrol. 2017; 18(1):318.

PMID: 29061163 PMC: 5653982. DOI: 10.1186/s12882-017-0734-z.

References

Finckenor M, Byrd-Bredbenner C . Nutrition intervention group program based on preaction-stage-oriented change processes of the Transtheoretical Model promotes long-term reduction in dietary fat intake. J Am Diet Assoc. 2000; 100(3):335-42. DOI: 10.1016/S0002-8223(00)00104-8. View

Block G, Klassen P, Lazarus J, Ofsthun N, Lowrie E, Chertow G . Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004; 15(8):2208-18. DOI: 10.1097/01.ASN.0000133041.27682.A2. View

Cupisti A, Ferretti V, DAlessandro C, Petrone I, Di Giorgio A, Meola M . Nutritional knowledge in hemodialysis patients and nurses: focus on phosphorus. J Ren Nutr. 2012; 22(6):541-6. DOI: 10.1053/j.jrn.2011.11.003. View

Mayne T, Benner D, Ricketts K, Burgess M, Wilson S, Poole L . Results of a pilot program to improve phosphorus outcomes in hemodialysis patients. J Ren Nutr. 2011; 22(5):472-9. DOI: 10.1053/j.jrn.2011.08.006. View

Aghakhani N, Samadzadeh S, Mafi T, Rahbar N . The impact of education on nutrition on the quality of life in patients on hemodialysis: a comparative study from teaching hospitals. Saudi J Kidney Dis Transpl. 2012; 23(1):26-30. View

Covic A, Seica A, Gusbeth-Tatomir P, Gavrilovici O, Goldsmith D . Illness representations and quality of life scores in haemodialysis patients. Nephrol Dial Transplant. 2004; 19(8):2078-83. DOI: 10.1093/ndt/gfh254. View

Eknoyan G, Lameire N, Barsoum R, Eckardt K, Levin A, Levin N . The burden of kidney disease: improving global outcomes. Kidney Int. 2004; 66(4):1310-4. DOI: 10.1111/j.1523-1755.2004.00894.x. View

Kaveh K, Kimmel P . Compliance in hemodialysis patients: multidimensional measures in search of a gold standard. Am J Kidney Dis. 2001; 37(2):244-66. DOI: 10.1053/ajkd.2001.21286. View

Lam L, Twinn S, Chan S . Self-reported adherence to a therapeutic regimen among patients undergoing continuous ambulatory peritoneal dialysis. J Adv Nurs. 2010; 66(4):763-73. DOI: 10.1111/j.1365-2648.2009.05235.x. View

10.

Richard C . Self-care management in adults undergoing hemodialysis. Nephrol Nurs J. 2006; 33(4):387-94. View

11.

Denhaerynck K, Manhaeve D, Dobbels F, Garzoni D, Nolte C, de Geest S . Prevalence and consequences of nonadherence to hemodialysis regimens. Am J Crit Care. 2007; 16(3):222-35. View

12.

Ford J, Pope J, Hunt A, Gerald B . The effect of diet education on the laboratory values and knowledge of hemodialysis patients with hyperphosphatemia. J Ren Nutr. 2004; 14(1):36-44. DOI: 10.1053/j.jrn.2003.09.008. View

13.

Gregory M . Cost-effective dialysis for the developing world. Ethn Dis. 2009; 19(1 Suppl 1):S1-65-7. View

14.

Molassiotis A . Dietary and fluid compliance in Chinese hemodialysis patients. Int J Nurs Stud. 2002; 39(7):695-704. DOI: 10.1016/s0020-7489(02)00007-x. View

15.

Morais A, Silva M, Faintuch J, Vidigal E, Costa R, Lyrio D . Correlation of nutritional status and food intake in hemodialysis patients. Clinics (Sao Paulo). 2005; 60(3):185-92. DOI: 10.1590/s1807-59322005000300002. View

16.

Kimmel P, Emont S, Newmann J, Danko H, Moss A . ESRD patient quality of life: symptoms, spiritual beliefs, psychosocial factors, and ethnicity. Am J Kidney Dis. 2003; 42(4):713-21. DOI: 10.1016/s0272-6386(03)00907-7. View

17.

Stuart A . The effect of an educational patient compliance program on serum phosphate levels in patients receiving hemodialysis. J Ren Nutr. 2000; 10(2):80-4. DOI: 10.1016/s1051-2276(00)90004-9. View

18.

Nerbass F, Morais J, Dos Santos R, Kruger T, Koene T, da Luz Filho H . Adherence and knowledge about hyperphosphatemia treatment in hemodialysis patients with hyperphosphatemia. J Bras Nefrol. 2010; 32(2):149-55. View

19.

Lim S, Gun N . Secondary hyperparathyroidism and calcium phosphate control in a hemodialysis population. Acta Med Indones. 2007; 39(2):71-4. View

20.

Sabbah I, Drouby N, Sabbah S, Retel-Rude N, Mercier M . Quality of life in rural and urban populations in Lebanon using SF-36 health survey. Health Qual Life Outcomes. 2003; 1:30. PMC: 194221. DOI: 10.1186/1477-7525-1-30. View