EFFECTS OF 12 WEEKS OF PERSONALIZED NUTRITIONAL COUNSELING ON NUTRITIONAL STATUS AND QUALITY OF LIFE IN HEMODIALYSIS PATIENTS IN A DEVELOPING COUNTRY

 

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EFFECTS OF 12 WEEKS OF PERSONALIZED NUTRITIONAL COUNSELING ON NUTRITIONAL STATUS AND QUALITY OF LIFE IN HEMODIALYSIS PATIENTS IN A DEVELOPING COUNTRY

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Sonia
Yaqub
Sonia Yaqub sonia.yaqub@aku.edu Aga Khan University Medicine Karachi Pakistan *
Amna Hamid amna.hamid@aku.edu Aga Khan University Medicine Karachi Pakistan -
Safia Awan safia.awan@aku.edu Aga Khan University Medicine Karachi Pakistan -
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The nutritional status and personalized nutritional counseling (PNC) of chronic hemodialysis (HD)patients has seldom been studied in Pakistan. The aim of this study was to prospectively evaluate the effects of PNC in laboratory parameters, body composition and quality of life of HD patients during 12 weeks of follow-up.

This is a single center quasi experimental study using a pre-test and post-test design with participants being their own control. It was conducted in hemodialysis unit at the Aga Khan University Hospital Karachi (AKUH). The intervention was individualized dietary counselling provided to each patient. All patients were assessed by a trained renal dietitian at baseline and then a 3 weeks interval until end of the study period (total 4 sessions). The patients were nutritionally assessed using 7-point SGA scale by a trained dietitian. Biochemical parameters predictive of malnutrition were checked at baseline and edema free dry body weight using bioelectric impedance analysis (BIA) was calculated prior to nutrition education sessions. As a secondary outcome, quality of life was also assessed in all patients using World health organization Quality of Life brief questionnaire (WhoQoL-BReF).

A total of 30 patients were enrolled in this study. mean age was 61.1 ± 14.1 years and 53.3% were males. Hypertension and diabetes were seen in 73.3% and 63.3% cases respectively. Mean duration of CKD was 4.2 ± 3.5 years and they had been on dialysis for 2.3 ± 2.5 years. The mean BMI was 24.6 ± 4.6 kg/m2. Among 30 patients, 21 (70%) were mild to moderately malnourished at baseline. At 12 weeks follow up, waist circumference significantly decreased (39.3 ± 6.0 vs. 38.4 ± 5.8, p value=0.02); Serum cholesterol (baseline: 142.5 ± 29.8 vs. 3 months: 162.1 ± 44.7, p value=0.001), serum creatinine (6.9 ± 2.3 vs 7.7 ± 2.2, p=0.01), albumin (3.6 ± 0.35 vs 3.7 ± 0.31, p=0.02) and calcium (8.5 ± 0.48 vs 8.7 ± 0.65, p=0.05) were significantly increased. The nutritional status (SGA) was observed to significantly change over time. Among 18 individuals who were malnourished at baseline, three became well-nourished. As for quality of life questionnaire, scores on psychological (baseline:  55.4 ± 8.1, 3 months: 59.1 ± 4.9; p value=0.04) and environment (baseline: 70.4 ± 6.2, 3 months: 73.9 ± 8.9; p value=0.03) domain were significantly increased whereas no difference was seen in social and physical domains was observed.

 

Our study suggests that PNC contributes to the improvement of important nutritional parameters and quality of life (psychological and environmental domains) in patients on hemodialysis.  

Kewords