Higher Frequency of Fruit Intake Is Associated With a Lower Risk of Constipation in Hemodialysis Patients: A Multicenter Study.

OBJECTIVES: Constipation is a multifactorial gastrointestinal disorder commonly found in hemodialysis (HD) patients. In this multicenter cross-sectional study, we aimed to evaluate the prevalence and factors associated with constipation, including the frequency of dietary fiber intake. METHODS: HD patients from 4 dialysis clinics were invited. Participants answered a questionnaire which included Roma IV criteria to assess constipation status, use of medications, and lifestyle habits. A food frequency questionnaire with 7 response options on the main dietary fiber sources (fruits, vegetables, legumes, whole grains, and seeds) was also applied. Answers were transformed into a score to estimate the weekly intake frequency, and every score point corresponded to one time per week. Demographical and laboratory data were obtained from medical records. Univariate analysis was used to compare participants according to constipation status, and variables with P < .20 were included in the regression analysis model. RESULTS: Three hundred five HD patients were included (male: 51%; age: 52.2 ± 14.7 years old; HD vintage: 46 (19-82) months). Ninety-three participants had constipation (30.5%). Median (interquartile) food frequency questionnaire scores were as follows: fruits: 6 (2-14); vegetables: 6 (3-10); legumes: 3 (1-7); whole grain: 0 (0-1); and seeds: 0 (0-0). In univariate analysis, participants with constipation were significantly older, had lower literacy, higher prevalence of diabetes, and lower total beverage intake. The logistic regression analysis model also included body mass index, wheelchair need, sedentarism, fruits score, and seeds score (all with P < .20 in the univariate analysis). The independent predictors of constipation were diabetes (odds ratio = 1.96, 95% confidence interval 1.07-3.6, P = .03) and fruits intake score (odds ratio = 0.95, 95% confidence interval 0.91-0.99, P = .04). CONCLUSIONS: Almost one-third of the participants had constipation. The independent determinants of constipation were diabetes and lower frequency of fruit intake. Nutritional counseling to increase fiber intake can potentially decrease the prevalence of constipation in this population.

Perceptions of hemodialysis patients about dietary and fluid restrictions.

INTRODUCTION: Dietary regimen for hemodialysis (HD) patients is complicate and identifying characteristics and reasons of those most likely to experience difficulty in adhering to dietary restrictions is important. OBJECTIVE: To quantify HD patient's perceptions about dietary and fluid restrictions, acknowledge individual reasons that facilitate or complicate their adherence, and also their relationship with demographic, nutritional and clinical characteristics. METHODS: Multi-center cross-sectional study in five dialysis facilities. HD patients (n = 147; 48% male; age: 51,3 ± 13,6 years) were encouraged to score on a scale of 0 to 10 their perception of the degree of difficulty to adhere the nutritional advice regarding control of sodium, fluid, potassium and phosphorus intake. RESULTS: Sodium score was 4(1-7), fluids 6(3-8), potassium 4(2-6) and phosphate 6(3-8). Percentage of patients who perceived a greater difficulty (score ≥ 6) to control fluids and phosphate intake was higher than for sodium and potassium. Participants with excessive % interdialytic weight gain (%IDWG) had a higher score for fluids; the ones with hypercalemia perceived more difficulty to control potassium intake than others as well as hyperphosphatemic patients compared to normophosphatemic to control phosphorus intake. Participants with a greater difficulty to control sodium intake also perceived a greater difficulty to control fluids, potassium and phosphate intake. CONCLUSION: Participants perceived a greater difficulty to control fluid and phosphate intake rather than sodium and potassium, higher perceptions scores were associated with subgroups and with worse control of clinical parameters. Moreover, patients with a greater difficulty to control some dietary item also found harder to control the other ones.

Perceptions of hemodialysis patients about dietary and fluid restrictions / Percepções de pacientes em hemodiálise sobre as restrições alimentares

Abstract Introduction: Dietary regimen for hemodialysis (HD) patients is complicate and identifying characteristics and reasons of those most likely to experience difficulty in adhering to dietary restrictions is important. Objective: To quantify HD patient's perceptions about dietary and fluid restrictions, acknowledge individual reasons that facilitate or complicate their adherence, and also their relationship with demographic, nutritional and clinical characteristics. Methods: Multi-center cross-sectional study in five dialysis facilities. HD patients (n = 147; 48% male; age: 51,3 ± 13,6 years) were encouraged to score on a scale of 0 to 10 their perception of the degree of difficulty to adhere the nutritional advice regarding control of sodium, fluid, potassium and phosphorus intake. Results: Sodium score was 4(1-7), fluids 6(3-8), potassium 4(2-6) and phosphate 6(3-8). Percentage of patients who perceived a greater difficulty (score ≥ 6) to control fluids and phosphate intake was higher than for sodium and potassium. Participants with excessive % interdialytic weight gain (%IDWG) had a higher score for fluids; the ones with hypercalemia perceived more difficulty to control potassium intake than others as well as hyperphosphatemic patients compared to normophosphatemic to control phosphorus intake. Participants with a greater difficulty to control sodium intake also perceived a greater difficulty to control fluids, potassium and phosphate intake. Conclusion: Participants perceived a greater difficulty to control fluid and phosphate intake rather than sodium and potassium, higher perceptions scores were associated with subgroups and with worse control of clinical parameters. Moreover, patients with a greater difficulty to control some dietary item also found harder to control the other ones.

Resumo Introdução: as recomendações dietéticas para pacientes em hemodiálise (HD) são complexas e identificar as características e as razões das pessoas com maior dificuldade em aderir às restrições de alimentos e bebidas pode ser fundamental. Objetivos: quantificar as percepções dos pacientes em HD sobre as restrições alimentares e de líquidos, reconhecer as razões individuais que facilitam ou complicam sua adesão, bem como sua relação com as características demográficas, nutricionais e clínicas. Métodos: estudo transversal multicêntrico realizado em cinco unidades de diálise. Os pacientes em HD (n = 147, 48% do sexo masculino, idade: 51,3 ± 13,6 anos) foram encorajados a pontuar em uma escala de 0 a 10 a sua percepção do grau de dificuldade de aderir ao aconselhamento nutricional para o controle de sódio, líquidos, potássio e fósforo. Resultados: o escore de sódio foi 4 (1-7); de líquidos 6 (3-8); de potássio 4 (2-6); e de fosfato 6 (3-8). O precentual de pacientes que percebiam uma maior dificuldade (escore ≥ 6) no controle de líquidos e de fosfato foi maior do que para o sódio e o potássio. Os participantes com elevado ganho de peso interdialitico (%GPID) referiram maior pontuação para líquidos; os com hipercalemia perceberam mais dificuldade para controlar a ingestão de potássio que os demais, bem como os pacientes hiperfosfatêmicos em comparação com os normofosfatêmicos para controlar a ingestão de fósforo. Os participantes com maior dificuldade para controlar a ingestão de sódio também perceberam uma maior dificuldade para controlar o consumo dos demais itens investigados. Conclusão: os participantes perceberam maior dificuldade no controle da ingestão de líquidos e de fontes de fosfato do que de sódio e potássio. Maiores escores de percepção foram associados a alguns subgrupos e a pior controle dos parâmetros clínicos. Além disso, os pacientes com maior dificuldade para controlar algum item dietético também referiram ser mais difícil de controlar os outros itens investigados.