Authors (including presenting author) :
Leung EYT(1), Ho ICH(1), Yuen XKS(1), Yu VMW(1)
Affiliation :
(1)Department of Dietetics, Queen Mary Hospital, Hong Kong
Introduction :
Dietary management for pre-dialysis chronic kidney disease (p-dCKD) is recognised as complex. Nutrition education, exerting clinical impact via improving nutrition literacy, remains a challenge in the p-dCKD population.
Objectives :
The study examined the effect of a pragmatic renal diet group education (RDGE) intervention on nutrition literacy, renal function and self-efficacy in p-dCKD patients. The associations between changes in nutrition literacy and renal function before and after the RDGE were explored.
Methodology :
81 p-dCKD patients (estimated glomerular filtration rate (eGFR)< 60ml/min/1.73m2), referred for diet counselling, enrolled into the RDGE at the dietetic outpatient clinic in Queen Mary Hospital of Hong Kong from 2016 to 2019. The RDGE, emphasizing on active patient participation, comprised of multiple modules: 1) education on protein exchange and dietary restrictions on salt, potassium and phosphorus, 2) menu planning and making appropriate food choices, and 3) cooking demonstrations with hands-on tips. Each patient received a booklet containing a set of food exchange lists, menu planning tool and recipes for p-dCKD management.
A questionnaire on p-dCKD dietary management with a total score of 18 was administered by each patient before and after the RDGE. The scores of the questionnaire, eGFR and incident rates of hyperkalaemia (serum K>5.0mmol/L) and hyperphosphotaemia (serum PO4>1.46mmol/L) within 6 months before and after the RDGE were compared, and their associations were analysed via multivariate linear regression. Patient Enablement Instrument (PEI) was administered after the RDGE to examine the effect on patient empowerment in p-dCKD management.
Result & Outcome :
The overall renal nutrition literacy yielded significant improvement after the RDGE (total score (median(IQR)):14(3.5) Vs 16(2), P< 0.001), particularly on dietary K and PO4 literacy (P< 0.001). The eGFR remained static before and 6-month after the RDGE. Whilst insignificant difference in the incident rate of hyperphosphataemia, the incident rate of hyperkalaemia 6-month after the RDGE achieved significant reduction (P=0.01). After multi-variate adjustments, the enhanced dietary K literacy association with the reduction in hyperkalaemia incident rate persisted (P=0.039, β=0.278). PEI revealed more than 85% participants improved their self-perceived ability to understand and cope with p-dCKD after the RDGE.
The multi-modular RDGE played a contributory role in patient empowerment of preserving renal function via enhancing nutrition literacy, associated with significant reduction in hyperkalaemia complication in p-dCKD management.
