Authors (including presenting author) :
Leung EYT(1), Ho ICH(1), Yuen XKS(1), Yu VMW(1)
Affiliation :
(1)Department of Dietetics, Queen Mary Hospital
Introduction :
Dietary management for pre-dialysis chronic kidney disease (p-dCKD) is 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 intervention were explored.
Methodology :
81 p-dCKD patients (estimated glomerular filtration rate (eGFR)< 60ml/min/1.73m2), referred for diet counselling, were arranged 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 impact on patient empowerment in p-dCKD management.
Result & Outcome :
The total score of the questionnaire significantly increased after the intervention, implicating general enhancement in renal nutrition literacy (Median (IQR): 14(3.5) Vs 16(2), P< 0.001). Sub-category scores analysis yielded significant improvement specifically in dietary K and PO4 literacy (P< 0.001). Whilst eGFR remained static before and 6-month after the RDGE, the incident rate of hyperkalaemia 6-month after the RDGE achieved significant reduction (P=0.01). After multi-variate adjustments, the improved dietary K literacy was still significantly associated with the reduction in hyperkalaemia incident rate (P=0.039, =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.
