DIETARY PATTERNS IN HEMODIALYSIS PATIENTS: RELATIONSHIP WITH CLINICAL AND NUTRITIONAL PARAMETERS

Abstract Background and Aims Nutritional recommendations for hemodialysis (HD) patients focus on the achievement of a sufficient energy and protein intake without exceeding phosphorus, potassium, sodium and/or fluids intake limits. This study aimed to identify different dietary patterns of HD patients and analyze their relationship with clinical and nutritional parameters. Method This was a longitudinal prospective multicenter study with 582 HD patients from 37 dialysis centers. Dry weight, Kt/V, serum potassium, phosphorus, calcium, sodium, creatinine and C-reactive protein were measured. Dietary intake was obtained using the Food Frequency Questionnaire. Dietary patterns were derived from principal component analysis based on 20 food groups which were adjusted for total energy intake. Linear regression was used to analyze patterns and the variables of interest. All statistical tests were performed using SPSS 26.0 software. A p-value lower than 0.05, was considered statistically significant. Results Patients’ mean age was 67.8±17.7 years and median HD vintage was 65 (43-104) months. Three different dietary patterns were identified: “Western” (31.3% of the patients) with high intake of soft drinks, home-made fried potatoes, caffeinated drinks, red and processed meat, and low intake of fruit and vegetables soup; “Mediterranean” (33.5% of the patients) with high intake of vegetables, beans, fish, olive oil, eggs, and low intake of milk and milk products. Finally, “Low animal protein” (35.2% of the patients) with high intake of whole grain bread, cookies and sweets, vegetables soup and low intake of white bread, rice, pasta and potatoes. Regarding clinical parameters, the Mediterranean pattern was predictor of a higher dry weight (p=0.001), higher creatinine (p=0.032) and lower serum calcium (p=0.024), whereas Western pattern predicted higher phosphorus (p=0.006), sodium (p=0.014) and creatinine (p=0.001). Low animal protein pattern predicted lower creatinine levels (p=0.011). After adjusting for age, gender, presence of diabetes, HD vintage and Kt/V, serum calcium was the only parameter which remained statistical significant within the Mediterranean pattern. Comparing the nutritional parameters studied, the Mediterranean pattern was the strongest predictor of a higher intake of protein (%) (p<0.001), folate (p<0.001), vitamin B12 (p<0.001), vitamin B6 (p<0.001), vitamin C (p<0.001), vitamin D (p<0.001), potassium (p=0.015) and omega 3 fatty acids (p<0.001) and a lower intake of carbohydrates (%) (p<0.001), calcium (p<0.001) and sodium (p=0.006). Conclusion Three different dietary patterns were identified in these HD population. The pattern which was closer to the well-known Mediterranean diet was associated with a better nutritional intake profile, which, at least theoretically, are associated with better clinical outcomes.