Impact of dietary education on reduction of hyperkalaemia among Chinese pre-dialysis chronic kidney disease patients

摘要

Background: Nutrition education, exerting clinical impact via improving nutrition literacy, remains a challenge in the pre-dialysis Chronic Kidney Disease (p-dCKD) population. Aim: To examine the effect of a multi-modular renal diet group education (RDGE) intervention on nutrition literacy and renal function in Chinese p-dCKD patients. Methods: 81 p-dCKD patients (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2) were enrolled in the RDGE at the dietetic outpatient clinic in Queen Mary Hospital, Hong Kong from 2016 to 2019. The RDGE comprised of multiple modules: 1) dietary education on salt, potassium and phosphorus, 2) menu planning, and 3) cooking demonstrations. Each patient received a toolkit of food exchange lists, menu planner and recipes. A questionnaire on p-dCKD dietary management with a total score of 18 was administered before and after the RDGE. The scores of the questionnaire, eGFR and incident rates of hyperkalaemia (serum potassium>5.0 mmol/L) and hyperphosphotaemia (serum phosphate>1.46 mmol/L) within 6 months before and after the RDGE were compared, and their associations were analysed via multivari-ate linear regression. Results: The increase in total questionnaire scores after the intervention revealed general enhancement in renal nutrition literacy (Median (IQR): 14(3.5) Vs 16(2), P < 0.001), specifically in dietary K and PO4 literacy (P < 0.001). Whilst eGFR remained static, 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, p = 0.278). Conclusion: The multi-modular RDGE contributed to preserving renal function via enhancing nutrition literacy, associated with significant reduction in hyperkalaemia complication in p-dCKD management.