Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.727
Index Copernicus  – 166.39
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2018, vol. 27, nr 2, February, p. 217–224

doi: 10.17219/acem/67050

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Nutrient intake assessed with Diet History Questionnaire II, in relation to long-term calcium-phosphate control in hemodialysis patients with end-stage renal failure

Katarzyna Wyskida1,A,B,C,D,E,F, Jarosław Wajda2,B, Dariusz Klein3,4,B, Joanna Witkowicz5,B, Rafał Ficek6,B, Sylwia Rotkegel7,B, Urszula Spiechowicz-Zatoń8,B, Joanna Kocemba-Dyczek9,10,B, Jarosław Ciepał11,B, Magdalena Olszanecka-Glinianowicz1,C,D,E,F, Andrzej Więcek6,E,F, Jerzy Chudek7,12,A,C,D,E,F

1 Health Promotion and Obesity Management Unit, Department of Pathophysiology, Medical University of Silesia, Poland

2 Dialysis Center, Provincial Specialist Hospital No. 3 in Rybnik, Poland

3 Dialysis Center in Tychy, Centrum Dializa Sp. z o.o., Poland

4 Dialysis Center in Pszczyna, Centrum Dializa Sp. z o.o., Poland

5 Dialysis Center in Siemianowice Śląskie, Nefrolux, Poland

6 Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Poland

7 Dialysis Center in Katowice, Centrum Dializa Sp. z o.o., Poland

8 Dialysis Center in Chorzów, Centrum Dializa Sp. z o.o., Poland

9 Dialysis Center in Żory, Centrum Dializa Sp. z o.o., Poland

10 Dialysis Center in Wodzisław Śląski, Centrum Dializa Sp. z o.o., Poland

11 Dialysis Center in Sosnowiec, Centrum Dializa Sp. z o.o., Poland

12 Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia, Katowice, Poland


Background. Diet is a key factor that determines proper alignment of calcium-phosphate and nutritional status among hemodialysis (HD) patients.
Objectives. To assess the nutrient intake in relation to long-term calcium-phosphate control in HD patients with end-stage renal failure.
Material and Methods. The study included 107 patients (66 men, 41 women) from 10 dialysis centers in the Upper Silesia region of Poland. To analyze the diet composition during the previous year, a portion-sized version of the Diet History Questionnaire II (DHQ-II) from National Institutes of Health was used. The nutrient intake was assessed in accordance with the most complex recommendations on HD patients’ nutrition – K/DOQI Clinical Practice Guidelines for nutrition in chronic renal failure. Poor long-term alignment of calcium-phosphate homeostasis was defined as the presence of over 50% monthly phosphorus concentrations exceeding 5 mg/dL, and for calcium 10.2 mg/dL, during the last 6-month period.
Results. Lower than recommended protein intake was found in 63% of HD patients (average consumption: 0.9 ±0.5 g/kg/day). Most of the patients consumed too much fat (33.5 ±6.7% of daily energy intake) and sodium (2912 ±1542 mg/day). In 42% of patients, dietary phosphorus intake was consistent with the recommendations (13.3 ±7.5 mg/kg/day). Protein intake over 1.2 g/kg/day resulted in an increased consumption of phosphorous, but did not increase the risk of misalignment of phosphorus concentrations (OR = 1.15 [0.40–3.27]); p = 0.8). Poor control of serum phosphorus concentrations was observed in 69% of patients (they were on average 8 years younger). The average intake of protein and phosphate in the groups with good or not satisfactory serum phosphorus alignment did not differ significantly.
Conclusion. Adequate control of protein intake is not sufficient to obtain phosphorus alignment, especially in younger HD patients.

Key words

diet, hemodialysis, food frequency questionnaire, calcium-phosphate control, nutrient intake

References (23)

  1. Da J, Xie X, Wolf M, Disthabanchong S, Wang J, Zha Y. Serum phosphorus and progression of CKD and mortality: A meta-analysis of cohort studies. Am J Kidney Dis. 2015;66:258–265.
  2. Rutkowski B. National Consultant Board of and Expert Group. Statement of the National Consultant in Nephrology Board concerning education of nephrological patients. Nephrol Dial Pol. 2009;13:116–118.
  3. Dąbrowski P, Olszanecka-Glinianowicz M, Chudek J. Nutrition in chronic kidney disease. Endokrynol Otył Zab Przem Mat. 2011;7:229–237.
  4. Kalantar-Zadeh K, Kopple JD. Nutritional management of maintenance hemodialysis patients. In: Kopple JD, Massry SG, Kalantar--Zadeh K, eds. Nutritional Management of Renal Diseases. Academic Press; 2013:503–538.
  5. Palmer SC, Hanson CS, Craig JC, et al. Dietary and fluid restriction in CKD: A thematic synthesis of patient views from qualitative studies. Am J Kidney Dis. 2015;65:559–573.
  6. Załuska W, Klinger M, Kusztal M, et al. Recommendations of the Working Group of the Polish Society of Nephrology for the criteria of quality treatment in dialysis patients with end-stage renal disease. Nephrol Dial Pol. 2015;1:6–11.
  7. Goldsmith DJ, Covic A, Fouque D, et al. Endorsement of the Kidney Disease Improving Global Outcomes (KDIGO) Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Guidelines: A European Renal Best Practice (ERBP) commentary statement. Nephrol Dial Transplant. 2010;25:3823–3831.
  8. National Kidney Foundation K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease. Am J Kidney Dis. 2003;42(Suppl 3):S1–S201.
  9. Nowicki M, Rutkowski B, Myśliwiec M, Grenda R. Position Statement of the Polish Nephrology Consultants’ Working Group on the diagnosis and treatment of chronic kidney disease-mineral and bone disorders. Nephrol Dial Pol. 2010;14(1);1–5.
  10. Subar AF, Thompson FE, Kipnis V, et al. Comparative validation of the Block, Willett, and National Cancer Institute food frequency questionnaires: The Eating at America’s Table Study. Am J Epidemiol. 2001; 154:1089–1099.
  11. National Kidney Foundation K/DOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure. Am J Kidney Dis. 2000;35(Suppl 2):S1–S140.
  12. Fouque D, Vennegoor M, Ter Wee P, et al. EBPG guideline on nutrition. Nephrol Dial Transplant. 2007;22(Suppl 2):ii45–ii87.
  13. Włodarek D, Głąbska D, Rojek-Trębicka J. Assessment of diet in chronic kidney disease female predialysis patients. Ann Agric Envirl Med. 2014;21:829–834.
  14. Włodarek D, Głąbska D, Rojek-Trębicka J. Assesment of the nutritional knowledge, associated with low-protein diet following, on predialysis patients with chronic kidney disease. Nephrol Dial Pol. 2012; 16:11–14.
  15. Rao P, Reddy GC, Kanagasabapathy AS. Malnutrition-inflammation-atherosclerosis syndrome in chronic kidney disease. Indian J Clin Biochem. 2008;23:209–217.
  16. Kardasz M, Małyszko J, Stefańska E, Ostrowska L. Assessment of dietary habits in hemodialysis and peritoneal dialysis patients. ­Przegl Lek. 2011;68:216–221.
  17. Wyszomierska A, Puka J, Myszkowska-Ryciak J, Narojek L. The period of dialysis and nutritional habits of patients with the end stage renal disease. Rocz Panstw Zakl Hig. 2009;60:2289–2292.
  18. Luis D, Zlatkis K, Comenge B, et al. Dietary quality and adherence to dietary recommendations in patients undergoing hemodialysis. J Ren Nutr. 2016;26:190–195.
  19. Szurkowski M. The impact of personalized education on adherence to medical recommendations and effectiveness of treatment of calcium-phosphate disorders in patients with chronic renal failure undergoing chronic dialysis. Nephrol Dial Pol. 2015;19:32–39.
  20. Wyskida K, Klein D, Sadowski L, et al. Factors affecting the poor phosphate control in hemodialysis patients with end stage chronic kidney disease. Nephrol Dial Pol. 2012;16:75–79.
  21. Górski T, Biedunkiewicz B, Król E, Rutkowski P, Renke M, Rutkowski B. Epidemiology of calcium phosphate metabolism disturbances among dialysed patients in Poland in 2003–2006. Nephrol Dial Pol. 2015;19:55–59.
  22. Fouque D, Horne R, Cozzolino M, Kalantar-Zadeh K. Balancing nutrition and serum phosphorus in maintenance dialysis. Am J Kidney Dis. 2014;64:143–150.
  23. Kunachowicz H, Nadolna I, Iwanow K. Tabele składu i wartości odżywczej żywności. 1st ed. Warszawa: Wydawnictwo Lekarskie PZWL; 2005: 242–344.