Dietary Intake, Comorbidities and Nutrition Status of Maintenance Hemodialysis Patients Attending Renal Unit Kenyatta National Hospital, Kenya
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Date
2023-10
Authors
Maina, Rachael Muthoni
Journal Title
Journal ISSN
Volume Title
Publisher
Kenyatta University
Abstract
Chronic Kidney Disease globally has been worrying as it has risen to being the 17th leading cause of mortality in 2015. It is approximated that in Kenya 4% are affected which may not be the true burden as the country lacks national registries. Diabetes and hypertension, the major etiologies of kidney failure are epidemic in Kenya. Although there are good guidelines by the Kidney Disease Outcome Quality Initiative on the recommended dietary energy and protein intake, hemodialysis patients are unable to meet the targets because of the dietary restrictions to prevent mineral imbalances, low socioeconomic status and presence of comorbidities. Protein Energy Wasting, an indication of low nutrition status of patients is seen in 18-75% of hemodialysis patients. This called the need to evaluate, do the hemodialysis patients in Kenya meet the required dietary intake, what the comorbidities are affecting them and what is their nutrition status? Therefore, the objective of the present study was to know the dietary intake, comorbidities and nutrition status of hemodialysis patients. A cross-sectional analytical study was conducted among 84 respondents undergoing hemodialysis present during the month of November 2021 at Kenyatta National Hospital renal unit. They were selected using consecutive purposive sampling. Data collection was done using a digitalized questionnaire for the socio-demographic and economic factors, presence of comorbidities, a 7-point subjective global assessment scale to assess the nutrition status, two 24hr dietary recalls both on non-dialysis and dialysis days, Individual dietary diversity score from the average 24hr recall, a 7-day food frequency questionnaire and nutrition supplement consumption to evaluate the nutrient intake. The researcher also conducted a focus group discussion with 12 dialysis patients and caregivers to know the factors that caused proper and poor adherence to diet. Quantitative data were analyzed using SPSS version 25 and Updated Nutri-survey 2018 while qualitative content, hand-coding and presented in form of themes. The mean age was 42.24±16.6 years with 41% being male. About a third 38.1% were employed and a majority 66.7% relied on family for financial support. Diabetes Mellitus (20.2%), present or past malignancy (4.8%) and cardiovascular illness (4.8%) were comorbidities present. The average energy intake was 14.738±8.46 kcals/ kg body weight/ day lower than endorsed 30-35kcal/kg/day. There was no significant difference (t=.990, p-value=0.325) in energy intake on dialysis and non-dialysis day. The mean protein intake was 0.43g/kg/day way lower than advocated 1.2g/kg/day. The mean daily micronutrients intake was as follows: sodium, 904.54±805.27mg; potassium 973.57±595.2mg; phosphorus, 549.835±401.91mg, calcium, 203.78±127.325mg; zinc 4.92±4.02mg; vitamin C, 42.83±31.58mg; and vitamin B6, 0.815±0.685mg. The average 7-point Subjective Global Assessment score was 4.95±0.963 with 70% having protein-energy wasting (score ≤ 5). Employment (P =.007) and education level (P= .035) were found to be significantly associated with nutrition status. There was no significant relationship noted between average energy intake (P=0.446), average protein intake (P=0.16) and nutrition status. Comorbidities had no significant association with nutrition status(P=.221). Fear of respiratory distress and hope for better health caused adhere to nutrition counselling. NHIF cover not inclusive of nutrition service charges, low purchasing power and constant delays due to machine breakdown and water issues caused poor dietary adherence. This study reveals that there was low dietary intake and moderate protein energy wasting. It can be curbed by proper and continuous nutrition counseling by the renal nutritionist. Ministry of Health, National and County Hospital heads to ensure full NHIF medical cover inclusive of laboratory biochemical tests and nutrition services for continuous nutrition status review.
Description
A Research Thesis Submitted in Partial Fulfillment of the Requirement for the Award of the Degree of Master of Science (Food, Nutrition and Dietetics) School of Health Sciences of Kenyatta University, October 2023.
Keywords
Dietary Intake, Comorbidities, Nutrition Status, Hemodialysis Patients, Renal Unit, Kenyatta National Hospital, Kenya