Tsai Wan-Chuan, Yang Ju-Yeh, Luan Chia-Chin, Wang Yuh-Jiun, Lai Yu-Chuan, Liu Lie-Chuan, Peng Yu-Sen
Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, No. 21, Section 2, Nanya South Road, Banqiao District, New Taipei City 220, Taiwan, China.
Dietary Department, Far Eastern Memorial Hospital, No. 21, Section 2, Nanya South Road, Banqiao District, New Taipei City 220, Taiwan, China.
Clin Exp Nephrol. 2016 Oct;20(5):815-821. doi: 10.1007/s10157-015-1212-1. Epub 2015 Dec 11.
Sustained adherence to dietary phosphorus (P) restriction recommendations among hemodialysis patients is questionable. The aim of this study was to evaluate the effectiveness of additional diet education delivered by a dietitian on the control of hyperphosphatemia.
We conducted an 8-month prospective observational study in hemodialysis patients who had uncontrolled hyperphosphatemia. In the first half of the study (experimental) period, the dialysis nurses and physicians provided the routine dietetic education with the control group (n = 31), while the experimental group (n = 30) received the routine dietetic education plus an additional diet education delivered by dietitians. Both groups received the routine dietetic education in the rest of the study period to test whether the improvement of serum P level was sustained. The primary outcomes were changes in serum P level.
At baseline, there was no significant difference in serum P levels between groups (P = 0.27). In the experimental period, monthly serum P levels decreased significantly in both groups (P < 0.001) and the magnitudes of reduction were 1.81 ± 1.46 and 0.94 ± 1.33 mg/dL in the experimental and control groups, respectively (P = 0.02), at the end. The experimental group maintained such improvement for one more month (P = 0.02), but faded out over time.
Renal diet education guided either by dietitians plus dialysis staffs or dialysis staffs alone reduces serum P level and dietitian-guided diet education provides an additional benefit on controlling hyperphosphatemia in hemodialysis patients.
血液透析患者能否持续遵循饮食中磷（P）限制建议仍存在疑问。本研究旨在评估营养师提供的额外饮食教育对控制高磷血症的有效性。
我们对患有未控制的高磷血症的血液透析患者进行了为期8个月的前瞻性观察研究。在研究的前半段（实验）期间，透析护士和医生为对照组（n = 31）提供常规饮食教育，而实验组（n = 30）则接受常规饮食教育外加营养师提供的额外饮食教育。在研究的剩余期间，两组均接受常规饮食教育，以测试血清磷水平的改善是否持续。主要结局是血清磷水平的变化。
基线时，两组间血清磷水平无显著差异（P = 0.27）。在实验期间，两组的每月血清磷水平均显著下降（P < 0.001），最终实验组和对照组的下降幅度分别为1.81±1.46和0.94±1.33mg/dL（P = 0.02）。实验组又维持了一个月的这种改善（P = 0.02），但随着时间推移逐渐消失。
由营养师加透析工作人员或仅由透析工作人员指导的肾脏饮食教育均可降低血清磷水平，且营养师指导的饮食教育在控制血液透析患者的高磷血症方面具有额外益处。
