血液透析患者的饮食建议：COVID-19 大流行期间远程医疗方法的影响。

Dietary Advice in Hemodialysis Patients: Impact of a Telehealth Approach During the COVID-19 Pandemic.

机构信息

Nutrition Department, Nephrocare, Lisbon, Portugal.

出版信息

J Ren Nutr. 2022 May;32(3):319-325. doi: 10.1053/j.jrn.2021.04.002. Epub 2021 May 5.

DOI:10.1053/j.jrn.2021.04.002

PMID:34147308

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8098055/

Abstract

OBJECTIVE

The purpose of this study was to assess the effect of a telehealth-delivered nutritional intervention via telephone in maintenance hemodialysis (HD) patients during the coronavirus outbreak.

METHODS

This was a multicenter, observational, prospective, and longitudinal study of 156 patients undergoing maintenance HD from 15 dialysis units conducted during the COVID-19 pandemic. We assigned patients to receive dietary counseling through a phone call, according to their biochemical and nutritional parameters. Dry weight, intradialytic weight gain percentage (%IDWG), body mass index, potassium, phosphorus, calcium, calcium/phosphorus product, normalized protein catabolic rate, albumin, and hemoglobin were recorded at baseline and 1 month after nutrition counseling.

RESULTS

The prevalence of hyperkalemia and hyperphosphatemia decreased significantly after dietary advice. A statistically significant reduction in serum potassium and phosphorus levels was observed in patients receiving counseling for hyperkalemia and hyperphosphatemia. In addition, there was a statistically significant decrease in the prevalence of hypophosphatemia. We also observed a significant decrease in %IDWG, although no statistically significant differences were detected in patients with high %IDWG. The data demonstrated statistically significant differences in potassium and phosphorus values when the person receiving the phone contact was the patient or the caregiver. The main statistically significant differences in hypophosphatemia %IDWG were only observed when contact was made directly with the patient. No differences were observed when the contact was made through nursing homes.

CONCLUSION

Our results suggest that telehealth-delivered dietary interventions can improve the clinical and nutritional parameters of HD patients. Consequently, this strategy may be effective for promoting continuous nutritional monitoring in these patients, in particular when conducting a face-to-face option is not crucial.

摘要

目的

本研究旨在评估在冠状病毒病疫情期间通过电话对维持性血液透析（HD）患者进行远程医疗营养干预的效果。

方法

这是一项多中心、观察性、前瞻性和纵向研究，纳入了在 COVID-19 大流行期间来自 15 个透析单位的 156 名接受维持性 HD 的患者。根据患者的生化和营养参数，我们通过电话为其分配饮食咨询。在基线和营养咨询后 1 个月记录干体重、透析内体重增加百分比（%IDWG）、体重指数、钾、磷、钙、钙/磷产物、标准化蛋白分解率、白蛋白和血红蛋白。

结果

饮食建议后，高钾血症和高磷血症的患病率显著下降。接受高钾血症和高磷血症饮食咨询的患者，其血清钾和磷水平有统计学意义的降低。此外，低磷血症的患病率也有统计学意义的降低。我们还观察到 %IDWG 显著降低，尽管高 %IDWG 患者中未检测到统计学显著差异。当接受电话联系的人是患者或护理人员时，钾和磷值存在统计学显著差异。当直接与患者联系时，仅观察到低磷血症 %IDWG 的主要统计学显著差异。当通过养老院联系时，未观察到差异。