Mannan H, Issa E, Attieh R, Sacre Y
Translational Health Research Institute and School of Medicine, Western Sydney University, Campbelltown campus, NSW, Australia.
Department of Nutrition and Dietetics, Holy Spirit University of Kaslik, Jounieh, Lebanon.
BMC Nephrol. 2025 Feb 14;26(1):81. doi: 10.1186/s12882-024-03936-w.
Hyperphosphatemia is deemed to be an asymptomatic silent killer, its high prevalence in patients undergoing hemodialysis (HD) is correlated mainly with malnutrition and mortality. Dietitian's renal nutrition education has a major impact on chronic kidney disease patients' knowledge, and attitude towards nutrition guidelines. However, a large number of factors are acting as barriers to the appropriate practices of Lebanese dietitians in renal therapy. This study evaluated the knowledge, attitudes, and practices (KAP) of licensed dietitians (LDs) regarding hyperphosphatemia management in patients undergoing HD.
A total of 408 LDs from Mount-Lebanon Governorate in Lebanon participated in this study. A 52-item online questionnaire was used to assess nutritional phosphorus' KAP of all LDs, in compliance with dietetic practices with KDOQI guidelines updated version 2020 and identified the factors preventing dietitians from dealing with renal patients undergoing HD, e.g., nutrition care. The data was analyzed using SPSS version 25.
There was a significant association between KAP levels, and almost all sociodemographic characteristics evaluated. Only 2% of dietitians applied all KDOQI guidelines, 64% attained poor and moderate knowledge, and 60% had a positive attitude towards renal care. Working in a clinical field was a common predictor of positive knowledge (adjusted OR = 2.453, 95% CI 1.244-4.836), positive attitude (adjusted OR = 1.900, 95% CI 1.300-2.541) and positive practice (adjusted OR = 0.192, 95% CI 0.184-0.491) while HD/hospital-based field increased the odds for positive knowledge (adjusted OR = 4.520, 95% CI 1.189-17.182). LDs, compared to registered dietitians, had lower odds of positive knowledge (adjusted OR = 0.390, 95% CI 0.231-0.658) and positive attitude (adjusted OR = 0.270, 95% CI 0.154-0.471). Lack of training was the main reason preventing the appropriate dietetic practices regarding hyperphosphatemia management in patients undergoing HD.
The Ministry of Public Health (MOPH) should be asked to endorse the integration of renal nutrition programs in the Lebanese curriculum, to aid in the empowerment of dietitians from different backgrounds towards renal therapy, in order to enhance the knowledge and attitude regarding nutritional guidelines of poorly supported Lebanese patients undergoing HDhemodialysis. Other stakeholders may include the Syndicate of Dietitians in Lebanon.
高磷血症被认为是一种无症状的沉默杀手，其在接受血液透析（HD）患者中的高患病率主要与营养不良和死亡率相关。营养师的肾脏营养教育对慢性肾病患者的知识以及对营养指南的态度有重大影响。然而，大量因素阻碍了黎巴嫩营养师在肾脏治疗中的适当实践。本研究评估了执业营养师（LDs）对HD患者高磷血症管理的知识、态度和实践（KAP）。
黎巴嫩黎巴嫩山省的408名LDs参与了本研究。使用一份包含52个条目的在线问卷来评估所有LDs对营养性磷的KAP，该问卷符合2020年更新版KDOQI指南的饮食实践，并确定了阻碍营养师处理HD肾病患者（如营养护理）的因素。使用SPSS 25版对数据进行分析。
KAP水平与几乎所有评估的社会人口统计学特征之间存在显著关联。只有2%的营养师应用了所有KDOQI指南，64%的人知识水平较差和中等，60%的人对肾脏护理持积极态度。在临床领域工作是积极知识（调整后的OR = 2.453，95% CI 1.244 - 4.836）、积极态度（调整后的OR = 1.900，95% CI 1.300 - 2.541）和积极实践（调整后的OR = 0.192，95% CI 0.184 - 0.491）的常见预测因素，而基于HD/医院的领域增加了积极知识的几率（调整后的OR = 4.520，95% CI 1.189 - 17.182）。与注册营养师相比，LDs具有积极知识（调整后的OR = 0.390，95% CI 0.231 - 0.658）和积极态度（调整后的OR = 0.27
