Abstract
Background and Aims
Patients undergoing hemodialysis (HD) treatment usually have a low intake of food groups rich in dietary fiber to avoid hyperkalemia. However, dietary potassium is not associated with serum potassium or hyperkalemia in recent studies, and higher intake of fiber food groups such as fruits and vegetables is associated with lower mortality and other complications in HD populations. This multicenter cross-sectional study aimed to investigate the frequency of intake of dietary fiber sources, its determinants, and the relationship with hyperkalemia in HD patients.
Method
Prevalent HD patients from four dialysis clinics in Southern Brazil were invited to participate (at least 80% of eligible patients from each clinic). Patients were interviewed by the researchers and answered a food frequency questionnaire (FFQ) with the main dietary fiber sources (fruits, vegetables, legumes, whole grains cereals and seeds) with seven frequency possibilities (from never to more than twice a day). To estimate the weekly frequency of intake, answers were transformed into a score. Every score point corresponded to one time per week (ex.: score 7 = seven times per week). The sum of the five scores was calculated to determine the total score. Demographical and laboratory data were obtained from medical records. Univariate analysis was used to assess total score associations, and the variables with P<0.20 were included in the regression analysis model.
Results
305 HD patients were included (male: 51%; age: 52.2 ± 14.7 years old; HD vintage: 46 (19 – 82) months; hyperkalemia: 29%). Median (interquartile) FFQ scores were: fruits: 6 (2-14); vegetables: 6 (3-10); legumes: 3 (1-7); whole-grain: 0 (0-1) and seeds: 0 (0-0). Total score was 19 (14-28) and correlated with age (r=0.15; P=0.01), HD vintage (r=-0.22; P=<0.001) and body mass index (BMI) (r=0.15; P=0.007). Patients with diabetes had a higher total score (22 (15-31) versus 18 (13-27) P=0.03). Only the vegetables score correlated with serum potassium (r=0.17; P=0.03) and no difference was found between dietary fiber food groups scores and total score with hyperkalemia. The linear regression analysis model also included gender and education (years at school) (all with P<0.20 in the univariate analysis). The independent predictors of dietary fiber total score were age (OR=0.1 (95%IC 0.01-0.20);P=0.04), HD vintage (month) (OR=-0.03 (95%IC -0.06 - -0.01);P=0.02) and years at school (OR=0.27 (95%IC 0.85-0.46);P=0.005).
Conclusion
The usual frequency of intake of fiber sources was low, and its independent determinants were age, HD vintage and education. The lack of association with hyperkalemia suggests that other dietary sources and clinical factors should be considered to manage hyperkalemia in this population.
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