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      Análisis de la influencia del cuidador principal en el estado nutricional del paciente en hemodiálisis Translated title: Analysis of the influence of the primary caregiver in the nutritional status of the patient on hemodialysis

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          Abstract

          Resumen Introducción: La población que se encuentra en tratamiento renal sustitutivo con hemodiálisis sufre frecuentemente cierto grado de desnutrición calórico-proteica debido a las restricciones dietéticas y la mala elección de alimentos. Esta desnutrición unida a la inflamación repercute en su calidad de vida e incrementa su mortalidad. Objetivos: Determinar el estado nutricional de los pacientes en tratamiento con hemodiálisis y su relación con quién elabora su comida. Comprobar la relación entre el grado de cumplimiento de las recomendaciones terapéuticas y su estado nutricional. Material y Método: estudio transversal y descriptivo en una población de pacientes en hemodiálisis hospitalaria. Se recogieron datos sociodemográficos, antecedentes clínicos, resultados analíticos y antropométricos. El estado nutricional se valoró mediante la escala MIS. Se realizó un análisis descriptivo e inferencial de las variables a estudio. Resultados: El grado de desnutrición se situó en el 32,4%(n=34). No se encontró ninguna significación estadística entre el estado nutricional y el cuidador principal. Pese a que el 76,5% refirió seguir las recomendaciones dietéticas, tan solo un 44% tenía unos valores séricos de potasio adecuados y el 34,7% cumplía con la ganancia de peso interdialítica recomendada. Conclusiones: La desnutrición sigue siendo un problema frecuente en las unidades de hemodiálisis. Se deben tomar medidas para reducirla, ya sea con acciones educacionales sobre alimentación o incluso valorar el uso de suplementos dietéticos. Enfermería debe seguir reforzando las recomendaciones dietéticas para que ese cumplimiento referido por nuestros pacientes pueda objetivarse y verse reflejado en sus resultados analíticos.

          Translated abstract

          Abstract Introduction: People undergoing renal replacement therapy for hemodialysis frequently suffer a certain degree of caloric-protein malnutrition due to dietary restrictions and poor food choices. Malnutrition together with inflammation affects quality of life and increases mortality. Objectives: To determine the nutritional status of patients on hemodialysis and the relationship with who cooks the food. To establish the relationship between the degree of compliance with the therapeutic recommendations and the nutritional status. Material and Method: Cross-sectional and descriptive study in a population of patients on hospital hemodialysis. Sociodemographic data, clinical history, analytical and anthropometric results were collected. Nutritional status was assessed using the MIS scale. A descriptive and inferential analysis of the variables under study was carried out. Results: The degree of malnutrition was 32.4% (n = 34). No significant difference was found between nutritional status and the main caregiver. Although 76.5% reported following the dietary recommendations, only 44% had adequate serum potassium values and 34.7% met the recommended inter-dialytic weight gain. Conclusions: Malnutrition continues to be a frequent problem in hemodialysis units. Measures should be taken to reduce this problem, either with educational actions on nutrition or even evaluating the use of dietary supplements. Nursing must continue to reinforce dietary recommendations so that compliance referred by patients can be objectified and reflected in the analytical results.

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          Management of natural and added dietary phosphorus burden in kidney disease.

          Phosphorus retention occurs from higher dietary phosphorus intake relative to its renal excretion or dialysis removal. In the gastrointestinal tract the naturally existing organic phosphorus is only partially (∼60%) absorbable; however, this absorption varies widely and is lower for plant-based phosphorus including phytate ( 80%). The latter phosphorus often remains unrecognized by patients and health care professionals, even though it is widely used in contemporary diets, in particular, low-cost foods. In a nonenhanced mixed diet, digestible phosphorus correlates closely with total protein content, making protein-rich foods a main source of natural phosphorus. Phosphorus burden is limited more appropriately in predialysis patients who are on a low-protein diet (∼0.6 g/kg/d), whereas dialysis patients who require higher protein intake (∼1.2 g/kg/d) are subject to a higher dietary phosphorus load. An effective and patient-friendly approach to reduce phosphorus intake without depriving patients of adequate proteins is to educate patients to avoid foods with high phosphorus relative to protein such as egg yolk and those with high amounts of phosphorus-based preservatives such as certain soft drinks and enhanced cheese and meat. Phosphorus rich foods should be prepared by boiling, which reduces phosphorus as well as sodium and potassium content, or by other types of cooking-induced demineralization. The dose of phosphorus-binding therapy should be adjusted separately for the amount and absorbability of phosphorus in each meal. Dietician counseling to address the emerging aspects of dietary phosphorus management is instrumental for achieving a reduction of phosphorus load. Copyright © 2013 Elsevier Inc. All rights reserved.
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            An integrative review of the methodology and findings regarding dietary adherence in end stage kidney disease

            Background Dietary modification is an important component of the management of end stage kidney disease (ESKD). The diet for ESKD involves modifying energy and protein intake, and altering sodium, phosphate, potassium and fluid intake. There have been no comprehensive reviews to date on this topic. The aims of this integrative review were to (i) describe the methods used to measure dietary adherence (ii) determine the rate of dietary adherence and (iii) describe factors associated with dietary adherence in ESKD. Methods The Web of Science and Scopus databases were searched using the search terms ‘adherence’ and ‘end stage kidney disease’. Of the 787 potentially eligible papers retrieved, 60 papers of 24,743 patients were included in this review. Of these papers, 44 reported the rate of dietary adherence and 44 papers described factors associated with adherence. Results Most of the evidence regarding dietary adherence is derived from studies of hemodialysis patients (72% of patients). The most common method of measuring dietary adherence in ESKD was subjective techniques (e.g. food diaries or adherence questionnaires). This was followed by indirect methods (e.g. serum potassium, phosphate or interdialytic weight gain). The weighted mean adherence rate to ESKD dietary recommendations was 31.5% and 68.5% for fluid recommendations. Adherence to protein, sodium, phosphate, and potassium recommendations were highly variable due to differences in measurement methods used, and were often derived from a limited evidence base. Socioeconomic status, age, social support and self-efficacy were associated with dietary adherence. However, factors such as taste, the impact of the diet on social eating occasions; and dietetic staffing also appear to play a role in dietary adherence. Conclusion Dietary adherence rates in people with ESKD are suboptimal. Further research is required on dietary adherence in patients with ESKD from different social, educational, economic and ethnic groups. This research may identify other factors which may impact upon adherence, and could be used to inform the design of future strategies to improve dietary adherence. Future research that reports not just the rate of adherence to individual components of the nutrient prescription but also the overall quality of the diet would be useful.
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              Measuring adherence to behavioral and medical interventions.

              Measuring adherence to medical and behavioral interventions is important to clinicians and researchers since inadequate adherence can reduce the effectiveness of an intervention. Unfortunately, there is no gold standard for measuring adherence across health behaviors. Adherence needs to be defined situationally with parameters of acceptable adherence carefully delineated and appropriate to the health behavior being studied. Additionally, measurement methods must be valid, reliable, and sensitive to change; this paper reviews these criteria. Methods used to measure adherence to dietary interventions include 24-hour recalls, food diaries, and food frequency questionnaires. Direct and indirect calorimetry, doubly labeled water, and a variety of self-report methods can be used to measure adherence in physical activity interventions. Adherence to pharmacological interventions is assessed using self-report methods, biochemical measures, medication counts, and the automated pharmacy database review strategy. The strengths and weaknesses of these methods for measuring adherence to dietary, physical activity, and pharmacological interventions are reviewed. Control Clin Trials 2000;21:188S-194S
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                Author and article information

                Journal
                enefro
                Enfermería Nefrológica
                Enferm Nefrol
                Sociedad Española de Enfermería Nefrológica (Madrid, Madrid, Spain )
                2254-2884
                2255-3517
                December 2020
                : 23
                : 4
                : 381-387
                Affiliations
                [1] Santander orgnameHospital Universitario Marqués de Valdecilla orgdiv1Unidad de Hemodiálisis orgdiv2Servicio de Nefrología Spain
                [2] Santander orgnameServicio Cántabro de Salud orgdiv1Subdirección de Cuidados Spain
                [3] Mompia Castilla y León orgnameUniversidad Católica de Ávila orgdiv1Escuela Universitaria de Enfermería Clínica Mompia Spain
                Article
                S2254-28842020000400007 S2254-2884(20)02300400007
                10.37551/s2254-28842020039
                207f7cc1-0abc-4827-950e-f60834395c13

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 04 November 2020
                : 13 October 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 14, Pages: 7
                Product

                SciELO Spain

                Categories
                Originales Breves

                hemodiálisis,cuidadores,cumplimiento y adherencia al tratamiento,dieta,desnutrición,caregivers,treatment adherence and compliance,diet,hemodialysis,malnutrition

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