Patients on hemodialysis who received dietary counseling on the phone during the COVID-19 pandemic experienced improvements in a variety of parameters associated with nutritional status, according to study findings.
“The barriers to regular and individualized dietary support for patients on [hemodialysis] HD include geographic location, time and financial issues,” Ana Valente, MSc, of the nutrition department at Nephrocare in Portugal, and colleagues wrote. “These constraints already limit access to adequate nutritional monitoring, but the situation worsens dramatically if we consider the recent coronavirus disease (COVID-19) pandemic. To overcome this problem, novel strategies and approaches are necessary.”
To address this, Valente and colleagues assigned 156 patients to receive phone calls from a dietitian between April 2020 and May 2020 and collected clinical and nutritional parameters at baseline and 1 month following the intervention (all participants, at baseline, had phosphorus greater than 5.5 mg per dL or less than 3.5 mg per dL, potassium greater than 5.5 mEq per dL or less than 3.5 mEq per dL and intradialytic weight gain greater than 4.5%). In some instances, counseling was not provided directly to the patient but to the caregiver or through a nursing home. Phone calls lasted a mean of 16.7 minutes.
“Dietary advice focused on altered parameters that were reviewed with each patient and a dietary assessment through a 24-hours recall was also performed and discussed with the patient in order to recommend changes in eating habits,” the researchers wrote of the intervention. “Written summarized nutritional recommendations including methods to reduce intake of phosphorus, potassium, and liquids, or alternatively, to increase phosphorus intake were discussed with patients or their caregivers whenever necessary.”
Results showed the prevalence of hyperkalemia and hyperphosphatemia decreased significantly after dietary advice, with patients who received counseling for the conditions seeing a reduction in serum potassium and serum phosphorus levels. Researchers also observed a decrease of 0.4% in intradialytic weight gain following the intervention.
According to Valente and colleagues, counseling was most effective when the phone calls were made directly to the patient, though improvements occurred when calls were made to a caregiver. No impact was seen when contact was made through a nursing home.
“A possible explanation could be that although the nutritional intervention and recommendations are similar, the application of these measures in a nursing home context could be more complex due to logistics, high number of residents, or other limitations often seen in those environments,” the researchers theorized. “Furthermore, we speculate that the person with whom the contact is performed (eg, dietitian, nurse, technical director, or auxiliary/kitchen staff) may also play an important role.”
Researchers recommend future research look at how dietary interventions might be conducted directly in nursing homes. In addition, they encourage studies evaluating the effectiveness of various methods of counseling (eg, telephone, video conferences, email, text messages or apps).