Barriers to adequate protein nutrition among hemodialysis patients.
OBJECTIVE
Determine the relative importance of potential medical, behavioral, and socioeconomic barriers to adequate protein nutrition among hemodialysis patients.


METHODS
Cross-sectional study.


METHODS
All 22 chronic hemodialysis units in northeast Ohio.


METHODS
298 randomly selected chronic hemodialysis patients.


METHODS
We interviewed and abstracted the chart of each patient to assess protein nutritional status (albumin and protein catabolic rate), potential medical barriers (poor appetite, inadequate dialysis, bioincompatible dialysis membrane, difficulty chewing, and comorbid conditions), potential behavioral barriers (knowledge of protein containing foods and dietary noncompliance), and potential socioeconomic barriers (expense of protein containing foods and needing help shopping and cooking).


METHODS
We used logistic regression to examine the relationship between protein nutritional status and potential barriers.


RESULTS
Albumin levels of <35 g/L were independently associated with Kt/V of <1.2 (odds ratio, 2.4), having more than three comorbid conditions (odds ratio, 4.0), inability to name any protein-containing foods (odds ratio, 2. 3), and needing help shopping and cooking (odds ratio, 2.6). Normalized protein catabolic rate of <1.0 g/kg/d was independently associated with poor appetite (odds ratio, 3.3), Kt/V of <1.2 (odds ratio, 3.1), and dietary compliance as indicated by low interdialytic fluid gain (odds ratio, 2.2).


CONCLUSIONS
Three medical factors (poor appetite, inadequate dialysis, and comorbid conditions), two behavioral factors (lack of knowledge of protein containing foods and low interdialytic fluid gain), and one socioeconomic factor (needing help shopping and cooking) are independently associated with inadequate protein nutrition among hemodialysis patients. Further work is needed to develop interventions to overcome these barriers and to determine the effect of such interventions on protein nutrition and patient mortality and morbidity.
Division of Nephrology, MetroHealth Medical Center, Cleveland, OH, USA.
A R
AR
Sehgal
J
J
Leon
J A
JA
Soinski
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003710:Demography; D004044:Dietary Proteins / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D009820:Ohio / Q000453:epidemiology; D015995:Prevalence; D011502:Protein-Energy Malnutrition / Q000453:epidemiology; D006435:Renal Dialysis; D012959:Socioeconomic Factors
D004044:Dietary Proteins