title: Exploring Problems in Following the Hemodialysis Diet and Their Relation to Energy and Nutrient Intakes: The BalanceWise Study.
abstract: OBJECTIVE
  To identify the problems experienced by hemodialysis (HD) patients in attempting to follow the HD diet and their relation to energy and nutrient intakes.
  
  
  METHODS
  Cross-sectional analysis of baseline data from the BalanceWise Study.
  
  
  METHODS
  Participants included community-dwelling adults recruited from outpatient HD centers. After excluding participants with incomplete dietary analyses (n = 50), 140 African American and white (40/60%) men and women (52/48%) on chronic intermittent HD for at least 3 months (median 3 years) were included.
  
  
  METHODS
  Participant responses, on a 5-point Likert scale ranging from "not at all a problem" to "a very important problem for me," to 34 questions pertaining to potential barriers to following the HD diet in the previous 2 months were classified as either a problem (1) or not a problem (2-5).
  
  
  METHODS
  Energy and nutrient intakes determined using the Nutrition Data System for Research® based on 3, non-consecutive, unscheduled, 2-pass 24-hour dietary recalls collected on 1 dialysis and 1 non-dialysis weekday, and 1 non-dialysis weekend day.
  
  
  RESULTS
  More than half of participants reported having problems related to specific behavioral factors (e.g., feeling deprived), technical difficulties (e.g., tracking nutrients), and physical condition (e.g., appetite), but issues of time and food preparation and behavioral factors tended to be most deterministic of reported dietary intakes. Longer duration of HD was associated with lower intakes of protein, potassium, and phosphorus (P < .05).
  
  
  CONCLUSIONS
  Registered dietitian nutritionists should consider issues of time and food preparation, and behavioral factors in their nutrition assessment of HD patients and should continually monitor HD patients for changes in protein intake that may occur over time.
authors.affiliation: Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York. Electronic address: davidstjules@gmail.com.
authors.forename: David E
authors.initials: DE
authors.lastname: St-Jules
authors.affiliation: Department of Nutrition, Food Studies, and Public Health, New York University Steinhardt, New York, New York.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Woolf
authors.affiliation: Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Pompeii
authors.affiliation: Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Sevick
mesh_terms: D001741:Black or African American; D000368:Aged; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D016226:Phosphorus, Dietary / Q000008:administration & dosage; D017419:Potassium, Dietary / Q000008:administration & dosage; D011502:Protein-Energy Malnutrition / Q000175:diagnosis; D006435:Renal Dialysis / Q000009:adverse effects*; D012959:Socioeconomic Factors; D012982:Sodium, Dietary / Q000008:administration & dosage; D011795:Surveys and Questionnaires; D019282:Wasting Syndrome / Q000175:diagnosis; D044465:White People
chemical_list: D004044:Dietary Proteins; D016226:Phosphorus, Dietary; D017419:Potassium, Dietary; D012982:Sodium, Dietary