engleski

MP622EDUCATIONAL level is associated with ultrafiltration rate, adherence to dietray recommendations and use of phosphate binders in hemodialysis patients

Introduction and Aims: One of the major goals of an adequate hemodialysis (HD) treatment is normalization of body water homeostasis and extracellular volume, while fluid overload represents an established risk factor for the development of arterial hypertension, left ventricular hypertrophy, and cardiovascular mortality. Additionally, proper nutritional habits and use of phosphate binders are associated with cardiovascular morbidity and mortality in HD population. Educational level may significantly affect health care outcomes, however, no study has been performed on this topic in HD population. In this study, we aimed to examine the impact of educational level on ultrafiltration rate, adherence to dietary recommendations and phosphate binders use in chronic HD patients. Methods: This study enrolled 101 patients treated with HD at least 3 months (F/M: 44/ 57, mean age 60, 8 (range 21-87), mean HD vintage 67 months (range 3-479). Routine visits with the aim of nutritional status assessment, examination of nutritional habits and education are performed at our centre every 6 months. Demographic data, laboratory tests and ultrafiltration rate were recorded, while patients were interviewed for the use of phosphate binders and adherence to dietary recommendations from the last visit. We used three categories of educational level: low-up to 8 school-years, middle-8-12 years and high-more than 12 years of education. Results: 27 patients were in the low, 53 in the middle, 19 in the high group, while data were missing for 2 patients. Gender did not influence educational status, while in the group of patients older than 75 years, borderline significantly more patients had low than middle or high educational level ( p=0.06). Ultrafiltration was significantly influenced by educational status - middle- educational level group had the highest ultrafiltration, followed by low and high educational group (F=8.16, p=0.001). Self-reported adherence to dietary recommendations was also influenced by educational level (low - no adherence 48.5%, yes 51.85%, middle - 33.96% vs.66.04%, high -15.79% vs. 84.21%, respectively, p=0.07, chi-square 5.18). Self-reported major problem was appetite in the low group, while both middle and high educational level group emphasized phosphorus control. Discrepancy between self- reported and doctor-evidenced phosphate binders usage was found in 21 patients, 52.5% of patients from the low, 42.9% from the middle, and only 4.8% from the high educational level group. Conclusions: In conclusion, educational level has significant influence on ultrafiltration, adherence to dietary recommendations and phosphate binders use in HD patients. Specific educational activities with different approach to each educational group may increase awareness and adherence in HD patients.

education ; protein-energy wasting ; hemodialysis ; adherence

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