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DIETARY ADVICE IN HEMODIALYSIS PATIENTS: IMPACT OF A TELEHEALTH APPROACH DURING THE COVID-19 PANDEMIC

Telehealth technologies are being implemented widely and can be used to provide education and self-management support to help and sustain lifestyle changes, namely in patients with chronic diseases. The purpose of this study was to assess the effect of a telehealth-delivered nutritional intervention, via the telephone, in maintenance hemodialysis (HD) patients during the coronavirus outbreak.

This was a multicenter observational prospective longitudinal study of a cohort of 156 patients in maintenance HD from 15 dialysis units conducted during the COVID-19 pandemic. We assigned patients to receive dietary counselling, through a phone call, according to their biochemical and nutritional parameters (potassium >5.5mEq/L; phosphorus >5.5mg/dL or <3.5mg/dL; interdialytic weight gain percentage (%IDWG) >4.5%). Dry weight, %IDWG, body mass index, potassium, phosphorus, calcium, calcium/phosphorus product, normalized protein catabolic rate, albumin and hemoglobin were recorded at baseline and 1 month after the nutrition counselling. A p-value < 0.05 was considered statistical significant.

The prevalence of patients with hyperkaliemia and hyperphosphatemia decreased significantly after the dietary advice (50% vs. 34.6% and 36.5% vs. 19.2%, respectively). A statistical significant reduction in serum potassium (mEq/L) [median: 6.2 (IQ:6.0-6.5) vs. 5.7 (IQR:5.3-6.1)] and phosphorus (mg/dL) [median: 6.5 (IQR: 6.1-7.2) vs. 5.5 (4.7-6.1)] was observed in patients receiving counselling for hyperkalemia and hyperphosphatemia. In addition, there was a statistical significant decrease in the prevalence of patients with hypophosphatemia (28.8% vs. 18.6%). There was also a significant decrease in the %IDWG [(median: 4.8% (IQR: 4.2-6.8) vs. 4.4% (IQR: 3.8-6.2)], although no statistically significant differences were observed in the prevalence of patients with high %IDWG. Regarding the person contacted by telephone, data showed statistically significant differences in potassium (mEq/L) [patient – median: 6.2 (IQR:6.1-6.4) vs. 5.7 (IQR: 5.4-6.0); caregiver – mean: 6.3 ± 0.3 vs. 5.7 ± 0.7] and phosphorus (mg/dL) [patient –median: 6.5 (6.1-7.2) vs. 5.6 (4.9-6.1); caregiver – mean: 6.7±0.8 vs. 5.1±1.5] values when the contact was with the patient or the caregiver. In relation to hypophosphatemia (mg/dL) (mean: 2.4±0.7 vs. 3.0±0.9) and %IDWG [median: 4.6% (IQR: 4.1-7.1) vs. 4.1% (IQR: 3.5-6.6)], the main statistically significant differences were only observed when the contact was done directly with the patient. No differences were seen whenever the contact was with the nursing homes.

Our results suggest that telehealth-delivered dietary interventions can improve clinical and nutritional parameters in HD patients. Therefore, it may be an effective strategy to promote a continuous nutritional monitoring in these patients, at least, when or where the face-to-face option is a critical factor.