Access Type

Open Access Dissertation

Date of Award

January 2020

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Nutrition and Food Science

First Advisor

Pramod Khosla

Abstract

Methods to identify patients at risk for End stage renal disease (ESRD) are a high priority in Bangladesh, where kidney transplants/dialysis options are limited and costly. Every year, 35,000 to 40,000 people reach ESRD in Bangladesh, but currently available facilities can hardly accommodate only 9000 to 10,000 new patients with twice weekly dialysis and the remaining 66% have no access to any kind of renal replacement therapy (RRT) in the form of dialysis or transplantation. Nutrition is an important factor in maintaining good health of hemodialysis patients. However, data on nutritional status of Bangladeshi dialysis patients is limited and is not adequately documented.The purpose of the first study (specific aim I and II) was to assess current health and nutritional status of hemodialysis (HD) patients in a specialized renal hospital in Dhaka, Bangladesh. We assessed 133 patients (49% male) at the Kidney Foundation Hospital and Research Institute (in 2017 and 2018) based on different anthropometric, biochemical, and clinical parameters. Lipid profiles and subfractions were analyzed and patients with dyslipidemia (DL) were characterized using ATP (Adult Treatment Panel) III guideline. Patients were also analyzed based on 2x weekly versus 3x weekly dialysis in order to see if there were any significant differences between these two groups. Patients with protein-energy wasting (PEW) were identified using criteria from the International Society of Renal Nutrition and Metabolism (ISRNM). Therefore, we conclude that, in this specialized renal hospital, no significant differences were found based on dialysis frequency. However, both mixed and atherogenic DL were prevalent and 64% of patients were having DL based on TAG/HDL-C ratio. Prevalence of PEW was 18%, thus both DL and PEW were common among the study cohort. The figures may be underestimates as only one clinic was evaluated. If this is the scenario in an Urban renal-specialized hospital in Bangladesh, it is obvious that, many more hemodialysis patients were also suffering from DL and PEW all over the country.

For specific aim III, we took an attempt to develop an educational tool for improving renal-specific nutrition knowledge among Bangladeshi dialysis patients in the form of a “Nutrition booklet” based on robust analysis of local Food compoition table and then incorporated key observations based on scientific basis into the booklet. Provision of renal-specific nutrition knowledge may help renal patients make more informed food choices. This may be especially important in resource-poor settings where nutritional support is a low-priority amongst health-care providers. The renal-specific nutrition booklet was developed only for Bangladeshi dialysis patients and made feasible to use in practice as an educational tool to improve their selection of food items as well as adherence towards renal-specific diet practice through this study. Additionally, we took initiative to educate and train a group of graduate students (in nutrition) with basic skills to assist renal staff in nutrition and anthropometric assessments in a hospital providing dialysis services in Dhaka, Bangladesh. The outcomes for both attempts were hopeful. Individuals with expertise in renal nutrition and associated aptitude in nutrition assessment are scarce in resource-poor countries which limit the opportunity to conduct research in this field in order to find the hidden truth behind the occurrence and severity of disease. Therefore, attempts should be made to generate trained manpower in order to facilitate research work in renal nutrition field in such region.

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