Abstract / Summary
Optimal nutrition is a central to the care of people receiving maintenance hemodialysis, yet dietary intake in these patients is usually measured by self-report, and self-report is known to be unreliable. Evidence from resource-limited dialysis settings is scarce. This cross-sectional study assessed dietary intake among 181 adults receiving maintenance hemodialysis at four hospital-based units in Bangladesh, and examined how screening reported intake for plausibility changes conclusions about guideline adherence. Intake was measured by three non-consecutive 24-hour recalls and compared with the Kidney Disease Outcomes Quality Initiative (KDOQI) recommendations. Reporting plausibility was classified from the ratio of energy intake to estimated basal metabolic rate. Appetite was assessed using the Appetite and Diet Assessment Tool. Of 178 participants with complete data, 65.2% reported acceptable, 32.0% under-reported and 2.8% over-reported energy intake. In the cohort as a whole, only 20 of 176 (11.4%) met the energy target of 30-35 kcal/kg/day and 58 (33.0%) met the protein target of at least 1.0 g/kg/day. Screening changed these estimates in opposite directions according to the type of target. For intake targets, adherence rose once implausible reports were excluded: energy from 11.4% to 15.5% and protein from 33.0% to 47.4%. For restriction targets the reverse occurred: apparent adherence to the sodium limit fell from 73.6% to 65.5% and to the phosphorus limit from 88.2% to 84.5%. The phosphorus-to-protein ratio exceeded 12 mg/g in all but five participants. Poor appetite was common (42.0%) but did not correspond to lower measured intake, and was instead associated with reporting plausibility (p = 0.024). Unscreened self-reported intake simultaneously overstates dietary inadequacy and understates dietary excess, and should not be used unfiltered to guide nutritional decisions in this population.