Effect of behavioral stage-based nutrition education on management of osteodystrophy among hemodialysis patients, Lebanon

Objective: Assess the effect of intensive nutrition education by trained dedicated dietitians on osteodystrophy management among hemodialysis patients. Methods: Randomized controlled trial in 12 hospital-based hemodialysis units equally distributed over clusters 1 and 2. Cluster 1 patients were either assigned to usual care (n=96) or to individualized intensive staged-based nutrition education by a dedicated renal dietitian (n=88). Cluster 2 patients (n=210) received nutrition education from general hospital dietitians, educating their patients at their spare time from hospital duties. Main outcomes were: (1) dietary knowledge(%), (2) behavioral change, (3) serum phosphorus (mmol/L), each measured at TO (baseline), TI (post 6 month intervention) and T2 (post 6 month follow up). Results: Significant improvement was found only among patients receiving intensive education from a dedicated dietitian at TI; the change regressed at T2 without statistical significance: knowledge (TO: 40.3; TI: 64; T2: 63) and serum phosphorus (T0 1.79; TI: 1.65; T2: 1.70); behavioral stages changed significantly throughout the study (TO: Preparation, T1: Action, T2: Preparation). Conclusion: The intensive protocol showed to be the most effective. Practice implications: Integrating dedicated dietitians and stage-based education in hemodialysis units may improve the nutritional management of patients in Lebanon and countries with similar health care systems.