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

• Randomized multicenter study in hemodialysis units with 3 study protocols.
• Dietitians and patients empowered for optimal dietary management of osteodystrophy.
• Patient outcomes improved in the group receiving individualized nutrition education.
• Can be a model for health care reform in dialysis units of developing countries.

ObjectiveAssess the effect of intensive nutrition education by trained dedicated dietitians on osteodystrophy management among hemodialysis patients.MethodsRandomized 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 T0 (baseline), T1 (post 6 month intervention) and T2 (post 6 month follow up).ResultsSignificant improvement was found only among patients receiving intensive education from a dedicated dietitian at T1; the change regressed at T2 without statistical significance: knowledge (T0: 40.3; T1: 64; T2: 63) and serum phosphorus (T0: 1.79; T1: 1.65; T2: 1.70); behavioral stages changed significantly throughout the study (T0: Preparation, T1: Action, T2: Preparation).ConclusionThe intensive protocol showed to be the most effective.Practice implicationsIntegrating 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.