K LAMBERT1, L BIRD1, A BORST2, A FULLER2, E NEALE2, J WILLIAMS3, M SMITH3, Y PROBST2, M LONERGAN1
1Illawarra Shoalhaven Local Health District , Wollongong , Australia, 2Faculty of Science, Medicine and Health, University of Wollongong, Wollongong , Australia, 3Illawarra Health and Medical Research Institute, Wollongong, Australia
Aim: To determine the safety and efficacy of using a non-drug treatment to improve bowel health in haemodialysis patients.
Background: Constipation is common in haemodialysis patients, a condition exacerbated by dietary and fluid restrictions, inactivity and polypharmacy.
Methods: Stable patients from two haemodialysis units in the Illawarra region were recruited to a 10-week repeated measures, within subject, pragmatic clinical trial. After a 2-week wash-in period, participants were provided with almonds (40g/d) for a four week intervention period; followed by a two week washout period and four weeks of participants acting as their own control, consuming their usual diet with no nuts as per usual renal diet recommendations. The primary safety outcome measure was change in serum potassium and phosphate; and the primary efficacy measure was change in bowel habits.
Results: To date, 21 participants completed four weeks of the intervention (mean 66 ± 15.1 years, 59% male, mean dry weight 80.6 ± 21.3 kg, 45% anuric, 48% with adequate bowel frequency, 24% cognitively impaired, mean kt/V 1.5). Mean baseline fibre intake was 23.2 g± 8.6 /day. Intervention adherence exceeded 85% each week of the intervention. Preliminary per protocol unadjusted generalised linear models for repeated measures analyses indicated no significant change in serum potassium (p=0.87) or phosphate (p=0.35) during the intervention. There was no significant difference in the proportion of participants with hyperkalemia (p=0.86) or hyperphosphatemia (p=0.35) following consumption of the intervention. Compared to baseline, there was a higher proportion of participants (80%) with adequate bowel habits at week 4 (p=0.05).
Conclusions: Consumption of 40g/d almonds may be a safe and effective short-term non-drug treatment for constipation in adults undertaking haemodialysis. Further long-term studies are required.
Kelly Lambert is an Advanced Accredited Practicing Dietitian and Renal Dietitian. Kelly is passionate about using research to improve health outcomes for adults with kidney disease. Her clinical nutrition research interests focus on developing, implementing and evaluating dietary interventions as well as translating research evidence into dietetic practice. Kelly currently holds an NHMRC Translating Research Into Practice Fellowship to develop, implement and evaluate a new health literacy sensitive model of renal dietetic care. Kelly is also active in the area of teaching and training, and maintains an active research supervision program with numerous HDR students in the area of nephrology.