Identification of the Dietary Protein Sources and Their Association with Serum Phosphorus Levels among Patients with Kidney Failure

Background: Major dietary protein sources double as major sources of phosphorus with implications on serum phosphorus in kidney failure (KF) patients. Objectives: To identify the dietary protein sources of kidney failure patients and its association with their serum phosphorus (SP).Methods: Cross-sectional design involving 22 patients with kidney failure ≥ 18 years, recruited from the Renal and Dialysis Unit of the Korle-Bu Teaching Hospital. Sources and amount of protein and phosphorus were determined using quantitative food frequency questionnaire. Serum phosphorus was obtained from patients’ hospital records. Correlation between dietary and serum phosphorus was determined. Data were analyzed using SPSS version 21 at a 95% CI at p ≤ 0.05.Results: Mean age was 46.2 ± 2.5 years. Sources of protein and phosphorus were cereals, animal protein (AP) and legumes and nuts (L&N). The highest contribution for both protein and phosphorus was from cereals (65.7% and 63.4%) respectively. There was no significant correlation between all sources of phosphorus with SP (AP r2 = 0.120, p = 0.595; L&N r2 = -0.045, p= 0.843; cereals r2 = 0.117, p = 0.604) howbeit, legumes and nuts showed a negative correlation.Conclusion; Main dietary source of both protein and phosphorus was cereals. There was no significant correlation between all sources of phosphorus with serum phosphorus levels. Appropriate medical nutrition therapy by qualified nutritionist/dietitians is recommended for this group to prevent protein energy wasting. Keywords: kidney failure, protein, phosphorous, protein energy wasting, serum phosphorous. DOI: 10.7176/JBAH/12-16-04 Publication date:August 31st 202

Rationale and Design of the Diet, CKD, and Apolipoprotein L1 Study in Low-Income and Middle-Income Countries

IntroductionDiet, chronic kidney disease (CKD), and Apolipoprotein L1 (APOL1) (DCA) Study is examining the role of dietary factors in CKD progression and APOL1 nephropathy. We describe enrollment and retention efforts and highlight facilitators and barriers to enrollment and operational challenges, as well as accommodations made in the study protocol.MethodsThe DCA study is enrolling participants in 7 centers in West Africa. Participants who consented were invited to complete dietary recalls and 24-hour urine collections in year 1. We conducted focus groups and semistructured interviews among study personnel to identify facilitators and barriers to enrollment as well as retention and operational challenges in the execution of the study protocol. We analyzed emerging themes using content analyses.ResultsA total of 712 participants were enrolled in 18 months with 1256 24-hour urine and 1260 dietary recalls. Barriers to enrollment were the following: (i) a lack of understanding of research, (ii) the burden of research visits, and (iii) incorporating cultural and traditional nuances when designing research protocols. Factors facilitating enrollment were the following: (i) designing convenient research visits, (ii) building rapport and increased communication between the research team and participants, and (iii) cultural sensitivity - adapting research protocols for the populations involved. Offering home visits, providing free dietary counseling, reducing the volume of study blood collection, and reducing the frequency of visits were some changes made in the study protocol that increased participant satisfaction.ConclusionAdopting a participant-centered approach with accommodations in the protocol for cultural adaptability and incorporating participant feedback is vital for carrying out research in low-income and middle-income regions