Tips for cholesterol control in patients on hemodialysis¹²

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KIDNEY DISEASE is associated with a number of risk factors for cardiovascular disease (CVD) including a high incidence of diabetes, hypertension, and dyslipidemias. CVD accounts for almost half of all deaths among patients with end-stage renal disease (ESRD).1 Findings from a recent study indicate that dyslipidemias in hemodialysis (HD) patients—including increased serum low-density lipoprotein (LDL) cholesterol and decreased high-density lipoprotein (HDL) cholesterol—negatively impact cardiovascular profiles and influence both the frequency and length of hospitalizations.2

Paradoxically, although higher body mass index (BMI) is a risk factor for CVD in the general population,3 maintaining BMI at the high end of the normal range (20–27.5 kg/m²) may reduce morbidity and mortality in HD patients.4 Furthermore, HD patients are encouraged to increase protein intake from animal sources (which are relatively high in fat, saturated fat, and cholesterol) to avoid the hypoalbuminemia that is also predictive of increased mortality.5 Clearly, dietary management of these patients should focus on optimizing nutritional status while reducing risk factors for CVD.

This teaching tool for HD patients has been adapted from an American Heart Association publication for the general population.6 The handouts comprising this patient education tool address the selection of protein-rich foods while limiting saturated fat and cholesterol intake. In addition, providing information on “Foods to Eat” as well as “Foods to Avoid” encourages appropriate caloric intake for maintenance of acceptable BMI. These handouts can be used to teach HD patients with a history of high cholesterol and/or triglyceride levels about healthy food choices from each of the food groups. The information may be presented in its entirety or broken down to address the separate food groups over several counseling sessions.

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References 

1. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases . USRDS US Renal Data System Annual Data Report. 1999;
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2. Baugh ME, Stoltz ML, VanBeber AD, et al.  Are lipid values and BMI related to hospitalizations in the hemodialysis population?. J Ren Nutr. 2001;11:37–45
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3. Krauss RM, Eckel RH, Howard B, et al.  AHA Dietary Guidelines: Revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation. 2000;102:2284–2299
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4. Fleischmann E, Teal N, Dudley J, et al.  Influence of excess weight on mortality and hospital stay in 1346 hemodialysis patients. Kidney Int. 1999;55:1560–1567
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5. National Kidney Foundation . Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Nutrition in Chronic Renal Failure. Am J Kidney Dis. 2000;35:S40–S41
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6. American Heart Association . Fighting Heart Disease and Stroke. 1998; Available at http://www.deliciousdecisions.org. Accessed March 11
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Further reading 

• 1 Column Editor: Beth McQuiston, MS, RD, LD
• 2 This Patient Information Forum may be photocopied for the purpose of distribution to patients only, but not for any other purposes, such as copying for general distribution, for advertising or promotional purposes, for creating new collective works, or for resale.Professional review and adaptation before patient use is encouraged.