{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T19:11:02Z","timestamp":1760037062190,"version":"build-2065373602"},"reference-count":29,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Stage 5 chronic kidney disease (CKD), or end-stage renal disease (ESRD), requires renal replacement therapy, commonly hemodialysis (HD). This treatment necessitates dietary changes due to impaired excretory function and protein-energy wasting (PEW). A structured diet with adequate energy, protein, electrolytes, and fluids is essential. The aim was to characterize habitual dietary intake in adults on HD relative to KDOQI and ESPEN recommendations. Methods: In this cross-sectional study, 50 adults on maintenance HD at the Medical University of Warsaw completed a validated Food Frequency Questionnaire (55 items, nine frequency categories). The study was questionnaire-based and did not collect, link, or analyze dialysis efficacy indices, residual diuresis, or anthropometric measurements; all dietary estimates are independent of these clinical parameters. Estimated intakes of energy, macronutrients, fiber, electrolytes (Na, K, Ca, P), and fluids were compared with KDOQI 2020 and ESPEN 2021 recommendations. Sensitivity analyses included deterministic scenarios and Monte Carlo simulations. Results: Mean intakes were 2696.9 \u00b1 1392.7 kcal and 87.7 \u00b1 35.3 g protein; 64% and 82% met reference values. Sensitivity analyses revealed per-kg shortfalls in heavier patients (&gt;75 kg): Monte Carlo medians were 37.8 kcal\/kg\/day and 1.28 g\/kg\/day. Diets were fat-dominant (~46%E), with low carbohydrates (~40%E) and low fiber, about 8 g per 1000 kcal. Sodium and phosphorus were elevated, about 1119 mg and 498 mg per 1000 kcal, while calcium was low (~346 mg\/1000 kcal). Conclusions: Despite adequate mean intake, sensitivity analyses revealed per-kg energy\/protein deficits and elevated sodium and phosphorus. Individualized counseling with electrolyte and fluid management, greater dietary diversity, and psychosocial support is warranted in HD.<\/jats:p>","DOI":"10.3390\/nu17193161","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T08:05:36Z","timestamp":1759824336000},"page":"3161","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Food Frequency Questionnaire to Estimate Dietary Adherence in Hemodialysis Patients: A Pilot Study"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9473-9954","authenticated-orcid":false,"given":"\u0141ukasz","family":"Czy\u017cewski","sequence":"first","affiliation":[{"name":"Department of Geriatric Nursing, Faculty of Health Sciences, Medical University of Warsaw, 02-007 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agnieszka","family":"Stel\u0119gowska","sequence":"additional","affiliation":[{"name":"Student Geriatric Scientific Circle, Faculty of Health Sciences, Medical University of Warsaw, 02-007 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4798-1497","authenticated-orcid":false,"given":"Magdalena","family":"Durlik","sequence":"additional","affiliation":[{"name":"Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, 02-014 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janusz","family":"Wyzga\u0142","sequence":"additional","affiliation":[{"name":"Department of Nephrology Nursing, Faculty of Health Sciences, Medical University of Warsaw, 02-007 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7048-8094","authenticated-orcid":false,"given":"Andrzej","family":"Silczuk","sequence":"additional","affiliation":[{"name":"Department of Environmental Psychiatry, Medical University of Warsaw, 02-353 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beata Irena","family":"Si\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1053\/j.ajkd.2020.05.006","article-title":"KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update","volume":"76","author":"Ikizler","year":"2020","journal-title":"Am. J. Kidney Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1056\/NEJMra1700312","article-title":"Nutritional Management of Chronic Kidney Disease","volume":"377","author":"Fouque","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1111\/sdi.12348","article-title":"Dietary restrictions in dialysis patients: Is there anything left to eat?","volume":"28","author":"Tortorici","year":"2015","journal-title":"Semin. Dial."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2024). KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int., 105, S117\u2013S314.","DOI":"10.1016\/j.kint.2023.10.018"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2238","DOI":"10.1016\/j.clnu.2024.08.002","article-title":"ESPEN practical guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease","volume":"43","author":"Sabatino","year":"2024","journal-title":"Clin. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Chen, Y.H., Liu, W.L., Duong, T.V., Wong, T.C., Chen, H.H., Chen, T.H., Hsu, Y.H., Peng, S.J., and Yang, S.H. (2022). Effect of Different Nutritional Education Based on Healthy Eating Index for HemoDialysis Patients on Dietary Quality and Muscle Mass. Nutrients, 14.","DOI":"10.3390\/nu14214617"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1093\/jn\/nxaa010","article-title":"End-Stage Renal Disease Patients Lose a Substantial Amount of Amino Acids during Hemodialysis","volume":"150","author":"Hendriks","year":"2020","journal-title":"J. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Gebrie, M.H., and Ford, J. (2019). Depressive symptoms and dietary non-adherence among end stage renal disease patients undergoing hemodialysis therapy: Systematic review. BMC Nephrol., 20.","DOI":"10.1186\/s12882-019-1622-5"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"105","DOI":"10.5114\/ms.2021.107454","article-title":"Assessment of the realisation of individual dietary guidelinesin patients undergoing haemodialysis treatment in the context of nutrient level and energy requirements","volume":"37","author":"Tokarska","year":"2021","journal-title":"Med. Stud."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2363589","DOI":"10.1080\/0886022X.2024.2363589","article-title":"Dietary nutrient intake and nutritional status in maintenance hemodialysis patients: A multicenter cross-sectional survey","volume":"46","author":"Chen","year":"2024","journal-title":"Ren. Fail."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1053\/j.jrn.2025.03.004","article-title":"Nutritional Intake and Diet Quality in Hemodialysis Patients: Scope for Improvement","volume":"35","author":"Visser","year":"2025","journal-title":"J. Ren. Nutr."},{"key":"ref_12","unstructured":"(2022, October 09). The EPIC-Norfolk Food Frequency Questionnaire. Available online: https:\/\/www.epic-norfolk.org.uk\/wp-content\/uploads\/2020\/11\/CAMB-PQ-6-1205a_front.pdf."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e37679","DOI":"10.1097\/MD.0000000000037679","article-title":"Prevalence and factors associated with malnutrition among hemodialysis patients in a single hemodialysis center in Vietnam: A cross-sectional study","volume":"103","year":"2024","journal-title":"Medicine"},{"key":"ref_14","first-page":"82","article-title":"Assessment of dietary habits in hemodialysis patients with normal mass, overweight and obesity","volume":"1","author":"Kardasz","year":"2011","journal-title":"Bromatol. Chem. Toksykol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.clnesp.2024.06.025","article-title":"Replacement of the massive amino acid losses induced by hemodialysis: A new treatment option proposal for a largely underestimated issue","volume":"63","author":"Murtas","year":"2024","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Murtas, S., Aquilani, R., Fiori, G., Maestri, R., Iadarola, P., Graccione, C., Contu, R., Deiana, M.L., Macis, F., and Secci, R. (2022). Effects of a Novel Amino Acid Formula on Nutritional and Metabolic Status, Anemia and Myocardial Function in Thrice-Weekly Hemodialysis Patients: Results of a Six-Month Randomized Double-Blind Placebo-Controlled Pilot Study. Nutrients, 14.","DOI":"10.3390\/nu14173492"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"6491","DOI":"10.1007\/s00216-023-04926-x","article-title":"Evaluation of amino acids and other related metabolites levels in end-stage renal disease (ESRD) patients on hemodialysis by LC\/MS\/MS and GC\/MS","volume":"415","author":"Pallerla","year":"2023","journal-title":"Anal. Bioanal. Chem."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"sfae361","DOI":"10.1093\/ckj\/sfae361","article-title":"Nutritional outcomes between different techniques of intradialytic amino acid replacement: A randomized controlled trial","volume":"18","author":"Dumrongsukit","year":"2024","journal-title":"Clin. Kidney J."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Massini, G., Caldiroli, L., Molinari, P., Carminati, F.M.I., Castellano, G., and Vettoretti, S. (2023). Nutritional Strategies to Prevent Muscle Loss and Sarcopenia in Chronic Kidney Disease: What Do We Currently Know?. Nutrients, 15.","DOI":"10.3390\/nu15143107"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Navab, F., Foshati, S., Vajdi, M., Askari, G., Moeinzadeh, F., Heshamtipour, H., Mirzaeian, S., and Rouhani, M.H. (2024). Is there any association between type of dietary fat and quality of life in hemodialysis patients? A cross-sectional study. Front. Nutr., 11.","DOI":"10.3389\/fnut.2024.1430595"},{"key":"ref_21","first-page":"56","article-title":"Poor adherence of hemodialysis patients to dietary restrictions","volume":"22","author":"Kowal","year":"2018","journal-title":"Nefrol. Dial. Pol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Ahmed, S., Rahman, T., Ripon, M.S.H., Rashid, H.U., Kashem, T., Md Ali, M.S., Khor, B.H., Khosla, P., Karupaiah, T., and Daud, Z.A.M. (2021). A Food Frequency Questionnaire for Hemodialysis Patients in Bangladesh (BDHD-FFQ): Development and Validation. Nutrients, 13.","DOI":"10.3390\/nu13124521"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1644","DOI":"10.1016\/j.clnu.2021.01.028","article-title":"ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease","volume":"40","author":"Fiaccadori","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Zhuang, Y., Wang, X., Zhang, X., Fang, Q., Zhang, X., and Song, Y. (2023). The relationship between dietary patterns derived from inflammation and cognitive impairment in patients undergoing hemodialysis. Front. Nutr., 10.","DOI":"10.3389\/fnut.2023.1218592"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1053\/j.jrn.2006.07.012","article-title":"Removal of potassium from tuberous root vegetables by leaching","volume":"16","author":"Burrowes","year":"2006","journal-title":"J. Ren. Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/j.1755-6686.2011.00212.x","article-title":"Dietary egg whites for phosphorus control in maintenance haemodialysis patients: A pilot study","volume":"37","author":"Taylor","year":"2011","journal-title":"J. Ren. Care"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1093\/ckj\/sfac102","article-title":"Home-delivered meals as an adjuvant to improve volume overload and clinical outcomes in hemodialysis","volume":"10","author":"Perez","year":"2022","journal-title":"Clin. Kidney J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1053\/j.jrn.2020.03.005","article-title":"Culinary Medicine as a Core Component of the Medical Nutrition Therapy for Kidney Health and Disease","volume":"31","author":"Moore","year":"2021","journal-title":"J. Ren. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e29","DOI":"10.1053\/j.jrn.2017.12.013","article-title":"Attention to Food Phosphate and Nutrition Labeling","volume":"28","author":"Watanabe","year":"2018","journal-title":"J. Ren. Nutr."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/19\/3161\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:49:51Z","timestamp":1760035791000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/19\/3161"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,7]]},"references-count":29,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["nu17193161"],"URL":"https:\/\/doi.org\/10.3390\/nu17193161","relation":{},"ISSN":["2072-6643"],"issn-type":[{"type":"electronic","value":"2072-6643"}],"subject":[],"published":{"date-parts":[[2025,10,7]]}}}