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Nutrition and dietary intake and their association with mortality and hospitalisation in adults with chronic kidney disease treated with haemodialysis: protocol for DIET-HD, a prospective multinational cohort study
  1. Suetonia C Palmer1,
  2. Marinella Ruospo2,3,
  3. Katrina L Campbell4,
  4. Vanessa Garcia Larsen5,
  5. Valeria Saglimbene2,
  6. Patrizia Natale2,
  7. Letizia Gargano2,
  8. Jonathan C Craig6,
  9. David W Johnson7,
  10. Marcello Tonelli8,
  11. John Knight9,
  12. Anna Bednarek-Skublewska2,10,
  13. Eduardo Celia2,
  14. Domingo del Castillo2,
  15. Jan Dulawa2,11,
  16. Tevfik Ecder2,
  17. Elisabeth Fabricius2,
  18. João Miguel Frazão2,12,
  19. Ruben Gelfman2,
  20. Susanne Hildegard Hoischen2,
  21. Staffan Schön2,
  22. Paul Stroumza2,
  23. Delia Timofte2,
  24. Marietta Török2,
  25. Jörgen Hegbrant2,
  26. Charlotta Wollheim2,
  27. Luc Frantzen2,
  28. G F M Strippoli2,6,13,14,
  29. on behalf of DIET-HD Study investigators
  1. 1Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
  2. 2Diaverum Medical Scientific Office, Lund, Sweden
  3. 3Division of Nephrology and Transplantation, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
  4. 4Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  5. 5Faculty of Medicine, National Health and Lung Institute, Imperial College of Science, Technology, and Medicine, Royal Brompton campus, London, UK
  6. 6Sydney School of Public Health, Edward Ford Building, University of Sydney, Sydney, New South Wales, Australia
  7. 7Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  8. 8Cumming School of Medicine, University of Calgary, 2500 University Drive Northwest, Calgary, Alberta, Canada
  9. 9The George Institute for Global Health, Sydney, New South Wales, Australia
  10. 10Department of Nephrology, Medical University of Lublin, Lublin, Poland
  11. 11Department of Internal Medicine, Metabolic Diseases, Medical University of Silesia, Katowice, Poland
  12. 12Nephrology and Infectiology Research and Development Group, INEB, and School of Medicine, Porto University, Porto, Portugal
  13. 13Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
  14. 14Diaverum Academy, Bari, Italy
  1. Correspondence to Professor G F M Strippoli; gfmstrippoli{at}


Introduction Adults with end-stage kidney disease (ESKD) treated with haemodialysis experience mortality of between 15% and 20% each year. Effective interventions that improve health outcomes for long-term dialysis patients remain unproven. Novel and testable determinants of health in dialysis are needed. Nutrition and dietary patterns are potential factors influencing health in other health settings that warrant exploration in multinational studies in men and women treated with dialysis. We report the protocol of the “DIETary intake, death and hospitalisation in adults with end-stage kidney disease treated with HaemoDialysis (DIET-HD) study,” a multinational prospective cohort study. DIET-HD will describe associations of nutrition and dietary patterns with major health outcomes for adults treated with dialysis in several countries.

Methods and analysis DIET-HD will recruit approximately 10 000 adults who have ESKD treated by clinics administered by a single dialysis provider in Argentina, France, Germany, Hungary, Italy, Poland, Portugal, Romania, Spain, Sweden and Turkey. Recruitment will take place between March 2014 and June 2015. The study has currently recruited 8000 participants who have completed baseline data. Nutritional intake and dietary patterns will be measured using the Global Allergy and Asthma European Network (GA2LEN) food frequency questionnaire. The primary dietary exposures will be n-3 and n-6 polyunsaturated fatty acid consumption. The primary outcome will be cardiovascular mortality and secondary outcomes will be all-cause mortality, infection-related mortality and hospitalisation.

Ethics and dissemination The study is approved by the relevant Ethics Committees in participating countries. All participants will provide written informed consent and be free to withdraw their data at any time. The findings of the study will be disseminated through peer-reviewed journals, conference presentations and to participants via regular newsletters. We expect that the DIET-HD study will inform large pragmatic trials of nutrition or dietary interventions in the setting of advanced kidney disease.


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