Peripherality and Indicators of Nutrition Status in Jewish Israeli Hemodialysis Patients: A Cross-Sectional Study

Background: Geographic peripherality in Israel is linked to poorer health outcomes and may disproportionately affect patients requiring chronic therapies such as hemodialysis (HD). Though malnutrition and inflammation are strong predictors of morbidity and mortality in HD patients, regional differences in nutritional status and dietary adherence are unclear. Objectives: To examine the association between peripherality and malnutrition risk, dietary intake, and adherence to nutrition guidelines among Jewish Israeli adults on HD. Methods: In this multi-center, cross-sectional study, 154 adult Jewish HD patients were recruited from the northern periphery (n = 66) and central regions of Israel (n = 88). Demographic, clinical, laboratory, and anthropometric data were obtained from medical records. Nutrient intake was assessed using the multi-pass 24 h dietary recall method. Malnutrition risk was classified using BMI and serum albumin; the C-reactive protein-to-albumin ratio (CAR) was also calculated. Adherence to International Society of Renal Nutrition and Metabolism (ISRNM) dietary guidelines was evaluated. Between-group comparisons and multivariable regression analyses were conducted. Results: Overall, participant characteristics were similar between groups; however, coronary heart disease prevalence and dialysis vintage were higher in the periphery. Participants from the periphery had lower serum albumin, blood urea nitrogen, hemoglobin, and blood pressure, but higher LDL cholesterol. Sodium intake was significantly higher and adherence to ISRNM sodium guidelines markedly lower in the periphery. In multivariable analysis, peripherality reduced the odds of meeting sodium recommendations by 92.8%. Adherence to energy and protein guidelines was low in both groups. Nearly half of participants had some level of elevated malnutrition risk using the categorized variable, and an overall difference in the categories of malnutrition risk was detected, driven by the increase in the moderate risk category in the periphery. The composite malnutrition risk variable (any increase in risk vs. no increase in risk) did not differ by peripherality. Peripherality was independently associated with higher percent ideal body weight (%IBW), but not with CAR. Conclusions: Peripherality among Jewish Israeli HD patients is associated with differences in nutrition biomarkers, cardiovascular burden, and dietary adherence, especially sodium intake. Interventions considering peripherality should be explored.