Assessing Diet Quality in Hemodialysis with Brief Screeners: Multicenter Findings on Dietary Diversity and Ultraprocessed Foods

Purpose Rapid and low-burden tools to assess diet quality are needed in clinical settings characterized by high nutritional risk and limited consultation time, such as hemodialysis (HD) care. We aimed to assess dietary diversity and ultra-processed food (UPF) intake using validated brief dietary screeners in patients undergoing HD, identify their determinants, and compare dietary patterns between dialysis and non-dialysis days. Methods In this multicenter cross-sectional study, patients on HD from seven dialysis units answered two validated dietary screeners assessing diversity of unprocessed and minimally processed foods and UPF intake. Screeners were applied on one dialysis day and one non-dialysis day. Scores ranged from 0 to 13, and median values were used to classify participants into higher versus lower dietary diversity and UPF intake. Multivariable logistic regression models were used to identify independent determinants. Results Among 297 participants (mean age 52.1 ± 14.1 years; 57.9% men), the median dietary diversity score was 6 (4.5–7). Higher dietary diversity was independently associated with older age, shorter dialysis vintage, and absence of obesity. The median UPF score was 2.5 (2–4), with higher UPF intake associated with younger age, male sex, and obesity. Dietary diversity did not differ between dialysis and non-dialysis days, whereas UPF intake was significantly higher on dialysis days. Conclusion Patients undergoing HD exhibited low dietary diversity and higher UPF intake on dialysis days. Brief dietary screeners were able to detect clinically relevant dietary patterns and determinants, supporting their use for routine nutritional monitoring and targeted counseling in HD care.