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Rethinking the Restriction on Nutrition During Hemodialysis

            Patients on hemodialysis have a 20% higher rate of mortality in the United States compared to other industrialized countries.  This difference could be attributed to being allowed to eat during treatment, this is known as intradialytic feeding.  Intradialytic feeding is not generally allowed during treatment in the U.S. because it is thought that eating during dialysis will make the treatment less effective, cause a greater fluctuation in blood pressure and gastrointestinal issues.   More recent studies have shown that these side effects are rare and the patients are at a greater risk of poor protein status and inflammation caused by hemodialysis.  Research has shown that up to 75% of patients on hemodialysis suffer from protein energy wasting, which lowers their quality of life and increases their mortality risk.  The Kidney Disease Outcomes Quality Initiative recommends increased calorie and protein needs (35 kcal/kg; 1.2 g Protein/kg) for HD patients.  Many patients find this incredibly difficult to follow due to poor appetite, dietary restrictions and timing of treatment. Consuming high proteins supplements or eating food during HD treatment could help combat these issues.  Recent studies have shown that patients allowed to consume supplements or food during HD treatments have an improved protein balance after a single treatment.  They also have improved subjective global assessments and albumin/prealbumins.  Some dialysis clinics have begun to give patients protein supplements during treatment, however the practice is not widespread.

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Kistler, B., Fitchsen, P., Ikizler, A., & Wilund, K. (2015). Rethinking the Restriction on Nutrition During Hemodialysis Treatment. Journal of Renal Nutrition, 25(2), 81-87. Retrieved from: http://www.jrnjournal.org/article/S1051-2276(14)00160-5/pdf.

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