Use of in-between-meals decrease protein and energy deficit in hemodialysis patients

Reduced protein intake and protein breakdown during dialysis treatment causes protein energy wasting (PEW), which can contribute to a higher morbidity and mortality. This intervention aims to provide the optimal protein and energy intake during dialysis days.

An intervention study was conducted among adult hemodialysis patients. During six weeks, patients received protein and energy rich in between meals in addition to the normal meals, during their dialysis treatment. Patients also received information about the importance of sufficient protein. The energy and protein requirement and nutritional status was determined at the start of the intervention. Nutritional status was measured with the Subjective Global Assessment (SGA). At the start and after six weeks body weight, handgrip strength, appetite and serum phosphate was measured and food intake was estimated by a food history.

28 patients were included, five withdrew during the study. Data of the remaining 11 men and 12 women were analyzed. Age was 55.4±12.7 years (mean ± SD), BMI was 24.5±4.4. Before the intervention the dialysis patients were used to eat on dialysis days on average 1.0±0.5 grams of protein/kg body weight (82±37% of  protein requirement, p = 0.01) and 25±10 kcal/kg body weight (85±26% of the estimated energy requirement, p = 0.01). 35% of the patients reached their protein requirements and 44% their energy requirements.
After the intervention was the average protein intake of the entire group 1.2±0.5 g/kg body weight (p=0.002) and the energy intake 29±10 kcal/kg body weight (p = 0.05). 61% of the patients reached their protein requirements and 57% their energy requirements. Body weight, appetite, handgrip strength and serum phosphate remained unchanged.

Two out of tree dialysis patients consume insufficient amounts of protein and energy on days of dialysis. In-between-meals with additional energy and protein during these days, in combination with information about sufficient protein and energy intake, can improve protein and energy intake in hemodialysis patients.