Short daily hemodialysis and nutritional status in patients with chronic renal failure

Abstract

Malnutrition is a frequent complication in hemodialysis patients and is associated with increased mortality and morbidity. Interventions such as oral or intravenous nutritional supplements have often failed to improve nutritional status. We report here the effect that daily dialysis, practiced in our center since 1997, has had on nutritional parameters. Seventeen patients treated with conventional hemodialysis (4-5 hours, three times per week, for 9.6 +/- 8.4 years) were converted to short daily hemodialysis (2-2.5 hours, six times per week, for a mean of 39.1 +/- 23.5 months). Dietary, anthropometric, and biochemical evaluations were performed during conventional hemodialysis, after 1 year on short daily hemodialysis (sDHD(year)), and at the end of follow-up (sDHD(end)). Daily protein intake increased from 1.21 +/- 0.27 g/kg/day with conventional hemodialysis to 1.51 +/- 0.47 g/kg/day at sDHD(year) and 1.51 +/- 0.37 g/kg/day at sDHD(end). Energy intake increased from 33.6 +/- 9.5 kcal/kg/day to 38.3 +/- 10.9 kcal/kg/day at sDHD(year) and 39.4 +/- 9.4 kcal/kg/day at sDHD(end). The normalized protein equivalent nitrogen appearance (nPNA) increased from 1.19 +/- 0.34 g/kg/day with conventional hemodialysis to 1.34 +/- 0.43 g/kg/day sDHD(year) and 1.37 +/- 0.37 g/kg/day sDHD(end). Biochemical indicators also increased: serum albumin increased from 40.2 +/- 3.3 g/L to 44.5 +/- 4.6 g/L and 45.1 +/- 4.1 g/L, and prealbumin increased from 0.32 +/- 0.06 g/L to 0.38 +/- 0.09 g/L and 0.36 +/- 0.09 g/L, respectively. These improvements were accompanied by an increase in body weight from 62.0 +/- 10.6 kg on conventional hemodialysis to 64.3 +/- 10.2 kg at sDHD(year) and 65.5 +/- 9.7 kg at sDHD(end). All the changes between conventional hemodialysis and short daily hemodialysis were statistically significant. Increased frequency is more important than increased dialysis dose. Short daily hemodialysis appears to be a suitable method to improve nutritional status in dialysis patients.