Effect of an intradialytic protein-rich meal intake in nutritional and body composition parameters on hemodialysis patients

Abstract

Background and aims: Protein intake is a key point to maintain an adequate nutritional status in hemodialysis (HD) patients. There are some studies that confirm the positive influence of intradialytic oral nutritional supplementation in several nutritional parameters in HD patients. The aim of this study was to evaluate the effect of an intradialytic protein rich meal in nutritional and body composition parameters on HD patients.

Methods: This was a 6-months single center non-randomized study with 99 patients in HD from one Nephrocare dialysis unit in Portugal. Patients in the intervention group (IG) presented one albumin value ≤ 3.8 g/dL in the two measurements prior to the beginning of the study. The IG ate a protein rich meal during each treatment. The control group (CG) continued to eat their usual snack brought from home. Albumin, nPCR, potassium, phosphorus, C-reactive protein (CRP), dry weight and body composition were measured at baseline and at the end of the study.

Results: Patient's mean age was 69.9 ± 12.9 years and HD vintage, 60.0 ± 50.5 months. Both groups were similar at the start of the study, except in albumin (p = 0.019). After the intervention, protein intake increased in the IG (p = 0.001). Albumin decreased in both groups but this difference was higher and only statistically significant in the CG (p = 0.039). Regarding body composition, in the CG, the fat tissue index (FTI) (p = 0.022) and the lean tissue index (LTI) (p = 0.003) diminished after the 6 months of the follow-up. However, in the IG the LTI value also reduced (p = 0.008) but FTI increased (p = <0.001) at the end of the study. There were no statistically significant differences on dry weight, potassium, phosphorus, and CRP.

Conclusion: Apart from the effect on protein intake, the importance of this study relies on the positive changes in regard to patient's body composition obtained after 6 months of an intradialytic intake of a protein rich meal during the HD treatment. This type of intervention can contribute to ameliorate patient's nutritional status without a negative effect on other parameters.

Keywords: Body composition; Hemodialysis; Intradialytic meal; Nutritional status; Protein intake.