Pilot Study of the Effects of High-Protein Meals During Hemodialysis on Intradialytic Hypotension in Patients Undergoing Maintenance Hemodialysis

Abstract

Objective: Patients undergoing hemodialysis (HD) have high protein and energy requirements, and protein-energy wasting is common and associated with poor outcomes. Eating during dialysis may improve nutritional status by counteracting the catabolic effects of HD treatment; but eating during HD may be discouraged because of concerns of postprandial hypotension. However, little data are available to support this practice. In this study, we hypothesized that high-protein meals during HD do not lead to symptomatic intradialytic hypotension events.

Design: A 9-week, nonrandomized, parallel-arm study.

Setting: A single in-center HD clinic.

Subjects: Eighteen patients undergoing HD from 2 shifts completed the study. Patients were aged 62 ± 16 years with dialysis vintage of 3.4 ± 2.6 years.

Intervention: Patients in the intervention group (n = 9) undergoing HD received meals of ∼30 g protein and ∼1/3 daily recommended intakes of sodium, potassium, phosphorus, and fluid during dialysis for 25 consecutive HD sessions. The control group (n = 9) completed all aspects of the study including a visit by study personnel but were not given meals. The 25 consecutive sessions before the start of the intervention/control phase were used as a baseline comparison for each patient.

Main outcome measure: Symptomatic hypotension event frequency.

Results: In the intervention arm, there were 19 symptomatic hypotension events in 5 patients prestudy and 18 events in 6 patients during the study. In the control arm, there were 16 events in 7 patients prestudy and 13 events in 7 patients during the study. Change in the frequency of symptomatic hypotension events from prestudy to during study was not different between groups (P = .71). There was no effect of meals on nutritional status, but patients reported positive attitudes toward receiving meals during dialysis.

Conclusion: High-protein meals during HD did not increase symptomatic hypotension events. Larger, longer term studies are needed to confirm these results and evaluate whether high-protein meals on dialysis benefit nutritional status and clinical outcomes.

Figure 1. Blood pressure over treatment time

Changes in mean arterial blood pressure during standard hemodialysis (open circles) and standard hemodialysis in which patients consumed high protein meals (closed circles). No significant interactions between groups (p>0.05). However, main effect of time and group (p<0.05). Abbreviations: mm, millimeters, Hg, mercury.

Figure 2. Patient Attitudes on Nutrition and Meals during Dialysis at the End of the 9-Week Study

Error bars represent SEM. P-values are for differences between groups. Q1 = “how easy do you feel it is for you to eat nutritiously or follow a renal diet?”; Q2 = “how interested would you be in receiving nutritious meals during dialysis?”; Q3 = “how interested would you be in a meal delivery service (to your home); “How important is price/taste/convenience/nutrition.