Dietary protein and nutritional supplements in conventional hemodialysis

Abstract

Protein energy wasting (PEW) is a condition commonly occurring among patients with ESRD on hemodialysis. PEW is characterized by depletion of protein and energy stores and is caused by multiple factors related to chronic kidney disease, acute and chronic comorbidities and by renal replacement therapy itself. Anorexia is central in the pathogenesis of PEW; it is frequently observed in these patients whose protein and energy intakes are typically lower than guidelines recommendations. If untreated, PEW invariably leads to major complications, and may activate a vicious circle with further worsening of nutritional status. Dietary counseling and nutritional status monitoring play a key role in the prevention and treatment of PEW, since they allow an early identification of high risk patients, as well as the assessment of the response to nutritional intervention. Different nutritional approaches can be implemented following thorough nutritional counseling. These are chosen on the basis of patients' spontaneous dietary intake, severity of PEW and acute comorbidities. Initially, regular encounters with the dietitian allow patients to clarify doubts and strengthen basic concepts on nutrition to improve dietary intake and prevent PEW. When PEW is present or the patient is at high risk, the clinician may opt for the administration of oral intradialytic or daily supplements, aiming at increasing energy and protein intake, while in selected cases intradialytic parenteral nutrition may be used. This review addresses the main issues of nutritional status in ESRD patients on hemodialysis-its evaluation and monitoring, as well as at describing the available nutritional interventions.

Survey on the Perception of Health Professionals on the Use of Intradialytic Oral Nutrition in Patients under Hemodialysis

“…ION is an anabolic strategy to improve PEW in patients with kidney disease and has shown important benefits such as decreasing catabolism, and therefore, improving patient's nutritional status, and survival rates [13][14][15][16] . These effects are explained by adding an average of 10 kcals/kg and 0.3-0.4 g/kg of protein to the patient's diet 4,24 . However, despite this evidence and that ION is a common practice in European and Eastern Asian countries, it is not frequently used in North America 25 , including Mexico due to some disadvantages perceived by HCP such as changes in blood pressure during the digestion process, the risk of bronchial aspiration or infections, and the work overload of the responsible personnel 17 .…”

“…The diagnosis of PEW has been strongly associated with an increased risk of morbidity and mortality in patients on hemodialysis (HD) treatment 2,3 . It is well known that PEW starts from early stages of CKD and one of its main components is a low energy and protein intake of patients 4,5 . The components of PEW have a direct effect on caloric and protein intake.…”

Introduction to treatment considerations in conventional hemodialysis ‐ What we know

“…The current state of knowledge on the ideal dialysate bicarbonate concentration is then discussed by Basile et al, emphasizing the need to focus on the clinical and nutritional status of the major outliers on both the acid and alkaline sides of the curve . Sabatino et al address the main issues of nutritional status in hemodialysis patients and summarize its evaluation and monitoring, as well as the available nutritional interventions to prevent protein energy wasting and its associated poor outcomes …”

Ice Cream Substitute For Patients With End Stage Renal Disease

“…Research may be more difficult to collect for ESRD disease patients and nutrition focused studies. This is due to multiple potential barriers from both the researcher and patient side, such as patients with ESRD are higher risk for comorbidities which could become difficult controlling for when collecting results, also ESRD care is already a heavy burden and can be high stress on the patient, further care or extra steps for a study may be too much to add to an already heavy medical care (Decker liberalizations would be taught through thorough nutrition counseling and education, the current national recommendations support the more stringent renal diet (Sabatino et al, 2018). Though counseling and intervention through behavioral change is beneficial as one begins to follow a renal diet, the complexity of the diet requires the ability to sustain change, which can be difficult for ESRD patients (Campbell, Palmer, & Johnson, 2017).…”

“…Studies designate that supplemental nutrition support is highly combatant against protein energy wasting and weight loss, both of which are predictors of mortality (Kalantar-Zadeh et al, 2011b). Oral supplementation, especially when intake of supplementation began before diagnosis of malnutrition, combats the catabolic state of dialysis (Sabatino et al, 2018). Sezer, Bal, Tutal, Uyar, and Acar (2014) observed that renal specific oral supplementation, meaning the products were lower in potassium and phosphorus than nonrenal specific oral supplements, did significantly improve malnutrition and inflammation which was noted with nutrition parameters such as anthropometrics like body mass index, fat-free mass, and muscle mass, serum albumin and transferrin.…”