Eating During Hemodialysis Treatment: A Consensus Statement From the International Society of Renal Nutrition and Metabolism

Abstract

Poor nutritional status and protein-energy wasting are common among maintenance dialysis patients and associated with unfavorable outcomes. Providing foods, meal trays, snack boxes, and/or oral nutritional supplements during hemodialysis can improve nutritional status and might also reduce inflammation, enhance health-related quality of life, boost patient satisfaction, and improve survival. Potential challenges include postprandial hypotension and other hemodynamic instabilities, aspiration risk, gastrointestinal symptoms, hygiene issues, staff burden, reduced solute removal, and increased costs. Differing in-center nutrition policies exist within organizations and countries around the world. Recent studies have demonstrated clinical benefits and highlight the need to work toward clear guidelines. Meals or supplements during hemodialysis may be an effective strategy to improve nutritional status with limited reports of complications in real-world scenarios. Whereas larger multicenter randomized trials are needed, meals and supplements during hemodialysis should be considered as a part of the standard-of-care practice for patients without contraindications.

Does Kidney Longevity Mean Healthy Vegan Food and Less Meat or Is Any Low-Protein Diet Good Enough?

“…1 It is important to note that in dialysis-dependent patients without residual kidney function, higher protein-intake targets are often recommended such as 1.2-1.4 g/kg IBW per day, and these patients should also eat during hemodialysis. 5 In this issue of the Journal of Renal Nutrition, Choi et al 6 evaluated the safety of providing supplemental meals during hemodialysis to boost the protein intake. They demonstrated no adverse effects of the meals consumed during the dialysis treatment and were able to use a varied meal plan that included a vegan approach.…”

Malnutrition Risk in Hemodialysis Patients in Israel: Results of the Status of Nutrition In Hemodialysis Patients Survey Study

“…Nutrition intake and anthropometric measures improved, and PEW was reduced in a randomized clinical trial of ONS in HD patients [48]. Increasing ONS use in HD patients with malnutrition risk should be further investigated to establish their inclusion as part of evidence-based patient care, as has been proposed by the ISRNM [49].…”

Not All Protein Cookies Are Created Equal

“…5 It is not a surprise that this cohort may have poor nutritional status and protein-energy wasting. 6 Albumin is a marker of morbidity and mortality and an indicator of nutritional status in those treated with kidney replacement therapy. A recently published consensus statement by the International Society of Renal Nutrition and Metabolism speaks to the benefit of eating during dialysis.…”

“…This recommendation is based on studies that have shown nutrition support may reverse the catabolic process of dialysis itself and might over time result in improved nutritional parameters. 6 The high-protein individually packaged cookies described in this article are suited to be eaten during dialysis. Table 1 lists the nutrient content of protein added cookies available at Wegmans in Rochester NY.…”