Eating during the Hemodialysis Session: A Practice Improving Nutritional Status or a Risk Factor for Intradialytic Hypotension and Reduced Dialysis Adequacy?

Abstract

Historically, eating during the hemodialysis treatment has been associated with increased risk for adverse intradialytic symptoms and events, risks that have resulted in the implementation of restrictive in-center nutrition policies. Recent studies, however, have recorded a shift in clinical practice with a higher proportion of physicians following the view that administration of intradialytic meals and supplements represents a simple and effective approach to enhance caloric intake and improve nutritional status among patients on hemodialysis. This shift towards less restrictive in-center nutrition practices is mainly supported by evidence from observational studies associating intradialytic nutritional supplementation with improvements in protein-energy wasting, inflammatory state, and health-related quality of life. In sharp contrast, earlier and recent interventional studies have documented that feeding during the hemodialysis treatment provokes a rapid postprandial decline in blood pressure and raises the incidence of symptomatic intradialytic hypotension. Furthermore, other studies have shown that postprandial redistribution in intravascular volume and enhanced blood supply to the gastrointestinal circulation may interfere with the adequacy of the delivered hemodialysis. Those who defend the position that intradialytic nutritional support is beneficial do not dispute the physiology of postprandial hemodynamic response, but they argue against its clinical significance. In this article, we provide an overview of studies that explored the effect of eating during the hemodialysis treatment on intradialytic hemodynamic stability and adequacy of the delivered hemodialysis. We reason that these risks have important clinical implications that are not counteracted by anticipated benefits of this strategy on caloric intake and nutritional status.

How to Overcome Anabolic Resistance in Dialysis-Treated Patients?

“…In many dialysis centers HD patients are fasting throughout the entire dialysis session, for fear of hypotension or vomiting ( 144 ). In addition, patients are often suggested not eating before the session, so it is very common that those on an afternoon HD session miss their noon meal (or they miss their breakfast if they have a planned morning HD session).…”

Significance of Levocarnitine Treatment in Dialysis Patients

“…Approximately 75% of end-stage kidney disease patients commencing hemodialysis treatment experience left ventricular dysfunction, represented by reduced LVEF, which is a significant risk factor for congestive heart failure [ 97 ]. Furthermore, intradialytic hypotension has been linked to mortality and is an independent predictor of mortality in this population [ 97 , 98 , 99 ].…”

İntradiyalitik Besin Alımı ve İntradiyalitik Hipotansiyon

“…Yayınlanmış veriler, intradiyalitik besin tüketiminin genel olarak yararlı olup olmadığı konusunda belirsizlik yaratmaktadır. Hastaların HD sırasında besin tüketimine izin verilmesi durumunun tartışmalı olması nedeniyle HD merkezlerinde intradiyalitik beslenme konusunda farklı uygulamalar mevcuttur (18,19).…”

“…İntradiyalitik beslenmenin arteriyel kan basıncında düşüşe ve hemodinamik bozukluklara neden olduğu bildirilmiştir. Bu sebeplerle HD hastalarının diyaliz esnasında besin tüketmeleri önerilmezken, (4, 8-17) HD tedavisin katabolik doğası nedeniyle oluşan protein enerji malnütrisyonunu düzeltmek, hipoalbuminemiyi düzeltmek, yaşam kalitesini artırmak, ek besin sağlamak gibi sebeplerle de hastaların intradiyalitik besin tüketimi önerilmektedir (18,19).…”