Effect of energy intake on nutritional status in maintenance hemodialysis patients

Abstract

Although maintenance hemodialysis (MHD) patients are often wasted, little is known about their dietary energy needs. We studied four men and two women in a clinical research center while they received diets providing 45, 35 and 25 kcal/kg desirable body weight/day; diets were fed, in random order, for 21 to 23 days each. Protein intake, 1.13 +/- 0.02 (SEM) g protein/kg/day, was similar with all three diets. Body weight rose with 45 and 35 kcal/kg/day (P less than 0.05) and fell with 25 kcal/kg/day (P less than 0.05). Nitrogen balance, adjusted for estimated unmeasured losses, was neutral with 45 and 35 kcal/kg/day and negative with 25 kcal/kg/day. Balance was neutral or positive in 6 of 6, 4 of 6, and 0 of 6 patients fed 45, 35, 25 kcal/kg/day, respectively. Nitrogen balance, many plasma amino acids and changes in body weight, mid-arm circumference, mid-arm muscle area and body fat each correlated with energy intake. Resting energy expenditure was normal. The energy intake estimated from regression equations to maintain neutral nitrogen balance was 38.5 kcal/kg desirable weight/day; for body fat and weight, it was 32 kcal/kg/day. These data suggest that MHD patients have normal energy expenditure and approximately normal requirements for maintenance of protein balance, body weight and body fat. An average energy intake of about 38 kcal/kg desirable weight/day may be necessary to maintain nitrogen balance in these patients.

Nutritional status of hemodialysis patients with secondary hyperparathyroidism

“…The energy intake of our patients, of 23 to 25 kcal kg -1 day -1 , was far below the recommended amount for patients on hemodialysis (29), as systematically observed in many studies (1,6,7). Anorexia of chronic renal failure may be implicated in this low energy intake and may be related to the malnutrition of these patients (30).…”

Impacto do hábito de jantar sobre o perfil dietético de pacientes em hemodiálise

“…15 Protein intake values below the recommended ones are in accordance with the findings of several other studies, 20,24,[26][27][28][29] suggesting a negative nitrogen balance, which jeopardizes the nutritional status of HD patients. Slomowitz et al 30 have reported that some patients cannot maintain protein balance and lack of uremic toxicity with an energy intake of 25 to 35 kcal/kg/day and protein intake of 1.1 g/kg/day, requiring a slightly greater protein intake of 1.2 g/kg/day.…”

Albumina sérica como marcador nutricional de pacientes em hemodiálise

“…Entretanto, tem sido sugerido que em pacientes em hemodiálise a retenção de nitrogênio é dependente da ingestão energética. Uma ingestão energética insuficiente leva a um balanço nitrogenado negativo, ainda que na vigência de uma oferta protéica adequada, enquanto que uma oferta elevada de energia aumenta a utilização protéica, proporcionando um balanço nitrogenado neutro a positivo 32 .…”