Nutritional intake on dialysis and non-dialysis days and the effect of intradialytic food provision among hemodialysis patients, a single-center study.

Abstract

Background/objectives: Patients receiving hemodialysis (HD) are at risk of malnutrition due to the considerable time required to attend dialysis, which may reduce food intake on dialysis days (DDs). We assessed dietary intake on one DD and two non-dialysis days (NDDs) and the impact of intradialytic food consumption on nutritional status.

Subjects/methods: We conducted a cross-sectional study of 60 HD outpatients using the Global Leadership Initiative on Malnutrition criteria, dietary records, and bioimpedance analysis to assess nutritional intake and status.

Results: Their mean age was 62 ± 14 years; 65% were male, 27% had sarcopenia, 67% were frail, and one-third were classified with malnutrition. Three-day averaged dietary records showed that only 8% met the Kidney Disease Outcomes Quality Initiative energy and protein recommendations; both were lower on the DD compared with NDDs: 14.8 (10.7-22.3) vs 16.3 (13.3-22.9) kcal/kg/day (p = 0.018) and 0.72 ± 0.35 vs 0.87 ± 0.38 g/kg/day (p = 0.001), respectively. Forty-three percent brought food on the DD, and their energy and protein intakes did not differ between the DD and NDDs. In contrast, those who did not bring food had lower energy (p < 0.001) and protein intakes (p < 0.001) on the DD. Patients who brought food did not experience any greater peri-dialytic hypotension (n = 10, 38% vs n = 14, 41%), despite lower extracellular water-to-total body water ratios (p = 0.007).

Conclusion: Nutritional intake remains suboptimal in many hemodialysis patients, particularly on DDs. These findings suggest that providing or bringing food during dialysis may help improve or maintain nutritional intake. However, longitudinal studies are required to confirm these findings.