Safety and efficacy of very low calorie diet (VLCD) in patients receiving haemodialysis therapy

Very low calorie diets (VLCDs) are an obesity treatment option in the general population, but their efficacy and safety in patients on haemodialysis (HD) is unknown. Prospective single arm study of VLCD in haemodialysis patients. All participants received 2.5–3.3 MJ/day for 12 weeks. Weekly assessment of VLCD, pre and post dialysis weight, interdialytic weight gain, and blood electrolytes occurred for the first 4 weeks, then fortnightly for another 8 weeks. Linear mixed models compared the change in weight over time as well as biochemical outcomes including potassium. 22 participants (9 home HD (HHD) and 13 satellite HD (SHD)) enrolled with 19 completing the 12 week intervention. Mean post-dialysis weight declined from 121.1 kg at baseline to 109.9 at week 12 resulting in average decline of 0.88 kg per week (95% C.I. 0.71, 1.05, p < 0.001) with 12 week mean percentage weight loss9.3% (SD 3.5). Mean post-dialysis BMI declined from 40.9 kg/m2 at baseline to 37.1 kg/m2 at week 12 (95% C.I. 0.25, 0.35, p < 0.001). Serum potassium rose from week 1 to 3, stabilised week 4 to 6 and fell from week 8, returning near baseline by week 12. Six of the nine (66.6%) HHD participants and seven of the thirteen (70%) SHD participants had at least one episode of hyperkalaemia (K > 6 mmol/L). There were no clinical changes in serum sodium, corrected calcium, phosphate levels during the study. VLCD with dietitian supervision was effective in producing significant weight reduction, with an acceptable safety profile in patients treated with haemodialysis.