NITROGEN-BALANCE IN HOSPITALIZED CHRONIC-HEMODIALYSIS PATIENTS

Malnutrition is an important factor in the increased morbidity and mor tality of chronic hemodialysis (CHD) patients. Dietary protein intake necessary to maintain neutral nitrogen balance appears to be higher in CHD patients due to various catabolic effects of the hemodialysis pro cedure, including nutrient losses and increased energy expenditure. Di etary intake may be further decreased in hospitalized CHD patients. We examined this issue in 18 CHD patients (9 male, 9 female) who were ad mitted to a regular ward. Daily protein intake (DPI) and daily caloric intake were measured for each patient. In addition, protein catabolic rate (PCR) calculated from interdialytic changes in BUN were calculat ed. Our results showed that mean (+/- SD) DPI was 0.79 +/- 0.41 g/kg/d ay, while PCR was 0.93 +/- 0.38 g/kg/day. Dietary protein and energy i ntake were 66% and 50% of suggested values, respectively, and DPI acco unted for only 85% of PCR. Mean nitrogen balance was negative by -2.11 +/- 2.77 g of nitrogen/day (range -9.91 g of nitrogen/day to +3.89 g of nitrogen/day). Biochemical nutritional parameters such as serum alb umin, cholesterol, prealbumin and transferrin obtained one week follow ing admission were also indicative of undernutrition (3.16 +/- 0.39 g/ dl, 132 +/- 30 mg/dl, 20 +/- 7.4 mg/dl, 154 +/- 49 mg/dl, respectively ). We conclude that hospitalized CHD patients have inadequate protein and energy intake and this is evidenced by a significant deterioration in nutritional parameters during hospitalization. More aggressive nut ritional interventions may be needed for this group of patients to pre vent the adverse effects of hospitalization on nutritional status.