High protein/energy vs. standard protein/energy nutritional regimen in thetreatment of malnourished hemodialysis patients

Although malnutrition is frequently encountered in maintenance hemodialysis (MHD) patients, a clear method of treating this complication is still lack ing. Failure of nutritional support regimens may be due to inadequate suppo rt of dietary needs. Therefore, a high vs. standard or low protein/energy d ietary regimen was studied in malnourished MHD patients. A total of 18 maln ourished MHD patients selected according to subjective global assessment (S GA)-scores and biochemical indicators of malnutrition (serum albumin < 40 g /l, cholesterol < 200 mg/dl, prealbumin <30 mg/dl; two out of three) were a ssigned to three treatment groups: (A: 45 kcal/kg/d and 1.5 g protein/kg/d; B: 35 kcal/kg/d and 1.2 g protein/kg/d; C: spontaneous intake supplemented with 10% of mean protein and energy intake). A and B received food supplem ents at appropriate dosing to reach the targeted nutritional intake. During 3-month follow-up nutrient intake was assessed by repeated 4-day dietary d iaries. Compliance and tolerance was good in each group. Weight gain (1.2+/ -0.4 kg) was observed in group A, but not in B and C. Serum albumin levels increased by 1.0+/-0.5 g/l in group A, but not in B and C. Prealbumin and c holesterol levels were unaffected. Weight change correlated with mean dieta ry energy intake, but not with mean dietary protein intake. We conclude tha t prescription of 45 kcal/kg/d and 1.5 g protein/kg/d may be necessary to a chieve weight gain and improvement of nutritional indices in malnourished M HD pts. Oral food supplements can be used safely and effectively to increas e nutrient intake to high levels in these patients. Copyright (C) 2000 S. K arger AG, Basel.