Nephrol Dial Transplant (2003) 18: 1874-1881
© 2003 European Renal Association-European Dialysis and Transplant Association
Daily nutrient intake represents a modifiable determinant of nutritional status in chronic haemodialysis patients
1 Nephrology and Dialysis, Country Hospital in Polla (SA), 2 Ariano Irpino (AV) and 3 Solofra (AV) and 4 Second University of Naples, Italy
Correspondence and offprint requests to: Vincenzo Bellizzi, MD, PhD, Nephrology and Dialysis Unit, Polla Hospital, Via P. Capone, 7, I-84122 Salerno, Italy. Email: vincenzo.bellizzi{at}tin.it
Background. In maintenance haemodialysis patients, daily food intake is changeable; however, its relationship with nutritional status is unexplored. This study aimed to evaluate the isolated, long-term effect of daily nutrient intake on nutritional status in haemodialysis patients.
Methods. We performed a prospective 1-year controlled study in 27 chronic haemodialysis patients, without recognized risk factors for malnutrition. Each day for 1 week, four times in the year, we measured protein nitrogen appearance, and assessed dietary protein (DPI) and energy (DEI) intake from dietary diaries. We compared the nutritional outcome of patients spontaneously reducing nutrient intake below the threshold of 0.8 g/kg body weight/day for DPI and 25 kcal/kg body weight/day for DEI during the week (LOW, n = 8), with controls at adequate nutrient intake (CON, n = 19). An interventional 6-month study was then carried out in LOW to verify the cause–effect relationship.
Results. All patients showed a day-by-day reduction of whole nutrient intake during interdialytic period, which was mostly relevant in the third interdialytic day (L3). During the 1-year study, even in the presence of adequate dialysis dose and normal inflammatory indexes, body weight (68.0 ± 5.5 to 65.8 ± 5.9 kg), serum albumin (3.96 ± 0.07 to 3.66 ± 0.06 g/dl) and creatinine (9.2 ± 1.1 to 8.1 ± 0.7 mg/dl) significantly decreased in LOW but not in CON. Diaries evidenced in LOW a reduced number of meals at L3 that was explained by the fear of excessive interdialytic weight gain. During the interventional study, daily DPI and DEI increased at L3; this was associated with a significant increment of body weight, and serum albumin and creatinine levels.
Conclusions. In maintenance haemodialysis patients the persistent, marked reduction of daily nutrient intake, even if limited to a single day of the week, is an independent determinant of reversible impairment of nutritional status.
Keywords: daily nutrient intake; energy intake haemodialysis; nutrition; nutritional status; protein intake; protein nitrogen appearance