Nutritional management of dialysis patients: balancing among nutrient intake, dialysis dose, and nutritional status.
BACKGROUND
Recommended protein intake for dialysis patients is much higher compared with allowance for normal adults. The authors tried to make a consideration on balancing among nutrient intake, dialysis dose, and nutritional status in maintenance dialysis patients.


METHODS
In 57 patients, 13 on hemodialysis (HD) and 44 on continuous ambulatory peritoneal dialysis (CAPD), serum urea nitrogen (SUN), albumin, weekly creatinine clearance of CAPD, and body protein mass by multifrequency bioelectrical impedance analysis were measured. Energy intake was examined from the patients' food diary by a registered dietitian, and protein intake was estimated by both the patients' food diary and calculation of protein equivalent nitrogen appearance.


RESULTS
In HD patients, predialysis SUN levels significantly correlated with the amounts of protein intake (r = 0.893; P < 0.001), and there was no correlation between post- and next predialysis SUN levels. In CAPD patients, SUN levels significantly correlated with the amounts of protein intake (r = 0.645; P < 0.001), and there was no correlation between SUN levels and weekly Ccr. The amounts of protein intake were significantly correlated with body protein mass (r = 0.365; P = 0.014), and there were significantly positive relationships between the amounts of protein intake and energy intake in both HD (r = 0.798; P < 0.001) and CAPD patients (r = 0.631; P = 0.006).


CONCLUSIONS
Whereas higher intake of protein requires higher doses of dialysis, lower intake of protein with sufficient energy intake requires lower doses of dialysis, and both could give the same effects on nutritional status.
Nakao
Toshiyuki
T
Department of Nephrology, Tokyo Medical University, Tokyo, Japan. t-nakao@tokyo-med.ac.jp
Matsumoto
Hiroshi
H
Okada
Tomonari
T
Kanazawa
Yoshie
Y
Yoshino
Maki
M
Nagaoka
Yume
Y
Takeguchi
Fumihiro
F
D000328:Adult; D001071:Appointments and Schedules; D001806:Blood Urea Nitrogen; D001823:Body Composition; D003404:Creatinine / Q000097:blood / Q000378:metabolism / Q000652:urine; D015930:Diet Records; D004044:Dietary Proteins / Q000378:metabolism; D017097:Electric Impedance; D002149:Energy Intake; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D015596:Nutrition Assessment; D009751:Nutritional Requirements; D009752:Nutritional Status; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods; D011506:Proteins / Q000032:analysis; D006435:Renal Dialysis / Q000379:methods*; D012709:Serum Albumin
D004044:Dietary Proteins; D011506:Proteins; D012709:Serum Albumin; D003404:Creatinine