title: Nutrition in hemodialysis patients previously on a supplemented very low protein diet.
abstract: BACKGROUND
  Nutritional safety of protein-restricted diets in patients with chronic renal failure is controversial. In the present study, we have assessed the evolution of nutritional status after initiation of hemodialysis in patients previously treated by a supplemented very low protein diet (SVLPD).
  
  
  METHODS
  Nutritional data were prospectively collected during the first year of hemodialysis from 15 consecutive patients treated with a SVLPD (0.3 g protein/kg/day supplemented with essential amino acids, calcium, iron, and vitamins) and compared to 15 age- and gender-matched end-stage renal disease (ESRD) patients previously on a less-restricted diet (0.90 +/- 0.21 g protein/kg/day) who started hemodialysis during the same period. Dual-energy x-ray absorptiometry (DEXA) was used to assess body composition at 0, 6, and 12 months. Hemodialysis prescriptions, biologic data and 3-day food records were collected every 3 months.
  
  
  RESULTS
  Protein intake was higher than 1.2 g/kg/day in both groups as soon as 3 months after the start of hemodialysis. Albumin and prealbumin increased significantly during the first 6 months in all patients. Body mass index (BMI) increased in all patients (+0.97 +/- 1.31 kg/m2; P < 0.001) reflecting a gain in fat mass in the overall population (+2.36 +/- 2.94 kg/m2; P < 0.001) while lean body mass remained stable overall.
  
  
  CONCLUSIONS
  Once on hemodialysis, SVLPD patients rapidly increased protein intake. Nutritional status improved in all patients, with a gain in fat mass in all, and a gain in lean body mass in SVLPD men only. These data indicate that treatment with a SVLPD prior to hemodialysis initiation is nutritionally safe.
authors.affiliation: Service de Néphrologie, Hôpital Pellegrin, Bordeaux, France. benoit.vendrely@chu-bordeaux.fr
authors.forename: Benoît
authors.initials: B
authors.lastname: Vendrely
authors.forename: Philippe
authors.initials: P
authors.lastname: Chauveau
authors.forename: Nicole
authors.initials: N
authors.lastname: Barthe
authors.forename: Wael
authors.initials: W
authors.lastname: El Haggan
authors.forename: Françoise
authors.initials: F
authors.lastname: Castaing
authors.forename: Valérie
authors.initials: V
authors.lastname: de Précigout
authors.forename: Christian
authors.initials: C
authors.lastname: Combe
authors.forename: Michel
authors.initials: M
authors.lastname: Aparicio
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D018753:Diet, Protein-Restricted; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000178:diet therapy*; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000517:prevention & control; D006435:Renal Dialysis