title: Let them eat during dialysis: an overlooked opportunity to improve outcomes in maintenance hemodialysis patients.
abstract: In individuals with chronic kidney disease, surrogates of protein-energy wasting, including a relatively low serum albumin and fat or muscle wasting, are by far the strongest death risk factor compared with any other condition. There are data to indicate that hypoalbuminemia responds to nutritional interventions, which may save lives in the long run. Monitored, in-center provision of high-protein meals and/or oral nutritional supplements during hemodialysis is a feasible, inexpensive, and patient-friendly strategy despite concerns such as postprandial hypotension, aspiration risk, infection control and hygiene, dialysis staff burden, diabetes and phosphorus control, and financial constraints. Adjunct pharmacologic therapies can be added, including appetite stimulators (megesterol, ghrelin, and mirtazapine), anabolic hormones (testosterone and growth factors), antimyostatin agents, and antioxidative and anti-inflammatory agents (pentoxiphylline and cytokine modulators), to increase efficiency of intradialytic food and oral supplementation, although adequate evidence is still lacking. If more severe hypoalbuminemia (<3.0 g/dL) not amenable to oral interventions prevails, or if a patient is not capable of enteral interventions (e.g., because of swallowing problems), then parenteral interventions such as intradialytic parenteral nutrition can be considered. Given the fact that meals and supplements during hemodialysis would require only a small fraction of the funds currently used for dialysis patients this is also an economically feasible strategy.
authors: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Medical Center, Orange, California 92868, USA. kkz@uci.edu
authors: Kamyar
authors: K
authors: Kalantar-Zadeh
authors: T Alp
authors: TA
authors: Ikizler
mesh_terms: D019587:Dietary Supplements; D006801:Humans; D034141:Hypoalbuminemia / Q000178:diet therapy* / Q000209:etiology; D062407:Meals; D009752:Nutritional Status; D018529:Nutritional Support / Q000191:economics; D011502:Protein-Energy Malnutrition / Q000178:diet therapy / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology*; D012709:Serum Albumin / Q000032:analysis
chemical_list: D012709:Serum Albumin