Haemodialysis patients with diabetes eat less than those without: A plea for a permissive diet.
OBJECTIVE
The main cause of malnutrition in haemodialysis patients is a spontaneous decline in energy and protein intakes. This study aims to report the dietary energy intake (DEI), dietary protein intake (DPI), and dietary micronutrient intake in a French HD population, to report factors associated with a low DPI and DEI, and to analyze if nutritional intake was correlated with nutritional status.


METHODS
We conducted an observational cross-sectional study in a haemodialysis population of 87 adult patients in July 2014. Daily nutritional oral intake, handgrip strength, body composition measured by bioimpedancemetry, and biological and dialysis parameters were obtained from medical records. Statistical analyses of parameters associated with DEI and DPI were performed.


RESULTS
The median age (interquartile range) of the population was 77.3 [71.1; 84.8] years, 57.5% were men, and 52.9% had diabetes mellitus. Median weight-adjusted DEI was 18.4 [15.7;22.3] kcal/kg per day (1308 [1078; 1569] kcal/day), and median weight-adjusted DPI was 0.80 [0.66; 0.96] g/kg per day (57.5 [47.1; 66.8] g/day). In multivariate analysis, weight-adjusted DEI was statistically lower in patients with diabetes (coefficient [95%CI] -3.81[-5.21;-2.41] kcal/kg per day; P = 0.01) but was not associated with the others parameters. When DEI was not adjusted for weight, diabetes was no longer associated with DEI, but female gender (-178[-259;-961] kcal/day; P = 0.03) and a higher Charlson comorbidity index (-30[-44;-15]; P = 0.04) were associated with a lower calorie intake. Results for DPI were similar except that the Charlson comorbidity index did not reach significance.


CONCLUSIONS
Diabetes is an important factor associated with low dietary intake in haemodialysis patients. Restrictive regimens should be prescribed cautiously in haemodialysis patients, especially in those with diabetes.
Phocean Nephrology Institute, Clinique Bouchard, Marseille, France.|Nephrology unit, Clinique Bouchard, Marseille, France.|Nephrology Dialysis Renal Transplantation Center, APHM, CHU Conception, Marseille, France.
Stanislas
S
Bataille
French National Institute for Agricultural Research, Research Unit 1260, Marseille, France.|Inserm, Research Unit 1062, Nutrition, Obesity and Thrombotic risks, Marseille, France.|Medical Faculty, Aix-Marseille University, Marseille, France.
Jean-François
JF
Landrier
French National Institute for Agricultural Research, Research Unit 1260, Marseille, France.|Inserm, Research Unit 1062, Nutrition, Obesity and Thrombotic risks, Marseille, France.|Medical Faculty, Aix-Marseille University, Marseille, France.
Julien
J
Astier
Cerba laboratory, Saint-Ouen l'Aumône, France.
Sylvie
S
Cado
Cerba Healthcare, Saint-Ouen l'Aumône, France.
Jérôme
J
Sallette
Phocean Nephrology Institute, Clinique Bouchard, Marseille, France.|Nephrology unit, Clinique Bouchard, Marseille, France.
Philippe
P
Giaime
Phocean Nephrology Institute, Clinique Bouchard, Marseille, France.|Nephrology unit, Clinique Bouchard, Marseille, France.
Jérôme
J
Sampol
Phocean Nephrology Institute, Clinique Bouchard, Marseille, France.|Nephrology unit, Clinique Bouchard, Marseille, France.
Hélène
H
Sichez
Phocean Nephrology Institute, Clinique Bouchard, Marseille, France.|Nephrology unit, Clinique Bouchard, Marseille, France.
Jacques
J
Ollier
Phocean Nephrology Institute, Clinique Bouchard, Marseille, France.|Nephrology unit, Clinique Bouchard, Marseille, France.
Jean
J
Gugliotta
Phocean Nephrology Institute, Clinique Bouchard, Marseille, France.|Nephrology unit, Clinique Bouchard, Marseille, France.
Marianne
M
Serveaux
Medistats, Marseille, France.
Julien
J
Cohen
French National Institute for Agricultural Research, Research Unit 1260, Marseille, France.|Inserm, Research Unit 1062, Nutrition, Obesity and Thrombotic risks, Marseille, France.|Medical Faculty, Aix-Marseille University, Marseille, France.
Patrice
P
Darmon
D000368:Aged; D000369:Aged, 80 and over; D001823:Body Composition; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D004044:Dietary Proteins / Q000008:administration & dosage*; D002149:Energy Intake; D005260:Female; D005602:France; D015577:Geriatric Assessment; D018737:Hand Strength; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D015596:Nutrition Assessment; D009752:Nutritional Status; D011502:Protein-Energy Malnutrition / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D064167:Recommended Dietary Allowances; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D016896:Treatment Outcome
D004044:Dietary Proteins
diabetes; dietary intake; haemodialysis; nutritional intake; protein energy wasting syndrome