Pilot Study of the Effects of High-Protein Meals During Hemodialysis on Intradialytic Hypotension in Patients Undergoing Maintenance Hemodialysis

Abstract

Objective Hemodialysis (HD) patients have high protein and energy requirements, and protein-energy wasting is common and associated with poor outcomes. Eating during dialysis may improve nutritional status by counteracting the catabolic effects of hemodialysis treatment; but, eating during HD may be discouraged due to concerns of postprandial hypotension. However, little data is available to support this practice. In this study, we hypothesized that high protein meals during HD does not lead to symptomatic intradialytic hypotension events. Design A 9-week, non-randomized, parallel-arm study. Setting A single in-center HD clinic. Subjects 18 HD patients from two shifts completed the study. Patients were 62±16 years-old in age with dialysis vintage 3.4±2.6 years. Intervention The intervention group (n=9) received meals of ~30g protein and ~1/3 daily recommended intakes of sodium, potassium, phosphorus, and fluid for hemodialysis patients during dialysis for 25 consecutive HD sessions. The control group (n=9) completed all aspects of the study including a visit by study personnel but were not given meals. The 25 consecutive sessions prior to the start of the intervention/control phase were used as a baseline comparison for each patient. Main Outcome Measure Symptomatic hypotension event frequency. Results In the intervention arm, there were 19 symptomatic hypotension events in 5 patients pre-study and 18 events in 6 patients during the study. In the control arm, there were 16 events in 7 patients pre-study and 13 events in 7 patients during the study. Change in the frequency of symptomatic hypotension events from pre-study to during study was not different between groups (P=0.71). There was no effect of meals on nutritional status, but patients reported positive attitudes towards receiving meals during dialysis. Conclusion High-protein meals during HD did not increase symptomatic hypotension events. Larger, longer-term studies are needed to confirm these results and evaluate whether high-protein meals on dialysis benefit nutritional status and clinical outcomes.