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Effect of prescribing a high protein diet and increasing the dose of dialysis on nutrition in stable chronic haemodialysis patients: a randomized, controlled trial.
Nephrol Dial Transplant. 2004 May; 19(5):1212-23.ND

Abstract

BACKGROUND

Protein requirements in stable, adequately dialysed haemodialysis patients are not known and recommendations vary. It is not known whether increasing the dialysis dose above the accepted adequate level has a favourable effect on nutrition. The aim of this study was to determine whether prescribing a high protein diet and increasing the dose of dialysis would have a favourable effect on dietary protein intake and nutritional status in stable, adequately dialysed haemodialysis patients. Effects on hyperphosphataemia and acidosis were also studied.

METHODS

Patients were randomized to a high dialysis dose (HDD) group (target Kt/V(eq) of 1.4) or a regular dialysis dose (RDD) group (target Kt/V(eq) of 1.0). All patients were prescribed a high protein (HP) diet [1.3 g/kg of ideal body weight (IBW)/day] and a regular protein (RP) diet (0.9 g/kg/day), each during 40 weeks in a crossover design. In 50 patients, 23 in the HDD and 27 in the RDD group follow-up was > or =10 weeks. These patients, aged 56+/-15 years, were included in the analysis. Nutritional status was assessed by anthropometry, plasma albumin and a nutritional index.

RESULTS

Delivered Kt/V(eq) in the HDD group (1.26+/-0.14) was significantly higher than in the RDD group (1.02+/-0.08). Protein intake estimated from total nitrogen appearance (PNA) measurements and food records (DPI) was significantly higher during the HP diet (PNA(IBW), 1.01+/-0.18 g/kg/day; DPI(IBW), 1.15+/-0.18 g/kg/day) than during the RP diet (PNA(IBW), 0.90+/-0.14 g/kg/day; DPI(IBW), 0.94+/-0.11 g/kg/day). Increasing the dialysis dose did not increase protein intake either during the HP or RP diet. Plasma albumin (41.9+/-3.0 g/l) lean body mass (107+/-15% of normal values) and the nutritional index did not differ between the dialysis dose groups or protein diets and remained stable overtime. Dry body weight (97+/-14%) and total fat mass increased over time in the HDD group, but remained stable in the RDD group suggesting an effect of dialysis dose on energy balance. There was no effect of the protein diets on dry body weight or total fat mass. Plasma phosphate levels and oral bicarbonate supplements were lower in the HDD group, but were comparable between the protein diets.

CONCLUSIONS

Prescribing a HP diet resulted in a modest increase in actual protein intake, but increasing dialysis dose did not have a contributing effect. A HP diet or increasing the dialysis dose did not have a favourable effect on the nutritional status. A dietary protein intake of at least 0.9 g/kg IBW/day appears to be sufficient for adequately dialysed haemodialysis patients without overt malnutrition.

Authors+Show Affiliations

Division of Nephrology, University Hospital Groningen, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

14993506

Citation

Kloppenburg, Wybe D., et al. "Effect of Prescribing a High Protein Diet and Increasing the Dose of Dialysis On Nutrition in Stable Chronic Haemodialysis Patients: a Randomized, Controlled Trial." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 19, no. 5, 2004, pp. 1212-23.
Kloppenburg WD, Stegeman CA, Hovinga TK, et al. Effect of prescribing a high protein diet and increasing the dose of dialysis on nutrition in stable chronic haemodialysis patients: a randomized, controlled trial. Nephrol Dial Transplant. 2004;19(5):1212-23.
Kloppenburg, W. D., Stegeman, C. A., Hovinga, T. K., Vastenburg, G., Vos, P., de Jong, P. E., & Huisman, R. M. (2004). Effect of prescribing a high protein diet and increasing the dose of dialysis on nutrition in stable chronic haemodialysis patients: a randomized, controlled trial. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 19(5), 1212-23.
Kloppenburg WD, et al. Effect of Prescribing a High Protein Diet and Increasing the Dose of Dialysis On Nutrition in Stable Chronic Haemodialysis Patients: a Randomized, Controlled Trial. Nephrol Dial Transplant. 2004;19(5):1212-23. PubMed PMID: 14993506.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of prescribing a high protein diet and increasing the dose of dialysis on nutrition in stable chronic haemodialysis patients: a randomized, controlled trial. AU - Kloppenburg,Wybe D, AU - Stegeman,Coen A, AU - Hovinga,Ton K Kremer, AU - Vastenburg,Gerard, AU - Vos,Pieter, AU - de Jong,Paul E, AU - Huisman,Roel M, Y1 - 2004/02/19/ PY - 2004/3/3/pubmed PY - 2004/12/16/medline PY - 2004/3/3/entrez SP - 1212 EP - 23 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 19 IS - 5 N2 - BACKGROUND: Protein requirements in stable, adequately dialysed haemodialysis patients are not known and recommendations vary. It is not known whether increasing the dialysis dose above the accepted adequate level has a favourable effect on nutrition. The aim of this study was to determine whether prescribing a high protein diet and increasing the dose of dialysis would have a favourable effect on dietary protein intake and nutritional status in stable, adequately dialysed haemodialysis patients. Effects on hyperphosphataemia and acidosis were also studied. METHODS: Patients were randomized to a high dialysis dose (HDD) group (target Kt/V(eq) of 1.4) or a regular dialysis dose (RDD) group (target Kt/V(eq) of 1.0). All patients were prescribed a high protein (HP) diet [1.3 g/kg of ideal body weight (IBW)/day] and a regular protein (RP) diet (0.9 g/kg/day), each during 40 weeks in a crossover design. In 50 patients, 23 in the HDD and 27 in the RDD group follow-up was > or =10 weeks. These patients, aged 56+/-15 years, were included in the analysis. Nutritional status was assessed by anthropometry, plasma albumin and a nutritional index. RESULTS: Delivered Kt/V(eq) in the HDD group (1.26+/-0.14) was significantly higher than in the RDD group (1.02+/-0.08). Protein intake estimated from total nitrogen appearance (PNA) measurements and food records (DPI) was significantly higher during the HP diet (PNA(IBW), 1.01+/-0.18 g/kg/day; DPI(IBW), 1.15+/-0.18 g/kg/day) than during the RP diet (PNA(IBW), 0.90+/-0.14 g/kg/day; DPI(IBW), 0.94+/-0.11 g/kg/day). Increasing the dialysis dose did not increase protein intake either during the HP or RP diet. Plasma albumin (41.9+/-3.0 g/l) lean body mass (107+/-15% of normal values) and the nutritional index did not differ between the dialysis dose groups or protein diets and remained stable overtime. Dry body weight (97+/-14%) and total fat mass increased over time in the HDD group, but remained stable in the RDD group suggesting an effect of dialysis dose on energy balance. There was no effect of the protein diets on dry body weight or total fat mass. Plasma phosphate levels and oral bicarbonate supplements were lower in the HDD group, but were comparable between the protein diets. CONCLUSIONS: Prescribing a HP diet resulted in a modest increase in actual protein intake, but increasing dialysis dose did not have a contributing effect. A HP diet or increasing the dialysis dose did not have a favourable effect on the nutritional status. A dietary protein intake of at least 0.9 g/kg IBW/day appears to be sufficient for adequately dialysed haemodialysis patients without overt malnutrition. SN - 0931-0509 UR - https://www.unboundmedicine.com/medline/citation/14993506/Effect_of_prescribing_a_high_protein_diet_and_increasing_the_dose_of_dialysis_on_nutrition_in_stable_chronic_haemodialysis_patients:_a_randomized_controlled_trial_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfh044 DB - PRIME DP - Unbound Medicine ER -