Type your tag names separated by a space and hit enter

Dietary restrictions in dialysis patients: is there anything left to eat?

Abstract

A significant number of dietary restrictions are imposed traditionally and uniformly on maintenance dialysis patients, whereas there is very little data to support their benefits. Recent studies indicate that dietary restrictions of phosphorus may lead to worse survival and poorer nutritional status. Restricting dietary potassium may deprive dialysis patients of heart-healthy diets and lead to intake of more atherogenic diets. There is little data about the survival benefits of dietary sodium restriction, and limiting fluid intake may inherently lead to lower protein and calorie consumption, when in fact dialysis patients often need higher protein intake to prevent and correct protein-energy wasting. Restricting dietary carbohydrates in diabetic dialysis patients may not be beneficial in those with burnt-out diabetes. Dietary fat including omega-3 fatty acids may be important caloric sources and should not be restricted. Data to justify other dietary restrictions related to calcium, vitamins, and trace elements are scarce and often contradictory. The restriction of eating during hemodialysis treatment is likely another incorrect practice that may worsen hemodialysis induced hypoglycemia and nutritional derangements. We suggest careful relaxation of most dietary restrictions and adoption of a more balanced and individualized approach, thereby easing some of these overzealous restrictions that have not been proven to offer major advantages to patients and their outcomes and which may in fact worsen patients' quality of life and satisfaction. This manuscript critically reviews the current paradigms and practices of recommended dietary regimens in dialysis patients including those related to dietary protein, carbohydrate, fat, phosphorus, potassium, sodium, and calcium, and discusses the feasibility and implications of adherence to ardent dietary restrictions and future research.

Links

  • PMC Free PDF
  • PMC Free Full Text
  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California; Long Beach Veterans Affairs Healthcare System, Long Beach, California; Department of Epidemiology, UCLA Fielding School of Public Health, University of California Los Angeles, Los Angeles, California; Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California.

    , , , , , , ,

    Source

    Seminars in dialysis 28:2 pg 159-68

    MeSH

    Diet, Reducing
    Eating
    Humans
    Kidney Failure, Chronic
    Renal Dialysis

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Review

    Language

    eng

    PubMed ID

    25649719

    Citation

    Kalantar-Zadeh, Kamyar, et al. "Dietary Restrictions in Dialysis Patients: Is There Anything Left to Eat?" Seminars in Dialysis, vol. 28, no. 2, 2015, pp. 159-68.
    Kalantar-Zadeh K, Tortorici AR, Chen JL, et al. Dietary restrictions in dialysis patients: is there anything left to eat? Semin Dial. 2015;28(2):159-68.
    Kalantar-Zadeh, K., Tortorici, A. R., Chen, J. L., Kamgar, M., Lau, W. L., Moradi, H., ... Kovesdy, C. P. (2015). Dietary restrictions in dialysis patients: is there anything left to eat? Seminars in Dialysis, 28(2), pp. 159-68. doi:10.1111/sdi.12348.
    Kalantar-Zadeh K, et al. Dietary Restrictions in Dialysis Patients: Is There Anything Left to Eat. Semin Dial. 2015;28(2):159-68. PubMed PMID: 25649719.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Dietary restrictions in dialysis patients: is there anything left to eat? AU - Kalantar-Zadeh,Kamyar, AU - Tortorici,Amanda R, AU - Chen,Joline L T, AU - Kamgar,Mohammad, AU - Lau,Wei-Ling, AU - Moradi,Hamid, AU - Rhee,Connie M, AU - Streja,Elani, AU - Kovesdy,Csaba P, Y1 - 2015/02/03/ PY - 2015/2/5/entrez PY - 2015/2/5/pubmed PY - 2015/12/15/medline SP - 159 EP - 68 JF - Seminars in dialysis JO - Semin Dial VL - 28 IS - 2 N2 - A significant number of dietary restrictions are imposed traditionally and uniformly on maintenance dialysis patients, whereas there is very little data to support their benefits. Recent studies indicate that dietary restrictions of phosphorus may lead to worse survival and poorer nutritional status. Restricting dietary potassium may deprive dialysis patients of heart-healthy diets and lead to intake of more atherogenic diets. There is little data about the survival benefits of dietary sodium restriction, and limiting fluid intake may inherently lead to lower protein and calorie consumption, when in fact dialysis patients often need higher protein intake to prevent and correct protein-energy wasting. Restricting dietary carbohydrates in diabetic dialysis patients may not be beneficial in those with burnt-out diabetes. Dietary fat including omega-3 fatty acids may be important caloric sources and should not be restricted. Data to justify other dietary restrictions related to calcium, vitamins, and trace elements are scarce and often contradictory. The restriction of eating during hemodialysis treatment is likely another incorrect practice that may worsen hemodialysis induced hypoglycemia and nutritional derangements. We suggest careful relaxation of most dietary restrictions and adoption of a more balanced and individualized approach, thereby easing some of these overzealous restrictions that have not been proven to offer major advantages to patients and their outcomes and which may in fact worsen patients' quality of life and satisfaction. This manuscript critically reviews the current paradigms and practices of recommended dietary regimens in dialysis patients including those related to dietary protein, carbohydrate, fat, phosphorus, potassium, sodium, and calcium, and discusses the feasibility and implications of adherence to ardent dietary restrictions and future research. SN - 1525-139X UR - https://www.unboundmedicine.com/medline/citation/25649719/full_citation L2 - https://doi.org/10.1111/sdi.12348 DB - PRIME DP - Unbound Medicine ER -