Dietary Protein and Physical Activity Interventions to Support Muscle Maintenance in End-Stage Renal Disease Patients on Hemodialysis

Abstract

End-stage renal disease patients have insufficient renal clearance capacity left to adequately excrete metabolic waste products. Hemodialysis (HD) is often employed to partially replace renal clearance in these patients. However, skeletal muscle mass and strength start to decline at an accelerated rate after initiation of chronic HD therapy. An essential anabolic stimulus to allow muscle maintenance is dietary protein ingestion. Chronic HD patients generally fail to achieve recommended protein intake levels, in particular on dialysis days. Besides a low protein intake on dialysis days, the protein equivalent of a meal is extracted from the circulation during HD. Apart from protein ingestion, physical activity is essential to allow muscle maintenance. Unfortunately, most chronic HD patients have a sedentary lifestyle. Yet, physical activity and nutritional interventions to support muscle maintenance are generally not implemented in routine patient care. To support muscle maintenance in chronic HD patients, quantity and timing of protein intake should be optimized, in particular throughout dialysis days. Furthermore, implementing physical activity either during or between HD sessions may improve the muscle protein synthetic response to protein ingestion. A well-orchestrated combination of physical activity and nutritional interventions will be instrumental to preserve muscle mass in chronic HD patients.

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

“…The missing element in the definition of the metabolic pattern of dialysis patients is physical activity. Metabolic balance is, in fact, significantly affected by physical exercise, which is a well-known modulator of the anabolic versus catabolic balance in kidney disease patients [143][144][145][146][147][148].…”

Dietary protein interventions to improve nutritional status in end-stage renal disease patients undergoing hemodialysis

“…Therefore, ample physical activity is likely required to achieve the full anabolic potential of dietary protein. A single bout of physical activity can increase the sensitivity of skeletal muscle tissue to the anabolic effects of protein ingestion for a period up to 24 h [ 41 ]. Although aerobic exercise has been shown to increase aerobic capacity in CHD patients [ 42 ], resistance-type exercise is considered to be the most potent form of physical activity to increase muscle mass and strength [ 43 ].…”

Therapeutic effects of exercise interventions for patients with chronic kidney disease: protocol for an overview of systematic reviews and meta-analyses of clinical trials

“…6 7 Reports of these poor prognoses among patients with CKD have created a greater emphasis on lifestyle interventions that reduce complications and improve HRQOL for them. [8][9][10] Exercise is a proven intervention associated with numerous health benefits in patients with CKD, and they are now encouraged to participate in insufficient levels of regular physical activity in daily life. 11 12 A growing number of systematic reviews and metaanalyses have examined the role of exercise in CKD treatment.…”

“… 6 7 Reports of these poor prognoses among patients with CKD have created a greater emphasis on lifestyle interventions that reduce complications and improve HRQOL for them. 8–10 …”