Effect of high-protein meals during hemodialysis combined with lanthanum carbonate in hypoalbuminemic dialysis patients: findings from the FrEDI randomized controlled trial

Rhee, Connie M.; You, Amy S.; Parsons, Tara Koontz; Tortorici, Amanda R.; St-Jules, David E.; Jing, Jennie; Lee, Martin L.; Benner, Debbie; Kövesdy, Csaba P.; Mehrotra, Rajnish; Kopple, Joel D.; Kalantar‐Zadeh, Kamyar

doi:10.1093/ndt/gfw323

Cited by 27 publications

(45 citation statements)

References 33 publications

(42 reference statements)

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“…In dialysis patients requiring high protein intake, risk for hyperphosphatemia can be substantial and should be carefully monitored and when appropriate, phosphate binders should be promptly instituted [143]. A recent prospective study by Rhee et al of a cohort ( n = 110) of hypoalbuminemic hemodialysis patients showed beneficial effects of increasing serum albumin (≥0.2 mg/dL) and maintaining serum phosphorous levels within a target range (3.5 to <5.5 mg/dL) by providing high-protein meals during hemodialysis combined with lanthanum carbonate administration [144]. It should be noted, however, the occurrence of intradialytic hypotension associated with the feeding was not detailed.…”

Section: Clinical Recommendationsmentioning

confidence: 99%

Protein Nutrition and Malnutrition in CKD and ESRD

2017

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Elevated protein catabolism and protein malnutrition are common in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The underlying etiology includes, but is not limited to, metabolic acidosis intestinal dysbiosis; systemic inflammation with activation of complements, endothelin-1 and renin-angiotensin-aldosterone (RAAS) axis; anabolic hormone resistance; energy expenditure elevation; and uremic toxin accumulation. All of these derangements can further worsen kidney function, leading to poor patient outcomes. Many of these CKD-related derangements can be prevented and substantially reversed, representing an area of great potential to improve CKD and ESRD care. This review integrates known information and recent advances in the area of protein nutrition and malnutrition in CKD and ESRD. Management recommendations are summarized. Thorough understanding the pathogenesis and etiology of protein malnutrition in CKD and ESRD patients will undoubtedly facilitate the design and development of more effective strategies to optimize protein nutrition and improve outcomes.

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Section: Clinical Recommendationsmentioning

confidence: 99%

Protein Nutrition and Malnutrition in CKD and ESRD

2017

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“…27 Improved nutritional status Biochemical improvements in biochemical measures such as albumin and prealbumin. 9,11 Nutritional reserve prevents acute catabolism associated with HD treatment. 13,14 Increased fat and lean mass.…”

Section: Reduced Mortalitymentioning

confidence: 99%

“…A common choice among researchers and clinicians has been to provide food and nutritional supplements during treatment. 5,6 Allowing patients to eat during treatment helps offset reduced dietary intake observed on treatment days 7,8 and has had a positive impact on nutritional status [9][10][11][12][13][14] and, possibly, outcomes. 15,16 However, since postprandial hypotension, gastrointestinal (GI) symptoms, and reduced treatment efficiency have been reported this practice remains controversial.…”

mentioning

confidence: 99%

Eating During Hemodialysis Treatment: A Consensus Statement From the International Society of Renal Nutrition and Metabolism

Kistler

Benner

Burrowes

et al. 2018

Journal of Renal Nutrition

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Poor nutritional status and protein-energy wasting are common among maintenance dialysis patients and associated with unfavorable outcomes. Providing foods, meal trays, snack boxes, and/or oral nutritional supplements during hemodialysis can improve nutritional status and might also reduce inflammation, enhance health-related quality of life, boost patient satisfaction, and improve survival. Potential challenges include postprandial hypotension and other hemodynamic instabilities, aspiration risk, gastrointestinal symptoms, hygiene issues, staff burden, reduced solute removal, and increased costs. Differing in-center nutrition policies exist within organizations and countries around the world. Recent studies have demonstrated clinical benefits and highlight the need to work toward clear guidelines. Meals or supplements during hemodialysis may be an effective strategy to improve nutritional status with limited reports of complications in real-world scenarios. Whereas larger multicenter randomized trials are needed, meals and supplements during hemodialysis should be considered as a part of the standard-of-care practice for patients without contraindications.

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“…The normalized protein catabolic rate (nPCR), a proxy for dietary protein intake among stable hemodialysis patients, has been shown to be associated with the serum albumin level as well as with better survival among hemodialysis patients [42, 48-50]. However, given that the nPCR does not account for urinary urea excretion, protein intake is underestimated with the nPCR among patients with RKF [48].…”

Section: Rkf and Nutritional Assessmentmentioning

confidence: 99%

“…Along with the fact that the hemodialysis procedure per se increases net protein catabolism, a low-protein diet may be discouraged because of concerns regarding protein energy wasting [94, 95]. Indeed, many dialysis patients have a protein intake lower than the recommended dietary allowance level (0.8 g/kg BW/day), and a recent randomized clinical trial revealed that high-protein meals during dialysis increase serum albumin levels [50]. …”

Section: How To Protect Rkfmentioning

confidence: 99%

Individualized Hemodialysis Treatment: A Perspective on Residual Kidney Function and Precision Medicine in Nephrology

Hur

Lee²,

Kalantar-Zadeh³

et al. 2018

Cardiorenal Med

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Background: Residual kidney function (RKF) is often expected to inevitably and rapidly decline among hemodialysis patients and, hence, has been inadvertently ignored in clinical practice. The importance of RKF has been revisited in some recent studies. Given that patients with end-stage renal disease now tend to initiate maintenance hemodialysis therapy with higher RKF levels, there seem to be important opportunities for incremental hemodialysis by individualizing the dose and frequency according to their RKF levels. This approach is realigned with precision medicine and patient-centeredness. Summary: In this article, we first review the available methods to estimate RKF among hemodialysis patients. We then discuss the importance of maintaining and monitoring RKF levels based on a variety of clinical aspects, including volume overload, blood pressure control, mineral and bone metabolism, nutrition, and patient survival. We also review several potential measures to protect RKF: the use of high-flux and biocompatible membranes, the use of ultrapure dialysate, the incorporation of hemodiafiltration, incremental hemodialysis, and a low-protein diet, as well as general care such as avoiding nephrotoxic events, maintaining appropriate blood pressure, and better control of mineral and bone disorder parameters. Key Message: Individualized hemodialysis regimens may maintain RKF, lead to a better quality of life without compromising long-term survival, and ensure precision medicine and patient-centeredness in nephrology practice.

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Effect of high-protein meals during hemodialysis combined with lanthanum carbonate in hypoalbuminemic dialysis patients: findings from the FrEDI randomized controlled trial

Cited by 27 publications

References 33 publications

Protein Nutrition and Malnutrition in CKD and ESRD

Protein Nutrition and Malnutrition in CKD and ESRD

Eating During Hemodialysis Treatment: A Consensus Statement From the International Society of Renal Nutrition and Metabolism

Individualized Hemodialysis Treatment: A Perspective on Residual Kidney Function and Precision Medicine in Nephrology

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