Effect of Dietary Education and High Energy/Protein Meals on Lean Body Mass during Hemodialysis Treatment in Hypoalbuminemic Hemodialysis Patients

Background Low intakes of energy, protein, vitamins, and minerals are common risk factors for malnutrition in maintenance hemodialysis (MHD) patients. Malnutrition is a known predictor of increased mortality amongst MHD patients. Preliminary research indicates intake of protein rich meals during dialysis replenishes loss from MHD, but studies were limited to a small number of dialysis sessions. Measuring change in lean body mass (LBM) of MHD patients is one way to determine the effects of a nutrition intervention aimed at improving outcomes. Methods An 8‐week randomized controlled trial was conducted among 110 MHD participants (18 to 85 years, mean age = 54±15 SD, 48 males, 62 females) with serum albumin <4.0 g/dL recruited from DaVita Dialysis centers in the greater Los Angeles area. The intervention group (n=55) was given high protein/high calorie meals during MHD as well as outpatient nutrition education with a dietitian that focused on lowering dietary phosphorus intake. The control group (n=55) received low protein/low calorie meals during MHD and minimal nutrition education. Dietary intake data were collected from a 3‐day food diary or 24‐hour recall and meal intake forms during MHD treatment. Lean body mass was assessed by dual‐energy X‐ray absorptiometry. Independent samples t‐tests were used to examine pre‐and post‐study changes in body composition with a significance level of p ≤ 0.05. Results No significant differences in LBM change (t= ‐1.10, p= 0.28) were found between treatment and control groups. Interestingly, the treatment group had an increase in LBM of approximately 600g post‐intervention and the control group had an increase in LBM of approximately 3300g. Though significant differences between groups were not found, it is to be noted that both groups had an increase in LBM. Conclusion This study explored the effects of nutritional education and the rendering of meals to MHD patients during dialysis, an area lacking in the literature. Limitations include inadequate access to community health professionals to interpret the educational information for patients who spoke languages other than English or Spanish. Additionally, level of education, work status, and overall stress may have played a role in outcomes; these factors were not controlled. Lastly, supplementary dietary intake during MHD both prior to and during the study was not monitored. Additional research is needed to further understand effective means of reducing malnutrition and monitoring the changes in LBM as a marker for malnutrition in MHD patients. Support or Funding Information Source of Research Support: This study was supported by the Los Angeles Biomedical Research Institute, as part of the Fosrenol for Enhancing Dietary Protein Intake in Hypoalbuminemic Dialysis Patients Study.