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Eating during the Hemodialysis Session: A Practice Improving Nutritional Status or a Risk Factor for Intradialytic Hypotension and Reduced Dialysis Adequacy?

1
Division of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, St. Kyriakidi 1, GR54636 Thessaloniki, Greece
2
Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, Medical School, Aristotle University of Thessaloniki, GR54006 Thessaloniki, Greece
*
Author to whom correspondence should be addressed.
Nutrients 2020, 12(6), 1703; https://doi.org/10.3390/nu12061703
Received: 18 May 2020 / Revised: 29 May 2020 / Accepted: 4 June 2020 / Published: 6 June 2020
(This article belongs to the Special Issue Nutrition Management for CKD (Chronic Kidney Disease))
Historically, eating during the hemodialysis treatment has been associated with increased risk for adverse intradialytic symptoms and events, risks that have resulted in the implementation of restrictive in-center nutrition policies. Recent studies, however, have recorded a shift in clinical practice with a higher proportion of physicians following the view that administration of intradialytic meals and supplements represents a simple and effective approach to enhance caloric intake and improve nutritional status among patients on hemodialysis. This shift towards less restrictive in-center nutrition practices is mainly supported by evidence from observational studies associating intradialytic nutritional supplementation with improvements in protein-energy wasting, inflammatory state, and health-related quality of life. In sharp contrast, earlier and recent interventional studies have documented that feeding during the hemodialysis treatment provokes a rapid postprandial decline in blood pressure and raises the incidence of symptomatic intradialytic hypotension. Furthermore, other studies have shown that postprandial redistribution in intravascular volume and enhanced blood supply to the gastrointestinal circulation may interfere with the adequacy of the delivered hemodialysis. Those who defend the position that intradialytic nutritional support is beneficial do not dispute the physiology of postprandial hemodynamic response, but they argue against its clinical significance. In this article, we provide an overview of studies that explored the effect of eating during the hemodialysis treatment on intradialytic hemodynamic stability and adequacy of the delivered hemodialysis. We reason that these risks have important clinical implications that are not counteracted by anticipated benefits of this strategy on caloric intake and nutritional status. View Full-Text
Keywords: dialysis adequacy; clinical outcomes; hemodialysis; hypotension; nutritional status dialysis adequacy; clinical outcomes; hemodialysis; hypotension; nutritional status
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Fotiadou, E.; Georgianos, P.I.; Chourdakis, M.; Zebekakis, P.E.; Liakopoulos, V. Eating during the Hemodialysis Session: A Practice Improving Nutritional Status or a Risk Factor for Intradialytic Hypotension and Reduced Dialysis Adequacy? Nutrients 2020, 12, 1703.

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