#NephMadness 2017: Agarwal lays down the law on eating during dialysis

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Rajiv Agarwal

Dr. Agarwal, MD, is Professor of Medicine at Indiana University School of Medicine. He received Indiana University Trustee’s teaching award and the young scholar award of the American Society of Hypertension. His research on hypertension in CKD has been continuously funded initiative since 2003 by the NIH. He served as an Associate Editor of NephSAP for 6 years.

Many dialysis units allow patients to eat during the treatment, others have no position on it, and still others prohibit it. It is an issue surrounded by substantial controversy. No surprise, then, that in-center practices and policies with respect to intradialytic food consumption vary considerably in different regions around the world.

The primary argument of clinicians defending the position that intradialytic meals should be offered is that this practice may benefit patients with protein-energy wasting and marginal nutritional status. Although the data are thin, I believe that intradialytic food intake should be avoided for the following reasons:

  1. Interventional studies, including randomized trials, provide evidence that food intake during dialysis causes a clinically significant reduction in systemic blood pressure (BP) during the postprandial period and elevates the risk of symptomatic intradialytic hypotension, a dialysis-related complication associated with increased mortality.
  2. Clinical studies show that eating during dialysis interferes with the adequacy of the delivered dialysis, whereas eating 2-3 hours before the dialysis session has no impact on the efficiency of the subsequent dialysis treatment.
  3. Recent randomized studies showed that high-protein meals during dialysis with concomitant administration of phosphate-binders improve serum albumin levels without a parallel increase in the risk of hyperphosphatemia did not report on the risks, that is, on the risk of intradialytic hemodynamic instability and less adequately delivered dialysis. 

On this basis, I conclude that instead of encouraging the widespread use of intradialytic meals and exacerbating the risk of adverse intradialytic events, the dialysis practices and policies should focus on adequate caloric intake of our patients during the out-of-dialysis periods.

Further adequately designed research is needed to explore this important area. Until then, I recommend that patients not be fed during dialysis.

Read more about Feeding During Dialysis in the Nutrition region.

– Guest Post written by Rajiv Agarwal 

As with all content on the AJKD Blog, the opinions expressed are those of the author of each post, and are not necessarily shared or endorsed by the AJKD Blog, AJKD, the National Kidney Foundation, Elsevier, or any other entity unless explicitly stated.

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