#NephMadness 2017: To Wait or Not to Wait

Posted on March 24, 2017 by AJKDblog in NephMadness // 1 Comment

Brandon M. Kistler

Dr. Kistler, PhD, RD, is Assistant Professor of Nutrition and Dietetics and Research Affiliate at the Fisher Institute for Health and Well-Being at Ball State University. His laboratory focuses on strategies to prevent inadequate or inappropriate nutrition in patients undergoing hemodialysis. Follow him @DrBMK_RD.

Sporting events used to be interrupted frequently by commercials that touted the slogan “Hungry, Why Wait?” to potential consumers.

If you are a patient undergoing hemodialysis, you are frequently asked to do just that: wait until after treatment to consume food or nutritional supplements. There have been many arguments put forth to support clinic policies restricting in-center nutrition. The most frequently cited is hemodynamic instability. In fact, many acute studies show a transient reduction in blood pressure following eating.

Despite the arguments against in-center nutrition, there are many reasons to support this practice:

Hemodialysis patients have elevated recommendations for protein and energy. Restrictive policies significantly shorten the time to spread meals and snacks outside of treatment and may result in interventions that replace (rather than increase) overall intake. Providing food or nutritional supplements during treatment has been shown to increase the consumption of protein and energy on treatment days.
Numerous clinical studies have demonstrated that providing meals or nutritional supplements during treatment can improve markers of nutritional status, including serum proteins, body composition, and subjective global assessment.
Observational data suggests that providing in-center nutrition results in increased quality of life. Feeling better may be one reason why many patients choose to eat even when encouraged to avoid this practice.
Observational data have demonstrated that malnourished patients (albumin ≤ 3.5g/dL) receiving intradialytic oral supplements have reduced mortality and possibly hospitalizations compared to similar patients who do not receive nutrition during treatment.

While I do not believe that our patients should “Grab a Snickers” during treatment, these data suggest that in-center nutrition has potential as a low-cost strategy to improve outcomes.

Read more about Feeding During Dialysis in the Nutrition region.

– Guest Post written by Brandon Kistler (@DrBMK_RD)

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.