Abstract
Sufficient protein intake is of great importance in hemodialysis (HD) patients, especially for maintaining muscle mass. Daily protein needs are generally estimated using bodyweight (BW), in which individual differences in body composition are not accounted for. As body protein mass is best represented by fat free mass (FFM), there is a rationale to apply FFM instead of BW. The agreement between both estimations is unclear. Therefore, the aim of this study is to compare protein needs based on either FFM or BW in HD patients. Protein needs were estimated in 115 HD patients by three different equations; FFM, BW and BW adjusted for low or high BMI. FFM was measured by multi-frequency bioelectrical impedance spectroscopy and considered the reference method. Estimations of FFM x 1.5g/kg and FFM x 1.9g/kg were compared with (adjusted)BW x 1.2 and x 1.5, respectively. Differences were assessed with repeated measures ANOVA and Bland-Altman plots. Mean protein needs estimated by (adjusted)BW were higher compared to those based on FFM, across all BMI categories (P<0.01) and most explicitly in obese patients. In females with BMI >30, protein needs were 69±17.4g/day higher based on BW and 45±9.3g/day higher based on BMI adjusted BW, compared to FFM. In males with BMI >30, protein needs were 51±20.4g/day and 23±20.9g/day higher compared to FFM, respectively. Our data show large differences and possible overestimations of protein needs when comparing BW to FFM. We emphasize the importance of more research and discussion on this topic.
Highlights
IntroductionProtein-energy wasting (PEW) is a syndrome that occurs in hemodialysis (HD) patients and has a negative impact on clinical course [1e3]
This study is discussing the topic on protein estimations by comparing estimations of protein needs based on fat free mass (FFM) with estimations based on BW in HD patients
Our data show large differences in FFM between males and females and differences in protein needs based on FFM among all body mass index (BMI) groups (P < 0.01)
Summary
Protein-energy wasting (PEW) is a syndrome that occurs in hemodialysis (HD) patients and has a negative impact on clinical course [1e3]. In the Netherlands often actual BW is used instead of ideal BW and in previous studies is suggested to adjust BW in under- and overweight patients, using body mass index (BMI) [11,12]. This is based on a study investigating protein needs in ICU patients, in which protein mass, fat free mass (FFM), was measured precisely with in vivo neutron activation analysis [13]. Results: Mean protein needs estimated by (adjusted)BW were higher compared to those based on FFM, across all BMI categories (P < 0.01) and most explicitly in obese patients.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
