Dietary protein intake less than 1.2 g/kg/day benefits chinese maintenance hemodialysis patients

Abstract

The K/DOQI guidelines recommend that MHD patients have a dietary protein intake (DPI) of at least 1.2 g/ kg/day to avoid malnutrition. It is hard for most Chinese MHD patients to meet the criteria. To know the nutritional status and metabolic results of different DPI in our patients is necessary. Part 1: Cross–sectional study: 189 MHD patients using low-flux dialyzers were enrolled in April 2009 in our center. Three-day-dietary diaries were analyzed by dietitians. Serum cholesterol, albumin, calcium and phosphate and CO2CP (carbon dioxide combining power) were examined. The nPCR was used to assess the accuracy of DPI. Part 2: Pilot study: A two–year, non-randomized controlled trial was carried out. The inclusion criteria were (1) MHD>3 years and Kt/V>1.2; (2) no residual renal function; (3) Serum albumin>35 g/l; (4) CRP<3.25 mmol/l; (5) Hemoglobin >90 g/l. Two groups were set: DPI>1.2 g/ kg/day ( NP group) and DPI <1.2 g/ kg/day (LP group). Patients kept a serial three-day-dietary diary and assessed serum albumin, phosphate, cholesterol and CO2CP every 3 months. Part 1: 126 patients' diaries, which DPI from the three-day-dietary diary was similar to the nPCR, are analyzed. 99 patients' DPI was less than 1.2 g/kg/day with an average calorie intake of 26.93±4.17 KCal/ kg/day. 27 patients' DPI was more than 1.2 g/kg/day with an average calorie intake of 29.46±2.73 KCal/ kg/day. There was no difference on serum albumin. However, the patients in high DPI group have higher serum phosphate and lower CO2CP (TABLE 1). Part 2: The average DPI in LP group was 1.05±0.11 g/kg/day with an average calorie intake of 26.65±3.18 KCal/ kg/day. The average DPI in NP group was 1.34±0.15 g/kg/day with an average calorie intake of 29.1±2.87 KCal/ kg/day. Serum albumin and cholesterol remained stable in both groups. Similarly, the patients in NP group have higher serum phosphate and lower CO2CP compared to LP group (TABLE 2). Conclusion DPI around 1.05 g/kg/day can maintain the nutritional status and ameliorate hyperphosphatemia and acidosis in Chinese MHD patients using low–flux dialyzers