Intradialytic meals remain controversial
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BOSTON — While experts have shared varying advice about eating during dialysis, there are not enough data to resolve this controversy, according to a presenter at the National Kidney Foundation Spring Clinical Meetings.
“Why is it controversial? It's straightforward. Ideally, we would have some randomized clinical trials that looked at hard endpoints that would provide us with some definitive conclusions on whether or not eating during dialysis is improving an outcome that we care about. Sometimes, and often in nutrition, we don't have that kind of research.,” David St-Jules, PhD, assistant professor in the department of nutrition at the University of Nevada, Reno, said in the presentation.
Studies have shown benefits of eating while on dialysis include improved nutrition status, reduced diet-related complications and improved patient satisfaction, St-Jules said. However, opposing studies show negatives, such as required resources, food safety and intradialytic hypotension (IDH).
St-Jules referenced studies from Kamyar Kalantar-Zadeh, MD, MPH, PhD, and Rajiv Agarwal, MD, MS, that showed opposite advice regarding nutrition status affected by eating during dialysis. While both sides gain support as time goes on, St-Jules noted there is no new research being done, only additional opinions being added to the topic.
Practices vary internationally. In Europe, South America, Asia, Australia and Africa, many practices provide meals for patients on dialysis as a part of their care. Prior to the COVID-19 pandemic, DaVita reported several centers allowed patients to eat during dialysis, St-Jules said, but about 75% had loose policies.
After examining studies that support intradialytic meals, St-Jude determined the top arguments show that patients bring small and healthy snacks. Therefore, he said that if the goal is to improve nutrition, eating during dialysis is a good decision. Additionally, many patients on dialysis have poor diets, so eating a prepared balanced meal during dialysis can significantly improve nutritional intake, even if it is just three times a week.
St-Jude found the most evidence-based reason to restrict intradialytic meals is to prevent IDH. This leads to access failure, hospitalization and other adverse events. However, he said it is unknown how severely meals affect IDH. Research shows that meals lower blood pressure, but there is no definitive measurement due to all the changing variables, he said.
“Unfortunately, IDH is unpredictable at this point in time,” St-Jules said.
St-Jude concluded the presentation by acknowledging both sides of the controversy have strong points, but large clinical trials with hard endpoints are required before the controversy is resolved. For now, doing what is best for individual patients seems to be the best way to determine whether they can eat while on dialysis, he said.
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St-Jules D. Eating on dialysis: Is this an outdated practice? Presented at: National Kidney Foundation Spring Clinical Meetings; April 5-10, 2022; Boston.
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