Intradialytic exercise, protein consumption does not prevent uremic toxin removal
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Exercise and consuming protein during hemodialysis does not compromise uremic toxin removal in patients with end-stage renal disease, according to data published in the Journal of Renal Nutrition.
Further, ingesting protein correlated with a greater reduction in urea during hemodialysis.
“It has been suggested that intradialytic dietary (protein) intake may interfere with the effective removal of uremic toxins, as smaller decreases of circulating urea concentrations during hemodialysis sessions have been reported with intradialytic food consumption,” Floris K. Hendriks, MD, from the department of human biology at NUTRIM School of Nutrition and Translational Research in Metabolism at Maastricht University in The Netherlands, and colleagues wrote. They added, “Intradialytic protein ingestion may affect the reduction ratio of urea during hemodialysis through absorption/release of urea in splanchnic organs or through postprandial splanchnic blood pooling and/or reduced perfusion of peripheral tissues. In contrast, intradialytic exercise increases perfusion of peripheral tissues and reduces splanchnic perfusion. However, whether these physiological changes due to intradialytic protein ingestion and/or exercise modulate uremic toxin removal during hemodialysis remains to be determined.”
In a randomized controlled crossover study, researchers examined 10 patients with ESKD who were on hemodialysis between March 2019 and August 2020.
For 4 weeks, patients consumed 40 g of milk protein or a non-protein placebo while resting and then again after a 30-minute intradialytic exercise. Patients reported scores on the Borg Ratings of Perceived Exertion scale while cycling to provide researchers with an estimate of their exertion level.
Researchers collected blood and spent dialysate samples throughout hemodialysis to measure reduction ratios and removal of urea, creatinine, phosphate, cystatin C and indoxyl sulfate. Urea removal throughout the 4-hour hemodialysis session served as the primary outcome.
Patients who consumed protein during hemodialysis experienced a 76% reduction of urea and a 46% reduction of indoxyl sulfate, whereas those who consumed the placebo experienced a 72% reduction of urea and a 40% reduction of indoxyl sulfate. Ingesting protein correlated with greater urea removal during hemodialysis.
However, protein consumption and exercise did not yield different results than a placebo for reduction ratios and removal of creatinine, phosphate and cystatin C during hemodialysis.
“In the present study, we show that intradialytic protein ingestion lowers the reduction ratios of protein-derived uremic toxins but does not compromise uremic toxin removal during hemodialysis. In addition, the combination of intradialytic protein ingestion and exercise does not compromise the removal of uremic toxins during hemodialysis,” Hendriks and colleagues wrote. “Therefore, exercise combined with protein ingestion can be implemented during hemodialysis to support muscle mass and strength preservation without attenuating hemodialysis efficiency.”
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