Effects of dietary intake, appetite, and eating habits on dialysis and non-dialysis treatment days in hemodialysis patients: Cross-sectional results from the HEMO study

Objective: To evaluate differences between dietary energy intake (DEI), dietary protein intake (DPI), appetite, dietary patterns, and eating habits during dialysis treatment days (DID) and non-dialysis treatment days (NDD) in 1,901 adults receiving maintenance hemodialysis who were enrolled in the baseline phase of the National Institutes of Health-sponsored Hemodialysis (HEMO) study. Design: A cross-sectional analysis of participants at baseline (before randomization). Setting: Fifteen clinical centers across the United States. Measurements: DEI, DPI, and self-reported assessment of appetite, dietary patterns, and eating habits. Results: For the entire study cohort, total mean (+/- SD) DEI (1,566 +/- 636 kcal/day) and weight-adjusted DEI (23.2 +/- 9.5 kcal/kg/day) were significantly higher (P < .0001) on NDD than on DD (1,488 +/- 620 kcal/day and 22.2 +/- 9.6 kcal/kg/day), respectively. Similarly, DPI was significantly higher (P < .0001) on NDD (65.0 +/- 29.0 g/day and 0.96 +/- 0.43 g/kg/day) than on DID (60.2 +/- 26.5 g/day and 0.90 +/- 0.41 g/kg/day). On DID and NDD, the mean weight-adjusted DEI for the entire cohort was less than the HEMO study standard of care (SOC) of greater than or equal to28 kcal/kg/day, whereas on NDD, several subgroups reported dietary protein intakes that were closer to the study's SOC. These included men, patients under 50 years of age, nonblack participants, those without diabetes, those with a normal or mild Index of Co-Existing Disease score, and those on dialysis for more than 5 years. Protein and energy intakes declined with worsening self-reported appetites in both DID and NDD after adjusting for other subgroup effects. Conclusion: Dietary energy and protein intakes of HEMO study participants were lower on DID than on NDD, and also lower than the SOC on both days, particularly with regard to energy intake. People receiving maintenance hemodialysis should be counseled to consume adequate amounts of energy and protein daily, especially on DID. Practitioners should monitor closely those patients who report poor appetite and should intervene appropriately. (C) 2003 by the National Kidney Foundation, Inc.