Haemodialysis patients with diabetes eat less than those without: A plea for a permissive diet

• Published in: Nephrology (Carlton, Vic.) Vic.), 2017-09, Vol.22 (9), p.712-719
• Main Authors: Bataille, Stanislas, Landrier, Jean‐François, Astier, Julien, Cado, Sylvie, Sallette, Jérôme, Giaime, Philippe, Sampol, Jérôme, Sichez, Hélène, Ollier, Jacques, Gugliotta, Jean, Serveaux, Marianne, Cohen, Julien, Darmon, Patrice
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Body Composition; Calories; Comorbidity; Cross-Sectional Studies; Diabetes; Diabetes mellitus; Diabetic Nephropathies - complications; Diabetic Nephropathies - diagnosis; Diabetic Nephropathies - physiopathology; Diabetic Nephropathies - therapy; Diet; Dietary intake; Dietary Proteins - administration & dosage; Energy Intake; Female; France; Geriatric Assessment; haemodialysis; Hand Strength; Hemodialysis; Humans; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - physiopathology; Kidney Failure, Chronic - therapy; Male; Malnutrition; Medical records; Multivariate analysis; Nutrition Assessment; nutritional intake; Nutritional Status; Population studies; protein energy wasting syndrome; Protein-Energy Malnutrition - diagnosis; Protein-Energy Malnutrition - etiology; Protein-Energy Malnutrition - physiopathology; Proteins; Recommended Dietary Allowances; Renal Dialysis - adverse effects; Risk Factors; Treatment Outcome
• ISSN: 1320-5358; 1440-1797
• DOI: 10.1111/nep.12837

Aim The main cause of malnutrition in haemodialysis patients is a spontaneous decline in energy and protein intakes. This study aims to report the dietary energy intake (DEI), dietary protein intake (DPI), and dietary micronutrient intake in a French HD population, to report factors associated with a low DPI and DEI, and to analyze if nutritional intake was correlated with nutritional status. Methods We conducted an observational cross‐sectional study in a haemodialysis population of 87 adult patients in July 2014. Daily nutritional oral intake, handgrip strength, body composition measured by bioimpedancemetry, and biological and dialysis parameters were obtained from medical records. Statistical analyses of parameters associated with DEI and DPI were performed. Results The median age (interquartile range) of the population was 77.3 [71.1; 84.8] years, 57.5% were men, and 52.9% had diabetes mellitus. Median weight‐adjusted DEI was 18.4 [15.7;22.3] kcal/kg per day (1308 [1078; 1569] kcal/day), and median weight‐adjusted DPI was 0.80 [0.66; 0.96] g/kg per day (57.5 [47.1; 66.8] g/day). In multivariate analysis, weight‐adjusted DEI was statistically lower in patients with diabetes (coefficient [95%CI] –3.81[−5.21;‐2.41] kcal/kg per day; P = 0.01) but was not associated with the others parameters. When DEI was not adjusted for weight, diabetes was no longer associated with DEI, but female gender (−178[−259;–961] kcal/day; P = 0.03) and a higher Charlson comorbidity index (−30[−44;–15]; P = 0.04) were associated with a lower calorie intake. Results for DPI were similar except that the Charlson comorbidity index did not reach significance. Conclusions Diabetes is an important factor associated with low dietary intake in haemodialysis patients. Restrictive regimens should be prescribed cautiously in haemodialysis patients, especially in those with diabetes. Summary at a glance In this study, the authors found that haemodialysis patients with diabetes take less calories and less protein per kg of dry weight than those without diabetes. They also found that their patients diet energy intake and diet protein intake were very low, less than in most published studies. This is an interesting and original study combining several nutritional parameters diet survey, anthropometrics, body composition with BIA, biomarkers providing new and additional findings to the nutritional field in haemodialysis patients.