Clinical Investigation

Kidney International (1989) 35, 704–711; doi:10.1038/ki.1989.42

Effect of energy intake on nutritional status in maintenance hemodialysis patients

Larry A Slomowitz1, Francisco J Monteon1, Mary Grosvenor1, Steward A Laidlaw1 and Joel D Koppel1

1Division of Nephrology and Hypertension, Harbor-UCLA Medical Center and UCLA Schools of Medicine and Public Health, Torrance and Los Angeles, California, USA

Correspondence: Joel D Koppel MD, Division of Nephrology and Hypertension, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, California 90509, USA.

Received 14 March 1988; Revised 6 September 1988.

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Abstract

Effect of energy intake on nutritional status in maintenance hemodialysis patients. Although maintenance hemodialysis (MHD) patients are often wasted, little is known about their dietary energy needs. We studied four men and two women in a clinical research center while they received diets providing 45, 35 and 25 kcal/kg desirable body weight/day; diets were fed, in random order, for 21 to 23 days each. Protein intake, 1.13 plusminus 0.02 (SEM) g protein/kg/day, was similar with all three diets. Body weight rose with 45 and 35 kcal/kg/day (P < 0.05) and fell with 25 kcal/kg/day (P < 0.05). Nitrogen balance, adjusted for estimated unmeasured losses, was neutral with 45 and 35 kcal/kg/day and negative with 25 kcal/kg/day. Balance was neutral or positive in 6 of 6, 4 of 6, and 0 of 6 patients fed 45, 35, 25 kcal/kg/day, respectively. Nitrogen balance, many plasma amino acids and changes in body weight, mid-arm circumference, mid-arm muscle area and body fat each correlated with energy intake. Resting energy expenditure was normal. The energy intake estimated from regression equations to maintain neutral nitrogen balance was 38.5 kcal/kg desirable weight/day; for body fat and weight, it was 32 kcal/kg/day. These data suggest that MHD patients have normal energy expenditure and approximately normal requirements for maintenance of protein balance, body weight and body fat. An average energy intake of about 38 kcal/kg desirable weight/day may be necessary to maintain nitrogen balance in these patients.

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