From the Guidelines
For patients with end-stage renal disease (ESRD) on dialysis, a high-protein diet is generally recommended, typically 1.0 to 1.2 grams of protein per kilogram of body weight per day, as suggested by the World Health Organization guidelines for the general population and considering the specific needs of dialysis patients 1. This recommendation is based on the most recent and highest quality study, which emphasizes the importance of maintaining adequate protein intake to offset catabolism and negative nitrogen balance in dialysis patients. The protein should be of high biological value, meaning it contains all essential amino acids, such as that found in eggs, meat, fish, and poultry. While maintaining this higher protein intake, dialysis patients should still monitor and potentially limit phosphorus, potassium, sodium, and fluid intake based on their individual lab values and clinical status. Some key points to consider when implementing a high-protein diet for ESRD patients on dialysis include:
- Maintaining a daily dietary protein intake of 1.0 to 1.2 g/kg to offset catabolism and negative nitrogen balance 1
- Ensuring the protein is of high biological value, containing all essential amino acids
- Monitoring and potentially limiting phosphorus, potassium, sodium, and fluid intake based on individual lab values and clinical status
- Regular nutritional assessment by a renal dietitian to adjust dietary recommendations according to changing clinical needs and laboratory parameters. It's also important to note that clinical trial evidence has not supported restricting dietary protein intake to lower levels to improve kidney or other clinical outcomes 1. In contrast to earlier stages of kidney disease where protein restriction is often advised, dialysis patients require more protein due to the dialysis process itself removing protein from the blood, putting them at risk for protein-energy malnutrition 1. Without adequate protein intake, dialysis patients may experience muscle wasting, decreased immune function, and poor wound healing. Therefore, a high-protein diet is essential for maintaining the overall health and well-being of ESRD patients on dialysis.
From the Research
Protein Requirements for ESRD Dialysis Patients
- The protein requirements for patients with end-stage renal disease (ESRD) are similar to those of healthy subjects 2.
- Elevated protein catabolism and protein malnutrition are common in patients with ESRD, and can be prevented and substantially reversed with proper management 3.
- A low protein diet may be beneficial for ESRD patients, as it can ameliorate uremic symptoms and some of its metabolic complications, and possibly slow the rate of progression of renal failure 2.
Dietary Protein Source and Phosphorus Levels
- Patients who primarily consume a plant-based diet tend to have lower levels of dietary protein and phosphorus compared to those who mainly consume an animal-based diet 4.
- Consuming more plant-based protein as part of a varied diet could be nutritionally adequate while limiting intake of absorbable dietary phosphorus 4.
- The levels of dietary protein and phosphorus were significantly lower in patients who primarily consumed a plant-based diet than in those who mainly consumed an animal-based diet 4.
Management of ESRD
- Patients with ESRD should be monitored for signs of protein-energy wasting and malnutrition 5.
- Controlling blood pressure in patients receiving dialysis improves mortality, and volume control through adequate dialysis and sodium restriction can help optimize hypertension treatment in these patients 5.
- Insulin is the preferred treatment for patients with ESRD and diabetes mellitus requiring medication 5.
- A palliative approach to ESRD is a reasonable alternative to dialysis, particularly for individuals with limited life expectancy, with severe comorbid conditions, or who wish to avoid medical interventions 5.