From the Guidelines
The recommended kilocalorie (kcal) intake for a patient undergoing hemodialysis (HD) is 35 kcal/kg body weight/d.
Rationale for kcal Intake
- The energy requirements for patients on maintenance hemodialysis (MHD) have been studied, and it has been found that a mean energy intake of 35 kcal/kg/d is necessary to maintain neutral nitrogen balance and unchanging body composition 1.
- This recommendation is based on studies that examined dietary energy requirements in MHD patients under metabolic balance conditions, where patients ingested diets providing 25,35, and 45 kcal/kg/d.
- For patients over 60 years of age, a daily energy intake of 30 to 35 kcal/kg/d is acceptable, considering reduced physical activity and lean body mass.
- It is essential to note that these recommendations are similar to those for normal adults of the same age who are engaged in mild daily physical activity, as indicated in the Recommended Dietary Allowances (RDA) 1.
Considerations for kcal Intake During HD Session
- Although the study does not specifically mention kcal intake during a hemodialysis session, the overall daily energy intake recommendation can be applied to guide nutrition counseling for patients undergoing HD.
- It is crucial to consider individual patient needs, taking into account factors such as age, physical activity level, and overall health status when determining the appropriate kcal intake.
From the Research
Kilocalorie Intake During Hemodialysis
- The average dietary energy requirement (DER) for hemodialysis (HD) patients is estimated to be around 31 ± 3 kcal · kg(-1) · d(-1) 2.
- Another study reported an energy intake of 29.5 ± 2.1 kcal/kg/day for HD patients 3.
- A pilot study provided high-protein meals of ∼30 g protein and ∼1/3 daily recommended intakes of sodium, potassium, phosphorus, and fluid during dialysis for 25 consecutive HD sessions 4.
- An older study found that an energy intake of 38.5 kcal/kg desirable weight/day was estimated to maintain neutral nitrogen balance in HD patients 5.
- However, the effect of food intake during HD on haemodynamic stability is still being researched, with one study finding a significant reduction in relative blood volume after food ingestion 6.
Energy Requirements for HD Patients
- The energy requirements for HD patients are similar to those of sedentary normal individuals 2.
- However, there is wide variability in energy requirements among individual HD patients, ranging from 26-36 kcal · kg(-1) · d(-1) 2.
- Inadequate caloric intake (< 35 kcal/kg/day) can lead to a negative nitrogen balance 3.
- An average energy intake of about 38 kcal/kg desirable weight/day may be necessary to maintain nitrogen balance in HD patients 5.