Introduction:
Protein-energy wasting (PEW) is a factor associated with increased morbidity and mortality in patients undergoing maintenance hemodialysis (MHD). Normalized protein catabolic ratio (nPCR) is often used as a measure of protein intake in MHD patients. This study aimed to estimate the number of patients with low normalized protein catabolic rate (nPCR), identify causes, and assess the effects of dietary counseling on nPCR and dietary intake.
Methods:
End-stage renal disease (ESRD) patients on MHD three times per week at our centre were enrolled. A 7-day diet recall followed by dietary counselling at baseline, and monthly follow-up sessions were conducted. Lab parameters, anthropometric measurements, and quality of life were recorded. The association between low nPCR and Kt/V, biochemical parameters, and dietary protein and calorie intake was analyzed. The Wilcoxon Signed Rank Test was used to note changes between baseline and follow-up nPCR, protein intake, and Subjective Global Assessment (SGA). Pearsons R was used to determine correlation between dialysis adequacy (spKt/V) and nPCR.
Results:
Fifty-three patients (52.83% males and 47.16% females) with a mean age of 54 ± 14 years were included, 40 of whom completed 12 months follow up. At the start, 70% had low nPCR (<0.8) with a mean of 0.6955 ± 0.1787. The correlation between nPCR and Kt/V was significant at the 0.01 level (2-tailed). The change in nPCR from baseline to follow-up after dietary counselling was significant at 12 months (p = 0.013, 95% CI -0.20 to -0.025). The effect of dietary counselling on calorie intake and protein intake at baseline and follow-up was also significant (p < 0.0001, and p < 0.0001, respectively) at 6 and 12 months of follow up. No correlation between low nPCR and CRP or SGA was observed.
Conclusions:
Our study showed a high prevalence of low nPCR in hemodialysis patients, which corresponded to a low dietary protein and caloric intake in most patients. Dietary counselling significantly improved average daily protein intake and nPCR.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.