Nutrition Support in Hemodialysis and Peritoneal Dialysis

Protein-energy wasting (PEW) is common among patients undergoing maintenance dialysis, and many signs of PEW can be improved with nutrition support therapy. Early and regular nutrition counseling by registered dietitian (or international equivalent) is essential for the prevention and treatment of PEW in maintenance dialysis patients. When nutrition counseling alone is unable to bridge the gap between protein-energy intake and the target requirements, oral nutritional supplements (ONS) should be prescribed to improve nutritional status. When maintenance dialysis patients with PEW are unable to meet protein and energy requirements with nutrition counseling and ONS, enteral tube feeding should be considered. Intradialytic parenteral nutrition (IDPN) should only be used as supplemental nutrition in hemodialysis patients with PEW, and adequate spontaneous protein and energy intakes are required to compensate for the difference between those provided by IDPN and the target requirements. Intradialytic amino acid therapy remains a viable option for protein-energy wasted peritoneal dialysis patients with insufficient dietary intake, as well as those with tolerance, compliance, and suitability issues of oral intake and other forms of enteral supplementation.