Pilot Study of the Effects of High-Protein Meals During Hemodialysis on Intradialytic Hypotension in Patients Undergoing Maintenance Hemodialysis

Mun Sun Choi, Brandon Kistler, Gretchen N Wiese, Elizabeth R Stremke, Amy J Wright, Ranjani N Moorthi, Sharon M Moe, Kathleen M Hill Gallant

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


OBJECTIVE: Patients undergoing hemodialysis (HD) have high protein and energy requirements, and protein-energy wasting is common and associated with poor outcomes. Eating during dialysis may improve nutritional status by counteracting the catabolic effects of HD treatment; but eating during HD may be discouraged because of concerns of postprandial hypotension. However, little data are available to support this practice. In this study, we hypothesized that high-protein meals during HD do not lead to symptomatic intradialytic hypotension events.

DESIGN: A 9-week, nonrandomized, parallel-arm study.

SETTING: A single in-center HD clinic.

SUBJECTS: Eighteen patients undergoing HD from 2 shifts completed the study. Patients were aged 62 ± 16 years with dialysis vintage of 3.4 ± 2.6 years.

INTERVENTION: Patients in the intervention group (n = 9) undergoing HD received meals of ∼30 g protein and ∼1/3 daily recommended intakes of sodium, potassium, phosphorus, and fluid during dialysis for 25 consecutive HD sessions. The control group (n = 9) completed all aspects of the study including a visit by study personnel but were not given meals. The 25 consecutive sessions before the start of the intervention/control phase were used as a baseline comparison for each patient.

MAIN OUTCOME MEASURE: Symptomatic hypotension event frequency.

RESULTS: In the intervention arm, there were 19 symptomatic hypotension events in 5 patients prestudy and 18 events in 6 patients during the study. In the control arm, there were 16 events in 7 patients prestudy and 13 events in 7 patients during the study. Change in the frequency of symptomatic hypotension events from prestudy to during study was not different between groups (P = .71). There was no effect of meals on nutritional status, but patients reported positive attitudes toward receiving meals during dialysis.

CONCLUSION: High-protein meals during HD did not increase symptomatic hypotension events. Larger, longer term studies are needed to confirm these results and evaluate whether high-protein meals on dialysis benefit nutritional status and clinical outcomes.

Original languageEnglish (US)
Pages (from-to)102-111
Number of pages10
JournalJournal of Renal Nutrition
Issue number2
StatePublished - Mar 2019
Externally publishedYes

Bibliographical note

Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.


  • Aged
  • Blood Pressure
  • Body Weight
  • Dietary Proteins/administration & dosage
  • Female
  • Humans
  • Hypotension/epidemiology
  • Male
  • Meals
  • Middle Aged
  • Nutritional Status
  • Patient Satisfaction
  • Pilot Projects
  • Renal Dialysis
  • Surveys and Questionnaires

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.


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