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      The Obsession with High Dietary Protein Intake in ESRD Patients on Dialysis: Is It Justified?

      Nephron

      S. Karger AG

      Protein catabolism, Dietary protein intake, Dialysis, Nitrogen balance

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          Abstract

          Background: The belief that dialysis patients require a much higher intake of protein than the average person is widely held among nephrologists and a recent editorial review on the care of patients undergoing hemodialysis advised a protein intake of at least 1.5 g/kg/day in this population. In theory, the requirements for daily protein intake of dialysis patients should be the same as normals plus whatever extra obligatory nitrogen losses are imposed by the dialytic process. Since the average loss of protein and/or amino acids is about 8 g/day in peritoneal dialysis and 8 g per session in hemodialysis patients, the daily intake of protein in dialysis patients needs to be increased only by this small magnitude. Methods: All the literature reporting on nitrogen balance data on different protein intakes in chronic maintenance dialysis patients was reviewed and analyzed. Results: There were 3 balance studies adressing this issue in hemodialysis patients and 6 in peritoneal dialysis patients. These data show that dialysis patients are in nitrogen balance even with a protein intake as low as 0.7 g/kg/day. Conclusions: The nitrogen balance data confirm that in stable dialysis patients a safe requirement of protein intake is about 1 g/kg/day and attempts at increasing protein intake beyond this value are not warranted. The persistent recommendation of a high dietary intake of protein for dialysis patients may reflect the influence of two other issues: the belief that dialysis is a catabolic event, and the data showing an inverse correlation between protein intake and outcome.

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          Most cited references 2

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          Care of patients undergoing hemodialysis.

           O Ifudu (1998)
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            Protein Catabolic Rate May Underestimate Dietary Protein Intake in Hemodialysis Patients

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              Author and article information

              Journal
              NEF
              Nephron
              10.1159/issn.1660-8151
              Nephron
              S. Karger AG
              1660-8151
              2235-3186
              2000
              October 2000
              22 September 2000
              : 86
              : 2
              : 105-108
              Affiliations
              Department of Medicine, Mount Sinai School of Medicine, New York, N.Y., USA
              Article
              45726 Nephron 2000;86:105–108
              10.1159/000045726
              11014977
              © 2000 S. Karger AG, Basel

              Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

              Page count
              References: 26, Pages: 4
              Product
              Self URI (application/pdf): https://www.karger.com/Article/Pdf/45726
              Categories
              Controversies in Nephrology<br>Section Editor: M.S. Oh, Brooklyn, N.Y.

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