Department of Nutrition and Health Science, Ball State University, Muncie, Indiana.
DaVita Inc., Denver, Colorado.
J Ren Nutr. 2018 Jan;28(1):4-12. doi: 10.1053/j.jrn.2017.10.003.
Poor nutritional status and protein-energy wasting are common among maintenance dialysis patients and associated with unfavorable outcomes. Providing foods, meal trays, snack boxes, and/or oral nutritional supplements during hemodialysis can improve nutritional status and might also reduce inflammation, enhance health-related quality of life, boost patient satisfaction, and improve survival. Potential challenges include postprandial hypotension and other hemodynamic instabilities, aspiration risk, gastrointestinal symptoms, hygiene issues, staff burden, reduced solute removal, and increased costs. Differing in-center nutrition policies exist within organizations and countries around the world. Recent studies have demonstrated clinical benefits and highlight the need to work toward clear guidelines. Meals or supplements during hemodialysis may be an effective strategy to improve nutritional status with limited reports of complications in real-world scenarios. Whereas larger multicenter randomized trials are needed, meals and supplements during hemodialysis should be considered as a part of the standard-of-care practice for patients without contraindications.
维持性透析患者普遍存在营养状况不佳和蛋白质能量消耗，与不良预后相关。在血液透析期间提供食物、餐盒、零食盒和/或口服营养补充剂可以改善营养状况，还可能减轻炎症、提高健康相关生活质量、提高患者满意度和改善生存率。潜在挑战包括餐后低血压和其他血流动力学不稳定、误吸风险、胃肠道症状、卫生问题、工作人员负担、溶质清除减少和成本增加。世界各地的组织和国家在中心内营养政策上存在差异。最近的研究表明了其临床获益，并强调需要制定明确的指南。血液透析期间的膳食或补充剂可能是改善营养状况的有效策略，在真实场景中报告的并发症有限。虽然需要更大规模的多中心随机试验，但对于没有禁忌症的患者，应考虑将血液透析期间的膳食和补充剂作为标准治疗的一部分。
