Nutrition and Chronic Kidney Disease

Denis Fouque; Solenne Pelletier; Denise Mafra; Philippe Chauveau

Disclosures

Kidney Int. 2011;80(4):348-357. 

In This Article

Will Protein Requirements Change in the Future? The Importance of Dialysis Membranes and Techniques

Dialysis membranes and techniques have dramatically evolved. High-flux membranes tend to clear solutes more rapidly and efficiently, in an attempt to reduce dialysis time. Hemofiltration techniques, including hemodiafiltration (pre- or postdilution) are designed to better remove middle molecules. However, a number of nutrients such as amino acids, vitamins, and trace elements may also be lost to a greater extent with these recent highly efficient techniques, and limited research is available to date to document this question.

For example, a polysulfone superflux dialyzer has been shown to induce an albumin loss of approximately 2.5 g per session during standard hemodialysis condition. When this filter is used during predilution hemodiafiltration, albumin loss is about 8 g per session, and during postdilution hemodiafiltration, albumin loss reaches 25 g per session.[84] Such an important albumin loss is hardly compatible with a balanced protein metabolism and cannot be restored by food intake. In a previous randomized control trial on high-flux dialyzer and anemia control,[85] 74 patients were allocated to two different membranes, a high-flux polymethyl methacrylate membrane and a low-flux cellulose one. After a 3-month follow-up, when looking at nutritional parameters, there was a significant decrease in serum albumin from 3.88±0.55 to 3.64±0.55 g/dl and in serum creatinine from 10.3±2.0 to 9.4±2.9 mg/dl in the high-flux membrane group, whereas dialysis dose did not change, which could be viewed as deleterious on a nutritional point of view.[85] In another study comparing predilution hemodiafiltration with a high-flux polysulfone dialyzer vs standard hemodialysis with a low-flux membrane, Beerenhout et al.[86] observed a gain of 1.4 kg of muscle mass at 1 year in the hemodialfiltration group vs 1.2 kg in the hemodialysis group (P<0.05), whereas there was no other nutritional or body composition change. Thus, data are lacking to predict if these emerging dialysis techniques will improve or may be at risk for patients' nutritional status. Further research should be encouraged.

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