Effect of Intradialytic Dietary Support on Nutritional Status, Muscle Strength, and Clinical Markers in Patients on Hemodialysis: a Cross-Sectional Study

Abstract

Background Intradialytic nutritional support influences nutritional status, muscle strength, and related clinical outcomes in patients undergoing hemodialysis (HD). This study aims to compare the effects of intradialytic nutrition on patient outcomes, malnutrition and sarcopenia risks, and handgrip strength (HGS) in HD patients. Methods A cross-sectional study was conducted involving 129 HD patients (62 receiving intradialytic nutritional support and 67 not) from two HD centers located in the same geographic region. Nutritional status was assessed using the MNA-SF, while physical performance was evaluated with SARC-F and HGS. Biochemical markers, including serum albumin, phosphorus, potassium, and hemoglobin (Hb) levels, were measured. Results The group receiving intradialytic nutritional support had significantly higher serum albumin (4.0 [3.7-4.2] g/dL vs. 3.5 [3.2-3.7] g/dL; p < 0.001, respectively) and potassium levels (5.6 [5.1-6.2] mmol/L vs. 5.0 [4.7-5.4] mmol/L; p < 0.001, respectively) compared to the group not receiving support. Phosphorus levels were similar between the two groups (4.8 [3.8-6.1] mg/dL vs. 5.3 [4.5-5.2] mg/dL; p = 0.059, respectively). The nutritional support group had lower Hb levels (10.9 +/- 1.7 g/dL vs. 11.8 +/- 2.0 g/dL; p = 0.008, respectively) and required higher doses of erythropoiesis-stimulating agents (32.0 [24.0-48.0] IU/monthx10(3) vs. 24.0 [18.0-33.0] IU/monthx10(3); p = 0.046, respectively). No significant differences were observed between the groups for MNA-SF and SARC-F scores (13.0 [12.0-14.0] vs. 14.0 [12.0-14.0]; p = 0.608, 5.0 [3.0-7.0] vs. 4.0 [2.0-6.0]; p = 0.053, respectively). The number of patients below the HGS cut-off (27/16 kg) was significantly lower in the nutritional support group (25 [40.3%] vs. 40 [59.7%]; p = 0.028, respectively), and the difference between groups was more pronounced in male patients in terms of median handgrip strength values. The nutritional support group had a higher rate of receiving social financial assistance (45 [72.6%] vs. 37 [55.2%]; p = 0.041) and a higher weekly protein intake. Conclusion Intradialytic nutritional support was associated with higher serum albumin levels and handgrip strength, with the latter being more prominent among male patients. However, potassium levels were found to be higher in the nutritional support group, which may present a clinical concern and warrants further monitoring. No significant differences were observed in malnutrition or sarcopenia risk. These findings highlight the potential benefits and limitations of intradialytic nutritional interventions and provide a basis for future prospective studies.