Intradialytic nutritional intake and adherence perspective of a national and continuous meal model in a large hemodialysis patient cohort.

BACKGROUND AND AIMS: Intradialytic (ID) oral nutritional support is recommended as part of comprehensive nutritional care for patients on maintenance hemodialysis (HD). Evidence on food-based, patient-centered, coherent and consistent approaches implemented at national scale is scarce. This study aimed to characterize the nutritional profile of a structured, autonomy-based ID meal model across a national HD clinics; to assess the differences in intradialytic nutritional intake between patients stratified by malnutrition-inflammation risk (MIS <6 vs. MIS ≥6) and by diabetes status; and to identify independent predictors of nutritional goal attainment and of intradialytic energy and protein intake.

METHODS

Cross-sectional nationwide analysis of 3032 HD patients from 27 outpatient clinics. The ID meal chosen during the mid-week session was recorded and quantified. Group comparisons used the Chi-square test and Mann-Whitney U test. Binary logistic regression identified independent predictors of nutritional goal attainment ≥300 kcal and ≥7 g protein per session. Multiple linear regression examined predictors of energy and protein intake, adjusting for age, sex, diabetes status, Charlson Comorbidity Index (CCI), HD vintage and body mass index (BMI).

RESULTS

Meal adherence was 97%. Sixty-six percent of patients attained the dual nutritional goal; median intake was 358 kcal, 12.7 g protein and 4.2 g fiber. Energy and protein intake were equivalent between MIS subgroups (p = 0.883 and p = 0.193). Diabetic patients consumed lower energy and carbohydrate, but equivalent protein compared with non-diabetic patients (p = 0.207). In logistic regression, older age (adjusted OR 0.808 per 10-year increment, 95% CI 0.763-0.856, p < 0.001) and shorter HD vintage (adjusted OR 1.024 per 12 months, 95% CI 1.012-1.048, p < 0.001) were the only independent predictors of goal non-attainment; diabetes and MIS ≥6 were not (p = 0.378 and p = 0.453 respectively). In linear regression, age and HD vintage were the only significant predictors of both energy (R2 = 2.2%) and protein intake (R2 = 1.0%); diabetes was not independently associated with either.

CONCLUSIONS

A structured, food-based, patient-centered intradialytic meal model, sustained by systematic education and monthly reassessment, delivers high adherence and nutritionally adequate macronutrient intake across a clinically heterogeneous HD population. Within the constraints of a cross-sectional design, these findings support the feasibility and nutritional appropriateness of a structured, food-based intradialytic meal model across clinically heterogeneous patient groups. Whether this translates into improved clinical outcomes requires longitudinal evaluation. The model should be considered as a component of a comprehensive nutritional strategy, complemented by individualzed counselling and regular re-assessment. In patients at high risk of malnutrition and diabetes, promoting autonomy in choosing the contents of the intra-dialytic meal appears to be safe and suitable for these patients' needs. Therefore, we believe it should be encouraged and complemented with nutritional education and counseling.