An International Expert Consensus Statement and Guidance Document on Implementation of Nutritional Supplementation in Patients on Dialysis.

INTRODUCTION

Although some international guidelines suggest treatment of protein-energy wasting (PEW) in patients receiving dialysis with oral or parenteral nutritional supplementation, there is a current lack of practical guidance on their implementation. This document, developed by an international expert group, aims to bridge this gap by providing evidence- and consensus-based statements for clinicians on the practical implementation of clinical nutrition in patients on dialysis.

METHODS

A globally diverse group consisting of 8 nephrologists and 3 dietitians developed this guidance document on oral nutritional supplementation (ONS) and intradialytic parenteral nutrition (PN; IDPN) in patients receiving dialysis. The group started with 46 statements, which were drawn up before 2 parallel on-site meetings in Kuala Lumpur and Frankfurt/Main in November 2024. These statements were discussed there, and after another round of anonymous review, were put up for anonymous voting, reaching a final stage of consensus statements using the method outlined by the European Society for Clinical Nutrition and Metabolism for informed best clinical practice.

RESULTS

Altogether, the 20 consensus statements and 34 practice points provide concise guidance to implement and execute nutritional support in patients receiving maintenance dialysis across clinical settings and national health care systems. The rationales for each statement outline the current evidence, interpret it in light of expert experience, and incorporate information gained from the authors' clinical practice.

CONCLUSION

Providing clinical nutrition to patients on dialysis requires a structured approach. Screening and regular nutritional assessment of all patients are the basis of this approach. The oral nutritional support strategy needs to consider patient preferences and may require renal-specific formulas. For patients with PEW, IDPN is a reliable nutritional support option that may be used in selected patients to supplement the oral diet or used in combination with ONS to help meet their nutritional requirements.