Dietary Protein and Physical Activity Interventions to Support Muscle Maintenance in End-Stage Renal Disease Patients on Hemodialysis

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Abstract

End-stage renal disease patients have insufficient renal clearance capacity left to adequately excrete metabolic waste products. Hemodialysis (HD) is often employed to partially replace renal clearance in these patients. However, skeletal muscle mass and strength start to decline at an accelerated rate after initiation of chronic HD therapy. An essential anabolic stimulus to allow muscle maintenance is dietary protein ingestion. Chronic HD patients generally fail to achieve recommended protein intake levels, in particular on dialysis days. Besides a low protein intake on dialysis days, the protein equivalent of a meal is extracted from the circulation during HD. Apart from protein ingestion, physical activity is essential to allow muscle maintenance. Unfortunately, most chronic HD patients have a sedentary lifestyle. Yet, physical activity and nutritional interventions to support muscle maintenance are generally not implemented in routine patient care. To support muscle maintenance in chronic HD patients, quantity and timing of protein intake should be optimized, in particular throughout dialysis days. Furthermore, implementing physical activity either during or between HD sessions may improve the muscle protein synthetic response to protein ingestion. A well-orchestrated combination of physical activity and nutritional interventions will be instrumental to preserve muscle mass in chronic HD patients.

Original languageEnglish
Article number2972
Number of pages13
JournalNutrients
Volume11
Issue number12
DOIs
Publication statusPublished - Dec 2019

Keywords

  • muscle wasting
  • exercise
  • nutrition
  • kidney disease
  • CHRONIC KIDNEY-DISEASE
  • ORAL NUTRITIONAL SUPPLEMENTATION
  • PATIENTS RECEIVING HEMODIALYSIS
  • RESISTANCE EXERCISE AUGMENTS
  • AMINO-ACID LOSSES
  • QUALITY-OF-LIFE
  • INTERNATIONAL SOCIETY
  • NITROGEN-BALANCE
  • ANABOLIC RESISTANCE
  • CONSENSUS STATEMENT

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