Effects of dietary protein restriction on nutritional status of hemodialysis patients

Abstract

Background: Protein catabolism increases during hemodialysis, yet research on low protein intake among hemodialysis patients remains limited compared to non-dialysis chronic kidney disease (CKD) populations.

Objective: To investigate the prevalence of dietary protein restriction practices among hemodialysis patients and evaluate their effect on nutritional status.

Methods: A descriptive exploratory study was conducted among 150 hemodialysis patients purposively sampled at one of the largest dialysis centers in Kathmandu district, Nepal. Anthropometric, biochemical, clinical, and dietary (ABCD) assessments were used. Structured questionnaires captured nutritional status, dietary patterns (24-hour recall, food frequency), and dietician consultation history. Height/weight were measured with a wooden height scale and mechanical weighing machine. Pre-dialysis blood samples were analyzed for serum albumin, urea, uric acid, total protein, and creatinine. Data were analyzed using SPSS version 25.

Results: Among 150 patients, 63.3% were male, 71.3% had undergone hemodialysis for 1–5 years, and 82.7% received in-center hemodialysis twice weekly. Based on serum albumin, 66.7% had protein-energy malnutrition (PEM), and 3.3% were classified as underweight by BMI. Low protein intake was attributed to dislike of protein-rich foods, financial constraints, and lack of awareness.

Conclusion: Protein restriction was associated with malnutrition in a substantial proportion of hemodialysis patients. Regular dietician consultation, individualized protein requirements by CKD stage, and consistent multidisciplinary follow-up are recommended.