National Kidney Foundation Releases Nutrition Guidelines for Dialysis Patients

Washington, DC
May 1 , 1999

In an effort to improve the survival rate of dialysis patients in the U.S., the National Kidney Foundation (NKF) today announced preliminary results of a workgroup convened to develop nutrition guidelines for both adults and children receiving chronic dialysis treatment. A draft of the guidelines was presented at the foundation's annual clinical nephrology meetings, held here. NKF plans to release the guidelines for public review in late summer.

Says Joel Kopple, MD, NKF President and chairman of the nutrition workgroup for NKF's Dialysis Outcomes Quality Initiative, "Malnutrition is a high predictor of mortality in maintenance dialysis patients. We anticipate that the publication of these guidelines will lead to an improvement in the nutritional status of dialysis patients and hopefully, boost their overall health, quality of life and survival rates."

Key highlights of the nutrition guidelines focus on dietary protein and energy requirements and methods of nutritional assessment. The following are the recommendations for protein and energy intake:

  • Optimal protein intake for maintenance adult hemodialysis patients is 1.2 grams per kilogram body weight per day. Children on hemodialysis should have their initial dietary protein intake based on the RDA for their age and an additional increment.

  • Optimal protein intake for chronic peritoneal dialysis patients is 1.3 gram per kilogram body weight per day. Optimal intake for children is based on the RDA and an additional 0.7-0.8 grams of protein per kilogram per day.

  • Optimal energy intake, or energy from fat and carbohydrates, for adult dialysis patients 60 years old or less is 35 kilocalories per kilogram per day. For patients over age 60, optimal intake is 30- 35 kilocalories per kilogram per day. Intake of calories from peritoneal dialysis fluid should be taken into account when considering total energy intake for those patients. Energy intake in children on both hemodialysis and peritoneal dialysis should initially be prescribed at the RDA level for chronological age. Later modifications can be made depending upon the child's response.

In terms of measuring nutritional status, the NKF recommends the following tools for use in adult dialysis patients:

  • Normalized Protein Equivalent of Nitrogen Appearance (nPNA), which is a measure derived from the daily net generation of urea and is normalized to the body weight,

  • Serum Albumin and Serum Prealbumin, which measure protein in the blood,

  • Subjective Global Assessment, which is a set of observations based on a patient's symptoms and physical examination,

  • Anthropometry, a measure of skinfold thickness and other aspects of body composition,

  • and Dual X-Ray Absorptiometry (DXA), an x-ray technique measuring the components of body mass.

The pediatric guidelines also cover nutritional supplements for children who are not growing normally due to kidney failure, vitamin and mineral requirements, performance of appropriate nutritional measurements, nutrition for hospitalized children on dialysis and evaluation for human growth hormone.

The NKF-DOQI nutrition guidelines are funded by an unrestricted grant from Sigma-Tau Pharmaceuticals, Inc, the worldwide leader in carnitine and metabolic research.

The National Kidney Foundation is dedicated to preventing kidney and urinary tract diseases, improving the health and well-being of individuals and families affected by these diseases and increasing the availability of all organs for transplantation. To obtain copies of the draft guidelines, which will be available for public review in late summer, call (800) 622-9010 x126.