OPTIMIZING INTRADIALYTIC NUTRITIONAL INTAKE: A SYSTEMATIC REVIEW OF SAFETY AND CLINICAL EFFECTS DURING HEMODIALYSIS
DOI:
https://doi.org/10.24269/ijhs.v9i2.12150Abstract
Hemodialysis is an essential therapy for patients with end-stage kidney disease; however, it is often accompanied by the risk of malnutrition, which contributes to reduced quality of life and increased mortality. Intradialytic eating (IDE) has the potential to offer clinical benefits for hemodialysis patients, but its practice remains controversial, particularly regarding safety and possible clinical outcomes. This study aims to evaluate the safety and clinical impact of IDE through a systematic review of the available scientific evidence. A comprehensive literature search was conducted using PubMed, Cochrane CENTRAL, ScienceDirect, EBSCO, and Scopus databases. Studies were selected based on relevance to the PICO framework. A total of 9,142 articles were identified, and after data screening and extraction, eight studies met the inclusion criteria. The findings suggest that intradialytic eating (IDE) has the potential to improve nutritional status and quality of life in hemodialysis patients at risk of malnutrition, although it still carries the risk of hypotension and blood pressure instability. Safe and effective implementation of IDE requires careful patient selection based on hemodynamic stability, provision of high-protein and low-electrolyte foods, administration during the mid-to-late phase of dialysis, and close clinical monitoring. Multidisciplinary team involvement and supportive health service policies are crucial for the long-term success of IDE practices.
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References
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[20] M. S. Gharib, M. S. Nazeih, and T. W. El Said, “Effect of intradialytic oral nutritional supplementation on nutritional markers in malnourished chronic hemodialysis patients: prospective randomized trial,†BMC Nephrol, vol. 24, no. 1, Dec. 2023, doi: 10.1186/S12882-023-03181-7.
[21] P. G. M. Semadhi, I. G. R. Widiana, K. T. P. Merati, and C. I. Y. K. Kumbara, “Blood Pressure Variation and Complication of End Stage Renal Disease Patients Undergoing Hemodialysis in RSUP Sanglah Denpasar | Jurnal Harian Regional,†JURNAL MEDIKA UDAYANA, vol. 12, no. 2, pp. 1–10, Feb. 2023, Accessed: Jul. 14, 2025. [Online]. Available: https://jurnal.harianregional.com/eum/full-80212
[22] S. Chaara, P. Rootjes, G. Wijngaarden, M. Nubé, C. de Roij van Zuijdewijn, and M. Grooteman, “#2812 Continuous blood pressure monitoring with a finger cuff is unreliable in chronic hemodialysis patients,†Nephrology Dialysis Transplantation, vol. 39, no. Supplement_1, May 2024, doi: 10.1093/NDT/GFAE069.757.
[23] D. De Backer et al., “How can assessing hemodynamics help to assess volume status?,†Intensive Care Med, vol. 48, no. 10, pp. 1482–1494, Oct. 2022, doi: 10.1007/S00134-022-06808-9/METRICS.
[2] B. M. Kistler et al., “Eating During Hemodialysis Treatment: A Consensus Statement From the International Society of Renal Nutrition and Metabolism,†Journal of Renal Nutrition, vol. 28, no. 1, pp. 4–12, Jan. 2018, doi: 10.1053/J.JRN.2017.10.003/ASSET/53528241-FC86-443E-9248-AC5874D33080/MAIN.ASSETS/GR3.JPG.
[3] K. Kalantar-Zadeh et al., “Transition of care from pre-dialysis prelude to renal replacement therapy: The blueprints of emerging research in advanced chronic kidney disease,†Nephrology Dialysis Transplantation, vol. 32, no. suppl_2, pp. ii91–ii98, Apr. 2017, doi: 10.1093/NDT/GFW357,.
[4] J. J. Carrero, J. Burrowes, and C. Wanner, “A Long Road to Travel: Adherence to Dietary Recommendations and Adequate Dietary Phosphorus Control,†Journal of Renal Nutrition, vol. 26, no. 3, pp. 133–135, May 2016, doi: 10.1053/j.jrn.2016.03.004.
[5] L. I. Hong, W. Wang, E. Y. Chan, F. Mohamed, and H. C. Chen, “Dietary and fluid restriction perceptions of patients undergoing haemodialysis: an exploratory study,†J Clin Nurs, vol. 26, no. 21–22, pp. 3664–3676, Nov. 2017, doi: 10.1111/JOCN.13739.
[6] S. Ramos-Acevedo et al., “SURVEY ON THE PERCEPTION OF HEALTH PROFESSIONALS ON THE USE OF INTRADIALYTIC ORAL NUTRITION IN PATIENTS UNDER HEMODIALYSIS,†Rev Invest Clin, vol. 71, no. 4, pp. 255–264, Jul. 2019, doi: 10.24875/RIC.19002947.
[7] M. S. Choi et al., “Pilot Study of the Effects of High-Protein Meals During Hemodialysis on Intradialytic Hypotension in Patients Undergoing Maintenance Hemodialysis,†J Ren Nutr, vol. 29, no. 2, pp. 102–111, Mar. 2019, doi: 10.1053/J.JRN.2018.06.002.
[8] Y. A. Elkeraie, E. K. Amine, Y. S. Naga, and D. T. Mohamed, “Intradialytic Feeding Practice and Nutritional Status of Maintenance Hemodialysis Patients in Alexandria, Egypt,†Journal of High Institute of Public Health, vol. 53, no. 2, pp. 82–89, Aug. 2023, doi: 10.21608/JHIPH.2023.336230.
[9] M. Avci and F. Arikan, “The effect of food intake during hemodialysis on blood pressure: A nonrandomized experimental trial,†Therapeutic Apheresis and Dialysis, vol. 27, no. 4, pp. 661–668, Aug. 2023, doi: 10.1111/1744-9987.13967.
[10] S. Goyal, A. Bhat, and S. Kumar, “The effect of intradialytic food intake on hemodialysis adequacy and blood pressure; a quasi-experimental study,†J Nephropathol, vol. 13, no. 3, pp. e21460–e21460, Sep. 2023, doi: 10.34172/JNP.2023.21460.
[11] M. Badrasawi, M. Hamdan, T. Al-Jondi, A. Al-Jondi, E. dweik, and T. Joubeh, “The relationship between eating during hemodialysis session and dialysis adequacy, intradialytic hypotension biochemical indices and nutritional status, a cross sectional Palestinian study,†Clin Nutr ESPEN, vol. 58, pp. 734–735, Dec. 2023, doi: 10.1016/j.clnesp.2023.09.877.
[12] E. Fotiadou et al., “Feeding during Dialysis Increases Intradialytic Blood Pressure Variability and Reduces Dialysis Adequacy,†Nutrients 2022, Vol. 14, Page 1357, vol. 14, no. 7, p. 1357, Mar. 2022, doi: 10.3390/NU14071357.
[13] C. M. Rhee et al., “Effect of high-protein meals during hemodialysis combined with lanthanum carbonate in hypoalbuminemic dialysis patients: Findings from the FrEDI randomized controlled trial,†Nephrology Dialysis Transplantation, vol. 32, no. 7, pp. 1233–1243, Jul. 2017, doi: 10.1093/ndt/gfw323.
[14] C. Caetano, A. Valente, F. J. Silva, J. Antunes, and C. Garagarza, “Effect of an intradialytic protein-rich meal intake in nutritional and body composition parameters on hemodialysis patients,†Clin Nutr ESPEN, vol. 20, pp. 29–33, Aug. 2017, doi: 10.1016/J.CLNESP.2017.04.003.
[15] J. Li, G. Hou, X. Sun, A. Chen, and Y. Chai, “A Low-Cost, Intradialytic, Protein-Rich Meal Improves the Nutritional Status in Chinese Hemodialysis Patients,†Journal of Renal Nutrition, vol. 30, no. 2, pp. e27–e34, Mar. 2020, doi: 10.1053/j.jrn.2019.03.084.
[16] M. Ayala, M. Marchant, C. Hertz, and G. Castillo, “Intradialytic nutrition and quality of life in Chilean older patients in hemodialysis with protein-energy wasting,†Int Urol Nephrol, vol. 54, no. 8, pp. 1947–1955, Aug. 2022, doi: 10.1007/S11255-021-03077-1.
[17] N. S. Rao, A. Chandra, S. Saran, M. R. Kulshreshta, P. Mishra, and P. Tiwari, “Predialytic versus Intradialytic Nutrition: A Study to Assess Effects on Intradialytic Blood Pressure, Dialysis Adequacy, and Urea Removal,†Blood Purif, vol. 50, no. 6, pp. 823–828, Sep. 2021, doi: 10.1159/000512540,.
[18] S. López-Cisneros et al., “Does intradialytic oral nutrition impact hemodialysis patients’ quality of life, appetite, and safety? A pilot study of a crossover clinical trial,†Nutr Hosp, vol. 41, no. 2, pp. 315–325, Mar. 2024, doi: 10.20960/NH.04703.
[19] M. Ayala, M. Marchant, C. Hertz, and G. Castillo, “Intradialytic nutrition and quality of life in Chilean older patients in hemodialysis with protein-energy wasting,†Int Urol Nephrol, vol. 54, no. 8, pp. 1947–1955, Aug. 2022, doi: 10.1007/S11255-021-03077-1/FIGURES/2.
[20] M. S. Gharib, M. S. Nazeih, and T. W. El Said, “Effect of intradialytic oral nutritional supplementation on nutritional markers in malnourished chronic hemodialysis patients: prospective randomized trial,†BMC Nephrol, vol. 24, no. 1, Dec. 2023, doi: 10.1186/S12882-023-03181-7.
[21] P. G. M. Semadhi, I. G. R. Widiana, K. T. P. Merati, and C. I. Y. K. Kumbara, “Blood Pressure Variation and Complication of End Stage Renal Disease Patients Undergoing Hemodialysis in RSUP Sanglah Denpasar | Jurnal Harian Regional,†JURNAL MEDIKA UDAYANA, vol. 12, no. 2, pp. 1–10, Feb. 2023, Accessed: Jul. 14, 2025. [Online]. Available: https://jurnal.harianregional.com/eum/full-80212
[22] S. Chaara, P. Rootjes, G. Wijngaarden, M. Nubé, C. de Roij van Zuijdewijn, and M. Grooteman, “#2812 Continuous blood pressure monitoring with a finger cuff is unreliable in chronic hemodialysis patients,†Nephrology Dialysis Transplantation, vol. 39, no. Supplement_1, May 2024, doi: 10.1093/NDT/GFAE069.757.
[23] D. De Backer et al., “How can assessing hemodynamics help to assess volume status?,†Intensive Care Med, vol. 48, no. 10, pp. 1482–1494, Oct. 2022, doi: 10.1007/S00134-022-06808-9/METRICS.
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