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Protein intake in maintenance hemodialysis patients

Wajeh Y Qunibi, MD
William L Henrich, MD, MACP
Section Editor
Steve J Schwab, MD
Deputy Editor
Alice M Sheridan, MD


Protein intake may be inadequate in hemodialysis patients [1]. The hemodialysis procedure itself may adversely affect nutritional status by causing amino acid and albumin losses and by increasing protein catabolism via inflammation [2].

Low dietary protein intake may be associated with increased risk of death among hemodialysis patients [3-5]. Some studies suggest that protein intake itself is an independent predictor of outcome [3,6]. Therefore, it is important to monitor protein intake, along with other measures of nutrition among these patients.

It is difficult to directly measure protein intake. A method that is commonly used to estimate protein intake is to measure the rate of increase in serum urea nitrogen levels between two hemodialysis treatments. This indirect marker of protein intake is referred to as the protein equivalent of nitrogen appearance (PNA) or protein catabolic rate (PCR). The PCR is used to assess dietary protein intake in dialysis patients.

This topic reviews the use of the PCR for the estimation of protein intake and recommendations for optimal protein intake for dialysis patients.

The assessment of overall nutritional status and treatment of malnutrition among hemodialysis patients is discussed elsewhere. (See "Assessment of nutritional status in hemodialysis patients" and "Pathogenesis and treatment of malnutrition in maintenance hemodialysis patients".)

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Literature review current through: Nov 2017. | This topic last updated: Nov 17, 2016.
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