关键词: 维持性血液透析；透析中进食；蛋白质能量消耗；症状性低血压；低血糖

Abstract: Objective: To construct a standardized intradialytic meal management program for maintenance hemodialysis patients and evaluate its effects, to make eating during dialysis a standard and scientific practice of care. Methods: Based on literature search, and pilot-study, the standardized intradialytic meal management program was established. From September 2021 to March 2022, patients in three tertiary hospitals in Beijing who didn't eat during dialysis were enrolled. The intervention group received the 12-week standardized intradialytic meal management program, while the control group remained not eating during dialysis. The feasibility of the program was evaluated with enrollment and retention rates. The incidence of adverse events during dialysis, urea clearance index (Kt/V), serum albumin and the Malnutrition-Inflammation score (MIS) were compared between the two groups. Results: A total of 78 patients were randomized to the intervention group (n=40) and control group (n=38). The enrollment rate of the program was 89.7%; the retention rates of the intervention group and the control group were 85.0% and 81.6%, respectively. Differences of adverse events during dialysis and the incidence of Kt/V<1.2 were not statistically significant between the two groups (P>0.05). The incidence of hypoglycemia in the intervention group was lower than that in the control group (P<0.001). There were no significant differences in serum albumin level between the two groups (P>0.05). Among the subgroups with a baseline albumin level less than 40 g/L, the incidence of MIS<5 was significantly higher in the intervention group than that in the control group (P<0.05). Conclusion: The standardized intradialytic meal management program is feasible to control eating-related risks during dialysis, reduce the occurrence of hypoglycemia, and improve the nutritional status of patients with hypoalbuminemia.

Key words: maintenance hemodialysis; eating during dialysis; protein-energy wasting; symptomatic hypotension; hypoglycemia