#655 Warm meal after a haemodialysis session saves the day (and lives?)
Authors: Durlen Ivan , Babic Petar , Crnkovic Ivana Bedalov , Pohly Nicola , Strizić Ana , Crnogorac Matija , Horvatic Ivica 
Published: May 2024

Abstract

Background and Aims
The haemodialysis (HD) process leads to chronic nutrient deficiency, particularly of proteins and amino acids. About 6-12 grams of amino acids loss and 7-8 grams of protein loss occurring during each dialysis session may contribute to hypoalbuminemia, a strong predictor of malnutrition and mortality [1]. Optimal dietary protein intake (DPI) may replenish low plasma amino acids, but DPI inadequacy is a common issue in HD patients, as well as malnutrition due to comorbidities. COVID-19 has made dramatic changes in dialysis centers’ procedures, including the transition from warm meals to cold sandwiches for patients to eat after the session. After the end of COVID-19 pandemic warm meals (meat dish included) were reintroduced. Our aim was to quantify the effect of one to three warm meals per week after the HD session (depending on the regime) on the patients’ protein status.

Method
Data of 68 patients (24 females and 44 males) on chronic HD were collected after signing the ICF consisting of total protein and albumin values measured two months apart. The first measurement was done while patients were on the long-term sandwich diet after every HD session. The second measurement was done 45 days after the warm meal diet was initiated after every session. Serum total protein and serum albumin were measured, with normal intervals for total serum protein and albumin being 66–81 g/L and 45–51 g/L respectively. The values were compared using Wilcoxon signed-rank test.

Results
The average albumin value with dry food was 35.9 g/L and for total protein 63.6 g/L, with just 6 patients having normal albumin levels (8.8%) and 21 patients having normal total protein levels (30.9%). The average albumin value after 45 days of HD with warm meals was 39.8 g/L and 66.6 g/L for total protein, with 28 patients having normal albumin levels (41.2%) and 36 patients having normal total protein levels (52.9%). This marks an increase of 4.7% in average value of total protein (3 g/L) and statistically significant increase in albumin value of 10.8% (3.9 g/L, p &lt; 0.001). Greater number of patients had normal total protein and albumin values (4.7 times more patients had a normal albumin level after the initiation of warm meals, and 1.7 times more patients had normal total protein levels). There is a difference regarding male and female patients with a greater impact on males. Male patients had an average total proteins value increase of 5.3% (3.37 g/L) while female patients had 3.5% (2.29 g/L). There was a statistically significant increase in albumin value both for male (p &lt; 0.001) and female patients (p = 0.002). In male patients the average increase was 12% (4.33 g/L), while in female patients it was 8.5% (3.04 g/L). After the introduction of warm meals, 50% of male patients had normal albumin values (vs. 9% before), while 25% of female patients reached normal albumin values (vs. 8.3% before).

Conclusion
Patients on chronic HD suffer from malnutrition which could lead to significantly higher mortality. Adequate nutrition is crucial for their wellbeing. This study has shown that having a warm meal (protein based) can lead to an increase of total plasma protein and albumin with a higher impact on male patients. In this way we could increase DPI of HD patients, reduce the chance of malnutrition and reduce the cardiovascular risk and mortality.