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Abstract: FR-PO445

Effects of Eating Meals During Hemodialysis Treatment on Depressive Symptoms: The FrEDI Randomized Controlled Trial

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Okazaki, Masaki, University of California Irvine, Irvine, California, United States
  • Rhee, Connie, University of California Irvine, Irvine, California, United States
  • Narasaki, Yoko, University of California Irvine, Irvine, California, United States
  • Shen, Jenny I., Harbor-UCLA Medical Center, Torrance, California, United States
  • Dukkipati, Ramanath B., Harbor-UCLA Medical Center, Torrance, California, United States
  • Dai, Tiane, Harbor-UCLA Medical Center, Torrance, California, United States
  • Tong, Lili, Harbor-UCLA Medical Center, Torrance, California, United States
  • Adler, Sharon G., Harbor-UCLA Medical Center, Torrance, California, United States
  • Kopple, Joel D., Harbor-UCLA Medical Center, Torrance, California, United States
  • Kalantar-Zadeh, Kamyar, VA Long Beach Healthcare System, Long Beach, California, United States
Background

Approximately one-third of patients undergoing hemodialysis (HD) suffer from symptoms of depression. HD patients with low serum albumin levels who ingest high- vs. low-protein meals during HD sessions display improved their protein-energy status. We examined whether their depressive symptoms were also alleviated with intradialytic high-protein meals.

Methods

We examined data from participants in the Fosrenol for Enhancing Dietary Protein Intake in Hypoalbuminemic Dialysis Patients (FrEDI) Study (NCT01116947) who were on thrice-weekly HD with serum albumin <4.0 g/dL. Participants were randomized to receive either high-protein (50–55 g) meals or low-protein (<1 g) meals during HD treatments for 8 weeks. The primary outcome was depressive symptoms measured by the Beck Depression Inventory (BDI)-II survey at 8 weeks. Data on change in Mental Component Summary (MCS) as assessed by the SF-36 were also evaluated. Differences between pre-to-post scores within each study arm were examined using Wilcoxon signed-ranks test.

Results

Fifty-seven participants completed the BDI-II assessment. The mean (SD) age was 55 (±15) years; 56 % were female. The BDI-II score showed a statistically significant improvement among 26 participants in the high-protein meals (baseline, 11.5 [IQR, 5-20] vs. 8-weeks, 7 [IQR, 2-13], P=0.01). In the low-protein meals, BDI-II scores among 31 participants showed a trend toward improvement (baseline, 10 [IQR, 4-22] vs. 8-weeks, 6 [IQR, 1-15], P=0.077). The MCS showed no statistically significant changes either among 26 participants in high-protein meals (baseline, 37.2 [IQR, 16.5–48.7] vs. 8-weeks, 39.2 [IQR, 29.6–47.0], P=0.44) or among 31 participants in low-protein meals (baseline, 30.1 [IQR, 15.6–53.3] vs. 8-weeks, 33.4 [IQR, 16.8–48.6], P=0.97). Changes in BDI-II scores were not statistically different across meal composition.

Conclusion

Among HD patients who receive high- versus low-protein meals during thrice-weekly HD, those eating high-protein meals exhibited a significant improvement in depressive symptoms. Further clinical trials are needed to conclusively determine the efficacy and safety of intra-dialytic eating and meal provision in the dialysis clinics on patient-reported outcomes including unpleasant symptoms.

Funding

  • Private Foundation Support