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I’ve been a dialysis nurse for years. It has been our protocol not to allow patients to eat during dialysis. The only thing we allow patients to have during dialysis is ice. When I go to the ICU to dialyze a patient at the bedside, I tell the ICU nurse to hold the tube feeding. Eating during dialysis treatment has been associated with increased risk for intradialytic hypotension which is associated with higher mortality risk. Earlier studies have shown that eating during dialysis provokes a rapid postprandial decline in blood pressure and raises the incidence of symptomatic intradialytic hypotension (Agarwal & Georgianos, 2018). When you’re eating you require more blood to aid in digestion which then causes the blood pressure to drop. When the blood pressure drops, dialysis needs to be stopped early which can affect the adequacy. Eating also increases the risk of choking during dialysis.
There has been a shift in clinical practice with a higher proportion of physicians following the view that administration of intradialytic meals and supplements represents a simple and effective approach to enhance caloric intake and improve nutritional status among patients on hemodialysis (Fotiadou et al., 2020). This shift towards less restrictive in-center nutrition practices is mainly supported by evidence from observational studies associating intradialytic nutritional supplementation with improvements in protein-energy wasting, inflammatory state, and health-related quality of life. We have diabetic patients too with the tendency of having low blood sugar. The administration of intradialytic meals could be a preventive measure against hemodialysis-induced hypoglycemia.
We have looked closely at clinical benefits and highlighted the need to work toward clear guidelines. As long as it’s not a heavy meal, eating is now allowed. We continue to monitor their blood pressure. In our unit, we have started to give protein bars, protein shakes, and special rice crispies with high protein content. Light meals or supplements during hemodialysis may be an effective strategy to improve nutritional status of patients with limited reports of complications. This is now part of the standard-of-care practice for our patients.