Relationship between nitrogen balance, protein, and energy intake in haemodialysis patients.

Wasting and other signs of protein-energy malnutrition are present in a large proportion of patients with chronic renal failure [1]. Although the nutritional status may improve in some patients after haemodialysis treatment is started, it deteriorates in others during long-term treatment. Indeed, energy malnutrition, manifest as reduced subcutaneous fat stores (low triceps skinfold thickness), has been found in 20-60% of haemodialysis patients and signs of protein malnutrition, such as low serum albumin and low serum transferrin, have been reported in 15-70% of patients. A large number of studies have documented musclewasting and reduced muscle mass, as assessed by anthropometric measurements and total body nitrogen determinations as well as by the observation of low alkali-soluble protein in muscle in relation to DNA content (an index of muscle cell size) [1].