Association of Dietary Protein Intake and Lean Body Mass with Severity of Metabolic Acidosis in Patients on Hemodialysis

Background Persistent metabolic acidosis (MA) in hemodialysis (HD) patients leads to protein breakdown, insulin resistance, and increased cardiovascular mortality. However, there is limited literature on the prevalence, determinants, and impact of MA in HD patients in India. We studied the association between protein intake and lean body mass (LBM) with the severity of MA in patients on regular HD. Materials and Methods This single-center, cross-sectional study which enrolled patients >18 years on regular HD for at least 3 months. Normalized protein catabolic rate (nPCR) was measured, and protein intake was estimated using a diet diary. Urine nitrogen excretion was measured for 24 hours in patients with residual renal function, and the protein catabolic rate calculated from urea nitrogen excretion was added to the nPCR. LBM was estimated using the bioimpedance spectroscopy technique. Results In 107 patients, 49.53% received HD twice a week; AV fistula was the vascular access for 96%, and CKDu was the most common CKD etiology. After HD, 94 (87.85%) patients had MA, and 26 (24.29%) had uncorrected acidosis; 82.05 and 62.9% of men and women had low LBM, respectively. Protein intake in our population was 0.45 ± 0.11 g/kg/day by diet diary and 0.73 ± 0.23 g/kg from nPCR. There was no significant association between LBM and protein intake with the severity of MA. Conclusion Metabolic acidosis was common among HD patients but did not correlate with protein intake and LBM. Dietary protein intake was very low in HD patients.