Geriatric Nephrology and Urology

, Volume 5, Issue 3, pp 167–176 | Cite as

Nutrition in elderly hemodialysis patients

  • Jerrilynn D. Burrowes
  • Sharon H. Stall
Review Article


The elderly dialysis population is increasing. Current nutritional recommendations for this group of patients are based on extrapolations of the recommendations for the general well elderly and adult hemodialysis populations. More than 60% of patients receiving renal replacement therapy in the US will be over the age of 65 by the year 2000. This mandates the need for the development of age-specific nutrient recommendations for elderly dialysis patients. This article presents methods for assessing nutritional status and identifying and treating malnutrition in elderly hemodialysis patients, and psychosocial issues affecting their food intake. Protein, energy and vitamin recommendations for the general elderly and adult hemodialysis populations are also reviewed, and questions raised as to their appropriateness in elderly hemodialysis patients.

Key words

energy elderly geriatric hemodialysis nutrition protein 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Alpers DH, Stenson WF, Bier DM, editors. Manual of nutritional therapeutics. 3rd ed. Boston: Little, Brown, 1995:46.Google Scholar
  2. 2.
    Mignon F, Michel C, Mentre F, Viron B. Worldwide demographics and future trends and the management of renal failure in the elderly. Kidney Int 1993: 43(41 Suppl): 18S-26S.Google Scholar
  3. 3.
    Dwyer JT, Gallo JJ, Reichel W. Assessing nutritional status in elderly patients. Am Fam Phys 1993: 47: 613–9.Google Scholar
  4. 4.
    Rockwood K, Fox RA, Stolee P, Robertson D, Beattie BI. Frailty in elderly people an evolving concept. Can Med Assoc J 1994: 150: 489–95.Google Scholar
  5. 5.
    US Renal Data System 1994 Annual Data Report. Am J Kidney Dis 1994: 24: S33–87.Google Scholar
  6. 6.
    Harty J, Gokal R. Nutritional status in peritoneal dialysis. J Renal Nutr 1995: 5: 2–10.Google Scholar
  7. 7.
    Acchiardo SR, Moore LW, Latour PA. Malnutrition as the main factor in morbidity and mortality of hemodialysis patients. Kidney Int 1983: 24: 199–203.Google Scholar
  8. 8.
    Oksa H, Ahonen K, Pasternack A, Marnela KM. Malnutrition in hemodialysis patients. Scand J Urol Nephrol 1991: 25: 157–61.PubMedGoogle Scholar
  9. 9.
    Kelly MP, Kight MA, Migliore V. A prognostic nutrition index. J Renal Nutr 1993: 3: 10–22.Google Scholar
  10. 10.
    Young GA, Kopple JD, Lindholm B, Vonesh EE, DeVecchi A, Scalamogna A, et al. Nutritional assessment of continuous ambulatory peritoneal dialysis patients. Am J Kidney Dis 1991: 17: 462–71.PubMedGoogle Scholar
  11. 11.
    Rowland ML. Self reported weight and height. Am J Clin Nutr 1990: 52: 1125–33.PubMedGoogle Scholar
  12. 12.
    Chumlea WC, Roche AF, Mukherjee D, editors. Nutrition assessment of the elderly through anthropometry. Columbus, OH: Ross Laboratories, 1987.Google Scholar
  13. 13.
    Ham RJ. The signs and symptoms of poor nutritional status. Primary Care 1994: 21: 33–54.PubMedGoogle Scholar
  14. 14.
    Dwyer J. Nutritional problems of elderly minorities. Nutr Rev 1994: 52: S24–7.Google Scholar
  15. 15.
    Fisher J, Johnson A. Low body weight and weight loss in the aged. J Am Dietet Assoc 1990: 90: 1697–1706.Google Scholar
  16. 16.
    Henrich WL. Dialysis considerations in the elderly patient. Am J Kidney Dis 1990: 16: 339–41.PubMedGoogle Scholar
  17. 17.
    Heymsfield SB, Tighe A, Wang ZM. Nutritional assessment by anthropometric and biochemical methods. In: Shils ME, Olson JA, Shike M, editors. Modern nutrition in health and disease. 8th ed. Philadelphia: Lea and Febiger. 1994: 812–41.Google Scholar
  18. 18.
    Nelson EE. Anthropometry in the nutritional assessment of adults with end stage renal disease. J Renal Nutr 1991: 1: 162–72.Google Scholar
  19. 19.
    Nelson EE, Hong CD, Pesce AL, Peterson DW, Singh S, Pollak VE. Anthropometric norms for the dialysis population. Am J Kidney Dis 1990: 16: 32–7.PubMedGoogle Scholar
  20. 20.
    Stall S, Ginsberg N, Lynn RI, Zabetakis PM. Bioelectrical impedance analysis and dual energy x-ray absorptiometry to monitor nutritional status. Perit Dial Int 1995: (Suppl 5): 959: 62.Google Scholar
  21. 21.
    Stall S, Ginsberg NS, DeVita MV, Zabetakis PM, Lynn RI, Gleim GW, et al. Comparison of five body composition methods in peritoneal dialysis patients. Am J Clin Nutr. Accepted for publication.Google Scholar
  22. 22.
    Chertow GM, Lowrie EG, Wilmore DW, Gonzalez J, Lew NL, Ling J, et al. Nutritional assessment with bioelectrical impedance analysis in maintenance hemodialysis patients. J Am Soc Nephrol 1995: 6: 75–81.PubMedGoogle Scholar
  23. 23.
    Lowrie EG, Lew NL. Death risk in hemodialysis patients. The predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 1990: 15: 458–82.PubMedGoogle Scholar
  24. 24.
    Techan BP, Schleifer CR, Brown JM, Sigler MH, Raimondo J. Urea kinetic analysis and clinical outcome in CAPD. A live year longitudinal study. Adv Perit Dial 1990: 6: 181–5.PubMedGoogle Scholar
  25. 25.
    Owen WE, Lew NL, Liu Y, Lowrie EG, Lazarus JM. The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. N Engl J Med 1993: 329: 1001–6.PubMedGoogle Scholar
  26. 26.
    Iseki K, Kawazoe N, Fukiyama K. Serum albumin is a strong predictor of death in chronic dialysis patients. Kidney Int 1993: 44: 115–9.PubMedGoogle Scholar
  27. 27.
    Collins AJ, Ma JZ, Umen A, Keshaviah P. Urea index and other predictors of hemodialysis patient survival. Am J Kidney Dis 1994: 23: 272–82.PubMedGoogle Scholar
  28. 28.
    Kaysen GA, Rathore V, Shearer GC, Depner TA. Mechanisms of hypoalbuminemia in hemodialysis patients. Kidney Int 1995: 48: 510–6.PubMedGoogle Scholar
  29. 29.
    Gallagher-Allred CR. Geriatric care. In: Sinko MD, Cowell C, Gilbride JA, editors. Nutrition assessment. A comprehensive guide for planning intervention. Gaithersburg, MD: Aspen. 1995: 301–31.Google Scholar
  30. 30.
    Kratka R, Shuler C, Wolfson M. Nutrition in hemodialysis and peritoneal dialysis patients: In Nissenson AR, Fine RN, Gentile DE, editors. Clinical dialysis. 2nd ed. Norwalk, CT: Appleton & Lange. 1990: 350–65.Google Scholar
  31. 31.
    Fanelli MT, Woteki CE: Nutrient intakes and health status of older Americans: data from the NHANES II. Annals of the New York Academy of Sciences 1989: 561: 113–23.PubMedGoogle Scholar
  32. 32.
    Schiffman S. Changes in taste and smell: drug interactions and food preferences. Nutr Rev 1994: 52: S11–14.PubMedGoogle Scholar
  33. 33.
    Munro HN, Suter PM, Russell RM. Nutritional requirements of the elderly. Ann Rev Nutr 1987: 7: 23–49.Google Scholar
  34. 34.
    Briley ME. Food preferences of the elderly. Nutr Rev 1994: 52: S21–3.PubMedGoogle Scholar
  35. 35.
    Kicklighter JR. Characteristics of older adult learners: A guide for dietetics practitioners. J Am Dietet Assoc 1991: 91: 1419–22.Google Scholar
  36. 36.
    Hakim RM, Levin NW. Malnutrition in hemodialysis patients. Am J Kidney Dis 1993: 21: 125–37.PubMedGoogle Scholar
  37. 37.
    Gotch FA, Sargent JA. A mechanistic analysis of the National Cooperative Dialysis Study (NCDS). Kidney Int 1985: 28: 526–34.PubMedGoogle Scholar
  38. 38.
    Gotch FA. Kinetic modeling in hemodialysis. In: Nissenson A, Fine RA, editors. Dialysis therapy. Philadelphia: Hanley & Belfus, 1986: 86–9.Google Scholar
  39. 39.
    Daugirdas JT. Chronic hemodialysis preseription: A urea kinetic approach. In: Daugirdas JT, Ing TS, editors. Handbook of dialysis. 2nd ed. Boston: Little. Brown, 1994: 92–120.Google Scholar
  40. 40.
    NIH Hemodialysis Study Manual of Operations 1995: 4.1–4.90.Google Scholar
  41. 41.
    Parker TF, Husni L. Delivering the preseribed dialysis. Sem in Dialysis 1993: 6: 13–5.Google Scholar
  42. 42.
    Committee on Dietary Allowances, Food and Nutrition Board, National Research Council: Recommended Dietary Allowances. 10th ed. National Academy Press, Washington DC, 1989.Google Scholar
  43. 43.
    Lachance P, Langseth L. The RDA concept. Time for a change? Nutr Rev 1994: 52: 266–70.PubMedGoogle Scholar
  44. 44.
    McDowell MA. The NHANES III supplemental nutrition survey of older Americans. Am J Clin Nutr 1994: 59 (Suppl). 224S-6S.PubMedGoogle Scholar
  45. 45.
    Campbell WW, Crim MC, Dallal GE, Young VR, Evans WJ. Increased protein requirements in elderly people new data and retrospective assessments. Am J Clin Nutr 1994: 60: 501–9.PubMedGoogle Scholar
  46. 46.
    Young VR, Scrimshaw NS. Protein needs for the elderly. Nutrition Notes. Rockville, MD: American Institute of Nutrition. 1975.Google Scholar
  47. 47.
    Kopple JD. Nutritional management. In: Massry SG, Glassrock RJ, editors. Textbook of nephrology. Baltimore. Williams & Williams, 1983: 8.3–8.12.Google Scholar
  48. 48.
    Kopple JD. Nutrition diet and the kidney. In: Shils ME, Olson JA, Shike M. editors. Modern nutrition in health and disease. 8th ed. Philadelphia: Lea and Febiger, 1994: 1102–34.Google Scholar
  49. 49.
    Bergstrom J. Why are dialysis patients malnourished? Am J Kidney Dis 1995: 26: 229–41.PubMedGoogle Scholar
  50. 50.
    Acchiardo SR. Nutrition in hemodialysis. Its measurement and meaning. Sem in Dialysis 1994: 7: 272–5.Google Scholar
  51. 51.
    Burrowes JD, Gibbons SM, Kautman AM, Levin NW. Decrease in PCR with advancing age despite high Kt V. Proceedings of the Third Annual Spring Clinical Nephrology Meetings of the National Kidney Foundation. 1994 April 7 10: Chicago (II) A-2. (Abstract).Google Scholar
  52. 52.
    Chernoff R, Lipschitz DA. Nutrition and aging. In: Shils ME, Young VR, editors. 7th ed. Modern nutrition in health and disease. Philadelphia: Lee & Febiger, 1988: 982–1000.Google Scholar
  53. 53.
    Garry PJ, Rhyne RL, Halioua I, Nicholson C. Changes in dietary patterns over a 6-year period in an elderly population. Annals of the New York Academy of Sciences 1989: 561: 104–12.PubMedGoogle Scholar
  54. 54.
    Schoenfeld PY, Henry RR, Laird NM, Rose DM. Assessment of nutritional status of the National Cooperative Dialysis Study population. Kidney Int 1983. 23(13 Suppl): S80–8.Google Scholar
  55. 55.
    Burrowes JD, Moy WC, Bluestone PA, Levin NW, Gibbons SG. Energy and dietary protein intakes in elderly hemodialysis patients. Proceedings of the Fourth Annual Spring Clinical Nephrology Meetings of the National Kidney Foundation. 1995 March 23–26, Washington (DC). A-3 (Abstract).Google Scholar
  56. 56.
    Abraham S, Johnson CL, Najjar MF, Weight by height and age for adults 18 74 years. United States. 1971 74 National Center for Health Statistics. Vital and health statistics. Series II. No. 208. DHEW Pub. No. (PHS) 79 1656. Public Health Service. Washington DC. US Government Printing Office. 1979.Google Scholar
  57. 57.
    Frisancho AR. New standards of weight and body composition by frame size and height for assessment of nutritional status of adults and the elderly. Am J Clin Nutr 1984: 40: 808–19.PubMedGoogle Scholar
  58. 58.
    Kopple JD. Effect of nutrition on morbidity and mortality in maintenance dialysis patients. Am J Kidney Dis 1994: 24: 1002–9.PubMedGoogle Scholar
  59. 59.
    Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel II). Second report of the expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel). Circulation 1994: 189: 1329–45.Google Scholar
  60. 60.
    Weisburger JH. Nutritional approach to cancer prevention with emphasis on vitamins antioxidants and carotenoids. Am J Clin Nutr 1991: 53: 226S-37S.PubMedGoogle Scholar
  61. 61.
    Suter PM, Russell RM. Vitamin requirements of the elderly. Am J Clin Nutr 1987: 45: 501–12.PubMedGoogle Scholar
  62. 62.
    Russell RM, Suter PM. Vitamin requirements of elderly people: An update. Am J Clin Nutr 1993: 51: 358–61.Google Scholar
  63. 63.
    Ausman LM, Russell RM. Nutrition in the elderly. In: Shils ME, Olson JA, Shike M, editors. Modern nutrition in health and disease. 8th ed. Philadelphia: Lea and Febiger. 1994: 770–80.Google Scholar
  64. 64.
    Coburn JW, Slatapolsky E. Vitamin D, parathyroid hormone, and renal osteodystrophy. In: Brenner BM, Rector FC, Jr., editors. The kidney. 3rd ed. Philadelphia: Saunders, 1986: 1657–1729.Google Scholar
  65. 65.
    Harum P. Nutrition management of the adult hemodialysis patient. In: Stover J, editor. A clinical guide to nutrition care in end stage renal disease. 2nd ed. Chicago, IL: The American Dietetic Association. 1994: 25–36.Google Scholar
  66. 66.
    Goldwasser P, Mittman N, Antignani A, Burrell D, Michel MA, Collier J, et al. Predictors of mortality in hemodialysis patients. J Am Soc Nephrol 1993: 3: 1613–22.PubMedGoogle Scholar
  67. 67.
    Ismatl N, Hakim RM, Oreopoulos DG, Patrikarea A. Renal replacement therapies in the elderly: Part I. Hemodialysis and chronic peritoneal dialysis. Am J Kidney Dis 1993: 22: 759–82.PubMedGoogle Scholar
  68. 68.
    Ross C, Rutsky EA. Dialysis modality selection in the elderly patient with end stage renal disease. Advantages and disadvantages of peritoneal dialysis. Adv Perit Dial 1990: (6 Suppl): 11–7.Google Scholar
  69. 69.
    Lindsay RM, Spanner E. A hypothesis: The protein catabolic rate is dependent upon the type and amount of treatment in dialyzed uremic patients. Am J Kidney Dis 1989: 13: 382–9.PubMedGoogle Scholar
  70. 70.
    Avram MM, Mittman N. Malnutrition in uremia. Sem in Nephrol 1994: 14: 238–44.Google Scholar
  71. 71.
    Lewis SL. Enteral nutrition in end stage renal disease. In: Stover J, editor. A clinical guide to nutrition care in end-stage renal disease. 2nd ed. Chicago, IL: The American Dietetic Association. 1994: 99–109.Google Scholar
  72. 72.
    Hood S, Liftman C. Parenteral nutrition for the patient with renal failure: In: Stover J, editor. A clinical guide to nutrition care in end-stage renal disease. 2nd ed. Chicago, IL: The American Dietetic Association. 1994: 111–21.Google Scholar
  73. 73.
    Ziegler TR, Lazarus JM, Young LS, Hakim R, Wilmore DW. Effects of recombinant human growth hormone in adults receiving maintenance hemodialysis. J Am Soc Nephrol 1991: 2: 1130–5.PubMedGoogle Scholar
  74. 74.
    Schulman G, Wingard RL, Hutchinson RL, Lawrence P, Hakim RM. The effects of recombinant human growth hormone and intradialytic paremteral nutrition in malnourished hemodialysis patients. Am J Kidney Dis 1993: 21: 527–34.PubMedGoogle Scholar
  75. 75.
    Blake, PG. Growth hormone and malnutrition in dialysis patients. Perit Dial Int 1995: 12: 210–6.Google Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • Jerrilynn D. Burrowes
    • 1
  • Sharon H. Stall
    • 2
  1. 1.Division of Nephrology and HypertensionBeth Israel Medical CenterNew YorkUSA
  2. 2.The Department of Medicine, Section of NephrologyLenox Hill HospitalNew YorkUSA

Personalised recommendations