Protein, Exercise During Hemodialysis Does Not Impede Uremic Toxin Removal

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Clinicians are increasingly using dietary protein and exercise interventions during hemodialysis to help maintain patients' muscle strength.

Protein intake and exercise during hemodialysis do not interfere with uremic toxin removal, according to investigators.

In a randomized crossover trial, investigators asked 10 patients to ingest 40 g of milk protein or a non-protein placebo at rest and following 30 minutes of exercise during hemodialysis sessions. Compared with placebo, protein intake during hemodialysis was associated with significantly lower reduction ratios of urea (73% vs 76%) and indoxyl sulfate (40% vs 46%). Protein intake, however, resulted in an additional removal of 2 g urea compared with placebo, as shown in spent dialysate, Luc J.C. van Loon, MD, of Maastricht University in The Netherlands and colleagues reported in the Journal of Renal Nutrition.

Creatinine, phosphate, and cystatin C removal was not affected by protein intake or exercise during hemodialysis.

“Thus, intradialytic protein ingestion does not compromise uremic toxin removal during hemodialysis, but increases the postprandial production of protein-derived uremic toxins,” the investigators wrote.

Intradialytic cycling for 30 minutes did not affect the reduction ratios or removal of any uremic toxin during hemodialysis. According to Dr van Loon’s team, exercise combined with protein intake during hemodialysis may preserve muscle mass and strength without impeding hemodialysis’ efficiency.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Hendriks FK, Kuijpers JHW, van Kranenburg JMX, et al. Intradialytic protein ingestion and exercise do not compromise uremic toxin removal throughout hemodialysis. J Ren Nutr. Published online August 18, 2022. doi:10.1053/j.jrn.2022.07.006

This article originally appeared on Renal and Urology News