Effect of Intradialytic Eating Timing on Hemodynamic Stability and Dialysis Adequacy in Hemodialysis Patients

This study is a quasi-experimental clinical trial using a non-equivalent control group design to evaluate the effect of different intradialytic eating times on hemodynamic stability and hemodialysis adequacy in patients with chronic kidney disease undergoing regular hemodialysis.

Hemodynamic instability, particularly intradialytic hypotension, is a common complication during hemodialysis and is associated with poor clinical outcomes, reduced dialysis efficiency, and increased cardiovascular risk. Intradialytic eating is widely practiced in many hemodialysis centers to support nutritional intake and prevent protein-energy wasting. However, previous studies have reported conflicting findings regarding its effects on blood pressure stability and dialysis adequacy. Some evidence suggests that postprandial splanchnic blood redistribution may contribute to blood pressure reduction and impaired solute clearance, while other studies emphasize nutritional benefits and improved patient well-being. Currently, there is no standardized guideline regarding optimal meal timing during hemodialysis.

This study is designed to address this clinical gap by systematically evaluating the effect of meal timing during dialysis on hemodynamic and dialysis adequacy parameters.

Participants will be adult patients with chronic kidney disease undergoing routine hemodialysis. A total of 40 participants will be enrolled and allocated into two groups:

Intervention group - patients will receive standardized meals at different time points during four hemodialysis sessions, with meal timing structured as follows: first hour, second hour, third hour, and fourth hour of the dialysis session across consecutive sessions.

Control group - patients will receive standard care and continue their usual eating and drinking habits during dialysis without structured intervention.

Hemodynamic parameters will be assessed repeatedly every 30 minutes during each dialysis session, including systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate. Hemodynamic stability will be evaluated based on blood pressure variability and changes during dialysis sessions.

Dialysis adequacy will be assessed using the Kt/V parameter, which reflects urea clearance efficiency and treatment adequacy.

Data will be analyzed to compare within-group and between-group differences in hemodynamic trends and dialysis adequacy across sessions. Repeated measures statistical analysis will be used to evaluate temporal changes in hemodynamic parameters and treatment adequacy associated with different intradialytic eating times.

The findings of this study are expected to identify an optimal and safe timing for intradialytic eating that minimizes hemodynamic instability while maintaining adequate dialysis efficiency. The results will provide clinically relevant evidence to support the development of standardized guidelines for intradialytic nutrition practices, contribute to safer dialysis care, and improve clinical outcomes for patients undergoing long-term hemodialysis.

Inclusion criteria

• Adults aged ≥ 18 years
• Diagnosed with chronic kidney disease (CKD)
• Undergoing regular maintenance hemodialysis
• Receiving hemodialysis on a routine schedule (e.g., twice weekly)
• Clinically stable during hemodialysis
• Able to eat orally during dialysis sessions
• Willing to participate and provide informed consent

Exclusion criteria

Patients with pre-dialysis with acute or severe cardiovascular conditions,, those receiving enteral/parenteral nutrition, with cognitive impairment, or who refuse or withdraw informed consent will be excluded."