Rehabilitation nutrition support for a hemodialysis patient with protein-energy wasting and sarcopenic dysphagia: A case report

Abstract

Background: Patients with end-stage renal failure may exhibit sarcopenia and protein-energy wasting (PEW). We report a case of improvement in physical function, muscle mass, and muscle strength by management of rehabilitation nutrition in a maintenance hemodialysis patient with PEW and sarcopenia. Case presentation: A 60-year-old man with an 8-year history of dialysis was admitted for pneumococcal meningitis. When he was transferred for rehabilitation 36 days following the onset, he was transferred to our hospital for rehabilitation and hemodialysis. On admission, energy intake was 1200 kcal/day, via a nasogastric tube, due to sarcopenic dysphagia. He was diagnosed with PEW, based on results from a biochemical examination, physical examination, and his low dietary intake. His height, dry weight, body mass index, Mini Nutritional Assessment-Short Form, albumin, C-reactive protein, and Geriatric Nutritional Risk Index were 166 cm, 46.5 kg, 16.9 kg/m2, 1 point, 2.1 g/dL, 0.22 mg/dL, and 63, respectively, indicating malnutrition. He was also diagnosed with sarcopenia because of low muscle mass, muscle strength, and physical function. Functional Independence Measure (FIM) was 58 points (motor 27, cognition 31). He was improved by a combination of rehabilitation including activities of daily living training, swallowing training, and nutrition management. Nutritional requirement was 1752 kcal/day of energy and 55.5 g/day (1.2 g/kg/day) of protein. Energy intake was added energy accumulation (300 kcal/day) to improve muscle mass and strength. On day 108, he was discharged to go home, he could walk outdoors, and his sarcopenic dysphagia improved. Conclusion: Aggressive management of rehabilitation nutrition to increase dry weight may improve PEW and sarcopenic dysphagia in patients undergoing maintenance hemodialysis.