PD411 - CASE REPORT: NUTRITION REHABILITATION IN A HEMODIALYSIS PATIENT WITH PNEUMONIA

PD411

CASE REPORT: NUTRITION REHABILITATION IN A HEMODIALYSIS PATIENT WITH PNEUMONIA

Z. Patel^1,*, B. Shah², S. Bhatte³, R. Bhoite⁴

¹Chief Dietitian, Dietetics Department, ²Director, Department of Nephrology, Gleneagles Hospital, Mumbai, ³Nutrition Science Specialist, Nutrition Science, ⁴Head, Nutrition Science, Dr. Reddy's Laboratories, Hyderabad, India

Rationale: Patients on maintenance hemodialysis are at high risk of protein-energy wasting, which is exacerbated during acute infections like pneumonia. Early nutritional intervention and optimizing nutritional intake (both protein and energy) is critical to improve clinical outcomes, reduce need for internsive care and need for mechanical ventillation.¹

Methods: A known case of hypertension with IgA nephropathy-associated chronic kidney disease on hemodialysis since 2011 (on hemodialysis since 2023) was admitted in June 2025 with pneumonia. Baseline evaluation showed poor dietary intake, and a dry weight 58 kg, hemoglobin 8.4 g/dL, serum creatinine 5.8 mg/dL, and albumin 3.0 g/dL. Nutritional assessment indicated severe malnutrition with Subjective Global Assessment (SGA) score of 26, Malnutrition Inflammation Score (MIS) of 20. A targeted intervention was initiated with a disease-specific oral nutritional supplement (40 g of Celevida DLS/day) providing 175 kcal and 19.2 g protein-spaced out into 3 feeds, along with dietary counseling. The electrolytes (sodium and potassium) were under control. 

Results: The appetite gradually improved with supplementation. Post-intervention of 6 months, dry weight increased to 64 kg. Hemoglobin improved to 12.7 g/dL and serum albumin to 3.4 g/dL. SGA and MIS scores decreased to 18 and 13, respectively, indicating improved nutritional and inflammatory status. Serum creatinine increased to 8.85 mg/dL, likely reflecting increased in weight and improved lean body mass.

Conclusion: Timely, targeted nutritional supplementation significantly improved nutritional status and clinical parameters, highlighting its role in managing protein-energy wasting in hemodialysis patients with acute illness.

References: 1. Pant, A. et al. (2021). Pneumonia in Patients with Chronic Kidney Disease... JNMA; journal of the Nepal Medical Association, 59(242), 1000–1003. 

Disclosure of Interest: Z. Patel: None declared, B. Shah: None declared, S. Bhatte Other: Publication Drafting Support, R. Bhoite Other: Publication Drafting Support