Hair Loss


PubMed Citation
Articles by Veeneman, J. M.
Articles by Huisman, R. M.

Vol. 284, Issue 5, E954-E965, May 2003

Protein intake during hemodialysis maintains a positive whole body protein balance in chronic hemodialysis patients
Jorden M. Veeneman1,2, Hermi A. Kingma3, Theo S. Boer3, Frans Stellaard2,3, Paul E. De Jong1,2, Dirk-Jan Reijngoud2,3, and Roel M. Huisman1,2
Division of Nephrology, Departments of 1 Internal Medicine and 3 Pediatrics, University Hospital Groningen and 2 Groningen University Institute of Drug Exploration, 9713 GZ Groningen, The Netherlands

Protein energy malnutrition is present in 18 to 56% of hemodialysis patients. Because hemodialysis has been regarded as a catabolic event, we studied whether consumption of a protein- and energy-enriched meal improves the whole body protein balance during dialysis in chronic hemodialysis (CHD) patients. Patients were studied on a single day between dialysis (HD protocol) in the morning while fasting and in the afternoon while consuming six small test meals. Patients were also studied during two separate dialysis sessions (HD+ protocol). Patients were fasted during one and consumed the meals during the other. Whole body protein metabolism was studied by primed constant infusion of L-[1-13C]valine. During HD, feeding changed the negative whole body protein balance observed during fasting to a positive protein balance. Dialysis deepened the negative balance during fasting, whereas feeding during dialysis induced a positive balance comparable to the HD protocol while feeding. Plasma valine concentrations during the studies were correlated with whole body protein synthesis and inversely correlated with whole body protein breakdown. We conclude that the consumption of a protein- and energy-enriched meal by CHD patients while dialyzing can strongly improve whole body protein balance, probably because of the increased amino acid concentrations in blood.

protein turnover; stable isotope; valine

This article has been cited by other articles:

D. S. C. Raj, T. Welbourne, E. A. Dominic, D. Waters, R. Wolfe, and A. Ferrando
Glutamine kinetics and protein turnover in end-stage renal disease
Am J Physiol Endocrinol Metab, January 1, 2005; 288(1): E37 - E46.
[Abstract] [Full Text] [PDF]


There was a time that I didn’t have anything to eat or drink on incenter dialysis as my first unit did not encourage it. But then as I read articles like the one I posted, I made the decision to eat meals on dialysis. It is difficult for me to have a normal appetite as an incenter dialysis patient, as with fluid/toxins building between txs., appetite is affected. I usually have a very small meal before txs., as with the build up of fluid/toxins, my appetite is very low at that time. But as soon as I get on tx and fluid/toxins are pulled off, my appetite comes back again. So, during the first 1 1/2 of tx, I have a nourishing meal/drink which sustains me. I also have a drink and dessert about 2 1/2 into the tx. which further energizes me. From what I hear about daily dialysis, appetite is greatly improved. I have read where those doing SDD eat on tx. if they want. Don’t know if those doing nocturnal have late night snacks. Would be interesting to hear their experiences.


Can someone explain the difference between albumin, total protein and npcr? How does one score enough protein in each of these areas without overdoing it on phosphorous?


I would encourage nutritonal snacks, things like strips of beef jerky, roasted pumpkin seeds…those things have excellent protein…but having a fully heavy meal on dialysis is a no no, bad…

On the contrary, having a protein drink is also good than having smething to munch on…liquids absorb faster than a heavy meal…


Does anyone have any facts on whether it’s better to take binders throughout meals rather than at the beginning or end?


gus writes:

I would encourage nutritonal snacks, things like strips of beef jerky, roasted pumpkin seeds…those things have excellent protein…but having a fully heavy meal on dialysis is a no no, bad…

For years, I have had normal sized nutritional meals as well as 2-3 6oz. drinks on incenter dialysis. I have never had a single problem. I believe it has been very healthful in my case. A true test would be to see what one can comfortably consume on tx.


Thankyou for the interesting article.
As for eating on Nocturnal, that would defeat the purpose of trying to sleep for me. I have a medium size meal before 7pm and try to be connected by 9pm, I find by 5am when I am ready to come off I am “busting” to go to the “loo” (Aussie for toilet ) as the meal has gone through me. Eating any more would make sleeping impossible!
I think eating more protein is the go, having been practically a vegetarian for the last 13 years since I was diagnosed, it is taking me a while to build up to eating more meat protein (there is only so much tofu one can eat)


for years but for long term its bad, hard on the heart and nerves…having a full blown meal on dialysis causes most of the blood to work hard on the stomach digesting the food…causing heart to beat faster, resulting in cramps, low blood pressure and even death… :oops:
…some people tend to handle the faster heart beat stress than others but do that long term and you will have some serious problems… :roll:


This information is copied and pasted from Nephron Information Center, a website developed by Steve Fadem, MD, a nephrologist in Houston. It’s from a page on renal nutrition that you can find at

[i]Rules for Eating During Your Dialysis Treatment if Permitted

  1. Some doctors allow patients to eat during dialysis. However, during dialysis the blood flow to your stomach and intestines may be reduced if your blood pressure falls. This is because the body preferentally sends blood to the brain in hypotension. If you have a tend to drop your blood pressure during treatments, you may not be allowed to eat during treatments.
  2. The food that you eat during dialysis will not be digested immediately, and the breakdown products from that meal will not be removed from your blood until your next treatment. THis needs to be taken into consideration when developing your meal plan.
  3. During dialysis the fluid you gained between treatments must be removed as well as the fluid you drink while on the machine. Thus, the pump must be set higher. There is a limit to how much fluid can be removed during a treatment, so be careful! Fluid restrictions still need to be considered. Drinking excessive fluid during dialysis will makes it difficult to reach your dry weight.
  4. Therefore, don’t ignore your diet and fluids while you dialyze!


I go out to eat everyday. I ask for a drink to go and take my binders in the car. My phosphorous runs 2.5 -3.5 and I dialyze 5 hours. I think the longer time on dialysis helps because it takes a minimum of 4 hours of dialysis for phosphorous to even start to be removed because it is a bigger molecule. That is why diet and binders are stressed so much because dialysis alone is not enough. :smiley:


--------------------------Simone said----------------------------------------------hi, I had the same problem, it is the heparin that has this side effect, now I switched to the low weight molecular heparin, it is my sixth week with it but I have seen no improvements, I know that in Austria a few patients swicthed to the regional citrate anticoagulant and solved the problem, in my country it is not used unfortunately.

I have to concur with Simone.
I was switched from Heparin to Clexane about 3 weeks ago after noticing I was losing a lot of hair. My hair felt awful after dialysis and I now must say it felt so much better almost after the first run with Clexane. My hair loss seems to have subsided too! 8)


Why not heparinless? I have been doing heparinless dialysis daily-short for over a year now!..ask your Doctor today! Just take a 1-2 baby asprin a day…that’s all…depending on body size you may need to take probably a normal asprin every two days…


I have read many discussions about hair loss, but have never read where anyone else used Clexane or baby aspirin. Are there any side effects? Very few dialysis patients I see seem to have a good head of hair. Wonder why nephrologists don’t know about these alternatives-none of mine have ever mentioned it.


Clexane is a low molecular weight Heparin such as that Simone suggested. It may be called something different in the states.
It is slightly more expensive than Heparin and as our drugs in Australia are Govt subsidised I presume they put us on Heparin as first option and then ( in my case ) see if we complain of side effects.
I guess hair loss in men is not quite the problem as in women with more hair to lose. Personally I hated the way my hair felt and am so pleased Clexane seems to be working. As for other side effects…?


Also here in Italy almost everybody uses unfractionated heparin because Clexane (I used to use Seleparina, it is the same) costs too much. I used this kind of heparin for 3 months, hair loss diminished a lot and I could see some new hair grow back, not too much though. Now fortunately I had a kidney transplant, I had a bad episode of anemia and an acute rejection, my hair started again to fall, now I feel good and I hope also this problem will disappear. Take care


Is it heparin, or is it just having kidney failure?


Thanks Simone

I wish you all the best and hope you continue to improve.

My hair feel so much better now and I don’t seem to be losing hair at all now. Might be just coincidental but whatever it is I am very pleased with the results.

Cheers and good luck. 8)


I had no side effects using the low molecular weight heparin, nephrologists don’t care too much about this kind of problems, think that when I told him first about this problem he answered he was losing it, too, and then left. Then I can tell you that in my center almost all the patients had a head full of hair, I was the only one suffering of this problem.


I am glad you solved your problem, I know it is a very underestimated problem for dialysis patients but nobody would like to see his/her hair coming out in handfulls from one day to another, right? Now I will see if something grows back with my new kidney or if it is too late, I know hair loss is common in males but it is bad for me to lose it due to dialysis, that already gave me lots of problems, if it was a genetic thing it would be ok.
Thanks for your words, I also wish you the best, take care!


Like most patients on dialysis, I have experienced hair loss. Most of my hair loss was in the earlier years. It was like a continual shedding. Fortunatley for me, I never lost so much that it was unsightly. But at one point, the shedding slowed down greatly and continued that way for a long time. I never found out the cause. As of a few months ago, I now am seeing the familiar shedding again, and again, have no firm answers. Nothing in my prescription, meds or diet has changed. My labs are always good.