Skip to main content
Top
Published in: BMC Nephrology 1/2023

Open Access 01-12-2023 | Research

Effect of intradialytic oral nutritional supplementation on nutritional markers in malnourished chronic hemodialysis patients: prospective randomized trial

Authors: Mohamed Sary Gharib, Mariem Shaker Nazeih, Tamer Wahid El Said

Published in: BMC Nephrology | Issue 1/2023

Login to get access

Abstract

Background and objectives

Malnutrition is prevalent in chronic hemodialysis (HD) patients. It increases mortality and negatively affects quality of life. This study aimed to assess the effect of intradialytic oral nutritional supplement (ONS) on nutritional markers in chronic HD patients with protein energy wasting (PEW).

Methods

This 3-month prospective, open-label, randomized controlled trial included 60 chronic HD patients with PEW. The intervention group (30 patients) received intradialytic ONS and dietary counseling, whereas the control group (30 patients) received only dietary counseling. Nutritional markers were measured at the beginning and end of the study.

Results

The mean age of the patients was 54 ± 12.7 years, and that of the HD vintage was 64 ± 49.3 months. Compared to the control group, the intervention group showed a significant increase in serum albumin (p < 0.001), prealbumin (p < 0.001), cholesterol (p = 0.016), body mass index (BMI) (p = 0.019), serum creatinine/body surface area (BSA) (p = 0.016), and composite French PEW score (= 0.002), as well as a significant decrease in high-sensitivity C-reactive protein (hs-CRP) (= 0.001). The total iron binding capacity, normalized protein nitrogen appearance, and hemoglobin levels increased significantly in both groups.

Conclusion

Intradialytic ONS and dietary counseling for three months were more effective than dietary counseling alone in terms of improving nutritional status and inflammation in chronic HD patients, as evidenced by increases in serum albumin, prealbumin, BMI, serum creatinine/BSA, composite French PEW score, and a decrease in hs-CRP.
Literature
1.
go back to reference Carrero JJ, Thomas F, Nagy K, Arogundade F, Avesani CM, Chan M, Chmielewski M, Cordeiro AC, Espinosa-Cuevas A, Fiaccadori E, Guebre-Egziabher F, Hand RK, Hung AM, Ikizler TA, Johansson LR, Kalantar-Zadeh K, Karupaiah T, Lindholm B, Marckmann P, Mafra D, Parekh RS, Park J, Russo S, Saxena A, Sezer S, Teta D, Ter Wee PM, Verseput C, Wang AYM, Xu H, Lu Y, Molnar MZ, Kovesdy CP. Global prevalence of protein-energy wasting in kidney disease: a Meta-analysis of contemporary observational studies from the International Society of Renal Nutrition and Metabolism. J Ren Nutr. 2018 Nov;28(6):380–92. https://doi.org/10.1053/j.jrn.2018.08.006. Carrero JJ, Thomas F, Nagy K, Arogundade F, Avesani CM, Chan M, Chmielewski M, Cordeiro AC, Espinosa-Cuevas A, Fiaccadori E, Guebre-Egziabher F, Hand RK, Hung AM, Ikizler TA, Johansson LR, Kalantar-Zadeh K, Karupaiah T, Lindholm B, Marckmann P, Mafra D, Parekh RS, Park J, Russo S, Saxena A, Sezer S, Teta D, Ter Wee PM, Verseput C, Wang AYM, Xu H, Lu Y, Molnar MZ, Kovesdy CP. Global prevalence of protein-energy wasting in kidney disease: a Meta-analysis of contemporary observational studies from the International Society of Renal Nutrition and Metabolism. J Ren Nutr. 2018 Nov;28(6):380–92. https://​doi.​org/​10.​1053/​j.​jrn.​2018.​08.​006.
2.
go back to reference Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, Franch H, Guarnieri G, Ikizler TA, Kaysen G, Lindholm B, Massy Z, Mitch W, Pineda E, Stenvinkel P, Treviño-Becerra A, Wanner C. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 2008 Feb;73(4):391–8. doi: https://doi.org/10.1038/sj.ki.5002585. Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, Franch H, Guarnieri G, Ikizler TA, Kaysen G, Lindholm B, Massy Z, Mitch W, Pineda E, Stenvinkel P, Treviño-Becerra A, Wanner C. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 2008 Feb;73(4):391–8. doi: https://​doi.​org/​10.​1038/​sj.​ki.​5002585.
3.
go back to reference Carrero JJ, Stenvinkel P, Cuppari L, Ikizler TA, Kalantar-Zadeh K, Kaysen G, Mitch WE, Price SR, Wanner C, Wang AY, ter Wee P, Franch HA. Etiology of the protein-energy wasting syndrome in chronic kidney disease: a consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). J Ren Nutr. 2013 Mar;23(2):77–90. https://doi.org/10.1053/j.jrn.2013.01.001. Carrero JJ, Stenvinkel P, Cuppari L, Ikizler TA, Kalantar-Zadeh K, Kaysen G, Mitch WE, Price SR, Wanner C, Wang AY, ter Wee P, Franch HA. Etiology of the protein-energy wasting syndrome in chronic kidney disease: a consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). J Ren Nutr. 2013 Mar;23(2):77–90. https://​doi.​org/​10.​1053/​j.​jrn.​2013.​01.​001.
4.
go back to reference Ikizler TA, Cano NJ, Franch H, Fouque D, Himmelfarb J, Kalantar-Zadeh K, Kuhlmann MK, Stenvinkel P, TerWee P, Teta D, Wang AY, Wanner C. International Society of Renal Nutrition and Metabolism. Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney Int. 2013 Dec;84(6):1096–107. https://doi.org/10.1038/ki.2013.147. Ikizler TA, Cano NJ, Franch H, Fouque D, Himmelfarb J, Kalantar-Zadeh K, Kuhlmann MK, Stenvinkel P, TerWee P, Teta D, Wang AY, Wanner C. International Society of Renal Nutrition and Metabolism. Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney Int. 2013 Dec;84(6):1096–107. https://​doi.​org/​10.​1038/​ki.​2013.​147.
8.
10.
11.
go back to reference Fouque D, McKenzie J, de Mutsert R, Azar R, Teta D, Plauth M, Cano N, Renilon Multicentre Trial Study Group. Use of a renal-specific oral supplement by haemodialysis patients with low protein intake does not increase the need for phosphate binders and may prevent a decline in nutritional status and quality of life. Nephrol Dial Transplant. 2008 Sep;23(9):2902–10. https://doi.org/10.1093/ndt/gfn131. Fouque D, McKenzie J, de Mutsert R, Azar R, Teta D, Plauth M, Cano N, Renilon Multicentre Trial Study Group. Use of a renal-specific oral supplement by haemodialysis patients with low protein intake does not increase the need for phosphate binders and may prevent a decline in nutritional status and quality of life. Nephrol Dial Transplant. 2008 Sep;23(9):2902–10. https://​doi.​org/​10.​1093/​ndt/​gfn131.
12.
go back to reference Calegari A, Barros EG, Veronese FV, Thomé FS. Malnourished patients on hemodialysis improve after receiving a nutritional intervention. J Bras Nefrol 2011 Dec;33(4):394–401. PMID: 22189801. Calegari A, Barros EG, Veronese FV, Thomé FS. Malnourished patients on hemodialysis improve after receiving a nutritional intervention. J Bras Nefrol 2011 Dec;33(4):394–401. PMID: 22189801.
13.
go back to reference Shinaberger CS, Greenland S, Kopple JD, Van Wyck D, Mehrotra R, Kovesdy CP, Kalantar-Zadeh K. Is controlling phosphorus by decreasing dietary protein intake beneficial or harmful in persons with chronic kidney disease? Am J Clin Nutr 2008 Dec;88(6):1511–8. doi: https://doi.org/10.3945/ajcn.2008.26665. Shinaberger CS, Greenland S, Kopple JD, Van Wyck D, Mehrotra R, Kovesdy CP, Kalantar-Zadeh K. Is controlling phosphorus by decreasing dietary protein intake beneficial or harmful in persons with chronic kidney disease? Am J Clin Nutr 2008 Dec;88(6):1511–8. doi: https://​doi.​org/​10.​3945/​ajcn.​2008.​26665.
15.
go back to reference Ikizler TA, Burrowes JD, Byham-Gray LD, KDOQI Nutrition in CKD Guideline Work Group, et al. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 update. Am J kidney diseases: official J Natl Kidney Foundation. 2020;76(3):1–S107.CrossRef Ikizler TA, Burrowes JD, Byham-Gray LD, KDOQI Nutrition in CKD Guideline Work Group, et al. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 update. Am J kidney diseases: official J Natl Kidney Foundation. 2020;76(3):1–S107.CrossRef
16.
go back to reference Cano NJ, Fouque D, Roth H, Aparicio M, Azar R, Canaud B, Chauveau P, Combe C, Laville M, Leverve XM, French Study Group for Nutrition in Dialysis. Intradialytic parenteral nutrition does not improve survival in malnourished hemodialysis patients: a 2-year multicenter, prospective, randomized study. J Am Soc Nephrol. 2007 Sep;18(9):2583–91. https://doi.org/10.1681/ASN.2007020184. Cano NJ, Fouque D, Roth H, Aparicio M, Azar R, Canaud B, Chauveau P, Combe C, Laville M, Leverve XM, French Study Group for Nutrition in Dialysis. Intradialytic parenteral nutrition does not improve survival in malnourished hemodialysis patients: a 2-year multicenter, prospective, randomized study. J Am Soc Nephrol. 2007 Sep;18(9):2583–91. https://​doi.​org/​10.​1681/​ASN.​2007020184.
20.
go back to reference Cheu C, Pearson J, Dahlerus C, Lantz B, Chowdhury T, Sauer PF, Farrell RE, Port FK, Ramirez SP. Association between oral nutritional supplementation and clinical outcomes among patients with ESRD. Clin J Am Soc Nephrol. 2013 Jan;8(1):100–7. https://doi.org/10.2215/CJN.13091211. Cheu C, Pearson J, Dahlerus C, Lantz B, Chowdhury T, Sauer PF, Farrell RE, Port FK, Ramirez SP. Association between oral nutritional supplementation and clinical outcomes among patients with ESRD. Clin J Am Soc Nephrol. 2013 Jan;8(1):100–7. https://​doi.​org/​10.​2215/​CJN.​13091211.
21.
23.
go back to reference Lacson E Jr, Wang W, Zebrowski B, Wingard R, Hakim RM. Outcomes associated with intradialytic oral nutritional supplements in patients undergoing maintenance hemodialysis: a quality improvement report. Am J kidney diseases: official J Natl Kidney Foundation. 2012;60(4):591–600.CrossRef Lacson E Jr, Wang W, Zebrowski B, Wingard R, Hakim RM. Outcomes associated with intradialytic oral nutritional supplements in patients undergoing maintenance hemodialysis: a quality improvement report. Am J kidney diseases: official J Natl Kidney Foundation. 2012;60(4):591–600.CrossRef
24.
26.
go back to reference Kittiskulnam P, Banjongjit A, Metta K, Tiranathanagul K, Avihingsanon Y, Praditpornsilpa K, Tungsanga K, Eiam-Ong S. The beneficial effects of intradialytic parenteral nutrition in hemodialysis patients with protein energy wasting: a prospective randomized controlled trial. Sci Rep 2022 Mar 16;12(1):4529. doi: https://doi.org/10.1038/s41598-022-08726-8. Kittiskulnam P, Banjongjit A, Metta K, Tiranathanagul K, Avihingsanon Y, Praditpornsilpa K, Tungsanga K, Eiam-Ong S. The beneficial effects of intradialytic parenteral nutrition in hemodialysis patients with protein energy wasting: a prospective randomized controlled trial. Sci Rep 2022 Mar 16;12(1):4529. doi: https://​doi.​org/​10.​1038/​s41598-022-08726-8.
27.
28.
go back to reference Boyd E. The growth of the surface area of the human body. J Am Stat Assoc. 1936;31:765–6.CrossRef Boyd E. The growth of the surface area of the human body. J Am Stat Assoc. 1936;31:765–6.CrossRef
34.
go back to reference Kalantar-Zadeh K, Kilpatrick RD, Kuwae N, McAllister CJ, Alcorn H Jr, Kopple JD, Greenland S. Revisiting mortality predictability of serum albumin in the dialysis population: time dependency, longitudinal changes and population-attributable fraction. Nephrol Dial Transplant. 2005 Sep;20(9):1880–8. https://doi.org/10.1093/ndt/gfh941. Kalantar-Zadeh K, Kilpatrick RD, Kuwae N, McAllister CJ, Alcorn H Jr, Kopple JD, Greenland S. Revisiting mortality predictability of serum albumin in the dialysis population: time dependency, longitudinal changes and population-attributable fraction. Nephrol Dial Transplant. 2005 Sep;20(9):1880–8. https://​doi.​org/​10.​1093/​ndt/​gfh941.
35.
go back to reference Evans DC, Corkins MR, Malone A, Miller S, Mogensen KM, Guenter P, Jensen GL, ASPEN Malnutrition Committee. The Use of visceral proteins as Nutrition markers: an ASPEN position paper. Nutr Clin Pract. 2021 Feb;36(1):22–8. https://doi.org/10.1002/ncp.10588. Evans DC, Corkins MR, Malone A, Miller S, Mogensen KM, Guenter P, Jensen GL, ASPEN Malnutrition Committee. The Use of visceral proteins as Nutrition markers: an ASPEN position paper. Nutr Clin Pract. 2021 Feb;36(1):22–8. https://​doi.​org/​10.​1002/​ncp.​10588.
Metadata
Title
Effect of intradialytic oral nutritional supplementation on nutritional markers in malnourished chronic hemodialysis patients: prospective randomized trial
Authors
Mohamed Sary Gharib
Mariem Shaker Nazeih
Tamer Wahid El Said
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2023
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-023-03181-7

Other articles of this Issue 1/2023

BMC Nephrology 1/2023 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine