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

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2008-09, Vol.23 (9), p.2902-2910
• Main Authors: Fouque, Denis, McKenzie, Jane, de Mutsert, Renée, Azar, Raymond, Teta, Daniel, Plauth, Mathias, Cano, Noel
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; albumin; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; compliance; Dietary Proteins - administration & dosage; Dietary Supplements - analysis; Emergency and intensive care: renal failure. Dialysis management; Female; haemodialysis; Health Status Indicators; Humans; Intensive care medicine; Kidney - drug effects; Male; malnutrition; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Nutritional Status; oral supplement; Phosphate-Binding Proteins - administration & dosage; Protein-Energy Malnutrition - prevention & control; Quality of Life; Renal Dialysis; Renal failure; Serum Albumin - analysis
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfn131

Background. Protein-energy wasting is a frequent and debilitating condition in maintenance dialysis. We randomly tested if an energy-dense, phosphate-restricted, renal-specific oral supplement could maintain adequate nutritional intake and prevent malnutrition in maintenance haemodialysis patients with insufficient intake. Methods. Eighty-six patients were assigned to a standard care (CTRL) group or were prescribed two 125-ml packs of Renilon 7.5® daily for 3 months (SUPP). Dietary intake, serum (S) albumin, prealbumin, protein nitrogen appearance (nPNA), C-reactive protein, subjective global assessment (SGA) and quality of life (QOL) were recorded at baseline and after 3 months. Results. While intention to treat analysis (ITT) did not reveal strong statistically significant changes in dietary intake between groups, per protocol (PP) analysis showed that the SUPP group increased protein (P < 0.01) and energy (P < 0.01) intakes. In contrast, protein and energy intakes further deteriorated in the CTRL group (PP). Although there was no difference in serum albumin and prealbumin changes between groups, in the total population serum albumin and prealbumin changes were positively associated with the increment in protein intake (r = 0.29, P = 0.01 and r = 0.27, P = 0.02, respectively). The SUPP group did not increase phosphate intake, phosphataemia remained unaffected, and the use of phosphate binders remained stable or decreased. The SUPP group exhibited improved SGA and QOL (P < 0.05). Conclusion. This study shows that providing maintenance haemodialysis patients with insufficient intake with a renal-specific oral supplement may prevent deterioration in nutritional indices and QOL without increasing the need for phosphate binders.