NDT Advance Access originally published online on April 11, 2008
Nephrology Dialysis Transplantation 2008 23(9):2902-2910; doi:10.1093/ndt/gfn131
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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
1 Department of Nephrology, Hôpital Edouard Herriot, 69003 Lyon and Université Lyon 1, INSERM U 870 Lyon, F-69003, France 2 Queen Margaret University, Edinburgh EH21 6UU, United Kingdom 3 Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands 4 Service de Néphrologie, Hôpital de Dunkerque, F-59385, France 5 Service de Néphrologie et d’Hypertension, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 17, CH 1005 Lausanne, Switzerland 6 Klinik für Innere Medizin, Städtisches Klinikum, Auenweg 38, 06847 Dessau, Germany 7 CRNH Auvergne, Laboratoire de Nutrition Humaine, BP 321, Clermont-Ferrand 63001 Cedex1, France
Correspondence and offprint requests to: Denis Fouque, Department of Nephrology, Hôpital Edouard Herriot, 69437 Lyon Cedex 03, France. Tel: +33-472-11-0202; Fax: +33-472-11-0203; E-mail: denis.fouque{at}chu-lyon.fr
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Abstract |
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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.
Keywords: albumin; compliance; haemodialysis; malnutrition; oral supplement
* Former Numico Research employees during the course of the trial.
Received for publication: 17.10.07
Accepted in revised form: 18. 2.08