A Low-Protein Diet with a Renal-Specific Oral Nutrition Supplement Helps Maintain Nutritional Status in Patients with Advanced Chronic Kidney Disease

Abstract

A low-protein diet (LPD) is recommended to patients with non-dialysis advanced chronic kidney disease (CKD) for delaying renal function decline. However, this approach potentially prevents an adequate calorie and micronutrient intake. We examined the influence of an LPD including a renal-specific oral nutrition supplement (RONS) on the nutrition status of patients with stage 3b–5 CKD. This multicenter, open-label study prospectively enrolled patients over 18 years of age, with an estimated glomerular filtration rate (eGFR) between 10 and 45 mL/min/1.73 m2, serum albumin ≥3.0 g/dL, and body mass index ≤30 kg/m2. All participants implemented the LPD with one serving of RONS daily for 6 months. Daily energy intake, nutrition status, renal function, and quality of life were assessed before and after the intervention. Of 53 enrolled patients, 35 (66.0%) completed the study. We found that RONS use increased patients’ energy intake and maintained their serum albumin, nutritional status, and quality of life. Body weight and handgrip strength increased significantly at 6 months after enrollment (p = 0.0357); eGFR slightly decreased at 3 and 6 months after enrollment, suggesting that patients’ residual renal function was preserved. Our findings support the conclusion that patients with non-dialysis advanced CKD may benefit from additional RONS besides their regular diet. Patients with advanced CKD receiving RONS might achieve better nutrition and delay renal function decline.

Oral Nutritional Supplement Prescription and Patient-Reported Symptom Burden Among Patients With Late-Stage Non-Dialysis Chronic Kidney Disease

“… 22 The lack of clinically meaningful associations between biochemical parameters and symptom burden has been observed in previous studies of patients receiving dialysis, with negligible correlations between changes in biochemical markers and changes in ESASr:Renal. 19 However, composite nutrition scores, such as the Malnutrition Inflammation Score and Subjective Global Assessment, have demonstrated associations with quality-of-life domains in HD 23 - 25 and non-dialysis CKD. 26 …”

Effects of a low-protein nutritional formula with dietary counseling in older adults with chronic kidney disease stages 3–5: a randomized controlled trial

“…A recent systematic review indicated that dialysis treatment involving a mix of various macronutrients for up to 12 months significantly increased lean body mass [ 28 ]. In a previous single-arm study, 35 patients with stage 3b-5 CKD adhering to a dietitian-guided LPD and a renal-specific formula noted considerable improvements in body weight and grip strength over six months [ 29 ]. In contrast with past studies, our findings showed that an LPD combined with a 6% LPF prompted a slight increase in body weight, muscle mass, and fat-free mass.…”

Efficacy and Safety of a High-Energy, Low-Protein Formula Replacement Meal for Pre-Dialysis Chronic Kidney Disease Patients: A Randomized Controlled Trial

“…First, the current study may have been too short in its relative duration and could not improve nutritional status. Previous studies have reported that body weight and BMI using renal-specific ONSs for six months were enhanced in patients with advanced CKD [31]. The ability to significantly increase energy intake to the extent that anthropometric indicators are also improved may take time in patients with end-stage renal disease who are at risk of PEW.…”