Amino acid profile after oral nutritional supplementation in hemodialysis patients with protein-energy wasting

Małgorzewicz, Sylwia; Gałęzowska, Grażyna; Cieszyńska-Semenowicz, Monika; Ratajczyk, Joanna; Wolska, Lidia; Rutkowski, Przemysław; Jankowska, Magdalena; Rutkowski, Bolesław; Dębska-Ślizień, Alicja

doi:10.1016/j.nut.2018.06.013

Cited by 15 publications

(9 citation statements)

References 19 publications

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“…Essential AA supplements offer the possibility to increase MPS; many observational studies have shown that in the short term, ONS can improve albumin and blood EAA profile in HD patients ( 156 ). A recent meta-analysis in HD patients shows that if short-term (3 months) ONS use increases BMI and serum albumin levels, prolonged ( > 3 months) supplementation does not causes such effects ( 158 ). Recently, Pokkrong et al ( 159 ) observed that ONS administered to 80 HD patients was associated with an improvement in energy, protein, fat, fiber and magnesium intake and 29–24% decrease in malnutrition-inflammation score (MIS), while the improvement in serum albumin was slight (5.3–3.3%).…”

Section: Discussion: How To Overcome Anabolic Resistance In Dialysis-treated Patients?mentioning

confidence: 99%

How to Overcome Anabolic Resistance in Dialysis-Treated Patients?

et al. 2021

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A current hypothesis is that dialysis-treated patients are “anabolic resistant” i. e., their muscle protein synthesis (MPS) response to anabolic stimuli is blunted, an effect which leads to muscle wasting and poor physical performance in aging and in several chronic diseases. The importance of maintaining muscle mass and MPS is often neglected in dialysis-treated patients; better than to describe mechanisms leading to energy-protein wasting, the aim of this narrative review is to suggest possible strategies to overcome anabolic resistance in this patient's category. Food intake, in particular dietary protein, and physical activity, are the two major anabolic stimuli. Unfortunately, dialysis patients are often aged and have a sedentary behavior, all conditions which per se may induce a state of “anabolic resistance.” In addition, patients on dialysis are exposed to amino acid or protein deprivation during the dialysis sessions. Unfortunately, the optimal amount and formula of protein/amino acid composition in supplements to maximixe MPS is still unknown in dialysis patients. In young healthy subjects, 20 g whey protein maximally stimulate MPS. However, recent observations suggest that dialysis patients need greater amounts of proteins than healthy subjects to maximally stimulate MPS. Since unneccesary amounts of amino acids could stimulate ureagenesis, toxins and acid production, it is urgent to obtain information on the optimal dose of proteins or amino acids/ketoacids to maximize MPS in this patients' population. In the meantime, the issue of maintaining muscle mass and function in dialysis-treated CKD patients needs not to be overlooked by the kidney community.

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Section: Discussion: How To Overcome Anabolic Resistance In Dialysis-treated Patients?mentioning

confidence: 99%

How to Overcome Anabolic Resistance in Dialysis-Treated Patients?

et al. 2021

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“…Interventional approaches to treat PEW diagnosed by the ISRNM criteria applied by other researchers indicated some limitations to interpretations. Enrolment of both PEW and non-PEW patients occurred with one study ( 21 ), another study failed to report the remission of PEW post-treatment ( 24 ), whereas the 3rd study was underpowered (total n = 16) and targeted only elderly HD patients ( 18 ). Further, whether exercise alone in comparison to combination treatments for HD patients are valid strategies that remain inconclusive, as study design limitations, such as inclusion of young and well-nourished patients ( 11 ), suboptimal intensity and duration of exercise ( 63 ), small sample size ( 11 , 18 ) and sensitivity of method in assessing muscle mass, are noted ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

“…The usability and low-cost US for muscle status assessment contrasts with gold standard methods, such as dual energy X-ray absorptiometry, magnetic resonance imaging, or computed tomography, which although having high accuracy and validity are not feasible for routine clinical use as they require trained personnel, are costly, and also pose radiation risk to patients with CKD (4,45,46). This further justifies the use of the US as an alternative bedside measure as it has been validated against computed tomography (24) to detect muscle wasting in HD patients (40). Interestingly, the NC group did not demonstrate any significant improvement in US measures as experienced by the group receiving ONS.…”

Section: Discussionmentioning

confidence: 99%

“…This multi-center, randomized open-label controlled trial was conducted between June 2016 and July 2019 with recruitment from 16 outpatient HD facilities representing government, private, and non-governmental organization sectors in the Klang Valley. Since serum prealbumin is a stable biomarker for protein synthesis in line with anabolism ( 24 ), the sample size calculation was therefore based on the study by Malgorzewicz et al ( 16 ) who used serum prealbumin as an endpoint to ONS provision. In our calculation, using the mean difference in serum prealbumin at 0.57 ± 8.1 g/L, the effect size calculated at 0.70 (moderate effect) with power at 80% and the level of significance set at 5%, the minimum required sample size was 25 patients per treatment arm.…”

Section: Methodsmentioning

confidence: 99%

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Muscle Status Response to Oral Nutritional Supplementation in Hemodialysis Patients With Protein Energy Wasting: A Multi-Center Randomized, Open Label-Controlled Trial

et al. 2021

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Background: Muscle wasting, observed in patients with end-stage kidney disease and protein energy wasting (PEW), is associated with increased mortality for those on hemodialysis (HD). Oral nutritional supplementation (ONS) and nutrition counseling (NC) are treatment options for PEW but research targeting muscle status, as an outcome metric, is limited.Aim: We compared the effects of combined treatment (ONS + NC) vs. NC alone on muscle status and nutritional parameters in HD patients with PEW.Methods: This multi-center randomized, open label-controlled trial, registered under ClinicalTrials.gov (Identifier no. NCT04789031), recruited 56 HD patients identified with PEW using the International Society of Renal Nutrition and Metabolism criteria. Patients were randomly allocated to intervention (ONS + NC, n = 29) and control (NC, n = 27) groups. The ONS + NC received commercial renal-specific ONS providing 475 kcal and 21.7 g of protein daily for 6 months. Both groups also received standard NC during the study period. Differences in quadriceps muscle status assessed using ultrasound (US) imaging, arm muscle area and circumference, bio-impedance spectroscopy (BIS), and handgrip strength (HGS) methods were analyzed using the generalized linear model for repeated measures.Results: Muscle indices as per US metrics indicated significance (p < 0.001) for group × time interaction only in the ONS + NC group, with increases by 8.3 and 7.7% for quadriceps muscle thickness and 4.5% for cross-sectional area (all p < 0.05). This effect was not observed for arm muscle area and circumference, BIS metrics and HGS in both the groups. ONS + NC compared to NC demonstrated increased dry weight (p = 0.039), mid-thigh girth (p = 0.004), serum prealbumin (p = 0.005), normalized protein catabolic rate (p = 0.025), and dietary intakes (p < 0.001), along with lower malnutrition–inflammation score (MIS) (p = 0.041). At the end of the study, lesser patients in the ONS + NC group were diagnosed with PEW (24.1%, p = 0.008) as they had achieved dietary adequacy with ONS provision.Conclusion: Combination of ONS with NC was effective in treating PEW and contributed to a gain in the muscle status as assessed by the US, suggesting that the treatment for PEW requires nutritional optimization via ONS.

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“…Many dialysis units now offer these oral supplements, at least to hypoalbuminemic patients, and a number of studies have addressed their effect on nutritional status and albumin or prealbumin levels [111][112][113][114][115][116][117]. Overall, reports are favorable on all outcomes tested; an interesting suggestion is the fact that providing oral nutritional supplements during dialysis seems to reduce the number of missed dialysis sessions, thus underlining the psychological importance that nutritional care has for our patients [116].…”

Section: Oral Nutritional Supplementsmentioning

confidence: 99%

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

et al. 2020

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Dialysis and nutrition are two sides of the same coin—dialysis depurates metabolic waste that is typically produced by food intake. Hence, dietetic restrictions are commonly imposed in order to limit potassium and phosphate and avoid fluid overload. Conversely, malnutrition is a major challenge and, albeit to differing degrees, all nutritional markers are associated with survival. Dialysis-related malnutrition has a multifactorial origin related to uremic syndrome and comorbidities but also to dialysis treatment. Both an insufficient dialysis dose and excessive removal are contributing factors. It is thus not surprising that dialysis alone, without proper nutritional management, often fails to be effective in combatting malnutrition. While composite indexes can be used to identify patients with poor prognosis, none is fully satisfactory, and the definitions of malnutrition and protein energy wasting are still controversial. Furthermore, most nutritional markers and interventions were assessed in hemodialysis patients, while hemodiafiltration and peritoneal dialysis have been less extensively studied. The significant loss of albumin in these two dialysis modalities makes it extremely difficult to interpret common markers and scores. Despite these problems, hemodialysis sessions represent a valuable opportunity to monitor nutritional status and prescribe nutritional interventions, and several approaches have been tried. In this concept paper, we review the current evidence on intradialytic nutrition and propose an algorithm for adapting nutritional interventions to individual patients.

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Amino acid profile after oral nutritional supplementation in hemodialysis patients with protein-energy wasting

Cited by 15 publications

References 19 publications

How to Overcome Anabolic Resistance in Dialysis-Treated Patients?

How to Overcome Anabolic Resistance in Dialysis-Treated Patients?

Muscle Status Response to Oral Nutritional Supplementation in Hemodialysis Patients With Protein Energy Wasting: A Multi-Center Randomized, Open Label-Controlled Trial

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

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