High Protein/Energy vs. Standard Protein/Energy Nutritional Regimen in the Treatment of Malnourished Hemodialysis Patients

Abstract

Although malnutrition is frequently encountered in maintenance hemodialysis (MHD) patients, a clear method of treating this complication is still lacking. Failure of nutritional support regimens may be due to inadequate support of dietary needs. Therefore, a high vs. standard or low protein/energy dietary regimen was studied in malnourished MHD patients. A total of 18 malnourished MHD patients selected according to subjective global assessment (SGA)-scores and biochemical indicators of malnutrition (serum albumin <40 g/l, cholesterol <200 mg/dl, prealbumin <30 mg/dl; two out of three) were assigned to three treatment groups: (A: 45 kcal/kg/d and 1.5 g protein/kg/d; B: 35 kcal/kg/d and 1.2 g protein/kg/d; C: spontaneous intake supplemented with 10% of mean protein and energy intake). A and B received food supplements at appropriate dosing to reach the targeted nutritional intake. During 3-month follow-up nutrient intake was assessed by repeated 4-day dietary diaries. Compliance and tolerance was good in each group. Weight gain (1.2±0.4 kg) was observed in group A, but not in B and C. Serum albumin levels increased by 1.0±0.5 g/l in group A, but not in B and C. Prealbumin and cholesterol levels were unaffected. Weight change correlated with mean dietary energy intake, but not with mean dietary protein intake. We conclude that prescription of 45 kcal/kg/d and 1.5 g protein/kg/d may be necessary to achieve weight gain and improvement of nutritional indices in malnourished MHD pts. Oral food supplements can be used safely and effectively to increase nutrient intake to high levels in these patients.

Wasting in chronic kidney disease

“…To the best of our knowledge, there are 13 randomized controlled trials [104][105][106][107][108][109][110][111][112] of nutritional therapy in ESRD patients. In eight out of the nine randomized trials with serum albumin as a surrogate outcome measure, significant improvement in hypoalbuminemia was reported [104][105][106][107][108][109][110][111][112]. Serum albumin did not increase significantly in the study by Fouque et al [113] but even in this study higher serum albumin and prealbumin levels were observed in those who achieved higher dietary protein intake.…”

The effect of dialysis dose and membrane flux on nutritional parameters in hemodialysis patients: Results of the HEMO Study

“…Most investigators have shown that serum albumin levels increase during the first six months of dialysis [49][50][51] followed by a decline in values during the second year of maintenance hemodialysis therapy [52]. Results from several small studies have shown that an increase in either energy or protein intake can increase serum albumin levels by 0.5 g/dL to 1.0 g/dL [14,15]. Other interventions in which protein or energy intake were increased did not result in a statistically significant increase in serum albumin levels; perhaps because they involved small numbers of patients and/or they were not randomized trials [2,[16][17][18][19].…”

“…Although the benefits of erythropoietin alpha on nutritional status in hemodialysis patients have been well documented, the effects of oral and parenteral supplementation and the correction of acidosis are uncertain [2,[14][15][16][17][18][19][20][21][22][23]. An increased dose of dialysis and the use of biocompatible membranes have also been used to enhance nutritional status in hemodialysis patients.…”

Role of Growth Hormone Deficiency and Treatment in Chronic Kidney Disease

“…A few studies have reported a possibility of reversing this morbidity and mortality following improvement of the malnutrition state [52,53,54]. To study this effect, investigators infused rhGH at varying doses with primary end points being change in body composition, LBM and other nutritional markers like serum albumin.…”