Nutritional status among peritoneal dialysis patients after oral supplement with ONCE dialyze formula

Abstract

Background:Malnutrition is an important problem in patients treated with long-term dialysis, and most dialysis patients have lower dietary energy and protein intake. This study was undertaken to examine whether orally administered Otsuka Nutrition Pharmaceutical (ONCE) dialyze formula (ODF) supplement would improve energy intake without mineral and electrolyte disturbances in patients with continuous ambulatory peritoneal dialysis (CAPD). Methods:The effects of ODF supplementation on nutrition markers including serum albumin and prealbumin concentrations and inflammatory stress in patients with chronic CAPD were evaluated. All patients received daily oral ODF supplements for 15 days. During follow-up, all patients were evaluated clinically and biochemically, and nutritional status was assessed. Results: Thirty patients with mean age 61.9±12.3 years and weekly Kt/V 2.2±0.4 were studied. The mean values for nutritional parameters included a body weight of 53.7±9.5 kg, a serum albumin level of 3.3±0.4 g/dL, a serum prealbumin level of 33.8±11.1 mg/dL, a dietary energy intake of 21.9±7.1 kcal/kg/day, and a dietary protein intake of 0.9±0.3 g/kg/day. After 15-day ODF treatment, these patients had significant dietary energy and protein, carbohydrate, fat, fiber, potassium, calcium, and magnesium intake from baseline (P<0.05). Furthermore, significant improvements were found in nutritional markers including body weight, blood urea nitrogen, and prealbumin levels, but no changes were observed in serum albumin and high-sensitivity C-reactive protein levels. At the end of follow-up, the frequency of patients with moderate malnutrition decreased from 24.2% to 18.2%, and no increased incidence was observed of hyperkalemia, hyperphosphatemia, and metabolic acidosis. Conclusion: ODF supplementation ameliorates low dietary energy and nutrient intake as well as improves serum prealbumin and body weight in patients with long-term CAPD.

Clinical efficacy and feasibility of whey protein isolates supplementation in malnourished peritoneal dialysis patients: A multicenter, parallel, open-label randomized controlled trial

“…Increased serum albumin levels were observed within both IG (þ1.35 g/L, d ¼ 0.32) and CG (þ3.42 g/L, d ¼ 0.72) patients postintervention which is again the likely effect of patient contact with the dietitian. Based on previous studies, depending on serum albumin for measuring intervention outcome is inadequate [4,5,10,15e19,21e23,40,41] as findings may be confounded by hydration and inflammation status [4,40,42]. However, between group comparisons were significant for serum urea (moderate), nPCR (large), and DPI (large) for the supplemented compared to control patients.…”

“…Given issues affecting supplementations targeting PD patients [5,15,17,19,21,40,41], we elected to report outcomes based on not just cause-effect relationships but also whether greater compliancy (based on increased nPCR) translated into improved nutritional outcomes in post hoc analyses [48]. Compliance to protein supplementation yielded sizeably large nPCR (d ¼ 0.80) and moderate serum urea (d ¼ 0.53) increases in IG patients, which are expected outcomes [9,15] and signify nPCR as a marker of nutrition status [10] while urea production also signifies metabolic breakdown of exogenous protein [15].…”

Education and Protein Supplementation Improve Nutritional Biomarkers among Hypoalbuminemic Peritoneal Dialysis Patients: A Quasi-Experimental Design

“…The intake of protein has reached the recommendation level in intervention groups. Oral protein supplementation (Otsuka Nutrition Pharmaceutical (ONCE) dialyze formula (ODF)) was found to increase the calorie and protein intake in hypoalbuminemic peritoneal dialysis patients [28]. Another study conducted by Sahathevan and colleagues in Malaysia found that oral protein supplementation was significantly associated with increased protein intake in an intervention group, and increased calorie intake in control groups [11].…”

“…In our study, after three-month nutritional education and protein supplementation, albumin was found to be increased in all groups, total protein was increased in control and milk protein groups, while BUN was increased in two intervention groups. Results of a previous study demonstrated that oral protein supplements (dietary renal-specific formula) could improve pre-albumin, BUN, and body weight in hypoalbuminemic patients [28]. Other types of oral protein supplements like whey protein could also improve nutritional status (serum albumin, normalized protein equivalent of total nitrogen appearance, and lean tissue index) in peritoneal dialysis patients [32].…”

Diagnosis, Prevention, and Treatment of Protein-Energy Wasting in Peritoneal Dialysis

“…This requires a minimum spontaneous dietary intake of 20 kcal/kg per day of energy and 0.4-0.8 g/kg per day of protein in order to meet the recommended dietary energy intake and dietary protein intake targets [50,68]. Oral nutritional supplements have been shown to improve protein-calorie intake and the nutritional status (body weight, prealbumin, SGA score) in PD patients [71,72]. However, a high rate of non-compliance and intolerance has been reported with the long-term use of these types of supplements [73].…”