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Ocepek A, Ekart R, Povalej Bržan P, Bevc S. Simply adding oral nutritional supplementation to haemodialysis patients may not be enough: a real-life prospective interventional study. Front Nutr 2023; 10:1253164. [PMID: 37927500 PMCID: PMC10620502 DOI: 10.3389/fnut.2023.1253164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Protein-energy wasting (PEW) is a common and serious co-morbidity in haemodialysis (HD) patients. Its importance as a prognostic factor has been increasingly recognised during the past decades. Much effort has been invested in the improvement of nutritional status and amelioration of consequences through different therapeutic approaches, either intradialytic parenteral nutrition or more commonly oral nutritional supplementation. In the article, we present the results of a prospective study in HD patients after 12 months of therapeutic intervention with oral nutritional supplements (ONS). Methods A total of 92 HD adult patients were enrolled in the study after 3 months of wash-out period. Baseline nutritional status was assessed using composite scores, laboratory markers, bioelectrical impedance analysis, and hand-grip strength test. Patients recognised as undernourished or at high risk for undernutrition received renal-specific commercially available ONS on HD day in addition to their regular diet. After 12 months, the effect of ONS on surrogate markers of undernutrition, serum albumin level, phase angle, and hand-grip strength was analysed in 71 surviving patients. Results After 12 months, data for 71 patients, 39 (54.9%) men, 62.4 ± 12.9 years, and median haemodialysis vintage 53.3 (IQR 27.5-92.8) months, were available. Patients were divided into three groups: group A patients were with normal nutritional status at baseline not necessitating ONS; group B patients received ONS; and group C patients were entitled to receive but refused to take ONS. The baseline results showed statistically significant differences between the groups in serum albumin levels and phase angle but not hand-grip strength. Differences between the groups remained statistically significant at month 12; we did not find any statistically significant positive changes within the groups, indicating no positive effect of intervention with ONS. Conclusion In a prospectively designed interventional single-centre study, we did not find a statistically significant change in surrogate markers of PEW in our cohort of HD patients, receiving ONS for 12 months. Since PEW is an independent risk factor influencing the survival of HD patients, efforts should be directed towards a timely and comprehensive nutritional approach, including intensive, personalised dietary counselling, increase in protein and energy intake and advocating tight control of nutritional status during HD treatment, possibly providing psychological support and motivation.
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Affiliation(s)
- Andreja Ocepek
- Department of Gastroenterology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | - Robert Ekart
- Department of Dialysis, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Petra Povalej Bržan
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
| | - Sebastjan Bevc
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
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Castro-Barquero S, Arias-Guillén M, Pi-Oriol S, Sacanella E, Romano-Andrioni B, Vidal-Lletjós S, Ruiz-León AM, Estruch R, Casas R. A Comparative Study of the Efficacy of an Intervention with a Nutritional Supplement for Patients with Chronic Kidney Disease: A Randomized Trial. J Clin Med 2022; 11:jcm11061647. [PMID: 35329972 PMCID: PMC8951226 DOI: 10.3390/jcm11061647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic kidney disease (CKD) involves heterogeneous diseases that affect the renal structure and function. Malnutrition plays a crucial role during patients with CKD on hemodialysis (HD) treatment and is associated with an increased rate and duration of hospitalizations. The aim of this randomized, parallel, intervention-controlled trial was to assess whether the use of daily supplementation with a new nutritional product developed by the Grand Fontaine Laboratories improves the nutritional status and anthropometric parameters of stage 5 CKD patients, compared with standard renal dietary advice, after three months of follow-up. Dietary intake, anthropometric measurements, physical activity, and blood samples were collected at baseline and after three months of intervention. Significant improvements were observed within the intervention group in body weight (1.5 kg [95% CI: 0.9 to 2.12 kg]) and BMI (0.54 kg/m2 [95% CI: 0.31 to 0.77]; p-value between groups, 0.002 and 0.006, respectively). In the control group, significant decreases were observed in transferrin saturation (-5.04% [95% CI: -8.88 to -1.21]) and alpha-tocopherol levels (-3.31 umol/L [95% CI: -6.30 to -0.32]). We concluded that daily dietary intake of a specific renal nutritional complement in CKD patients with or at risk of malnutrition may prevent deterioration in nutritional parameters.
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Affiliation(s)
- Sara Castro-Barquero
- Department of Medicine, Faculty of Medicine and Life Sciences, University of Barcelona, 08036 Barcelona, Spain; (S.C.-B.); (S.P.-O.); (E.S.); (R.E.)
- Department of Internal Medicine, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Marta Arias-Guillén
- Department of Nephrology, Hospital Clínic Barcelona, 08036 Barcelona, Spain;
| | - Sofia Pi-Oriol
- Department of Medicine, Faculty of Medicine and Life Sciences, University of Barcelona, 08036 Barcelona, Spain; (S.C.-B.); (S.P.-O.); (E.S.); (R.E.)
| | - Emilio Sacanella
- Department of Medicine, Faculty of Medicine and Life Sciences, University of Barcelona, 08036 Barcelona, Spain; (S.C.-B.); (S.P.-O.); (E.S.); (R.E.)
- Department of Internal Medicine, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
| | | | | | - Ana María Ruiz-León
- Department of Internal Medicine, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Mediterranean Diet Foundation, 08021 Barcelona, Spain
| | - Ramon Estruch
- Department of Medicine, Faculty of Medicine and Life Sciences, University of Barcelona, 08036 Barcelona, Spain; (S.C.-B.); (S.P.-O.); (E.S.); (R.E.)
- Department of Internal Medicine, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Rosa Casas
- Department of Medicine, Faculty of Medicine and Life Sciences, University of Barcelona, 08036 Barcelona, Spain; (S.C.-B.); (S.P.-O.); (E.S.); (R.E.)
- Department of Internal Medicine, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-93-2275745; Fax: +34-93-2275758
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