Efficacy of a High Protein Oral Nutritional Supplement in Maintenance Hemodialysis Patients

Tung-Wei Hung, Shu-Ru Zhuang and Chin-Kun Wang

Background and Objective: Protein energy wasting (PEW) with hypoalbuminemia is common in Chronic Kidney Disease (CKD). Dialysis patients may benefit from high protein (HP) supplementation. The aim of the present study was to investigate a high protein oral nutritional supplement (ONS) (intervention) that suitable for hemodialysis patient compared to an existing ONS formulated for CKD patients on maintenance hemodialysis (MHD) (control) in increasing serum albumin in hypoalbuminemic patients with similar recommended energy intake. Materials and Methods: This single-center prospective, randomized, open-label, controlled, parallel group study investigated patients on stable thrice-weekly MHD receiving either daily one or two bottles of intervention ONS or a control ONS for 8 weeks. Of 76 randomized patients, 68 were analysed. Dietary evaluation and individualized dietetic prescription was applied. Serum albumin, anthropometry, blood chemistry, hematology, vital signs and adherence were measured. Results: Both groups significantly increased (p<0.001) energy and macronutrient intake from baseline, resulting in comparable within-group increases in body weight and Body Mass Index (BMI) by week 8 (p<0.05). The intervention group had superior improvements in serum albumin compared to controls (group mean difference (95% CI) baseline to week 4 = 2.11 (0.51; 3.71) g/L and to week 8 = 2.25 (0.69; 3.81) g/L). The intervention group also had increased pre-albumin and total protein levels after 4 and 8 weeks (p<0.05 vs baseline). Conclusion: Post-dialysis blood urea nitrogen remained stable. The intervention group had increased hemoglobin, improved red cell morphology and lower hs-CRP. Adherence was >99% in both groups. There were no reports of gastrointestinal intolerance. The increase in serum albumin over time was more prominent in the intervention ONS group vs controls.

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