Abstract
In maintenance hemodialysis (MHD) patients, low protein intake is associated with protein-energy wasting, a risk factor that affects outcome. However, increased protein intake may lead to hyperphosphatemia and hyperkalemia, which are also mortality risk factors. Here, we evaluated the safety and effects of purified rice endosperm protein (REP), which contains less phosphorus and potassium than soy and casein proteins, as a supplemental protein source for MHD patients. This randomized, double-blind, placebo-controlled, crossover pilot study of REP supplementation (5 g/day × 4 weeks) was carried out in 50 Japanese adult MHD patients (1 dropped out); the primary outcome was the change in the urea kinetic-based normalized protein catabolic rate (nPCR), an indicator of protein intake in MHD patients. Intention-to-treat analyses of 24 patients in the REP-first group and 25 in the placebo-first group showed that REP supplementation increased nPCR significantly by 0.07 g/kg/day (95% confidence interval, 0.03–0.11), whereas changes in serum phosphorus and potassium concentrations were not different from the placebo. REP supplementation did not show a significant effect on other nutritional or metabolic parameters and no specific complications. In conclusion, purified REP with efficient bioavailability may be safe and useful for dietary supplementation in MHD patients.
Highlights
Casein protein*** 10.8 86.1 730 2.7 2.7 24.2 2.6 N/A, which is an index of dietary protein intake in this population, was reported to be suboptimal across countries, with a median value ranging from 0.91 g/kg/day in Japan to 1.10 g/kg/day in Spain[3]
A previous study reported a U-shaped association between normalized protein catabolic rate (nPCR) and mortality in maintenance hemodialysis (MHD) patients; where the best survival was observed between 1.0 and 1.4 g/ kg/day, and both lower (1.4 g/kg/day) nPCR were associated with greater mortality[7]
We investigated the effects of rice endosperm protein (REP) supplementation on nPCR, mineral metabolism, and nutritional and metabolic parameters in MHD patients with insufficient protein intake and inadequate nutritional status
Summary
Casein protein*** 10.8 86.1 730 2.7 2.7 24.2 2.6 N/A (nPCR), which is an index of dietary protein intake in this population, was reported to be suboptimal across countries, with a median value ranging from 0.91 g/kg/day in Japan to 1.10 g/kg/day in Spain[3] This suggests the need for protein supplementation for the majority of maintenance hemodialysis (MHD) patients. A simple, mass preparative procedure for rice endosperm protein (REP) was developed using an alkali extraction method[11] This isolate is characterized by >80% crude protein, with lower amounts of phosphorus and potassium compared with soy[12] and casein proteins[13] (Table 1). We investigated the effects of REP supplementation on nPCR, mineral metabolism, and nutritional and metabolic parameters in MHD patients with insufficient protein intake and inadequate nutritional status
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