Effects of Oral Nutritional Supplementation on Nutritional Status in Chronic Hemodialysis Patients

Abstract

Protein-calorie malnutrition is common in chronic hemodialysis (CHD) patients and is associated with poor outcome. Very few studies of oral nutritional supplementation have been conducted and these have shown mixed results. Objective : To evaluate nutritional status in our CHD patients receiving oral nutritional supplementation over a period of 6 months. Methods : 22 CHD patients with evidence of malnutrition were included in this prospective study. The inclusion criteria were serum albumin of ≤ 3.5 g/dL or serum prealbumin of ≤ 30 mg/dL and a decrease of dry weight ≥ 5% in the last 3 months or ≥ 10% in the last 6 months. Patients received nutrition intervention by various oral nutritional supplements providing 450 calories and 15.4 grams of protein per day. Compliance was assessed by questioning patients at each HD session. Nutritional parameters were recorded and results were analyzed using paired t test to examine the difference between compliant and non-compliant patients for each nutritional parameter at baselines and 6-month follow-up. Results : 10 patients were considered as non-compliant because ingesting < 75% of prescribed nutritional supplementation. In compliant patients, there were significant increases in concentrations of serum albumin (3.14 ± 0.72 vs 3.57 ± 0.95 g/dL, p < 0.01), serum prealbumin (24.7 ± 6.3 vs 29.5 ± 4.7 mg/dL, p < 0.01) and of the estimated dry weight (64.2 ± 8.5 vs 67.9 ± 6.1 kg, p < 0.05). There was not any significant modification of nutritional markers in non-compliant patients. Dietary intake estimated by dietary recall was unchanged during the study in all patients. Conclusions : When observed, oral nutritional supplementation is effective to improve nutritional markers in malnourished CHD patients. Limits of this intervention are weariness and non-compliance over time.