Abstract
PurposeThe study assessed the impact of intradialytic oral nutritional supplementation on the quality of life in patients receiving hemodialysis and diagnosed with protein energy wasting.MethodsA pre-test post-test quasi-experimental study was conducted before and after 3 months of intradialytic oral nutritional supplementation on 109 older hemodialysis patients. We measured before and after 3 months of intradialytic oral nutritional supplementation, the quality of life score, the burden of kidney disease, three quality of life scales and the mental and physical health status using KDQoL-SF™ 1.3, body composition and biochemical parameters of nutritional condition.ResultsThe mean age of the patients was 69.4 ± 3.4 years, 59% were male, and the time on dialysis was 63.5 ± 52.6 months. Comparing the baseline with month 3 of intradialytic oral nutritional supplementation, we observed to better quality of life. In contrast to malnutrition, score, specifically increased significantly score of symptoms/problems list related to hemodialysis, sexual function, social and cognitive function, sleep, pain, energy/fatigue and general state of health. Significant changes were also found in nutritional status, energy intake and body composition indicators. After 3 months of intradialytic oral nutritional supplementation, we observed a nutritional status recovery in one or more indicators in 92% of the patients.ConclusionOur findings indicate that 3 months of intradialysis oral nutritional supplementation improves the components of physical and mental quality of life and nutritional status in older patients receiving hemodialysis diagnosed with loss of protein energy. These results are relevant to improve the experience of patients with protein energy loss receiving hemodialysis.
Highlights
The term “Protein-Energy Wasting” (PEW) has been suggested to describe a clinical progressive depletion of protein and/or energy stores is often observed which has high prevalence rates [1]
The decline in serum albumin concentration occurring in Protein-energy wasting (PEW), which progresses with time on dialysis, is a strong predictor of mortality [7]
Interventions to mitigate the effects of PEW have considered the implementation of physical activity programs together with supplementation strategies aimed at increasing protein and caloric intake, in older patients, it is difficult to implement interventions aimed at improving aspects such as muscle strength, the increased protein and caloric intake is a more viable type of intervention [8,9,10]
Summary
The term “Protein-Energy Wasting” (PEW) has been suggested to describe a clinical progressive depletion of protein and/or energy stores is often observed which has high prevalence rates (up to 50–75% of patients with CKD stages IV–V) [1]. Protein-energy wasting (PEW) is associated with adverse clinical outcomes including greater morbidity, increased mortality from infection or cardiovascular conditions and impaired quality of life in patients receiving hemodialysis (HD) [2, 3]. Observational studies have reported a relationship between poor nutritional status and decreased quality of life (QoL) in HD patients, malnourished patients had poorer scores in almost all dimensions of QoL [20,21,22] and an association between higher malnutrition-inflammation scores and worsening of QoL have been identified. Few studies have evaluated the effect of intradialysis ONS on quality of life in older patients on hemodialysis. We investigated whether the administration of ONS for 3 months during the first hour of dialysis would affect the quality of life and nutritional status in HD patients diagnosed with PEW
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