Intradialytic Oral Nutritional Supplements Improve Quality of Life

Abstract

We applaud Dr Lacson and colleagues1Lacson Jr, E. Wang W. Zebrowski B. Wingard R. Hakim R.M. Outcomes associated with intradialytic oral nutritional supplements in patients undergoing maintenance hemodialysis: a quality improvement report.Am J Kidney Dis. 2012; 60: 591-600Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar on their important work demonstrating the positive impact of intradialytic oral nutritional supplementation (ONS) on hemodialysis patient survival. Years ago, we performed a study in which participants consumed an ONS product (16.6 g of protein and 475 calories per 240-mL serving) thrice weekly with each hemodialysis session.2Scott M.K. Shah N.A. Vilay A.M. Thomas III, J. Kraus M.A. Mueller B.A. Effects of peridialytic oral supplements on nutritional status and quality of life in chronic hemodialysis patients.J Ren Nutr. 2009; 19: 145-152Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar After 3 months, serum albumin values showed a significant benefit in study participants compared with patients in the unit who did not participate in the program. Although our study was not powered to look at mortality (n=44 in each group), we examined another set of outcomes that merits mention. In addition to monitoring laboratory nutritional indexes, we administered the Kidney Disease Quality of Life Short Form (KDQOL-SF; version 1.3) at baseline and the end of the study.3Hays R.D. Kallich J.D. Mapes D.L. Coons S.J. Carter W.B. Development of the Kidney Disease Quality of Life (KDQOL) instrument.Qual Life Res. 1994; 3: 329-338Crossref PubMed Scopus (818) Google Scholar We found that intradialytic ONS was associated with improvement in the role-physical domain of the KDQOL-SF as opposed to a decline among the comparator group (P=0.02). Therefore, participants who were given intradialytic ONS perceived that they were physically able to fulfill their responsibilities related to work and day-to-day roles. We wholeheartedly agree that serious consideration should be given to providing intradialytic ONS at hemodialysis centers. Intradialytic ONS is a fairly economical intervention that has the potential to greatly affect patient mortality,1Lacson Jr, E. Wang W. Zebrowski B. Wingard R. Hakim R.M. Outcomes associated with intradialytic oral nutritional supplements in patients undergoing maintenance hemodialysis: a quality improvement report.Am J Kidney Dis. 2012; 60: 591-600Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar as well as important, but sometimes undervalued, patient-reported outcomes such as quality-of-life measures.2Scott M.K. Shah N.A. Vilay A.M. Thomas III, J. Kraus M.A. Mueller B.A. Effects of peridialytic oral supplements on nutritional status and quality of life in chronic hemodialysis patients.J Ren Nutr. 2009; 19: 145-152Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar Abbott Laboratories provided the therapeutic nutrition and the Rand Corp permitted use of the KDQOL-SF instrument used in the original study.2Scott M.K. Shah N.A. Vilay A.M. Thomas III, J. Kraus M.A. Mueller B.A. Effects of peridialytic oral supplements on nutritional status and quality of life in chronic hemodialysis patients.J Ren Nutr. 2009; 19: 145-152Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar Financial Disclosure: The authors declare that they have no relevant financial interests. Outcomes Associated With Intradialytic Oral Nutritional Supplements in Patients Undergoing Maintenance Hemodialysis: A Quality Improvement ReportAmerican Journal of Kidney DiseasesVol. 60Issue 4PreviewInsufficient clinical data exist to determine whether provision of oral nutritional supplements during dialysis can improve survival in hypoalbuminemic maintenance hemodialysis patients. Full-Text PDF In Reply to ‘A More Cautious Stance on Nutritional Supplementation for Hypoalbuminemia Is Justified’ and ‘Intradialytic Oral Nutritional Supplements Improve Quality of Life’American Journal of Kidney DiseasesVol. 61Issue 2PreviewWe appreciate the complexity of the association between inflammation and malnutrition alluded to by Drs Friedman and Fadem.1 However, a low albumin level is not an exclusive marker of either a malnourished or an inflammatory state; both conditions may coexist in dialysis patients.2 More importantly, nutritional interventions have been described to positively affect patients regardless of whether they have coexisting inflammation.3,4 Intradialytic nutrition specifically has been shown to counteract catabolism during hemodialysis, normalize metabolic derangement, and increase serum albumin level. Full-Text PDF