Supervised oral protein supplementation during dialysis in patients with elevated C-reactive protein levels: a two phase, longitudinal, single center, open labeled study.

Srinivasan Beddhu,Tom Greene,Jill L Neilson,Yufeng Huang,Guo Wei,Rebecca Filipowicz,Xiaorui Chen

doi:10.1186/s12882-015-0070-0

Srinivasan Beddhu, Tom Greene + Show 5 more

Open Access

https://doi.org/10.1186/s12882-015-0070-0

Copy DOI

Abstract

BackgroundInflammation is considered one of the major causes of protein-energy wasting in maintenance hemodialysis (MHD) patients. It is unclear whether dietary interventions can impact nutritional status and quality of life in MHD patients with elevated C-reactive protein (CRP) levels. Therefore, we examined the hypothesis that supervised intra-dialysis protein supplementation in MHD patients with elevated plasma CRP will improve protein stores and quality of life.MethodsA 24 week, two phase, longitudinal, single center, open labeled study of 50 MHD patients with plasma CRP > 3 mg/L was conducted. During the 12-week observation phase dietary advice was provided to increase protein intake to 1.2 g/kg/day. In the 12-week treatment phase 45 g of liquid protein supplement was provided at each dialysis treatment. Protein nitrogen appearance (PNA), mid-arm muscle circumference (MAMC), serum albumin, body mass index (BMI) and quality of life (assessed by Short Form-12 questionnaire) were measured at baseline, 12 and 24 weeks.ResultsMedian plasma CRP at baseline was 16.0 (IQR 7.7 to 25.1) mg/L. The mean MAMC was 26.5 ± 3.9 cm, BMI 29.2 ± 6.9 kg/m2 and plasma albumin 3.8 ± 0.3 g/dl. During the intervention period, mean PNA increased by 0.13 g/kg/d (p = 0.01) under a mixed effects model. However, there were no clinically or statistically significant effects on MAMC (p = 0.87), plasma albumin (p = 0.70), BMI (p = 0.09), physical (p = 0.32) or mental (p = 0.96) composite scores.ConclusionsIn MHD patients with elevated plasma CRP but otherwise mostly normal nutritional parameters, intra-dialytic oral protein supplement was effective in increasing protein intake but did not provide a detectable impact on nutritional status or quality of life.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-015-0070-0) contains supplementary material, which is available to authorized users.

Highlights

Inflammation is considered one of the major causes of protein-energy wasting in maintenance hemodialysis (MHD) patients
The one and three year survival probabilities of incident hemodialysis patients are dismal at 74 % and 50 %, respectively [1]
Induced by inflammation is widely considered the underlying cause of Protein-energy wasting (PEW) in MHD patients [4]. It is unclear whether protein supplementation affects body composition, body size and quality of life in MHD patients with elevated C-reactive protein (CRP) levels

Summary

Introduction

Inflammation is considered one of the major causes of protein-energy wasting in maintenance hemodialysis (MHD) patients It is unclear whether dietary interventions can impact nutritional status and quality of life in MHD patients with elevated C-reactive protein (CRP) levels. Anorexia and hypercatabolism induced by inflammation is widely considered the underlying cause of PEW in MHD patients [4] It is unclear whether protein supplementation affects body composition, body size and quality of life in MHD patients with elevated C-reactive protein (CRP) levels. In an open labeled interventional trial, we examined the hypothesis that supervised protein supplementation during dialysis in MHD patients with elevated serum CRP will improve protein stores (as measured by mid-arm muscle circumference (MAMC) and plasma albumin), body size (as measured by body mass index (BMI)) and quality of life

Methods

Results

Conclusion