Systemic inflammation May limit the effect of protein supplement on nutritional status in peritoneal dialysis.

Abstract

Malnutrition and inflammation are highly prevalent and associated with poor outcomes in continuous ambulatory peritoneal dialysis (CAPD). Nutritional supplements are commonly used; however, presence of systemic inflammation could limit their effect. To evaluate the impact of systemic inflammation on nutritional status of CAPD patients receiving an oral protein supplement. Prospective observational study; 34 malnourished patients (subjective global assessment; SGA) received both nutritional counseling and oral egg albumin-based protein supplement. During 6-month of follow-up, patients had monthly clinical, and quarterly biochemical and inflammation [interleukin 6 and high sensitivity C-reactive protein (hsCRP)] evaluations. According to baseline hsCRP, patients were classified in two groups: Inflammation (>3mg/L) and No-inflammation (≤3mg/L). Comparing baseline vs final, macronutrient intake and SGA increased in both groups, however, improvement of SGA was more marked in the No-inflammation group at the end of the study: 70% improved, 25% no change and 5% worsened (p=0.001); whereas in the Inflammation group results were: 50% improved, 36% no change and 14% worsened (p=0.03). Additionally, at final evaluation, serum albumin tended to increase more in the No-inflammation (3.0±0.9 vs 3.4±1.1g/dL, p=0.08) than in Inflammation group (2.8±0.6 vs 3.0±0.9g/dL, p=0.66), and body mass index significantly increased in No-inflammation group (20.3±3.0 vs 21.6±3.3kg/m2, p<0.001) but not in Inflammation group (21.9±3.0 vs 22.5±3.3kg/m2, p=0.09). The presence of systemic inflammation in malnourished CAPD patients seemed to limit the trend for improvement on nutritional status observed with counseling and oral egg albumin-based protein supplement in patients without inflammation.