The use of dietary supplements in continuous ambulatory peritoneal dialysis patients

Abstract

Objective: To show the effect of dietary supplements on protein, calorie, phosphorus, potassium, and sodium intake. Design: A prospective study of 22 peritoneal dialysis patients over a study period of 8 weeks. The patients were selected according to those who were not taking dietary supplements (group A: 12 patients), and those who were (group B: 10 patients). Supplements used were Ensure Plus (Abbott) and Protein Forte (Fresenius). Nutritiol intake was assessed using 7-day food diaries at the start of the study and at 8 weeks from baseline. Urea kinetic modeling was performed at the start of the study. The following parameters were assessed and their relationships investigated: Kt V , normalized protein catabolic rate (nPCR), serum albumin, HCO 3, age of patient, duration on dialysis, body mass index (BMI), and protein, calorie, phosphorus, potassium, and sodium intake. Setting: Renal unit outpatients clinic in hospital. Main Outcome Measure: Dietary intake of calories, protein, phosphorus, potassium, and sodium. Results: Subjects in group B were significantly older than those in group A ( P =.009). A significant difference was found in protein intake and BMI between groups A and B with supplementation ( P = .018, P = .015, respectively), 7and a significant improvement in calorie and protein intake with supplements in group B ( P = .003, P = .003, respectively). The phosphorus, potassium, and sodium content of the supplements did not increase total intake above acceptable levels. Correlations were obtained between Kt V and BMI in group A ( r = .72, P = .01), and in group B between Kt V and protein g/kg IBW d ( r = .69, P = .03), protein g/kg IBW d and nPCR ( r = .86, P = .01). Conclusion: Dietary supplements are effective in improving calorie and protein intake without exceeding the recommended intakes of phosphorus, potassium, and sodium. Older patients in this study seem to need more nutritional support, which may have implications as the number of older patients accepted for renal replacement therapy is increasing.