Simply adding oral nutritional supplementation to haemodialysis patients may not be enough: a real-life prospective interventional study
IntroductionProtein-energy wasting (PEW) is a common and serious co-morbidity in haemodialysis (HD) patients. Its importance as a prognostic factor has been increasingly recognised during the past decades. Much effort has been invested in the improvement of nutritional status and amelioration of con...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-10-01
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| Series: | Frontiers in Nutrition |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnut.2023.1253164/full |
| _version_ | 1797656131696328704 |
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| author | Andreja Ocepek Robert Ekart Robert Ekart Petra Povalej Bržan Petra Povalej Bržan Sebastjan Bevc Sebastjan Bevc |
| author_facet | Andreja Ocepek Robert Ekart Robert Ekart Petra Povalej Bržan Petra Povalej Bržan Sebastjan Bevc Sebastjan Bevc |
| author_sort | Andreja Ocepek |
| collection | DOAJ |
| description | IntroductionProtein-energy wasting (PEW) is a common and serious co-morbidity in haemodialysis (HD) patients. Its importance as a prognostic factor has been increasingly recognised during the past decades. Much effort has been invested in the improvement of nutritional status and amelioration of consequences through different therapeutic approaches, either intradialytic parenteral nutrition or more commonly oral nutritional supplementation. In the article, we present the results of a prospective study in HD patients after 12 months of therapeutic intervention with oral nutritional supplements (ONS).MethodsA total of 92 HD adult patients were enrolled in the study after 3 months of wash-out period. Baseline nutritional status was assessed using composite scores, laboratory markers, bioelectrical impedance analysis, and hand-grip strength test. Patients recognised as undernourished or at high risk for undernutrition received renal-specific commercially available ONS on HD day in addition to their regular diet. After 12 months, the effect of ONS on surrogate markers of undernutrition, serum albumin level, phase angle, and hand-grip strength was analysed in 71 surviving patients.ResultsAfter 12 months, data for 71 patients, 39 (54.9%) men, 62.4 ± 12.9 years, and median haemodialysis vintage 53.3 (IQR 27.5–92.8) months, were available. Patients were divided into three groups: group A patients were with normal nutritional status at baseline not necessitating ONS; group B patients received ONS; and group C patients were entitled to receive but refused to take ONS. The baseline results showed statistically significant differences between the groups in serum albumin levels and phase angle but not hand-grip strength. Differences between the groups remained statistically significant at month 12; we did not find any statistically significant positive changes within the groups, indicating no positive effect of intervention with ONS.ConclusionIn a prospectively designed interventional single-centre study, we did not find a statistically significant change in surrogate markers of PEW in our cohort of HD patients, receiving ONS for 12 months. Since PEW is an independent risk factor influencing the survival of HD patients, efforts should be directed towards a timely and comprehensive nutritional approach, including intensive, personalised dietary counselling, increase in protein and energy intake and advocating tight control of nutritional status during HD treatment, possibly providing psychological support and motivation. |
| first_indexed | 2024-03-11T17:24:56Z |
| format | Article |
| id | doaj.art-90e4b424820f42c993a719740daa3c30 |
| institution | Directory Open Access Journal |
| issn | 2296-861X |
| language | English |
| last_indexed | 2024-03-11T17:24:56Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Nutrition |
| spelling | doaj.art-90e4b424820f42c993a719740daa3c302023-10-19T06:45:19ZengFrontiers Media S.A.Frontiers in Nutrition2296-861X2023-10-011010.3389/fnut.2023.12531641253164Simply adding oral nutritional supplementation to haemodialysis patients may not be enough: a real-life prospective interventional studyAndreja Ocepek0Robert Ekart1Robert Ekart2Petra Povalej Bržan3Petra Povalej Bržan4Sebastjan Bevc5Sebastjan Bevc6Department of Gastroenterology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, SloveniaDepartment of Dialysis, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, SloveniaFaculty of Medicine, University of Maribor, Maribor, SloveniaFaculty of Medicine, University of Maribor, Maribor, SloveniaFaculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, SloveniaFaculty of Medicine, University of Maribor, Maribor, SloveniaDepartment of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, SloveniaIntroductionProtein-energy wasting (PEW) is a common and serious co-morbidity in haemodialysis (HD) patients. Its importance as a prognostic factor has been increasingly recognised during the past decades. Much effort has been invested in the improvement of nutritional status and amelioration of consequences through different therapeutic approaches, either intradialytic parenteral nutrition or more commonly oral nutritional supplementation. In the article, we present the results of a prospective study in HD patients after 12 months of therapeutic intervention with oral nutritional supplements (ONS).MethodsA total of 92 HD adult patients were enrolled in the study after 3 months of wash-out period. Baseline nutritional status was assessed using composite scores, laboratory markers, bioelectrical impedance analysis, and hand-grip strength test. Patients recognised as undernourished or at high risk for undernutrition received renal-specific commercially available ONS on HD day in addition to their regular diet. After 12 months, the effect of ONS on surrogate markers of undernutrition, serum albumin level, phase angle, and hand-grip strength was analysed in 71 surviving patients.ResultsAfter 12 months, data for 71 patients, 39 (54.9%) men, 62.4 ± 12.9 years, and median haemodialysis vintage 53.3 (IQR 27.5–92.8) months, were available. Patients were divided into three groups: group A patients were with normal nutritional status at baseline not necessitating ONS; group B patients received ONS; and group C patients were entitled to receive but refused to take ONS. The baseline results showed statistically significant differences between the groups in serum albumin levels and phase angle but not hand-grip strength. Differences between the groups remained statistically significant at month 12; we did not find any statistically significant positive changes within the groups, indicating no positive effect of intervention with ONS.ConclusionIn a prospectively designed interventional single-centre study, we did not find a statistically significant change in surrogate markers of PEW in our cohort of HD patients, receiving ONS for 12 months. Since PEW is an independent risk factor influencing the survival of HD patients, efforts should be directed towards a timely and comprehensive nutritional approach, including intensive, personalised dietary counselling, increase in protein and energy intake and advocating tight control of nutritional status during HD treatment, possibly providing psychological support and motivation.https://www.frontiersin.org/articles/10.3389/fnut.2023.1253164/fullhaemodialysisprotein-energy wastingoral nutritional supplementationserum albuminphase anglehand-grip strength test |
| spellingShingle | Andreja Ocepek Robert Ekart Robert Ekart Petra Povalej Bržan Petra Povalej Bržan Sebastjan Bevc Sebastjan Bevc Simply adding oral nutritional supplementation to haemodialysis patients may not be enough: a real-life prospective interventional study Frontiers in Nutrition haemodialysis protein-energy wasting oral nutritional supplementation serum albumin phase angle hand-grip strength test |
| title | Simply adding oral nutritional supplementation to haemodialysis patients may not be enough: a real-life prospective interventional study |
| title_full | Simply adding oral nutritional supplementation to haemodialysis patients may not be enough: a real-life prospective interventional study |
| title_fullStr | Simply adding oral nutritional supplementation to haemodialysis patients may not be enough: a real-life prospective interventional study |
| title_full_unstemmed | Simply adding oral nutritional supplementation to haemodialysis patients may not be enough: a real-life prospective interventional study |
| title_short | Simply adding oral nutritional supplementation to haemodialysis patients may not be enough: a real-life prospective interventional study |
| title_sort | simply adding oral nutritional supplementation to haemodialysis patients may not be enough a real life prospective interventional study |
| topic | haemodialysis protein-energy wasting oral nutritional supplementation serum albumin phase angle hand-grip strength test |
| url | https://www.frontiersin.org/articles/10.3389/fnut.2023.1253164/full |
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