BackgroundLow serum albumin and a high dietary phosphorus to dietary protein ratio (PPR) have been tied to malnutrition among maintenance hemodialysis (MHD) patients. In turn, malnutrition is an alarming risk factor for increased mortality amongst this population. The administration of high protein/high calorie meals during dialysis in tandem with modified nutrition education may help alleviate hypoalbuminemia and an elevated PPR. Research on these strategies is limited.MethodsAn 8‐week randomized control trial of 110 MHD participants (18 to 85 years, mean age = 54±15 SD, 48 males, 62 females) with serum albumin <4.0 g/dL from DaVita Dialysis centers in the greater Los Angeles area was conducted. The intervention group (n=55) was provided with high protein/high calorie meals during MHD as well as outpatient nutrition education that focused on lowering dietary phosphorus intake, while the control group (n=55) received low protein/low calorie meals and minimal nutrition education. Dietary intake data were collected from a 3‐day food diary or 24‐hour recall and meal intake forms during MHD treatment. Independent samples t‐tests were used to examine pre‐ and post‐study changes in 1) dietary intake in MHD patients expressed by PPR and 2) serum albumin, with a significance level of p ≤ 0.05.ResultsNo significant association was found between intervention (meal provision during MHD treatment and modified nutrition education) and serum albumin (t = −0.21, p = 0.84). While not significant at p ≤ 0.05, there was a near significant difference in changes in PPR (t = −1.71, p = 0.09) between the intervention and control groups. PPR was shown to decrease in the intervention group post‐study.ConclusionThis study found a near significant association between meal provision during MHD treatment combined with modified nutrition education and changes in PPR post‐study, but not with serum albumin levels. These results indicate a need for further studies of meal provision during MHD treatment as well as longer‐term studies on modified nutrition education in an effort to establish dietary behavior change and decrease PPR.Support or Funding InformationThis study was supported by the Los Angeles Biomedical Research Institute, as part of the Fosrenol for Enhancing Dietary Protein Intake in Hypoalbuminemic Dialysis Patients Study
BACKGOUNDProtein energy wasting/malnutrition is a significant problem in MHD patients. More LBM and greater HGS are associated with better survival rates in MHD patients. These associations are not well described in hypoalbuminemic MHD patients who have increased morbidity and mortality.METHODSHypoalbuminemic (albumin <4.0 g/dL) MHD patients from DaVita Dialysis Centers in Los Angeles were enrolled in a randomized, controlled study (FREDI) associating meals during dialysis, phosphorus control and nutritional status. A dietitian measured HGS, assessed LBM by dual‐energy x‐ray absorptiometry, and protein and energy intake by interview‐assisted three‐day food record.RESULTSThe baseline association between protein and energy intake, HGS, and LBM was assessed in 65 (28 male, 37 female) MHD patients, including 33 Hispanics and 32 Non‐Hispanics with a mean (± SD) age of 56 (±13) years. Body Mass (kg) LBM (%) Seum Albumin (g/dL) HGS‐right hand (kg) Protein Intake (g/day) Energy Intake (kcal/day) 75.4 (±16.6) 68.9 (±8.5) 3.71 (±.27) 24.0 (± 8.7) 73.5 (± 31.3) 1573 (± 705) Protein intake (r=0.38, p=.002), energy intake (r=0.45, p<.001) and HGS (r=0.43, p<.001) were positively correlated with percent LBM. CONCLUSIONSThese findings suggest that even in hypoalbuminemic MHD patients, protein and energy intake is associated with better nutritional status assessed by HGS and LBM.Shire US Inc., Wayne, PA 19087.
BackgroundLow intakes of energy, protein, vitamins, and minerals are common risk factors for malnutrition in maintenance hemodialysis (MHD) patients. Malnutrition is a known predictor of increased mortality amongst MHD patients. Preliminary research indicates intake of protein rich meals during dialysis replenishes loss from MHD, but studies were limited to a small number of dialysis sessions. Measuring change in lean body mass (LBM) of MHD patients is one way to determine the effects of a nutrition intervention aimed at improving outcomes.MethodsAn 8‐week randomized controlled trial was conducted among 110 MHD participants (18 to 85 years, mean age = 54±15 SD, 48 males, 62 females) with serum albumin <4.0 g/dL recruited from DaVita Dialysis centers in the greater Los Angeles area. The intervention group (n=55) was given high protein/high calorie meals during MHD as well as outpatient nutrition education with a dietitian that focused on lowering dietary phosphorus intake. The control group (n=55) received low protein/low calorie meals during MHD and minimal nutrition education. Dietary intake data were collected from a 3‐day food diary or 24‐hour recall and meal intake forms during MHD treatment. Lean body mass was assessed by dual‐energy X‐ray absorptiometry. Independent samples t‐tests were used to examine pre‐and post‐study changes in body composition with a significance level of p ≤ 0.05.ResultsNo significant differences in LBM change (t= ‐1.10, p= 0.28) were found between treatment and control groups. Interestingly, the treatment group had an increase in LBM of approximately 600g post‐intervention and the control group had an increase in LBM of approximately 3300g. Though significant differences between groups were not found, it is to be noted that both groups had an increase in LBM.ConclusionThis study explored the effects of nutritional education and the rendering of meals to MHD patients during dialysis, an area lacking in the literature. Limitations include inadequate access to community health professionals to interpret the educational information for patients who spoke languages other than English or Spanish. Additionally, level of education, work status, and overall stress may have played a role in outcomes; these factors were not controlled. Lastly, supplementary dietary intake during MHD both prior to and during the study was not monitored. Additional research is needed to further understand effective means of reducing malnutrition and monitoring the changes in LBM as a marker for malnutrition in MHD patients.Support or Funding InformationSource of Research Support: This study was supported by the Los Angeles Biomedical Research Institute, as part of the Fosrenol for Enhancing Dietary Protein Intake in Hypoalbuminemic Dialysis Patients Study.
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