Energy supplementation and the nutritional status of hemodialysis patients

Abstract

Twenty-one patients undergoing regular hemodialysis completed a trial of energy supplementation. Nine patients added the glucose polymer Polycose to their usual diet and 12 acted as control subjects. The supplemented patients were asked to incorporate 100 or 150 g polymer, equivalent to 1600 or 2400 kJ (400 or 600 kcal) into their usual diet, daily for 6 mo. This resulted in a mean increase in energy intake of 1630 kJ (p less than 0.05) and a mean weight gain of 3.1 kg (p less than 0.005). The addition of glucose polymer to the diet resulted in a mean increase in body fat of 1.8 kg and the lean body mass increased by 1.3 kg. No significant effect on plasma triglycerides, urea, or creatinine was detected. The intake of macro- and micronutrients was not adversely affected and no clinical or psychological side effects were reported. Follow-up of these patients showed that the weight gain was maintained after 6 mo. Glucose polymer was an effective energy supplement that had beneficial effects on the nutritional status of hemodialysis patients.

High-calorie diet partially ameliorates dysregulation of intrarenal lipid metabolism in remnant kidney

“…Parenteral intradialytic calorie and amino acid supplementation has been shown to acutely reverse the net negative whole body-forearm muscle protein balance [10], increasing body weight, serum albumin and ApoA-I levels without altering plasma lipid concentration in ESRD patients maintained on hemodialysis. Moreover, trial of energy supplementation via addition of the glucose polymer Polycose to the usual diet for 6 months has been shown to significantly increase total and lean body mass, with no significant effect on plasma triglyceride level [11], in hemodialysis patients. Observational studies have shown that in patients with CKD Stages 3-5, the rate of decline in glomerular filtration rate is higher in patients with low energy intake than in patients with moderate or high energy intake [12].…”

Causes and Interventions for Malnutrition in Patients Undergoing Maintenance Dialysis

“…Indeed, Allman el al. [10], after ran domly allocating oral energy supplements during 6 months, reported an improvement in body composition of 9 MHD patients. This supplement was composed of about 450 kcal/ day glucose polymer.…”

“…These diets, if not carefully monitored, may be hypocaloric [8,9] and may impair the patient's nutritional status before starting the dialysis treatment. After starting dialysis, pa tients usually report spontaneous low energy intake [10], This has recently been observed in the pilot Mortality and Morbidity in Main tenance Hemodialysis Study [11] in patients entering the study (28 keal/kg body weight/ day without diabetes and 25 keal/kg/body weight/day with diabetes). Such low energy intakes might explain why these chronically diseased patients are frequently malnour ished.…”

“…This supplement was composed of about 450 kcal/ day glucose polymer. Compared to the control group (n = 12), the supplemented patients gained 3.1 kg over 6 months, distributed into 1.8 kg of fat and 1.3 kg of lean mass, as deter mined by anthropometric measurements [10]. It should be noted that these patients were not malnourished and that no change was ob served in any of the biological parameters T reatm ent o f M alnutrition in M aintenance Dialysis reported [10], However, these results are sup portive of the beneficial effects of energy-rich supplements to the extent that no severe mal nutrition is present.…”

Nutrition perdialytique

“…Ces données, observées indépendamment de l'état inflammatoire évalué par la C-réactive proteine sérique, démontrent l'inté-rêt du suivi diététique dans cette population. Plusieurs études contrôlées ont mis en évidence une amélioration de l'état nutritionnel lors de la supplémentation orale [30][31][32][33][34][35]. Une amélioration de la prise alimentaire spontanée lors de la prise de suppléments oraux a également été rapportée [35,36].…”