Muscle Status Response to Oral Nutritional Supplementation in Hemodialysis Patients With Protein Energy Wasting: A Multi-Center Randomized, Open Label-Controlled Trial

Sahathevan, Sharmela; Karupaiah, Tilakavati; Khor, Ban-Hock; Singh, B. P.; Daud, Zulfitri Azuan Mat; Fiaccadori, Enrico; Sabatino, Alice; Chinna, Karuthan; Gafor, Abdul Halim Abdul; Bavanandan, Sunita; Visvanathan, R.; Yahya, Rosnawati; Wahab, Zaimi; Goh, Bak Leong; Morad, Zaki; Bee, Boon Cheak; Wong, H.S.

doi:10.3389/fnut.2021.743324

Cited by 9 publications

(7 citation statements)

References 71 publications

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“…For example, Bernardes et al performed a systematic review and meta‐analysis on the effect of increased energy and/or protein intake on nutritional status in obstructive pulmonary disease patients and found an increase of 0.29 cm in MAMC 34 . In HD patients, Sahathevan et al performed a 6‐month open‐label randomized controlled trial with oral nutritional supplements and found an increase in MAMC in the intervention group of 0.4 cm 35 . A precise assessment of risk reduction associated with correction of metabolic acidosis in this specific patient population is impossible, but observational data from related patient populations may provide an indication.…”

Section: Discussionmentioning

confidence: 99%

Effects of correcting metabolic acidosis on muscle mass and functionality in chronic kidney disease: a systematic review and meta‐analysis

Visser,

van de Braak,

de Mik ‐ van Egmond

et al. 2023

J cachexia sarcopenia muscle

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Metabolic acidosis unfavourably influences the nutritional status of patients with non‐dialysis dependent chronic kidney disease (CKD) including the loss of muscle mass and functionality, but the benefits of correction are uncertain. We investigated the effects of correcting metabolic acidosis on nutritional status in patients with CKD in a systematic review and meta‐analysis. A search was conducted in MEDLINE and the Cochrane Library from inception to June 2023. Study selection, bias assessment, and data extraction were independently performed by two reviewers. The Cochrane risk of bias tool was used to assess the quality of individual studies. We applied random effects meta‐analysis to obtain pooled standardized mean difference (SMD) and 95% confidence intervals (CIs). We retrieved data from 12 intervention studies including 1995 patients, with a mean age of 63.7 ± 11.7 years, a mean estimated glomerular filtration rate of 29.8 ± 8.8 mL/min per 1.73 m2, and 58% were male. Eleven studies performed an intervention with oral sodium bicarbonate compared with either placebo or with standard care and one study compared veverimer, an oral HCl‐binding polymer, with placebo. The mean change in serum bicarbonate was +3.6 mEq/L in the intervention group and +0.4 mEq/L in the control group. Correcting metabolic acidosis significantly improved muscle mass assessed by mid‐arm muscle circumference (SMD 0.35 [95% CI 0.16 to 0.54], P < 0.001) and functionality assessed with the sit‐to‐stand test (SMD −0.31 [95% CI −0.52 to 0.11], P = 0.003). We found no statistically significant effects on dietary protein intake, handgrip strength, serum albumin and prealbumin concentrations, and blood urea nitrogen. Correcting metabolic acidosis in patients with CKD improves muscle mass and physical function. Correction of metabolic acidosis should be considered as part of the nutritional care for patients with CKD.

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Section: Discussionmentioning

confidence: 99%

Effects of correcting metabolic acidosis on muscle mass and functionality in chronic kidney disease: a systematic review and meta‐analysis

Visser,

van de Braak,

de Mik ‐ van Egmond

et al. 2023

J cachexia sarcopenia muscle

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“…37,38 Therefore, optimizing the nutritional status through dietary interventions and possibly protein supplementation can promote muscle mass preservation and overall physical function. 39 Proper dialysis treatment is essential to manage fluid and electrolyte imbalances, which can impact muscle function. Ensuring adequate dialysis therapy is necessary for maintaining patients' overall health and muscle status.…”

Section: Discussionmentioning

confidence: 99%

The relationship between skeletal muscle mass and exercise capacity in patients undergoing hemodialysis: An exploratory secondary‐analysis

Zhang,

Zhuang,

Qin

et al. 2023

Hemodialysis International

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BackgroundProtein‐energy wasting is commonly observed in patients undergoing hemodialysis, leading to reduced muscle mass and, in severe cases, sarcopenia, which significantly impacts the patients' quality of life and clinical outcomes. Exercise interventions are frequently employed to address muscle loss in these patients. However, the relationship between exercise capacity and skeletal muscle mass in this context remains uncertain. In this study, researchers conducted a series of body composition analysis and exercise capacity test to explore the relationship between exercise capacity and skeletal muscle mass.MethodsThis study recruited 32 patients undergoing hemodialysis and analyzed their demographic and clinical parameters. To assess aerobic exercise capacity, the incremental shuttle walking test (ISWT) was conducted, while the handgrip strength test was used to evaluate muscle strength. The patients' body compositions were assessed using the Fresenius Body Composition Monitor, and the appendicular skeletal muscle was scanned using a GE Healthcare Lunar iDXA scanner. Three sequential linear models were employed to model the relationship between ISWT and skeletal muscle mass. Model 1 regressed ISWT against gender and age; Model 2 added handgrip strength, fat tissue index, and Davies comorbidity scores as additional predictors; and Model 3 further included the appendicular skeletal muscle index (appendicular skeletal muscle/height).FindingsAfter controlling for age and gender (Model 1: R2 = 0.373), and subsequently including handgrip strength, fat tissue index, and Davies comorbidity score effects (Model 2: R2 = 0.581), the impact of appendicular skeletal muscle on ISWT was found to be non‐significant (Model 3: R2 = 0.600).ConclusionThere was no significant correlation observed between exercise capacity and skeletal muscle mass in patients undergoing hemodialysis, indicating the factors influencing exercise capacity in this patient population are complex and that increasing skeletal muscle mass may not necessarily involve solely addressing the improvement of exercise capacity.

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“…A standard oral nutritional supplement provides up to 5 kcal/kg/day and 0.3-0.4 g/kg/day of protein [48]. In a recent randomized controlled trial, Sahathevan et al [49] found that combination of oral nutritional support with nutritional counseling was effective in treating PEW and had positive effects on muscle status in hemodialysis patients.…”

Section: Impact Of Other Nutritional Interventions On Muscle Wasting ...mentioning

confidence: 99%

Dietary protein and muscle wasting in chronic kidney disease: new insights

Güngör

Kara

Hasbal

et al. 2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewMuscle wasting is an important health problem in chronic kidney disease (CKD) patients. Protein restriction in the diet can be one of the main causes of muscle wasting in this population. In this review, we aimed to investigate the relationship between dietary protein intake and muscle wasting in CKD patients according to recent literature.Recent findingsThe one of the main mechanisms responsible for the muscle wasting is the disturbances in skeletal muscle protein turnover. Muscle wasting primarily occurs when the rates of muscle protein breakdown exceed the muscle protein synthesis. Dietary protein intake represents an important role by causing a potent anabolic stimulus resulting a positive muscle protein balance. Compared to studies made in healthy populations, there are very limited studies in the literature about the relationship between dietary protein intake and muscle wasting in the CKD population. Majority of the studies showed that a more liberal protein intake is beneficial for muscle wasting in especially advanced CKD and hemodialysis populationSummaryAlthough evaluating muscle wasting in CKD patients, the amount of protein in the diet of patients should also be reviewed. Although excessive protein intake has some negative consequences on this patient group, a more liberated dietary protein intake should be taken into account in this patient group with muscle wasting and especially in dialysis patients.

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Muscle Status Response to Oral Nutritional Supplementation in Hemodialysis Patients With Protein Energy Wasting: A Multi-Center Randomized, Open Label-Controlled Trial

Cited by 9 publications

References 71 publications

Effects of correcting metabolic acidosis on muscle mass and functionality in chronic kidney disease: a systematic review and meta‐analysis

Effects of correcting metabolic acidosis on muscle mass and functionality in chronic kidney disease: a systematic review and meta‐analysis

The relationship between skeletal muscle mass and exercise capacity in patients undergoing hemodialysis: An exploratory secondary‐analysis

Dietary protein and muscle wasting in chronic kidney disease: new insights

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