Oral Protein-Energy Supplements in Peritoneal Dialysis: A Multicenter Study

Abstract

Background Protein-energy malnutrition is prevalent in peritoneal dialysis (PD) patients and is associated with increased morbidity and mortality. Objective To evaluate the impact of prophylactic treatment with an oral protein-energy supplement (Protenplus; Fresenius AG, Bad Homburg, Germany) on nutritional parameters in patients starting PD. Design Prospective, multicenter, randomized study of group A patients (Protenplus, n = 35) and group B (controls, n = 30), with evaluations at baseline and at 6 and 12 months. Statistical Methods: Efficacy of factors by linear mixed model analysis for repeated measurements, chi-square, t-test, and Mann–Whitney test. Outcome Parameters Patient compliance, serum albumin, and other nutritional parameters. Results No significant differences were found at baseline evaluation. During follow-up, a significant number of group A patients abandoned intake of the supplement due to noncompliance ( n = 7) or side effects ( n = 8) (χ2 p < 0.01). Patients with lower residual renal function were less likely to comply. The mixed model in the “intention to treat” analysis showed a significant increase related to supplement intake only in total lymphocyte count in group A. The “as treated” analysis of the 29 patients who fulfilled the study (9 in group A, 20 in group B) disclosed that belonging to group A constituted an independent factor for increased lymphocyte count ( p < 0.001), body weight ( p < 0.03), tricipital skinfold thickness ( p < 0.01), middle-arm muscle circumference ( p < 0.025), lean body mass (LBM) ( p < 0.002), creatinine LBM related to body surface area ( p < 0.001), and creatinine generation rate ( p < 0.002). However, these data may have been biased by the high rate of noncompliance in group A. Conclusions Protenplus proved to be unsuitable as a long term, oral protein-energy supplement in PD patients due to a high rate of noncompliance and intolerance, primarily among patients with lower residual renal function. The question of whether other products, better-tolerated as nutritional supplements, could compensate for daily protein peritoneal losses in long-term PD remains open.

The effectiveness of oral essential aminoacids and aminoacids containing dialysate in peritoneal dialysis

“…12 In another study, daily protein supplements were added to the meal of incident-PD patients, who were then followed-up for 12 months. 20 The mean albumin level of 90 patients was 3.75 g/dL, and no significant increase was observed in these studies following their completion. 12 However, patients with peritonitis were not excluded from these studies.…”

“…12 However, patients with peritonitis were not excluded from these studies. During their follow-up periods, 12,20 Eustace et al revealed that oral essential AAs are more effective in patients with very low serum albumin levels than in patients who have subnormal albumin levels. 21 In our study, the albumin levels were around 2.8 g/dL, which is lower than albumin levels in patients who were enrolled in the other studies referenced herein, and data from patients with peritonitis were excluded.…”

Intradialytische Ernährung – Oral? Enteral? Parenteral?

“…B. eine PEG-Sonde. Laut Marsen [18] [20]. Die PEG-Anlage, welche eine Nahrungszufuhr unabhängig vom Appetit sicherstellen könnte, ist bei erwachsenen Peritonealdialysepatienten kontraindiziert.…”

Oral nutritional supplementation in patients undergoing peritoneal dialysis: a randomised, crossover pilot study

“…Dietary advice encouraging patients on PD to eat more protein has been shown to be difficult to implement (Sutton et al 2007, Braglia Tarpey 2012, and use of oral nutritional supplements is common. Despite evidence that supplementation is effective in the patients undergoing HD (Kalantar-Zadeh et al 2011, Malgorzewicz et al 2011, studies report both improvement (Moretti et al 2009) and poor effectiveness of oral nutritional supplementation in the PD group (Teixido-Planas et al 2005, Poole & Hamad 2008. Most of these authors called for randomised controlled trials to further investigate the efficacy or otherwise of oral supplementation in the PD population.…”