|Background: Protein-energy malnutrition is an important problem for hemodialysis patients due to decreased quality of life, increased hospitalization, and mortality. The present study aimed to investigate the effect of nutritional supplement programs on the malnutrition and biochemical indicators of patients undergoing hemodialysis.|
Methods: In this Randomized Controlled Trial study, 66 patients undergoing hemodialysis were allocated to three groups according to the random allocation methods. Groups A and B received nutritional supplements IsoWhey protein powder (one cup or 24 grams’ powder) and BCAA Muscle Guard Tablet (6 tablets per day: 2 tablets every 8 hours), respectively, along with a schedule of nutrition counseling, nephrology visits, and telephone follow-up for two months. The control group (group C) received a routine diet without supplementation. Biochemical indicators (Hemoglobin, BUN before and after dialysis, creatinine, cholesterol, triglyceride, TIBC, total protein, albumin, ferritin) were measured for all three groups before, one and two months after the intervention, and nutritional status based on SGA was assessed before and after the intervention.
Results: Before the intervention, three groups were homogeneous in demographic variables, biochemical indicators, and nutritional status (P>0.05). But, after the intervention, there was a statistically significant difference between groups in means of TIBC, total protein, and albumin (P<0.05). Also, nutritional status significantly differed in groups after intervention (P=0.02). The two intervention groups achieved a better nutritional status after two months of taking the dietary supplement (P=0.008). But in the control group, there was no significant difference in nutritional status before and after the study (P<0.05).
Conclusion: According to the results of this study, it could be suggested that the use of nutritional supplements under the supervision of a nutritionist, along with patient education and consistent nutritional assessment, is suggested to improve the nutritional status of patients undergoing hemodialysis.
- Afaghi E, Tayebi A, Sajadi SA, Ebadi A. The relationship between nutritional status based on subjective global assessment and dialysis adequacy. Nephro-Urol Mon 2021;13(3):e116254. doi: 5812/numonthly.116254.
- Ebadi A, Tayebi A, Afaghi E. The effect of an oral nutritional supplement on nutritional status of hemodialysis patients in a military hospital. J Mil Med 2021;22(12):1222-30. doi: 10.30491/JMM.22.12.1222.
- Małgorzewicz S, Gałęzowska G, Cieszyńska-Semenowicz M, Ratajczyk J, Wolska L, Rutkowski P, Jankowska M, Rutkowski B, Dębska-Ślizień A. Amino acid profile after oral nutritional supplementation in hemodialysis patients with protein-energy wasting. Nutrition. 2019 ;57:231-6. doi: 10.1016/j.nut.2018.06.013. Epub 2018 Jul 11. PMID: 30184517.
- Afaghi E, Ebadi A, Tadrisi SD, Naghii MR. The effect of Nutrition Support Protocols on Patient Outcomes in Intensive Care Unit: A Systematic Review. Int J Med Rev 2015;2(2):256-60.
- Afaghi E, Tayebi A, Ebadi A, Sobhani V, Einollahi B, Tayebi M. The Effect of BCAA and ISO-WHEY Oral Nutritional Supplements on Dialysis Adequacy. Nephrourol Mon. 2016;8(6):e34993. doi: 10.5812/numonthly.34993. PMID: 27896236; PMCID: PMC5120366.
- As' habi A, Tabibi H, Hedayati M, Mahdavi-Mazdeh M, Nozari B. Association of energy-protein malnutrition with risk factors of cardiovascular diseases in hemodialysis patients. Iranian J Nutr Sci Food Technol 2011;6 (2):0-0. URL: http://nsft.sbmu.ac.ir/article-1-506-en.html.
- Sabatino A, Regolisti G, Karupaiah T, Sahathevan S, Sadu Singh BK, Khor BH, Salhab N, Karavetian M, Cupisti A, Fiaccadori E. Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis. Clin Nutr. 2017;36(3):663-71. doi: 10.1016/j.clnu.2016.06.007. Epub 2016 Jun 18. PMID: 27371993.
- Steyaert S, Holvoet E, Nagler E, Malfait S, Van Biesen W. Reporting of "dialysis adequacy" as an outcome in randomised trials conducted in adults on haemodialysis. PLoS One. 2019;14(2):e0207045. doi: 10.1371/journal.pone.0207045. PMID: 30721242. PMCID: PMC6363141.
- Aditia K, Palar S, Karema-Kaparang AM, Moeis ES, Sugeng C, Umboh O. POS-552 correlation of interleukin-6 levels, high sensitivity c-reactive protein, and malnutrition inflammation score with quality of life chronic kidney disease patients undergoing routine hemodialysis. Kidney International Reports. 2022;7(2):S239. doi: 1016/j.ekir.2022.01.584.
- Benner D, Brunelli SM, Brosch B, Wheeler J, Nissenson AR. Effects of oral nutritional supplements on mortality, missed dialysis treatments, and nutritional markers in hemodialysis patients. J Ren Nutr 2018;28(3):191-6. doi: 10.1053/j.jrn.2017.10.002. Epub 2017 Dec 6. PMID: 29221626.
- Cawood A, Elia M, Stratton R. Systematic review and meta-analysis of the effects of high protein oral nutritional supplements. Ageing Res Rev. 2012;11(2):278-96. doi: 10.1016/j.arr.2011.12.008. Epub 2011 Dec 22. PMID: 22212388.
- Philipson TJ, Snider JT, Lakdawalla DN, Stryckman B, Goldman DP. Impact of oral nutritional supplementation on hospital outcomes. Am J Manag Care. 2013;19(2):121-8. PMID: 23448109.
- Tayebi M, Tayebi A, Einollahi B, Ebadi A, Jafari A. Isometric resistance training and branched-chain amino acids supplementation can improve dialysis adequacy: A clinical trial. Nephrourol Mon 2019;11(2) ; e91175. doi: 5812/numonthly.91175.
- Taghdir M, Ashourpour M, Ghandchi Z, Pourghaderi M, Sepandi M, Alavi Naini A. Assessment of energy and protein intake and some of the related factors in hemodialysis patients referred to Imam Khomeini Hospital. Iranian Journal of Endocrinology and Metabolism 2011;13(6):690-6. URL: http://ijem.sbmu.ac.ir/article-1-1203-en.html.
- Chan M, Kelly J, Batterham M, Tapsell L. Malnutrition (subjective global assessment) scores and serum albumin levels, but not body mass index values, at initiation of dialysis are independent predictors of mortality: a 10-year clinical cohort study. J Ren Nutr. 2012;22(6):547-57. doi: 10.1053/j.jrn.2011.11.002. Epub 2012 Mar 9. PMID: 22406122.
- Bolasco P, Caria S, Cupisti A, Secci R, Saverio Dioguardi F. A novel amino acids oral supplementation in hemodialysis patients: a pilot study. Ren Fail. 2011;33(1):1-5. doi: 10.3109/0886022X.2010.536289. PMID: 21219197.
- Kloppenburg WD, Stegeman CA, Hovinga TK, Vastenburg G, Vos P, de Jong PE, Huisman RM. Effect of prescribing a high protein diet and increasing the dose of dialysis on nutrition in stable chronic haemodialysis patients: a randomized, controlled trial. Nephrol Dial Transplant. 2004;19(5):1212-23. doi: 10.1093/ndt/gfh044. Epub 2004 Feb 19. PMID: 14993506.
- Karen Pharma and Food Supplement Co. Amino acid [cited 2022 15 March]. Available from: https://en.karenpharma.com/Sport-PNC/Amino-acid.
- Karen Pharma and Food Supplement Co. High protein [Available from: https://en.karenpharma.com/Sport-PNC/High-protein.
- Akhlaghi Z, Sharifipour F, Nematy M, Safarian M, Malekahmadi M, Barkhidarian B, Norouzy A. Assessment of nutritional status in maintenance hemodialysis patients: A multicenter cross-sectional study in Iran. Semin Dial. 2021;34(1):77-82. doi: 10.1111/sdi.12917. Epub 2020 Oct 14. PMID: 33058310.
- Liu PJ, Ma F, Wang QY, He SL. The effects of oral nutritional supplements in patients with maintenance dialysis therapy: A systematic review and meta-analysis of randomized clinical trials. PLoS One. 2018;13(9):e0203706. doi: 10.1371/journal.pone.0203706. PMID: 30212514. PMCID: PMC6136747.
- Lacson E Jr, Wang W, Zebrowski B, Wingard R, Hakim RM. Outcomes associated with intradialytic oral nutritional supplements in patients undergoing maintenance hemodialysis: a quality improvement report. Am J Kidney Dis. 2012;60(4):591-600. doi: 10.1053/j.ajkd.2012.04.019. Epub 2012 May 24. PMID: 22632807.
- Moretti HD, Johnson AM, Keeling-Hathaway TJ. Effects of protein supplementation in chronic hemodialysis and peritoneal dialysis patients. J Ren Nutr. 2009;19(4):298-303. doi: 10.1053/j.jrn.2009.01.029. PMID: 19539184.
- Kalantar-Zadeh K, Braglia A, Chow J, Kwon O, Kuwae N, Colman S, Cockram DB, Kopple JD. An anti-inflammatory and antioxidant nutritional supplement for hypoalbuminemic hemodialysis patients: a pilot/feasibility study. J Ren Nutr. 2005;15(3):318-31. doi: 10.1016/j.jrn.2005.04.004. PMID: 16007562.
- Leonberg-Yoo AK, Wang W, Weiner DE, Lacson E Jr. Oral nutritional supplements and 30-day readmission rate in hypoalbuminemic maintenance hemodialysis patients. Hemodial Int. 2019;23(1):93-100. doi: 10.1111/hdi.12694. Epub 2019 Feb 14. PMID: 30762294; PMCID: PMC7699822.
- Scott MK, Shah NA, Vilay AM, Thomas J 3rd, Kraus MA, Mueller BA. Effects of peridialytic oral supplements on nutritional status and quality of life in chronic hemodialysis patients. J Ren Nutr. 2009;19(2):145-52. doi: 10.1053/j.jrn.2008.08.004. PMID: 19218041.
- Sohrabi Z, Eftekhari MH, Eskandari MH, Rezaianzadeh A, Sagheb MM. Intradialytic Oral Protein Supplementation and Nutritional and Inflammation Outcomes in Hemodialysis: A Randomized Controlled Trial. Am J Kidney Dis. 2016;68(1):122-30. doi: 10.1053/j.ajkd.2016.02.050. Epub 2016 Apr 15. PMID: 27086768.
- Jeloka TK, Dharmatti G, Jamdade T, Pandit M. Are oral protein supplements helpful in the management of malnutrition in dialysis patients? Indian J Nephrol. 2013 Jan;23(1):1-4. doi: 10.4103/0971-4065.107185. PMID: 23580797. PMCID: PMC3621231.
- Małgorzewicz S, Aleksandrowicz-Wrona E, Owczarzak A, Debska-Slizień A, Rutkowski B, Łysiak-Szydłowska W. Adipokines and nutritional status for patients on maintenance hemodialysis. J Ren Nutr. 2010;20(5):303-8. doi: 10.1053/j.jrn.2009.10.005. Epub 2010 Jan 13. PMID: 20071195.
- Dudar I, Shymova A, Gonchar Y, Loboda O, Krasiuk E. Quality of life in peritoneal dialysis patients and its relationship with nutrition disorders. Ukrainian Journal of Nephrology and Dialysis 2019;1(61): 45-52. doi: 31450/ukrjnd.1(61).2019.06.