PDF

Objectives: Malnutrition is a common problem in chronic renal disease patients during pre-dialysis and dialysis, leading to increased cardiovascular diseases and mortality. This study aimed to evaluate the efficacy of supplemental protein supplementation on malnutrition in peritoneal dialysis patients.

Methods: Eighty-four stable adult peritoneal dialysis patients included in this study. In addition to the standard diets, oral nutritional product (372 calories, 61 g protein, 30 g glutamine, and 30 g arginine/100 g powder sachet twice a day) gave to patients. Before the study and after three months from the supportive therapy; anthropometric measurements with serum urea, creatinine, total protein, albumin, cholesterol, KtV, body mass index was analyzed.

Results: The mean age of peritoneal dialysis patients was 60 (46-78) years. Serum urea levels from 96 ± 44 to 109 ± 42 mg/dL (p = 0.007), total protein levels from 5.85 ± 0.68 to 6.18 ± 0.66 g/dL (7.8%, p = 0.007), albumin levels increased from 3.02 ± 0.27 to 3.32 ± 0.34 g/dL (11.7%, p = 0.003) increased significantly after an average of 0.43 g/kg protein and 178 cal/day energy support.

Conclusions: Albumin is an indicator of malnutrition related mortality. Therefore, using of protein nutritional products in addition to standard treatment may be beneficial for malnourished peritoneal dialysis patients.

Peritoneal dialysis, malnutrition, albumin, protein supplementation

• 1. Ma L, Zhao S. Risk factors for mortality in patients undergoing hemodialysis: a systematic review and metaanalysis. Int J Cardiol.2017;238:151-8.
• 2. Stenvinkel P, Heimbürger O, Lindholm B. Wasting, but not malnutrition, predicts cardiovascular mortality in end-stage renal disease. Nephrol Dial Transplant 2004;19:2181-3.
• 3. Kopple JD. National Kidney Foundation K/DOQI Work Group. The National Kidney Foundation K/DOQI clinical practice guidelines for dietary protein intake for chronic dialysis patients. Am J Kidney Dis 2001;38(4Suppl1):S68-73.
• 4. Uhlig K, Macleod A, Craig J, Lau J, Levey AS, Levin A, et al. Grading evidence and recommendations for clinical practice guidelines in nephrology. A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2006;70:2058-65.
• 5. LeveyAS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2005;67:2089-100.
• 6. Mak RH, CheungW. Energy homeostasis and cachexia in chronic kidney disease. Pediatr Nephrol 2006;21:1807-14.
• 7. LindholmB, Heimbürger O, Stenvinkel P. What are the causes of protein-energy PEW in chronic renal insufficiency? Am J Kidney Dis 2002;39:422-5.
• 8. Canada-USA (CANUSA) Peritoneal Dialysis Study Group. Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. J Am Soc Nephrol 1996;7:198-207.
• 9. Yan X, Yang X, Xie X, Xiang S, Zhang X, Shou Z, et al. Association between comprehensive nutritional scoring system (CNSS) and outcomes of continuous ambulatory peritoneal dialysis patients. Kidney Blood Press Res 2017;42:1225-37.
• 10. Chung SH, Linholm B, Lee HB. Influence of initial nutritional status on continuous ambulatory peritoneal dialysis patient survival. Perit Dial Int 2000;20:19-26.
• 11. Nazar CM. Significance of diet in chronic kidney disease. J Nephropharmacol 2013;2:37-43.
• 12. Wang AY, Sea MM, Ho ZS, Lui SF, Li PK, Woo J. Evaluation of handgrip strength as a nutritional marker and prognostic indicator in peritoneal dialysis patients. Am J Clin Nutr 2005;81:79-86.
• 13. Mehrotra R, Kopple J. Nutritional management of maintenance dialysis patients: why aren't we doing better? Annu Rev Nutr 2001;21:343-79.
• 14. Olivares-Gandy HJ, Domínguez-Isidro S, López-Domínguez E, Hernández-VelázquezY, Tapia McClung H, Jorge de-la-Calleja. A telemonitoring system for nutritional intake in patients with chronic kidney disease receiving-peritoneal dialysis therapy. Comput Biol Med 2019;109:1-13.
• 15. Dombros N, Dratwa M, Feriani M, Gokal R, Heimbürger O, Krediet R, et al; EBPG Expert Group on Peritoneal Dialysis. European best practice guidelines for peritoneal dialysis. 8 Nutrition in peritoneal dialysis. Nephrol Dial Transplant 2005;20 Suppl 9:ix28-ix33.
• 16. Toigo G, Aparicio M, Attman PO, Cano N, Cianciaruso B, Engel B, et al. Expert working group report on nutrition in adult patients with renal insufficiency (Part 2 of 2). Clin Nutr 2000;19:281-91.
• 17. Clinical practice guidelines for nutrition in chronic renal failure. K/DOQI, National Kidney Foundation. Am J Kidney Dis 2000;35(6Suppl2):S1-140.
• 18. Ikizler TA, Cano NJ, Franch H, Fouque D, Himmelfarb J, Kalantar-Zadeh K, et al. Preventionand treatment of protein energy wasting in chronic kidney disease patients. International Society of Renal Nutrition and Metabolism. Kidney Int 2013;84:1096-107.
• 19. Eustace JA, Coresh J, Kutchey C, Te PL, Gimenez LF, Scheel PJ, et al. Randomized double- blind trial of oral essential amino acids for dialysis-associated hypoalbuminemia. Kidney Int 2000;57:2527-38.
• 20. González-Espinoza L, Gutiérrez-Chávez J, del Campo FM, Martínez-Ramírez HR, Cortés-Sanabria L, Rojas-Campos E, et al. Randomized, open label, controlled clinical trial of oral administration of an egg albumin-based protein supplement to patients on continuous peritoneal dialysis patients. Perit Dial Int 2005;25:173-80.
• 21. Moretti HD, Johnson AM, Keeling-Hathaway TJ. Effects of protein supplementation in chronic hemodialysis and peritoneal dialysis patients. J Ren Nutr 2009;19:298-303.