Effects of oral low-protein energy supplements on nutritional status in maintenance hemodialysis patients with protein-energy wasting: a randomized controlled trial.

Abstract

Background and objectives: Protein-energy wasting (PEW) is common among maintenance hemodialysis (MHD) patients and is strongly associated with mortality and adverse outcomes. This study aimed to assess the effects of low-protein energy supplements on the nutritional status of MHD patients with PEW.

Methods and study design: We conducted a prospective randomized controlled trial in 68 MHD patients suffering from PEW. Patients randomized to the intervention group received dietary counseling along with daily low-protein supplements containing 212 kcal of energy and 2.4 g of protein every day for 3 months. The control group received dietary counseling only. Dietary data, nutritional assessments, anthropometric measurements, bioelectrical impedance analysis and blood analysis were collected at baseline and after three months from both groups.

Results: Fifty-nine MHD patients completed the study. Patients in the intervention group showed an increase in energy intakes (p < 0.001). A significant decrease in the Malnutrition Inflammation Score (MIS) (p < 0.001) and Nutrition Risk Screening 2002 (p< 0.001) were found in the intervention group compared with the control group. Moreover, significant improvements in mid-upper arm circumference (p < 0.001), mid-arm muscle circumference (p < 0.001), albumin (p = 0.003), and prealbumin (p = 0.033) were observed in the intervention group compared with the control group.

Conclusions: The combination of oral low-protein supplements and dietary counseling for three months was more effective than dietary counseling alone in terms of improving the nutritional status of MHD patients with PEW.