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Observational Study
. 2015 Jun 23:16:87.
doi: 10.1186/s12882-015-0070-0.

Supervised oral protein supplementation during dialysis in patients with elevated C-reactive protein levels: a two phase, longitudinal, single center, open labeled study

Srinivasan Beddhu  1   2 , Rebecca Filipowicz  3 , Xiaorui Chen  4 , Jill L Neilson  5 , Guo Wei  6 , Yufeng Huang  7 , Tom Greene  8
Affiliations
Observational Study

Supervised oral protein supplementation during dialysis in patients with elevated C-reactive protein levels: a two phase, longitudinal, single center, open labeled study

Srinivasan Beddhu et al. BMC Nephrol. .

Abstract

Background: Inflammation is considered one of the major causes of protein-energy wasting in maintenance hemodialysis (MHD) patients. It is unclear whether dietary interventions can impact nutritional status and quality of life in MHD patients with elevated C-reactive protein (CRP) levels. Therefore, we examined the hypothesis that supervised intra-dialysis protein supplementation in MHD patients with elevated plasma CRP will improve protein stores and quality of life.

Methods: A 24 week, two phase, longitudinal, single center, open labeled study of 50 MHD patients with plasma CRP > 3 mg/L was conducted. During the 12-week observation phase dietary advice was provided to increase protein intake to 1.2 g/kg/day. In the 12-week treatment phase 45 g of liquid protein supplement was provided at each dialysis treatment. Protein nitrogen appearance (PNA), mid-arm muscle circumference (MAMC), serum albumin, body mass index (BMI) and quality of life (assessed by Short Form-12 questionnaire) were measured at baseline, 12 and 24 weeks.

Results: Median plasma CRP at baseline was 16.0 (IQR 7.7 to 25.1) mg/L. The mean MAMC was 26.5 ± 3.9 cm, BMI 29.2 ± 6.9 kg/m(2) and plasma albumin 3.8 ± 0.3 g/dl. During the intervention period, mean PNA increased by 0.13 g/kg/d (p = 0.01) under a mixed effects model. However, there were no clinically or statistically significant effects on MAMC (p = 0.87), plasma albumin (p = 0.70), BMI (p = 0.09), physical (p = 0.32) or mental (p = 0.96) composite scores.

Conclusions: In MHD patients with elevated plasma CRP but otherwise mostly normal nutritional parameters, intra-dialytic oral protein supplement was effective in increasing protein intake but did not provide a detectable impact on nutritional status or quality of life.

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Figures

Fig. 1
Fig. 1
Flow of study participants
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Fig. 2
Changes in protein nitrogen appearance during the observational and interventional phases
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Fig. 3
Changes in mid-arm muscle circumference during the observational and interventional phases
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Fig. 4
Changes in plasma albumin during the observational and interventional phases
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Fig. 5
Changes in body mass index during the observational and interventional phases
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Fig. 6
Changes in physical health composite scale scores during the observational and interventional phases
Fig. 7
Fig. 7
Changes in mental health composite scale scores during the observational and interventional phases
See this image and copyright information in PMC

References

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