The Effect of Oral Nutritional Supplement on Nutritional Status of Hemodialysis Patients in a Military Hospital

Document Type : Original Research

Authors

1 Baqiyatallah University of Medical Sciences

2 Department of Medical- Surgical, Faculty of Nursing, Aja University of Medical Sciences, Tehran, Iran

Abstract

Background and Aim: Malnutrition is a common problem for hemodialysis patients, leading to reduced quality of life, increased hospitalization, and increased mortality. Evaluation of nutritional status is one of the main determinants of the clinical status. The aim of this study was to investigate the effect of oral nutritional supplements (Iso Whey) on the nutritional status of hemodialysis patients.
Methods: In this clinical trial, 44 hemodialysis patients during random allocation divided into two Iso-whey and control groups. In intervention groups, Iso Whey protein powder was consumed for two months. The control group continued their routine diet. In all groups, before and after the intervention, nutritional status was evaluated based on Dialysis Malnutrition Score (DMS) and Malnutrition-Inflammation Score (MIS) scale.
Results: Both groups were matched in demographic variables and nutritional status before intervention (P>0.05). After the intervention, there was a significant difference between the groups in nutritional status based on DMS and MIS scale (P<0.05).
Conclusion: The findings showed that the intake of oral nutritional supplements resulted in improving hemodialysis patients' nutritional status. Therefore, using oral nutritional supplements under the supervision of a nutritionist with an educational program and regular assessment of nutritional status can be recommended to improve the nutritional status.

Keywords


1. Małgorzewicz S, Gałęzowska G, Cieszyńska-Semenowicz M, Ratajczyk J, Wolska L, Rutkowski P, et al. 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 2. Kalantar-Zadeh K. Protein-Energy Wasting. Nutrition in Kidney Disease: Springer; 2014. p. 219-30. doi:10.1007/978-1-62703-685-6_13 3. Hernández Morante JJ, Sánchez-Villazala A, Cutillas RC, Fuentes MCC. Effectiveness of a Nutrition Education Program for the Prevention and Treatment of Malnutrition in End-Stage Renal Disease. Journal of Renal Nutrition. 2014;24(1):42-9. doi:10.1053/j.jrn.2013.07.004 4. Kuhlmann MK KA, Wittwer M, Hörl WH. malnutrition in chronic renal failure. Nephrol Dial Transplant. 2007;220(22(Suppl 3):13-9. doi:10.1093/ndt/gfm016 5. Małgorzewicz S A-WE, Owczarzak A, Debska-Slizień A, Rutkowski B, ŁysiakSzydłowska W. Adipokines and nutritional status for patients on maintenance hemodialysis. Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation. 2010;20(5):303-8. doi:10.1053/j.jrn.2009.10.005 6. Sezer S, Bal Z, Tutal E, Uyar ME, Acar NO. Long‐term oral nutrition supplementation improves outcomes in malnourished patients with chronic kidney disease on hemodialysis. Journal of Parenteral and Enteral Nutrition. 2014;38(8):960-5. doi:10.1177/0148607113517266 7. Kooshki A, Tabibi H, Rivandi M. Status of Macro- and Micronutrient Intake as Compared to DRI in Hemodialysis Patients. Quarterly Journal of Sabzevar University of Medical Sciences. 2012;19 (1): 69-75. 8. Heng A E CN. Nutritional problems in adult patients with stage 5 chronic kidney disease on dialysis (both haemodialysis and peritoneal dialysis). Clin Kidney J. 2010;3(2):109-17. doi:10.1093/ndtplus/sfp147 9. 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. Nephro-urology monthly. 2016;8(6):1-6. doi:10.5812/numonthly.34993 10. 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 Journal of Nutrition Sciences & Food Technology. 2011;6(2): 43-54. 11. Sabatino A, Regolisti G, Karupaiah T, Sahathevan S, Singh BS, Khor B, et al. Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis. Clinical nutrition. 2017;36(3):663-71. doi:10.1016/j.clnu.2016.06.007 12. 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). doi:10.1371/journal.pone.0207045 13. 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. Journal of Renal Nutrition.2018;28(3):191-6. doi:10.1053/j.jrn.2017.10.002 14. Cheu C, Pearson J, Dahlerus C, Lantz B, Chowdhury T, Sauer PF, et al. Association between oral nutritional supplementation and clinical outcomes among patients with ESRD. Clinical Journal of the American Society of Nephrology. 2013;8(1):100-7. doi:10.2215/CJN.13091211 15. Hubbard GP, Elia M, Holdoway A, Stratton RJ. A systematic review of compliance to oral nutritional supplements. Clinical nutrition. 2012;31(3):293-312. doi:10.1016/j.clnu.2011.11.020 16. Lochs H, Allison S, Meier R, Pirlich M, Kondrup J, van den Berghe G, et al. Introductory to the ESPEN guidelines on enteral nutrition: terminology, definitions and general topics. Clinical nutrition. 2006;25(2):180-6. doi:10.1016/j.clnu.2006.02.007 17. Nieuwenhuizen WF, Weenen H, Rigby P, Hetherington MM. Older adults and patients in need of nutritional support: review of current treatment options and factors influencing nutritional intake. Clinical nutrition. 2010;29(2):160-9. doi:10.1016/j.clnu.2009.09.003 18. Saxena A, Kothari J, Gokulnath M, Gupta A, Carrero JJ. An Open Label Randomized Clinical Study Evaluating Impact of Nutritional Supplement in Malnourished Dialysis Patients (IMPROVES Trial) Protocol No PBL. PROS/07-11. Nephrol Urol open 1: 104. Nephrol Urol open; 2018. 19. Taghdir M, Ashourpour M, Ghandchi Z, Pourghaderi M, Sepandi M, Alavi Naini A-m. 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. 20. Roy LG, Shetty MS, Urooj A. Screening of Malnutrition Using Clinical, Dietary and Anthropometric Variables in an Indian Hemodialysis Population. JMED Res. 2015:1-14. doi:10.5171/2015.847823 21. Uy MC, Lim-Alba R, Chua E. Association of Dialysis Malnutrition Score with hypoglycemia and Quality of Life among Patients with Diabetes on Maintenance hemodialysis. Journal of the ASEAN Federation of Endocrine Societies. 2018;33(2):137. doi:10.15605/jafes.033.02.05 22. Tabibi H, As'habi A, Nozari B, Mahdavi-Mazdeh M, Hedayati M, Abdollahi M. Comparison of various methods for determination of protein-energy malnutrition with subjective global assessment in hemodialysis patients. Iranian Journal of Nutrition Sciences & Food Technology. 2011;5(4):13-22. doi:10.1111/j.1542-4758.2011.00582.x 23. Diaz-Martinez J, Martinez-Motta P, Campa A, Delgado-Enciso I, Huffman F, Baum M, et al. MIS and SGA Indices as Predictors of Mortality and Their Relationship with Nutrition Parameters in Hemodialysis Patients (P18-009-19). Current developments in nutrition. 2019;3(Supplement_1):nzz039. P18-09-19. doi:10.1093/cdn/nzz039.P18-009-19 24. Shasti S, Babajani M. The assessment of dialysis adequacy among hemodialysis patient in Tehran city. EBNESINA. 2011;14(1):23-7. 25. Farhadi M, Dadgari F, Farsi Z, Dadgari A. Dialysis adequacy in chronic hemodialysis patients in a military hospital. EBNESINA. 2015;14(1):36-42. 26. Bolasco P, Caria S, Cupisti A, Secci R, Saverio Dioguardi F. A novel amino acids oral supplementation in hemodialysis patients: a pilot study. Renal failure. 2011;33(1):1-5. doi:10.3109/0886022X.2010.536289 27. Bammens B, Evenepoel P, Verbeke K, Vanrenterghem Y. Impairment of small intestinal protein assimilation in patients with end-stage renal disease: extending the malnutrition-inflammation-atherosclerosis concept. The American journal of clinical nutrition. 2004;80(6):1536-43. doi:10.1093/ajcn/80.6.1536 28. Bammens B, Verbeke K, Vanrenterghem Y, Evenepoel P. Evidence for impaired assimilation of protein in chronic renal failure. Kidney international. 2003;64(6):2196-203. doi:10.1046/j.1523-1755.2003.00314.x 29. Gangurde HH, Chordiya MA, Patil PS, Baste NS. Whey protein. Scholar's Research Journal. 2011;1: 69-77. doi:10.4103/2249-5975.99663 30. Lynch CJ, Adams SH. Branched-chain amino acids in metabolic signalling and insulin resistance. Nature Reviews Endocrinology. 2014;10(12):723-736. doi:10.1038/nrendo.2014.171 31. Stratton RJ, Ek A-C, Engfer M, Moore Z, Rigby P, Wolfe R, et al. Enteral nutritional support in prevention and treatment of pressure ulcers: a systematic review and meta-analysis. Ageing research reviews. 2005;4(3):422-50. doi:10.1016/j.arr.2005.03.005 32. National Collaborating Centre for Acute Care. Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition. 2006. 33. Stratton RJ, Elia M. A review of reviews: a new look at the evidence for oral nutritional supplements in clinical practice. Clinical Nutrition Supplements. 2007;2(1):5-23. doi:10.1016/j.clnu.2007.04.004 34. Jahromi SR, Hosseini S, Razeghi E, pasha Meysamie A, Sadrzadeh H. Malnutrition predicting factors in hemodialysis patients. Saudi Journal of Kidney Diseases and Transplantation. 2010;21(5): 846-51. 35. Heng A-E, Cano NJ. Nutritional problems in adult patients with stage 5 chronic kidney disease on dialysis (both haemodialysis and peritoneal dialysis). NDT plus. 2010;3(2):109-17. doi:10.1093/ndtplus/sfp147 36. Martin-Alemañy G, Valdez-Ortiz R, Olvera-Soto G, Gomez-Guerrero I, Aguire-Esquivel G, Cantu-Quintanilla G, et al. The effects of resistance exercise and oral nutritional supplementation during hemodialysis on indicators of nutritional status and quality of life. Nephrology Dialysis Transplantation. 2016;31(10):1712-20. doi:10.1093/ndt/gfw297 37. Wright S, Weiner DE. Oral nutritional supplement use in dialysis patients: full speed ahead? American Journal of Kidney Diseases. 2012;60(4): 507-9. doi:10.1053/j.ajkd.2012.07.004 38. Harvinder GS, Swee WC, Karupaiah T, Sahathevan S, Chinna K, Ahmad G, et al. Dialysis malnutrition and malnutrition inflammation scores: Screening tools for prediction of dialysis-related protein-energy wasting in Malaysia. Asia Pac J Clin Nutr. 2016; 25:26-33. 39. Kaysen GA. Biological basis of hypoalbuminemia in ESRD. J Am Soc Nephrol. 1998; 9:2368-76. 40. Kaysen GA, Rathore V, Shearer GC, Depner TA. Mechanisms of hypoalbuminemia in hemodialysis subjects. Kidney Int. 1995;48:510-16. doi:10.1038/ki.1995.321 41. Caglar K, Fedje L, Dimmitt R, Hakim RM, Shyr Y, Ikizler TA. Therapeutic effects of oral nutritional supplementation during hemodialysis. Kidney international. 002;62(3):1054-9. doi:10.1046/j.1523-1755.2002.00530.x 42. Yusop NBM, Mun CY, Shariff ZM, Huat CB. Factors associated with quality of life among hemodialysis patients in Malaysia. PLoS One. 2013;8(12):1-11. doi:10.1371/journal.pone.0084152