Nutrition supplements in dialysis patients: use in peritoneal dialysis patients and diabetic patients

Malnutrition is common in dialysis patients. Low serum albumin is associated with increased mortality. Nutrition supplements have been used with success in dialysis patients in increasing serum albumin levels. The National Kidney Foundation of South Carolina Nutrition Supplement Program provides grants for supplements. We studied the effect of supplements on albumin levels in peritoneal dialysis (PD) patients, hemodialysis (HD) patients, and dialysis patients with diabetes. Dialysis patients with any combination of an annual income of less than $24,000, a documented albumin level of 35 g/L or under or significant weight loss were provided with 3 months of nutrition supplements. Albumin levels and weight were tracked for 3 months before, 3 months during, and 3 months after the supplement use. The study included 190 patients (157 on HD, 33 on PD). Serum albumin was significantly higher in HD patients than in PD patients during all study periods (before, during, and after supplement; p < 0.05). In the 121 dialysis patients with diabetes, we observed a significant increase in albumin during supplement period (p < or = 0.05). The improvement persisted after the supplement was stopped. Patients on PD had no significant increase in weight or albumin level during or after the supplement period. Nutrition supplements in dialysis patients lead to a significant improvement in serum albumin in HD patients, but no similar improvement in PD patients. Dialysis patients with diabetes had a significant improvement in serum albumin identical to that in dialysis patients without diabetes. Improved serum albumin levels could lead to decreased morbidity and mortality, but the relationship between supplement use and mortality needs further study.