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Published on: September 20, 2019
The effect of different timings of protein supplementation on variable outcomes in hemodialysis patients: a
Mohamed Mamdouh Elsayed1, Amr Mohamed Elkazaz2
1Nephrology and Internal Medicine Department, Faculty of Medicine, Alexandria University, Alkhartoom Square, El Azareeta, Alexandria, 21131, Egypt. dr_mohamedmamdouh87@yahoo.com.
Background:
Oral nutritional supplements (ONS) are commonly prescribed to provide protein and energy to hemodialysis (HD) patients. There is a debate about the appropriate timing to administer ONS. We aimed to study the effect of different timings of ONS on variable outcomes in HD patients.
Methods:
This research is a prospective, randomized, multicentric clinical trial (RCT) that included 120 patients on regular HD. Patients were allocated to receive ONS (25 gm protein powder/HD session) for 8 weeks either predialytic (1 h before the start of the session), intradialytic (2 h after the start of the session), or interdialytic (on non-dialysis days). Laboratory parameters, blood pressure (BP), dialysis adequacy, and nutritional parameters were assessed during the study.
Results:
At study end, BP at the end of HD dropped significantly in the intradialytic group compared to the other groups (p < 0.001). Serum albumin improved significantly in the predialytic (p < 0.001) and intradialytic (p = 0.039) groups. The mean subjective global assessment score increased significantly in the interdialytic group (p = 0.040). The Kt/V and urea reduction ratio decreased significantly only in the intradialytic group (p value < 0.001 and 0.001). Serum sodium, potassium, phosphorus, cholesterol, triglycerides, and adverse events did not significantly differ between the different groups.
Conclusions:
Predialytic ONS supplementation is a favorable option due to improved serum albumin with minimal effects on hemodynamics and dialysis adequacy compared to intradialytic and interdialytic supplementation.
Clinical Trials Registration:
ClinicalTrials.gov NCT05953636. First registration date: 1/07/2023.
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