SP612EFFECT OF A PROTEIN-RICH MEAL INTAKE DURING HEMODIALYSIS TREATMENT

Abstract

Introduction and Aims: Protein intake is a key point to maintain an adequate nutritional status in hemodialysis (HD) patients. There are some studies that confirm the positive influence of intradialytic oral nutritional supplementation in several nutritional parameters in HD patients. The aim of this study was to evaluate the effect of intradialytic oral nutrition supplementation in HD patients. Methods: This was a 6-months single center non-randomized controlled trial, with 85 patients in HD at least for 3 months (3 times/week). Patients were included in the intervention group (IG) if they presented at least one serum albumin value < 3.8 g/dL in the last two measurements before the beginning of the study and had not clinical limitations as well as accepted to eat a proposed meal. During the 6 months, the IG was given a meal during each HD treatment which consisted in 160 ml of a drink rich in protein and an egg sandwich. The control group (CG) continued to eat the snack that usually brought from home. Normalized protein catabolic rate (nPCR), serum albumin, potassium, phosphorus, C-Reactive Protein (CRP), dry weight and body composition parameters were measured at baseline and at the end of the 6 months. A p-value <0.05 was considered statistically significant. Results: At baseline patient's mean age and HD vintage were 69.9+/-12.9 years and 60.0 +/-50.5 months. Both groups were similar in the parameters studied at the start of the study, except in albumin (CG: 3.8+/-0.3; IG: 3.6+/-0.2; p=0.003). After the intervention, an increase in protein intake (nPCR) was observed only in the IG (baseline 1.08+/-0.27 g/ Kg/day; at 6 months 1.19+/-0.28 g/Kg/day; p=0.002). On the other hand, albumin decreased in both groups but this difference was higher and only statistically significant in the CG (CG: -0.14+/-0.23, p<0.001; IG: -0.01+/-0.19, p=0.68). No statistically significant differences were observed in hypoalbuminemia prevalence in the IG (baseline 82.1%; at 6 months 75.6%; p=0.250). On the contrary, the prevalence of hypoalbuminemia significantly increased in the CG (baseline 29.9%; at 6 months 61.4%; p<0.001). Regarding body composition, in the group of patients who did not eat the protein-rich meal, an increase in the prevalence of lean tissue index below the desirable values was observed (baseline 30.8%, at 6 months 50.0%; p=0.033). In the IG this values remained stable (baseline 22.5%, at 6 months 21.6%; p=0.71). In the IG, the percentage of patients with low fat tissue index decreased during the intervention period (baseline 22%, at 6 months 10.8%; p=0.046) whereas in the CG this value increased but without statistical significance (baseline 7.7%, at 6 months 14.3%; p=0.66). There were no statistically significant differences on dry weight ( p=0.25), potassium ( p=0.42), phosphorus (p=0.62), and CRP ( p=0.66). Conclusions: An intradialytic intake of a meal rich in protein contributes to improve protein intake and body composition parameters. Therefore, this type of intervention can contribute to ameliorate patient's nutritional status without affecting negatively other parameters. Other studies with the inclusion of individual nutritional counselling as well as intradialytic exercise should be performed to support these results.