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Effects of only Oral Protein Supplementation in malnourished Continuous Ambulatory Peritoneal Dialysis patients
Sahathevan S1, Se CH1, Ng SH1, Chinna K2, Goh BL3, Gafor H4, Bavanandan S5, Ahmad G5, Karupaiah T1§
1 Dietetics Program, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM)
2 Epidemiology and Biostatistics Unit, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya
3 Department of Nephrology, Serdang Hospital
4 Nephrology Unit, Department of Medicine, UKM Medical Centre
5 Department of Nephrology, Kuala Lumpur Hospital
ABSTRACT
Background: We evaluated the effect of only oral protein supplementation (OPS) on the nutritional status of malnourished CAPD patients.
Methods: Seventy-four CAPD patients were randomized to either an intervention (IG, n=37) or control (CG, n=37) group with both receiving standard dietary counseling. IG received whey protein powder (30.7g protein) daily for 6 months. Various nutritional parameters were assessed at baseline and 6 months. Mean differences (within and between groups) and differences for categorical data was determined.
Results: By study completion dietary protein intake (DPI) of IG was 29% greater >CG (P<0.001, ES=1.73). More IG patients achieved DPI adequacy (1.2 g/kg IBW) >CG (48.6% vs. 10.8%, P<0.001). Majority patients had dietary energy intake <30 kcal/kg IBW (IG=81.1% vs. CG=78.4%, P=0.772) despite dialysate calorie contribution of 281 ± 64 kcal/day. Body weight changes lacked significance between groups (P>0.05). Mid-arm circumference (diff: +0.29 ± 0.93, P=0.043, ES= 0.10) and mid-arm muscle area (diff: +0.97 ± 3.26, P=0.048, ES=0.12) significantly increased within IG but not in CG. Serum urea (IG= +2.17± 4.48 mmol/L, P=0.004, ES=0.49 vs. CG= +0.28 ± 3.99 mmol/L, P=0.425, ES=0.04), serum total protein (IG= +3.59 ± 6.60 g/L, P=0.001, ES=0.52 vs. CG= +2.95 ± 6.61g/L, P=0.007, ES=0.22) and nPCR (IG= +0.06 ± 0.13 g/kg/day, P<0.001, ES=0.22 vs CG=0.00 ± 0.16 g/kg/day, P=0.996, ES<0.001) levels significantly improved for IG>CG but serum albumin remained unchanged (P>0.05). Differences between groups for malnutrition-inflammation-score, handgrip strength and physical activity level were not significant (P>0.05).
Conclusion: A 6-month OPS improved some markers of nutritional status in malnourished CAPD patients, justifying OPS for nutritional repletion but DEI improvement should be also targeted.
Key words: oral protein supplementation, malnutrition, peritoneal dialysis