Journal of Renal Nutrition
Volume 14, Issue 2 , Pages 82-88, April 2004

Intradialytic amino acids supplementation in hemodialysis patients with malnutrition: results of a multicenter cohort study☆

Part of this report was presented in abstract form at the World Congress of Nephrology in Berlin, June, 2003.

  • Stanisław Czekalski, MD, PhD

      Affiliations

    • Corresponding Author InformationAddress reprint requests to Stanisław Czekalski, MD, PhD, Department of Nephrology, Transplantology and Internal Diseases, Prof. Stanisław Czekalski ul. Przybyszewskiego 49, 60-355 Poznań, Poland
    • Professor of Medicine, Head of Chair and Department of Nephrology, Transplantology and Internal Diseases, University of Medical Sciences, Poznań, Poland
    • ,
  • Roman Hożejowski, MD

      Affiliations

    • Medical Manager, Medical Department, Fresenius Kabi Poland, Warsaw, Poland
    • ,
  • Malnutrition Working Group

Abstract 

Objective

Prospective evaluation of the effect of 6-month-long intradialytic amino acids (AA) supplementation on selected nutritional variables in malnourished hemodialysis (HD) patients.

Design

Multicenter, prospective, (nonrandomized, noncontrolled) observational study.

Setting

Thirty-one HD units affiliated with academic centers and tertiary-care hospitals.

Patients

Adult patients treated by HD for at least 6 months. Inclusion criteria were: serum albumin concentration ≤39 g/L and at least 4% loss of body weight during the last 6 months in otherwise stable HD patients. From a cohort of 133 patients who were enrolled, 97 (54 men and 43 women) were eligible for the analysis.

Intervention

Intradialytic AA supplementation with 500 mL 10% solution per HD session for a period of 6 months.

Main outcome measures

Serum albumin concentration, modified Subjective Global Assessment (SGA) score, body mass index (BMI), mid-arm circumference (MAC), and total lymphocyte count. Measurements were recorded at baseline and after 3 and 6 months of AA supplementation.

Results

Serum albumin concentration increased significantly from the mean 32.5 ± 4.6g/L at baseline to 36.4 ± 4.8 g/L at 3 months (P < .001) and 37.1 ± 4.8g/L at final observation (P < .001 versus baseline). Significant correlation was observed between frequency of AA supplementation and serum albumin increase (r = 0.41; P < .0001). Rate of improvement negatively correlated significantly with baseline concentration of serum albumin (r = − 0.42; P < .0001). SGA score significantly improved from median of 16 points at baseline to 12 points at 3 months (P < .01) and 11 points at 6 months (P < .01 versus baseline), and this improvement also correlated with the frequency of AA supplementation. Small yet significant increase of MAC was observed at 6 months (from baseline 24.1 ± 4.3 to 24.8 ± 4.8 cm; P < .01), whereas BMI remained unchanged.

Conclusion

Intradialytic AA supplementation improves selected nutritional parameters of HD patients with malnutrition. The improvement depends on the intensity of supplementation.

 

☆ Supported in part by a grant from Fresenius Kabi, Poland.

PII: S1051-2276(04)00008-1

doi:10.1053/j.jrn.2004.01.007

Journal of Renal Nutrition
Volume 14, Issue 2 , Pages 82-88, April 2004

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