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.
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.
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.
★Professor of Medicine, Head of Chair and Department of Nephrology, Transplantology and Internal Diseases, University of Medical Sciences, Poznań, Poland
†Medical Manager, Medical Department, Fresenius Kabi Poland, Warsaw, Poland
Address reprint requests to Stanisław Czekalski, MD, PhD, Department of Nephrology, Transplantology and Internal Diseases, Prof. Stanisław Czekalski ul. Przybyszewskiego 49, 60-355 Poznań, Poland
☆ Supported in part by a grant from Fresenius Kabi, Poland.
ABSTRACT