The effect of dietary supplements on the nPCR in stable hemodialysis patients.
OBJECTIVE
To investigate whether (1) dietary supplements raise the normalized protein catabolic rate (nPCR) and/or further improve the nutritional status of stable hemodialysis patients who have both a low nPCR and a low dietary protein intake, <1.2 g/kg body weight/day; and if (2) protein intake measured by nPCR reflects protein intake measured by estimated food diaries in stable patients.


METHODS
Prospective experimental study with a single intervention group.


METHODS
Hospital outpatient hemodialysis unit.


METHODS
Seventeen stable chronic hemodialysis patients (10 men, 7 women) were studied over 8 months.


METHODS
Subjects with both a low nPCR and dietary protein intake <1.2 g/kg body weight/day received dietary supplements for the first 2 months. Measurements to assess protein intake and nutritional status were taken at baseline and repeated at the end of 2 months, and at 6 months postintervention.


METHODS
nPCR, dietary protein intake using 7-day estimated food diaries, serum urea, serum albumin, serum creatinine, serum bicarbonate, dialysis adequacy (Kt/V), and body mass index (BMI).


RESULTS
Dietary supplements significantly increased both the nPCR and the total protein intake at 2 months (1.21 +/- 0.26, 1.10 +/- 0.12, respectively) compared with baseline (0.95 +/- 0.18, 0.75 +/- 0.19, respectively) and 8 months (0.99 +/- 0.12, 0.78 +/- 0.21, respectively), P <.0001, respectively. There was no change in the nutritional status of the subjects. There was a significant difference between the nPCR and the dietary protein intake at baseline, P <.004; at 2 months, P <.047; and at 8 months, P <.001.


CONCLUSIONS
Dietary supplements can significantly increase the nPCR and dietary protein intake in stable hemodialysis patients with a low nPCR and dietary protein intake. Because a low nPCR is associated with a high morbidity and mortality rate, it may be prudent to supplement such patients. The use of the nPCR to quantify dietary protein intake in stable hemodialysis patients should be used with caution.
Patel
M G
MG
Barts and The London NHS Trust, St Bartholomew's Hospital, London, England.
Kitchen
S
S
Miligan
P J
PJ
D000368:Aged; D001639:Bicarbonates / Q000097:blood; D044383:Black People; D015992:Body Mass Index; D003404:Creatinine / Q000097:blood; D004044:Dietary Proteins / Q000008:administration & dosage; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D011506:Proteins / Q000378:metabolism*; D006435:Renal Dialysis; D012709:Serum Albumin / Q000032:analysis; D012727:Sex Characteristics; D014508:Urea / Q000097:blood; D044465:White People
D001639:Bicarbonates; D004044:Dietary Proteins; D011506:Proteins; D012709:Serum Albumin; D014508:Urea; D003404:Creatinine