title: Use of a renal-specific oral supplement by haemodialysis patients with low protein intake does not increase the need for phosphate binders and may prevent a decline in nutritional status and quality of life.
abstract: BACKGROUND
  Protein-energy wasting is a frequent and debilitating condition in maintenance dialysis. We randomly tested if an energy-dense, phosphate-restricted, renal-specific oral supplement could maintain adequate nutritional intake and prevent malnutrition in maintenance haemodialysis patients with insufficient intake.
  
  
  METHODS
  Eighty-six patients were assigned to a standard care (CTRL) group or were prescribed two 125-ml packs of Renilon 7.5(R) daily for 3 months (SUPP). Dietary intake, serum (S) albumin, prealbumin, protein nitrogen appearance (nPNA), C-reactive protein, subjective global assessment (SGA) and quality of life (QOL) were recorded at baseline and after 3 months.
  
  
  RESULTS
  While intention to treat analysis (ITT) did not reveal strong statistically significant changes in dietary intake between groups, per protocol (PP) analysis showed that the SUPP group increased protein (P < 0.01) and energy (P < 0.01) intakes. In contrast, protein and energy intakes further deteriorated in the CTRL group (PP). Although there was no difference in serum albumin and prealbumin changes between groups, in the total population serum albumin and prealbumin changes were positively associated with the increment in protein intake (r = 0.29, P = 0.01 and r = 0.27, P = 0.02, respectively). The SUPP group did not increase phosphate intake, phosphataemia remained unaffected, and the use of phosphate binders remained stable or decreased. The SUPP group exhibited improved SGA and QOL (P < 0.05).
  
  
  CONCLUSIONS
  This study shows that providing maintenance haemodialysis patients with insufficient intake with a renal-specific oral supplement may prevent deterioration in nutritional indices and QOL without increasing the need for phosphate binders.
authors.affiliation: Department of Nephrology, Hôpital Edouard Herriot, 69437 Lyon Cedex 03, France. denis.fouque@chu-lyon.fr
authors.forename: Denis
authors.initials: D
authors.lastname: Fouque
authors.forename: Jane
authors.initials: J
authors.lastname: McKenzie
authors.forename: Renée
authors.initials: R
authors.lastname: de Mutsert
authors.forename: Raymond
authors.initials: R
authors.lastname: Azar
authors.forename: Daniel
authors.initials: D
authors.lastname: Teta
authors.forename: Mathias
authors.initials: M
authors.lastname: Plauth
authors.forename: Noel
authors.initials: N
authors.lastname: Cano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004044:Dietary Proteins / Q000008:administration & dosage*; D019587:Dietary Supplements / Q000032:analysis; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007668:Kidney / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D028044:Phosphate-Binding Proteins / Q000008:administration & dosage; D011502:Protein-Energy Malnutrition / Q000517:prevention & control*; D011788:Quality of Life; D006435:Renal Dialysis; D012709:Serum Albumin / Q000032:analysis
chemical_list: D004044:Dietary Proteins; D028044:Phosphate-Binding Proteins; D012709:Serum Albumin