title: Association between oral nutritional supplementation and clinical outcomes among patients with ESRD.
abstract: OBJECTIVE
  Oral nutritional supplementation (ONS) was provided to ESRD patients with hypoalbuminemia as part of Fresenius Medical Care Health Plan's (FMCHP) disease management. This study evaluated the association between FMCHP's ONS program and clinical outcomes.
  
  
  METHODS
  Analyses included FMCHP patients with ONS indication (n=470) defined as 2-month mean albumin <3.8 g/dl until reaching a 3-month mean ≥3.8 g/dl from February 1, 2006 to December 31, 2008. Patients did not receive ONS if deemed inappropriate or refused. Patients on ONS were compared with patients who were not, despite meeting ONS indication. Patients with ONS indication regardless of use were compared with Medicare patients with similar serum albumin levels from the 2007 Centers for Medicare and Medicaid Services Clinical Performance Measures Project (CPM). Cox models calculated adjusted hospitalization and mortality risks at 1 year.
  
  
  RESULTS
  Among patients with indication for ONS, 276 received supplements and 194 did not. ONS use was associated with 0.058 g/dl higher serum albumin overall (P=0.02); this difference decreased by 0.001 g/dl each month (P=0.05) such that the difference was 0.052 g/dl (P=0.04) in month 6 and the difference was no longer significant in month 12 . In analyses based on ONS use, ONS patients had lower hospitalization at 1 year (68.4%; P<0.01) versus patients without ONS (88.7%), but there was no significant reduction in mortality risk (P=0.29). In analyses based on ONS indication, patients with indication had lower mortality at 1 year (16.2%) compared with CPM patients (23.4%; P<0.01).
  
  
  CONCLUSIONS
  These findings suggest that ONS use was associated with significantly lower hospitalization rates but had no significant effect on mortality in a disease management setting.
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, MI 48104, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Cheu
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Pearson
authors.forename: Claudia
authors.initials: C
authors.lastname: Dahlerus
authors.forename: Brett
authors.initials: B
authors.lastname: Lantz
authors.forename: Tania
authors.initials: T
authors.lastname: Chowdhury
authors.forename: Peter F
authors.initials: PF
authors.lastname: Sauer
authors.forename: Robert E
authors.initials: RE
authors.lastname: Farrell
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
authors.forename: Sylvia P B
authors.initials: SP
authors.lastname: Ramirez
mesh_terms: D000368:Aged; D019587:Dietary Supplements; D019468:Disease Management; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D034141:Hypoalbuminemia / Q000178:diet therapy* / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000178:diet therapy* / Q000401:mortality*; D008297:Male; D006278:Medicare; D008875:Middle Aged; D015397:Program Evaluation; D011502:Protein-Energy Malnutrition / Q000178:diet therapy / Q000401:mortality; D006435:Renal Dialysis / Q000401:mortality; D012709:Serum Albumin; D014481:United States / Q000453:epidemiology
chemical_list: D012709:Serum Albumin