title: Supervised oral protein supplementation during dialysis in patients with elevated C-reactive protein levels: a two phase, longitudinal, single center, open labeled study.
abstract: BACKGROUND
  Inflammation is considered one of the major causes of protein-energy wasting in maintenance hemodialysis (MHD) patients. It is unclear whether dietary interventions can impact nutritional status and quality of life in MHD patients with elevated C-reactive protein (CRP) levels. Therefore, we examined the hypothesis that supervised intra-dialysis protein supplementation in MHD patients with elevated plasma CRP will improve protein stores and quality of life.
  
  
  METHODS
  A 24 week, two phase, longitudinal, single center, open labeled study of 50 MHD patients with plasma CRP > 3 mg/L was conducted. During the 12-week observation phase dietary advice was provided to increase protein intake to 1.2 g/kg/day. In the 12-week treatment phase 45 g of liquid protein supplement was provided at each dialysis treatment. Protein nitrogen appearance (PNA), mid-arm muscle circumference (MAMC), serum albumin, body mass index (BMI) and quality of life (assessed by Short Form-12 questionnaire) were measured at baseline, 12 and 24 weeks.
  
  
  RESULTS
  Median plasma CRP at baseline was 16.0 (IQR 7.7 to 25.1) mg/L. The mean MAMC was 26.5 ± 3.9 cm, BMI 29.2 ± 6.9 kg/m(2) and plasma albumin 3.8 ± 0.3 g/dl. During the intervention period, mean PNA increased by 0.13 g/kg/d (p = 0.01) under a mixed effects model. However, there were no clinically or statistically significant effects on MAMC (p = 0.87), plasma albumin (p = 0.70), BMI (p = 0.09), physical (p = 0.32) or mental (p = 0.96) composite scores.
  
  
  CONCLUSIONS
  In MHD patients with elevated plasma CRP but otherwise mostly normal nutritional parameters, intra-dialytic oral protein supplement was effective in increasing protein intake but did not provide a detectable impact on nutritional status or quality of life.
authors.affiliation: VA Healthcare System, Salt Lake City, UT, USA. srinivasan.beddhu@hsc.utah.edu.|Department of Medicine, University of Utah School of Medicine, 85 North Medical Drive East, Room 201, 84112, Salt Lake City, UT, USA. srinivasan.beddhu@hsc.utah.edu.
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Beddhu
authors.affiliation: Department of Medicine, University of Utah School of Medicine, 85 North Medical Drive East, Room 201, 84112, Salt Lake City, UT, USA. rmef15@u.washington.edu.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Filipowicz
authors.affiliation: Department of Medicine, University of Utah School of Medicine, 85 North Medical Drive East, Room 201, 84112, Salt Lake City, UT, USA. xiaorui.chen@hsc.utah.edu.
authors.forename: Xiaorui
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Medicine, University of Utah School of Medicine, 85 North Medical Drive East, Room 201, 84112, Salt Lake City, UT, USA. Jill.Neilson@hsc.utah.edu.
authors.forename: Jill L
authors.initials: JL
authors.lastname: Neilson
authors.affiliation: Department of Medicine, University of Utah School of Medicine, 85 North Medical Drive East, Room 201, 84112, Salt Lake City, UT, USA. guo.wei@hsc.utah.edu.
authors.forename: Guo
authors.initials: G
authors.lastname: Wei
authors.affiliation: Department of Medicine, University of Utah School of Medicine, 85 North Medical Drive East, Room 201, 84112, Salt Lake City, UT, USA. Yufeng.Huang@hsc.utah.edu.
authors.forename: Yufeng
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Medicine, University of Utah School of Medicine, 85 North Medical Drive East, Room 201, 84112, Salt Lake City, UT, USA. Tom.Greene@hsc.utah.edu.
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D004044:Dietary Proteins / Q000627:therapeutic use*; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology; D009752:Nutritional Status; D009929:Organ Size; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis / Q000379:methods*; D012709:Serum Albumin; D016896:Treatment Outcome
chemical_list: D004044:Dietary Proteins; D012709:Serum Albumin; D002097:C-Reactive Protein