Effects of protein and omega-3 supplementation, provided during regular dialysis sessions, on nutritional and inflammatory indices in hemodialysis patients

Zulfitri A Mat Daud, Boniface Tubie, Judy Adams, Tracey Quainton, Robert Osia, Sharon Tubie, Deepinder Kaur, Pramod Khosla, Marina Sheyman, Zulfitri A Mat Daud, Boniface Tubie, Judy Adams, Tracey Quainton, Robert Osia, Sharon Tubie, Deepinder Kaur, Pramod Khosla, Marina Sheyman

Abstract

Purpose: Malnutrition and chronic inflammation in dialysis patients negatively impacts prognosis. However, intervening to correct this problem (through nutritional supplementation) is often hampered by poor compliance due to both medical and socioeconomic barriers. We have therefore performed a pilot study to investigate the technical feasibility of "directly observed treatment" of nutritional supplementation (protein and omega-3 fatty acids), administered during regular dialysis sessions. Secondary end points included observation of nutritional and inflammatory status of hypoalbuminemic patients undergoing hemodialysis.

Methods: Main inclusion criteria were serum albumin ≤ 3.9 g/dL (3 months prior to the study). Sixty-three eligible patients agreed to participate. Two intervention groups received 30 mL of a liquid protein supplement plus either 2.4 g omega-3 (1800 mg eicosapentaenoic acid + 600 mg docosahexaenoic acid) or a placebo, three times per week after their routine dialysis session for 6 months. Serum albumin, plasma lipids, and other indicators of nutritional and inflammatory status were measured.

Results: Directly observed nutritional supplementation resulted in a significant improvement in the low density lipoprotein cholesterol/high density lipoprotein cholesterol ratio in the omega-3 group as compared to the placebo group (P = 0.043). For the omega-3 group, serum albumin was also marginally higher after 6 months as compared to baseline (P = 0.07). The observed increase in C-reactive protein in the placebo group over 6 months was not apparent in the omega-3 group, although there was no significant difference between groups. Nuclear factor kappa B, malnutrition-inflammation score, normalized protein nitrogen appearance, body mass index, and hemoglobin were unaffected by the intervention.

Conclusion: "Directly observed treatment" with an omega-3 based supplement (as opposed to a pure protein supplement) showed beneficial effects on the lipid profile, and C-reactive protein levels. Further studies using a combination of outpatient and inpatient "directly observed treatment" of omega-3 based supplementation is warranted.

Keywords: hemodialysis; inflammation; nutritional status; protein and omega-3 supplementation.

Figures

Figure 1
Figure 1
Study’s flow chart. Notes: All patients at the Great Lake Dialysis clinic (n = 105) were screened for eligibility. Sixty-nine patients met the inclusion criteria but six of them declined to participate. The remaining 63 patients were randomized into omega-3 and placebo groups and underwent intervention for 6 months. Seven additional subjects (placebo, n = 4; omega-3, n = 3) were excluded from data analysis due to death (n = 4, 2 from each group) or hospitalization (n = 3). Two patients voluntarily dropped out as they were unable to swallow the capsules but their data were included in the analysis (intent to treat). Abbreviation: MIS, malnutrition-inflammation score.

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