Association Between Oral Nutritional Supplements and Serum Biomarkers on Hemodialysis Patients. A Retrospective Study

Abstract

Background: The prevalence of end-stage renal disease (ESRD) is expected to increase over the next few decades. ESRD is accompanied by various complications including malnutrition, uremia, electrolyte, mineral, and bone disorders. Continuously monitoring the clinical complications of patients on maintenance hemodialysis dialysis (HD) therapy is of great concern. Patients on maintenance HD are at risk of malnutrition which could lead to hospitalization, morbidity, and mortality of these patients. Therefore, this retrospective study aims to evaluate the effects of oral nutrition supplements (ONS) provided during hemodialysis on serum biomarkers of HD patients with hypoalbuminemia. Method: Laboratory measurements were taken before the start of ONS intake and after two months of continuous ONS intake on 34 patients who received ONS for two months. Serum biomarkers such as albumin, creatinine (Cr), potassium (K), phosphorus (P), calcium (Ca), and sodium (Na) data was extracted from the electrical medical records (EMR). The eligible patients received 7 bottles (125ml each bottle) per week for two months. Each bottle contains 9.4 grams of whey protein instead of animal protein because whey protein has a lower content of electrolytes. Statistical analysis using SPSS software and paired-t test was used to assess changes in serum biomarkers during the provision of supplements. Result: The provision of ONS with the patients on HD demonstrated a significant increase (P value 0.038 < 0.05) in serum albumin level (Mean: 31.91, SD 4.10) after two months compared to before ONS provision (Mean:30.64, SD 3.54). However, no statistically significant difference was found in other serum biomarkers (Cr, K, P, Ca, and Na). Conclusion: ONS provision in patients with hypoalbuminemia undergoing maintenance HD showed significant improvement in serum albumin levels that could lead to enhanced nutrition status. Additionally, no abnormal electrolyte disturbance was found in the duration of ONS provision. Hence, renal-specific ONS might be considered a complementary dietary supplement for malnourished HD patients. Furthermore, more trials are required with a large sample size to confirm the long-term efficacy of other brands of renal-specific ONS particularly in patients undergoing maintenance HD with different comorbidities.

Keywords: Hemodialysis, Hypoalbuminemia, Oral nutrition supplement, Serum biomarkers.

DOI: 10.7176/JHMN/113-05

Publication date: January 31^st 2024