NUTRITIONAL SUPPLEMENTATION IN DIALYSIS PATIENTS

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. In this study, we hypothesize that long-term administration of adequate intradialytic oral nutritional supplementation will increase visceral protein concentrations and somatic protein stores in chronic hemodialysis patients with uremic malnutrition. We will test this hypothesis by the following aims through a randomized, placebo-controlled, double-blinded study. Aim 1: Does long-term administration of intradialytic oral nutritional supplementation improve visceral protein concentrations in malnourished chronic hemodialysis patients? The primary outcome measure for this specific aim will be serum albumin concentration. Serum albumin concentration is dependent on dietary nutrient intake. Changes in serum albumin concentration are strongly associated with hospitalization and death risk in CHD patients. We will also measure additional markers of visceral protein concentrations as secondary outcome measures (serum prealbumin, serum transferrin). Aim 2: Does long-term administration of intradialytic oral nutritional supplementation improve somatic protein stores in malnourished chronic hemodialysis patients? The primary outcome measure for this specific aim is lean body mass measurement by dual-energy x-ray absorptiometry (DEXA). Currently, DEXA provides the most precise measure of lean body mass in CHD patients. We will also utilize other measures of somatic protein stores as secondary outcome measures (anthropometric measurements, lean body mass by bioelectrical impedance analysis).