NUTRITIONAL SUPPLEMENTATION IN DIALYSIS PATIENTS

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。在这项研究中，我们假设长期给予足够的透析内口服营养补充剂会增加慢性血液透析合并尿毒症营养不良患者的内脏蛋白质浓度和躯体蛋白质储存。我们将通过一项随机、安慰剂对照、双盲研究来验证这一假设。目的1：长期给予透析内口服营养补充剂是否能改善营养不良慢性血液透析患者的内脏蛋白浓度？这一特定目标的主要结局指标将是血清白蛋白浓度。血清白蛋白浓度取决于膳食营养摄入量。血清白蛋白浓度变化与冠心病患者住院和死亡风险密切相关。我们还将测量内脏蛋白浓度的其他标记物作为次要结果测量（血清白蛋白前、血清转铁蛋白）。目的2：长期给予透析内口服营养补充剂是否能改善营养不良慢性血液透析患者的体蛋白储存？这一特定目标的主要结果测量是通过双能x线吸收仪（DEXA）测量瘦体重。目前，DEXA为冠心病患者提供了最精确的瘦体重测量方法。我们还将利用其他测量体细胞蛋白质储存作为次要结果测量（人体测量，通过生物电阻抗分析瘦体重）。

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).