HONOLULU—Hemodialysis (HD) patients who take oral nutritional supplements (ONS) while dialyzing have improved survival and other benefits, according to findings released at the 16th International Congress on Nutrition and Metabolism in Renal Disease, reported Renal & Urology News.
In a symposium, Raymond Hakim, MD, PhD, a consultant nephrologist at Vanderbilt University Medical Center in Nashville, Tenn., presented results indicating that providing ONS during dialysis reduces patients' risk of death by up to 34 percent compared with not receiving ONS. The study was also published online ahead of print in the American Journal of Kidney Diseases (AJKD).
“We think our study has been critical in showing that providing malnourish patients with ONS attenuates the deficit of amino acids that occurs during dialysis and reduces mortality,” Hakim told Renal & Urology News. “It's important that malnourished patients receive ONS during dialysis because that's when they do not eat or have any oral intake for at least four hours, while they lose significant amounts of amino acids along with uremic toxins in the dialysate.”
Study design
Hakim, Eduardo Lacson Jr., MD, MPH, and others retrospectively studied 7,264 people who received ONS during HD (case patients) at Fresenius Medical Care North America (FMCNA) facilities and had at least one albumin level of 3.5 g/dL or less. They compared their outcomes to those from another 21,347 patients who also had at least one albumin level of 3.5 g/dL or less but did not receive ONS (controls). None of the subjects was receiving ONS outside of the HD center. The patients receiving ONS could choose among four products: NeproCarb Steady, ProStat RC, ZonePerfect, and VitalProteinRX.
The study included an intent-to-treat (ITT) population consisting of 5,227 case patients propensity-score matched with 5,227 controls. From the same patient population, they created an as-treated cohort consisting of 4,289 case patients propensity-score matched with 4,289 controls.
The characteristics of the matched pairs in both the ITT and as-treated analyses were similar, including mean baseline albumin levels of 3.3 g/dL in all groups. However, the as-treated ONS patients had been on dialysis slightly longer than the as-treated control patients, with a mean of 3.89 vs. 3.60 years.
