(P23-009-23) Impact of High Protein, Micro Nutrient Rich Oral Nutritional Supplement on Improving Clinical Nutritional Outcomes in Chronic Kidney Disease Patients on Hemodialysis

Objectives: To assess the impact of a unique blend of oral nutritional supplement with whey protein Isolate and selected micronutrients; on improving the nutritional status of Chronic Kidney disease (CKD) patients on maintenance hemodialysis (MHD) who are at high risk of protein energy wasting.

Methods: Single arm, prospective study was conducted in 100 CKD patients on hemodialysis. The supplement was administered as 2 serves (40g/serve) per day for 3 months. Adult patients of either genders on MHD and diagnosed as malnourished were included. Major exclusion criteria included patient with recurrent acute illness, Body weight less than 40 Kg and having malabsorption syndrome. Institutional ethics committee approval was sought and CTRI registration (CTRI/2022/04/041763) was done.

Clinical outcomes like serum albumin, prealbumin, haemoglobin, serum potassium & phosphorous, Hand Grip Strength (HGS), Modified Subjective Global Assessment (MSGA) score were evaluated at baseline and end of the study. Normality testing was done using Shapiro Wilk test. Data was analyzed using paired t-test (for normal data) and Wilcoxon signed rank test (for non-normal data) to find the mean difference between baseline and at the end of 1, 2 and 3 months study period.

Results: Out of 100 screened patients, 84 patients completed study. At the end of 3 months, compared to baseline, MSGA reduced by 3.45 score, which was statistically significant [ 26.91% (12.82 ± 3.69 Vs 9.37 ± 1.86; p = < 0.0001)], HGS before dialysis was improved by 42.65% (13.67 ± 5.68 Kg Vs 19.50 ± 5.03 Kg; p = < 0.0001) and HGS after dialysis was improved by 41.96% (13.44 ± 5.68 Kg Vs 19.08 ± 5.29 Kg; p = < 0.0001). Other vital parameters like serum albumin (3.83 ± 0.57 g/dL Vs 3.84 ± 0.36 g/dL; p = < 0.0001), prealbumin (0.25 ± 0.08 g/dL Vs 0.24 ± 0.06 g/dL; p = < 0.0001), haemoglobin (10.21 ± 2.11 g/dL Vs 10.08 ± 2.03 g/dL; p = < 0.0001), serum potassium (5.19 ± 0.66 mmol/L Vs 5.62 ± 0.78 mmol/L; p = 0.006), serum phosphorus (4.77 ± 1.54 mg/dL Vs 4.91 ± 1.91 mg/dL; p = < 0.0001) were maintained during the study period.

Conclusions: Protein-energy malnutrition (PEM) is strong predictor for morbidity, mortality and increases the rate of hospitalization. Scientifically designed formula as per KDOQI guidelines was able to improve the nutritional status of CKD patients on MHD and improve their quality of life.

Funding Sources: Dr. Reddy’s Laboratories Limited, India