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Oral Nutritional Supplementation in Peritoneal Dialysis Patients — Does it Work?

157 Malnutrition and hypoalbuminemia, often used interchangeably, are the most important prognostic indicators in peritoneal dialysis (PD) populations (1). However, despite this knowledge, the prevalence of both remains high in this group as attempts to alleviate the problem has resulted in minimal success (2). The etiology of malnutrition and hypoalbuminemia appears to be multifactorial in nature, with poor oral intake being an important contributor (3,4). It would seem to make intuitive sense that malnourished patients with poor oral intake should improve with oral nutritional supplementation and, hence, it is commonly practiced; yet the few studies published to date on PD patients have shown mixed results (Table 1) (5–10). This limited body of literature includes two clinical studies by Teixidó-Planas et al. (8) and González-Espinoza et al. (9) published in this issue of Peritoneal Dialysis International. Both however, provide only moderate additional evidence for the use of oral supplements in PD. Teixidó-Planas et al. enrolled 65 incident PD patients and randomized them to 12 months of either a commercial supplement providing 20 g of protein per day or no supplement. At baseline, this cohort had relatively preserved serum albumin concentrations, with the intervention group and control group having a mean of 3.75 ± 0.42 g/dL and 3.87 ± 0.49 g/dL respectively. During the trial, 30% of subjects were lost to follow-up and more of the subjects were noncompliant. No significant increase in serum albumin could be demonstrated in either the “intention to treat” or the “as treated” analysis. González-Espinoza et al. randomized 30 PD patients into two groups and followed them for 6 months. Patients enrolled were significantly malnourished based upon the baseline mean serum albumin and Subjective Global Assessment (SGA) scores. One group received an egg albumin-based protein supplement twice per day; the other group received no supplement. Both groups received otherwise standard care, including dietetic support. The authors discuss that the supplement they used was notable ORAL NUTRITIONAL SUPPLEMENTATION IN PERITONEAL DIALYSIS PATIENTS — DOES IT WORK?