Discussion
muscle mass, nausea, HD, inflammation, loss of muscle mass, PEW, weight gain, Muscle mass, intradialytic NEO-MUNE, intradialytic ONS, malnutrition
INFLAMMATION, SECONDARY, ADVERSE EFFECTS, MALNUTRITION
This study investigated the effect of intradialytic ONS administration for 3 months on nutritional markers in chronic HD patients with PEW. We reported the changes in the four PEW categories. Biochemical aspect was assessed using serum albumin, prealbumin, and cholesterol levels. Body mass was assessed using BMI. Muscle mass was assessed using serum creatinine/BSA and lean body weight. Dietary intake was assessed using nPNA as a surrogate for protein intake. Additionally, we studied changes in two other chemical parameters related to malnutrition, namely TIBC as a surrogate for transferrin level, which is included in the malnutrition-inflammation score [Serum albumin and prealbumin concentrations are robust markers of nutrition in HD patients [In this study, we found a significant increase in serum albumin and prealbumin concentrations after 3 months in the IG. In agreement with these results, previous studies reported similar conclusions [Total iron-binding capacity (TIBC), an indirect measure of transferrin, is an independent predictor of malnutrition in HD patients [Dry weight and BMI were two other nutritional markers that improved in the intervention arm of this study. Cano et al. [Compared to the CG, the IG showed improvements in surrogates of muscle mass, reaching statistical significance for serum creatinine and creatinine/BSA, but not for lean body weight. Serum creatinine is affected by muscle mass and meat intake [There was a significant increase in nPNA in both groups. The increase in nPNA in the control group could be attributed to increased protein consumption as a result of dietary counseling or to an increase in endogenous protein catabolism. We did not measure protein consumption by dietary recall; therefore, we were unable to clearly distinguish between the two explanations. Excess endogenous protein catabolism in the control group is a less appealing explanation because it would be associated with loss of muscle mass, which was not observed in our study. Bolasco et al. [The significant improvement in inflammation in the IG, as demonstrated by the significant decrease in hs-CRP, is an important finding of this study. This could be secondary to the improvement in nutritional status, or inflammation could be a primary issue that the anti-inflammatory elements of the ONS could be addressed. Reduced inflammation may have contributed to the improvement of malnutrition in the second case. Consistent with our findings, Tomayko et al. [We observed a significant increase in composite PEW score in the IG, whereas no changes were observed in the CG. This is due to improvements in the grades of individual components. Fouque et al. [All patients who completed the study were compliant. No significant adverse effects of ONS were reported, particularly no increase in predialysis serum phosphate or potassium levels, in the IG. In addition, there was no reported increase in the interdialytic weight gain. Two patients in the IG experienced mild nausea during the first few days of the study. They continued the study at their own will, and nausea subsided without the need to discontinue the supplement.One of the strengths of this study is that it was a prospective, controlled, randomized trial. The control arm allowed us to isolate the beneficial effects of ONS on nutritional parameters. Furthermore, ONS was administered to patients during dialysis sessions to ensure compliance and compensate for protein and energy losses. To the best of our knowledge, this is the first study to investigate the effect of intradialytic NEO-MUNE on nutritional markers on chronic HD patients. This study has some limitations. First, it was a single-center study with a small sample size. Second, the study was conducted over a short period, whereas clinical nutritional changes may take longer to be observed.