Kidney Week

Abstract: SA-PO1072

Effects of Oral Nutritional Supplements on Clinical Outcomes and Nutritional Markers in Hemodialysis Patients Qualifying with Serum Albumin 3.6 or 3.7 g/dL

Session Information

• Diet and Nutrition: Clinical
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Sibbel, Scott, DaVita Clinical Research, Minneapolis, Minnesota, United States

Scott Sibbel,

• Brosch, Becky, DaVita Kidney Care, Denver, Colorado, United States

Becky Brosch,

• Stasios, Maria Melts, DaVita Kidney Care, Denver, Colorado, United States

Maria Melts Stasios,

• Hunt, Abigail, DaVita Clinical Research, Minneapolis, Minnesota, United States

Abigail Hunt,

• Van Wyck, David B., DaVita Institute for Patient Safety, Denver, Colorado, United States

David B. Van Wyck,

• Nissenson, Allen R., DaVita Kidney Care, Denver, Colorado, United States

Allen R. Nissenson,

• Brunelli, Steven M., DaVita Clinical Research, Minneapolis, Minnesota, United States

Steven M. Brunelli,

• Benner, Deborah A., DaVita Kidney Care, Denver, Colorado, United States

Deborah A. Benner,

Background

Use of oral nutritional supplements (ONS) has been shown to improve clinical outcomes in dialysis patients with serum albumin ≤ 3.5 g/dL. However, there is evidence indicating patients with albumin < 3.8 g/dL are also at increased risk for death. Here, we evaluated the effects of providing ONS to dialysis patients with serum albumin 3.6 or 3.7 g/dL on clinical outcomes and nutritional markers.

Methods

This was a retrospective evaluation of a pilot program (May-Aug 2017) to provide ONS to in-center hemodialysis patients with a qualifying serum albumin measurement of 3.6 or 3.7 g/dL. ONS was provided to the patient at the time of dialysis treatment. ONS patients were matched to control patients from non-pilot facilities who had the same qualifying albumin (3.6 or 3.7 g/dL) and preceding albumin (n = 2902 per group). Clinical outcomes (death, hospitalization, missed dialysis treatments) and nutritional markers (albumin, normalized protein catabolic rate [nPCR], creatinine) were assessed over 180 days using longitudinal generalized linear models.

Results

There was a significantly lower death rate among ONS patients relative to controls (0.07 vs 0.12 per patient-year [PPY]; adjusted incidence rate ratio [aIRR] = 0.38; 95% confidence interval [CI] = 0.22-0.68). No significant differences were observed in hospitalizations (1.37 vs 1.16 PPY; aIRR = 1.04; 95% CI = 0.88-1.12), missed dialysis treatments (11.2 vs 11.4 PPY; aIRR = 0.98; 95% CI = 0.87-1.10), or nutritional markers.

Conclusion

These finding indicate that provision of ONS to dialysis patients with albumin > 3.5 g/dL could be beneficial in reducing mortality. Dialysis providers should consider expanding ONS programs to include patients with albumin <3.8 g/dL.

Funding

• Commercial Support – This was a research project conducted by the DaVita Institute for Patient Safety and supported by DaVita Kidney Care