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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

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Sibbel, Scott, DaVita Clinical Research, Minneapolis, Minnesota, United States
  • Brosch, Becky, DaVita Kidney Care, Denver, Colorado, United States
  • Stasios, Maria Melts, DaVita Kidney Care, Denver, Colorado, United States
  • Hunt, Abigail, DaVita Clinical Research, Minneapolis, Minnesota, United States
  • Van Wyck, David B., DaVita Institute for Patient Safety, Denver, Colorado, United States
  • Nissenson, Allen R., DaVita Kidney Care, Denver, Colorado, United States
  • Brunelli, Steven M., DaVita Clinical Research, Minneapolis, Minnesota, United States
  • Benner, Deborah A., DaVita Kidney Care, Denver, Colorado, United States
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