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Kidney Week

Abstract: PO0858

A Clinical Approach of Intradialytic Creatine Supplementation in Dialysis-Dependent CKD Patients: A Rationale and Study Design

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • van der Veen, Yvonne, Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands
  • Post, Adrian, Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands
  • Kremer, Daan, Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands
  • Westerhuis, Ralf, Dialyse Centrum Groningen, Groningen, Groningen, Netherlands
  • Franssen, Casper F.M., Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands
  • Wallimann, Theo, Eidgenossische Technische Hochschule Zurich, Zurich, Zürich, Switzerland
  • Bakker, Stephan J.L., Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands
Background

There is great need for identification of new, potentially modifiable risk factors for the poor HRQoL and excess risk of mortality in dialysis-dependent chronic kidney disease patients. Creatine is an essential contributor to cellular energy homeostasis, yet on a daily basis 1.6-1.7% of the total creatine pool is non-enzymatically degraded to creatinine and subsequently lost via urinary excretion, thus necessitating a continuous supply of new creatine to remain in steady-state. Due to an insufficient ability to synthesize creatine, unopposed losses to the dialysis fluid, and insufficient intake, hemodialysis patients are prone to creatine deficiency, and may benefit from creatine supplementation. To avoid problems with compliance, fluid balance and, furthermore, to prevent intradialytic losses of creatine to the dialysate, we aim to investigate the potential of intradialytic creatine supplementation in improving outcomes.

Methods

Here, we describe the rationale and design for a block-randomized, double-blind, placebo-controlled pilot study. A total of 16 hemodialysis patients will be included, divided into four groups receiving intradialytic creatine supplementation (0.5mM, 1.0mM, 1.5mM, 2.0mM), or a placebo for six weeks. The aim of the pilot study is to explore the creatine uptake in the circulation and tissues following different creatine supplementation dosages.

Results

The main parameters for the pilot study are the plasma creatine concentration and intra-erythrocytic creatine concentration of both pre- and post-hemodialysis samples. Secondary study parameters are handgrip strength as a measure of muscle strength, combined interdialytic urinary and intradialytic dialysate excretion of creatinine as a measure of muscle mass, and body composition measured with bioelectrical impedance analysis (BIA).

Conclusion

Intradialytic creatine supplementation may help to maintain creatine homeostasis among dialysis-dependent chronic kidney disease patients, and consequently improve important causes for impaired HRQoL, including protein energy wasting (PEW), fatigue, muscle weakness, depression, and cognitive impairment. The results from the pilot-study will serve as a basis for a larger double-blind, placebo-controlled supplementation trial.