Abstract: FR-OR074
Improving Nutritional and Clinical Outcomes in Peritoneal Dialysis (PD) Peritonitis: A Randomized Trial of Whey Protein Supplementation
Session Information
- What's New at Home (Dialysis)?
November 07, 2025 | Location: Room 351D, Convention Center
Abstract Time: 04:40 PM - 04:50 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Kanjanabuch, Talerngsak, Division of Nephrology, Department of Medicine and Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Pathum Wan, Bangkok, Thailand
- Faisatjatham, Surasak, Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Pathum Wan, Bangkok, Thailand
- Chuengsaman, Piyatida, Banphaeo-Charoenkrung Peritoneal Dialysis Center, Banphaeo Dialysis Group, Banphaeo Hospital, Sathon, Bangkok, Thailand
- Nopsopon, Tanawin, Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Pathum Wan, Bangkok, Thailand
- Sapsitthikul, Tossaporn, Division of Nephrology, Department of Medicine, Samut Prakan Hospital, Mueang Samut Prakan District, Samut Prakan, Thailand
- Tungsanga, Somkanya, Division of General Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Pathum Wan, Bangkok, Thailand
- Eiam-Ong, Somchai, Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Pathum Wan, Bangkok, Thailand
- Johnson, David W., Department of Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
Background
Hypoalbuminemia and protein-energy wasting complicate up to half of PD patients and predict worse morbidity and mortality during peritonitis. Despite the theoretical benefits of protein repletion, no trials have directly assessed whether targeted supplementation can improve nutritional status and clinical outcomes.
Methods
In this open-label, multicenter randomized trial (TCTR20210329002), 171 adult PD patients with peritonitis and serum albumin <3.5 g/dL were randomized 1:1 across nine Thai centers to receive either 30 g/day of oral whey protein isolate for 30 days plus standard nutritional counseling (intervention) or counseling alone (control). The primary outcome was a composite of all-cause mortality, relapse, repeat or refractory peritonitis, and hemodialysis transfer by day 180. Secondary outcomes included change in serum albumin and adverse events. Analyses followed intention-to-treat principles. Time-to-event outcomes were assessed using Cox regression and restricted mean survival time (RMST), and albumin trends were evaluated with linear mixed-effects models.
Results
Mean age was 59±15 years; 53% male; 85% on CAPD. Baseline albumin was 2.66±0.52 g/dL. The composite endpoint occurred in 41% of intervention vs. 58% of controls (HR 0.65; 95% CI 0.42–1.01; RMST gain 11.4 days; p=0.03). Refractory peritonitis was reduced in the intervention arm (24% vs. 41%; HR 0.58; 95% CI 0.36–0.92). Between-group albumin differences were +0.23 g/dL at day 7 (p<0.001), +0.31 at day 30 (p<0.001), +0.19 at day 90 (p=0.006), and +0.24 at day 120 (p=0.001)(Figure 1). Gastrointestinal symptoms were the most common adverse event (38% vs. 22%; p=0.11); no serious toxicity was reported.
Conclusion
In PD patients with peritonitis and hypoalbuminemia, short-term protein supplementation improved serum albumin and reduced refractory peritonitis and overall complications. This pragmatic, low-cost intervention may support recovery and warrants further study in broader PD populations.
Figure 1. Change in Serum Albumin
Funding
- Government Support – Non-U.S.