Protein Supplement Tied to Better Outcomes for Patients on Dialysis

Intradialytic oral protein supplementation was linked with improvements in several nutritional markers and real-world outcomes for patients on hemodialysis, according to a quality improvement study.

After 12 months, patients who received a liquid protein supplement at the end of each dialysis session had significant improvements in real-world outcomes. The frequency of hospitalizations dropped from 4.02 to 2.60 times per month and the average duration of hospital stays decreased from 5.71 to 4 days per month, reported Firouzeh Jazayeri, MSPH, RD, of UF Health in Gainesville, Florida.

This highlights the importance of integrating nutrition-focused interventions into routine dialysis care to improve overall patient outcomes, Jazayeri said at the National Kidney Foundation Spring Clinical Meeting.

Patients also demonstrated improved hemodialysis adequacy, with Kt/V rising from 1.56 to 1.69. This measurement indicates how effectively dialysis removes uremic toxins and the rise suggests improved treatment efficiency.

The normalized protein catabolic rate (nPCR) — a measure of protein breakdown in the body — also increased and remained above 1 g/kg/day. There was a significant positive correlation between nPCR and Kt/V (r=0.63, P=0.02), suggesting that higher protein intake is associated with better solute clearance and treatment efficiency.

“This initiative demonstrates that nutrition and dialysis adequacy are not separate targets, but closely interconnected,” she noted. “Our findings suggest that intradialytic protein supplementation can improve nutritional status without compromising dialysis adequacy, and may even support better clearance outcomes.”

Throughout the intervention, patients also had significant improvements in serum albumin (3.59 g/dL at baseline to 3.78 g/dL at month 12, P=0.02), with the largest gains occurring in the first 6 months. Albumin is the most abundant protein in the body and serves as a primary marker of protein energy wasting, she explained.

Serum creatinine — an indirect marker of muscle mass — also increased modestly from 8.46 mg/dL to 9.29 mg/dL. While this suggests a stabilization of muscle mass, the change did not reach statistical significance.

Low albumin is one of the strongest predictors of poor dialysis outcomes. Jazayeri explained that when protein energy wasting is present, it can negatively affect a patient’s tolerance to treatment.

“As we all know, protein energy wasting is common and frequently under-recognized in this population,” she said. It “starts at the very early stage of the renal failure and continues to progress as the kidney function declines. Protein energy wasting contributes to muscle loss, fatigue, reduced functional status, and poor recovery from illness.”

Prior data have also tied a serum albumin level under 3.0 g/dL to an increased risk of mortality, including all-cause, cardiovascular, and infection-related mortality in dialysis patients.

While current guidance suggests that chronic kidney disease patients limit protein to a target intake of 0.6 to 0.8 g/kg of body weight so kidneys don’t have to work overtime to remove excess waste, this recommendation is reversed once patients progress to dialysis. At that stage, a higher protein intake of 1 to 1.2 g/kg of body weight is necessary to maintain blood protein levels.

Because many patients struggle to meet this requirement through food alone, intradialytic supplementation provides a practical solution, said Jazayeri. By providing protein during the catabolic period, the intervention improves adherence and specifically targets high-risk patients.

The study followed 24 hemodialysis patients who had serum albumin levels below 4.0 g/dL for at least 3 months. Participants were given a 1-oz. liquid protein supplement containing 15 g of protein at the end of each session for 12 months.

Jazayeri concluded by noting the intervention was “very cheap” to implement.