EAL

CKD: Protein Energy Supplements: Oral Nutrition Supplements (2018)

Author and Year:

Fouque D et al 2008

PubMed ID:

Article Title:

Use of a renal-specific oral supplement by haemodialysis patients with low protein intake does not increase the need for phosphate binders and may prevent a decline in nutritional status and quality of life.

Authors:

Fouque D, McKenzie J, de Mutsert R, Azar R, Teta D, Plauth M, Cano N

Journal:

Nephrology, Dialysis, Transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

Year of publication:

2008

Volume:

Issue:

Page numbers:

2902-10

Study Design:

Randomized Controlled Trial

Risk of Bias Assessment Rating:

Neutral

Inclusion Criteria:

Mildly malnourished maintenance hemodialysis patients at screening were selected for inclusion in the study. Patients were recruited from 45 dialysis centers belonging to the Groupe de Recherche en Nutrition et Hemodialyse. These patients were selected from a total of 2398 subjects, aged greater than 18 years and on maintenance hemodialysis for at least 3 months. Mildly malnourished patients (defined as both serum albumin less than 40 g/L and body mass index less than 30 kg/m2) were selected for inclusion if they had a low protein intake, indicated by a normalized protein nitrogen appearance (nPNA) less than 1.0 g/kg/day, as this was considered a high risk for developing malnutrition.

Exclusion Criteria:

Patients with a C-reactive protein level greater than 20 mg/L at inclusion were excluded. Other exclusion criteria were nutritional supplementation within the last 2 months or the requirement for complete enteral nutrition, inadequate dialysis (Kt/V less than 1.2), peritoneal dialysis in the past 3 months or the use of any investigational drug.

Research Purpose:

The aim of this multicenter, randomized, open-label controlled trial was to study the effect of an energy-dense renal-specific oral nutritional supplement (Renilon 7.5) on nutritional intake and status in hemodialysis patients over a 3-month period. This study was designed to test the hypothesis that daily supplementation with a specific oral supplement could prevent or reduce deterioration of nutritional status of mildly malnourished maintenance hemodialysis patients.

Blinding efforts:

Not Reported

Study Location:

18 Dialysis Centers in France, Germany and Switzerland

Source(s) of Funding:

Government, Industry

Please specify names of funders:

This work was supported by Numico Research B.V. Fouque belongs to the Numico Scientific Advisory Board and has received lecture fees. McKenzie and de Mutsert were former Numico employees during the course of the trial.

Quality Criteria Checklist: Primary Research
Relevance Questions
	1.	Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)	Yes
	2.	Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?	Yes
	3.	Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?	Yes
	4.	Is the intervention or procedure feasible? (NA for some epidemiological studies)	Yes

Validity Questions
1.	Was the research question clearly stated?		Yes
	1.1.	Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?	Yes
	1.2.	Was (were) the outcome(s) [dependent variable(s)] clearly indicated?	Yes
	1.3.	Were the target population and setting specified?	Yes
2.	Was the selection of study subjects/patients free from bias?		???
	2.1.	Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?	Yes
	2.2.	Were criteria applied equally to all study groups?	Yes
	2.3.	Were health, demographics, and other characteristics of subjects described?	Yes
	2.4.	Were the subjects/patients a representative sample of the relevant population?	???
3.	Were study groups comparable?		Yes
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	No
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	Yes
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	Yes
4.	Was method of handling withdrawals described?		Yes
	4.1.	Were follow-up methods described and the same for all groups?	Yes
	4.2.	Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)	Yes
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	Yes
	4.4.	Were reasons for withdrawals similar across groups?	Yes
5.	Was blinding used to prevent introduction of bias?		Yes
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	No
	5.2.	Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)	Yes
6.	Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?		No
	6.1.	In RCT or other intervention trial, were protocols described for all regimens studied?	No
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	???
	6.4.	Was the amount of exposure and, if relevant, subject/patient compliance measured?	Yes
	6.5.	Were co-interventions (e.g., ancillary treatments, other therapies) described?	No
	6.6.	Were extra or unplanned treatments described?	???
	6.7.	Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?	???
7.	Were outcomes clearly defined and the measurements valid and reliable?		Yes
	7.1.	Were primary and secondary endpoints described and relevant to the question?	Yes
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	Yes
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	Yes
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	Yes
	7.5.	Was the measurement of effect at an appropriate level of precision?	Yes
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	Yes
	7.7.	Were the measurements conducted consistently across groups?	Yes
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		???
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	Yes
	8.2.	Were correct statistical tests used and assumptions of test not violated?	???
	8.3.	Were statistics reported with levels of significance and/or confidence intervals?	Yes
	8.4.	Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?	Yes
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	???
	8.6.	Was clinical significance as well as statistical significance reported?	Yes
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	Yes
9.	Are conclusions supported by results with biases and limitations taken into consideration?		Yes
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	Yes
10.	Is bias due to study's funding or sponsorship unlikely?		???
	10.1.	Were sources of funding and investigators' affiliations described?	Yes
	10.2.	Was the study free from apparent conflict of interest?	???