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. 2021 Jan 4;13(1):147. doi: 10.3390/nu13010147

Table 1.

Possible nutritional treatments of uremic sarcopenia in humans.

Nutritional
Approaches		 Author Year Study Population Nutritional Treatment Primary Outcome Primary End-Point
ONS Caglar K. et al. [110] 2002 85 malnourished CHD, HD patients ONS assumed during each HD session, containing 16.6 g of proteins, 22.7 g of lipids and 52.8 g of carbohydrates with energy content of 475 kcal. Significant increases in serum albumin and prealbumin levels were detected.
In addition, there was a 14% increase in SGA score.		 ONS assumed during HD improves some nutritional biomarkers in malnourished HD patients.
Lacson Jr E. et al. [111] 2012 5.227 HD patients with albumin level ≤3.5 g/dL
vs. 5.227 patients (control group)		 Four different intradialytic ONS were administered:
  • (a)

    19 g proteins, 425 kcal for dose;

  • (b)

    15 g proteins, 60 kcal for dose;

  • (c)

    14 g proteins, 210 kcal for dose;

  • (d)

    20 g proteins, 210 kcal for dose.

 A reduction in mortality was found in patients treated with ONS compared to non-treated group. ONS treatment allows a significant increase in survival of HD patients.
Wu H.L. et al. [84] 2013 55 CKD patients
(stage III-IV)
vs. 54 patients (control group)		 One daily ONS containing 0.6 g of proteins, 8.2 g of lipids, 30.9 g of carbohydrates and 1.9 g of fiber with energy content of 200 kcal. ONS significant decreased urine protein excretion therefore, daily protein intake was lower in the ONS group. Significant decrease of creatinine and urea nitrogen levels; in addition, there was a significant increase of eGFR. ONS has improved some blood parameters and improved the adherence to the nutritional therapy with less protein excretion.
Sezer S. et al. [112] 2014 32 malnourished HD patients
vs. 30 patients (control group)		 ONS containing 14 g of proteins, 19.2 g of lipids and 41.3 g of carbohydrates with energy content of 400 kcal.
In addition, during HD sessions was served a snack containing 14 g of proteins, 10 g of lipids and 55 g of carbohydrates with energy content of 300 kcal.		 Significant increases in serum albumin levels were detected.
Furthermore, there was a significant increase in the dry weight of the ONS patients and a significative reduction in the dry weight of the control group.
In addition, a reduction of EPO dose requirement and MIS was detected in the treated group.		 ONS treatment improves serum albumin levels and allows a lower EPO dose requirement in HD patients.
Benner D. et al. [113] 2018 3.374 HD patients with albumin level ≤3.5 g/dL
vs. 3.374 patients (control group)		 Two different ONS were used:
  • (a)

    21.6 g of proteins and 475 kcal for dose;

  • (b)

    16 g of proteins and 70 kcal for dose.

 There was a 69% reduction in mortality and a 33% reduction in missed dialysis sessions. ONS treatment allows a significant increase in survival in HD patients with albumin level ≤3.5 g/dL.
Leonberg-Yoo A.K. et al. [114] 2019 1420 HD patients
vs. 4.059 patients (control group)		 Six different intradialytic ONS were used:
  • (a)

    19 g proteins and 425 kcal for dose;

  • (b)

    15 g proteins and 60 kcal for dose;

  • (c)

    14 g proteins and 210 kcal for dose;

  • (d)

    20 g proteins and 210 kcal for dose;

  • (e)

    16 g proteins and 90 kcal for dose;

  • (f)

    16 g proteins and 160 kcal for dose.

 There was a decrease of re-hospitalization within 30 days of first discharge. ONS treatment reduces post-discharge hospital readmission rates.
IDPN Marsen T.A. et al. [115] 2017 39 HD patients
with PEW
vs. 44 patients (control group)		 IDPN treatment three times/week containing (one dose):

  • glucose (70%);

  • amino acids (15%);

  • lipids (20%)

  • vitamins;

  • L-carnitine.

 Significant increases in serum prealbumin levels were detected. IDPN used during HD session improves prealbumin levels.
Thabet A.F. et al. [116] 2017 20 HD patients
vs. 20 patients (control group)		 IDPN treatment three times/week. In addition, patients received EPO, iron dextran, folic acid and vitamin B 12. Significant increases in hemoglobin and albumin levels were detected. In addition, there was a significant increase in BMI.
Significant reduction in MIS was detected. 		IDPN treatment allows an improvement of refractory anemia, as it permits an increase in hemoglobin and prealbumin levels and also an increase in body weight. It also leads to a reduction in MIS.
Deleaval P. et al. [60] 2020 6 HD patients Two dialysates were used during HD treatment:

  • Standard dyalisate;

  • Dialysate enriched in BCAA (valine, isoleucine, leucine).

 During the HD treatment with standard dialysate a reduction in plasmatic valine was found, while with dialysate enriched in BCAA HD treatment there was an increase in plasmatic valine, isoleucine and leucine. The use of dialysate enriched in BCAA allows the restoration of normal plasma BCAA levels.
ω-3 supplementation Gharekhani A. et al. [117] 2014 27 HD patients
vs. 27 patients (control group)		 Six capsules per day of ω-3 supplementation (180 mg eicosapentaenoic acid and 120 mg docosahexaenoic acid in each capsule). ω-3 supplementation is a significant independent predictor for the increase of serum prealbumin level after adjusting post-treatment nutritional markers.
Significant decrease in ferritin levels and IL-10/IL-6 ratio was detected.		 ω-3 supplementation in HD patients permits a slight reduction of inflammation.
Asemi Z. et al. [118] 2016 90 HD patients
vs. 30 patients (control group)		 Four groups for supplementation per day:

  • 1250 mg/day ω-3 PUFA containing 600 mg eicosapentaenoic acid and 300 mg docosahexaenoic acid;

  • 400 IU/day vitamin E;

  • 1250 mg ω-3 PUFA containing 600 mg eicosapentaenoic acid and 300 mg docosahexaenoic acid + 400 IU vitamin E;

  • placebo (control group).

 Significant reduction in SGA, FPG, insulin levels and HOMA-IR were detected. In addition, there was a significant enhancement in QUICKI. ω-3 PUFA and vitamin E combined supplementation improve SGA and the metabolic profile in HD patients.
Fiber Krishnamurthy V.M.R. et al. [119] 2012 1.105 CKD patients
(stage IIIa-IV)
vs. 13.438 subjects (control group)		 Two groups were divided into two subgroups according to fiber dietary intake:

  • Low total fiber (<14.5 g/day);

  • High total fiber (≥14.6 g/day).

 Significant decrease in CRP was detected in CKD patients with high total fiber dietary consumption. The high dietary fiber consumption is associated with a minor inflammation risk and mortality in CKD patients.

Abbreviations: BCAA, Branched-chain amino acid; BIA, Bioelectrical impedance analysis; BMI, Body mass index; CHD, Coronary heart disease; CKD, Chronic kidney disease; CRP, C-reactive protein; e-GFR, Estimated glomerular filtration rate; EPO, Erythropoietin; FPG, Fasting plasma glucose; HD, Hemodialysis; HOMA-IR, Homeostasis model of assessment of insulin resistance; IDPN, Intra-dialytic parenteral nutrition; IL, Interleukin; MIS, Malnutrition inflammation score; MPS, Muscle protein synthesis; ONS, Oral nutritional supplements; PUFA, Polyunsaturated fatty acids; QUICKI, Quantitative insulin sensitivity check index; SGA, Subjective global assessment.