The Effect Of Enteral Nutriton With Low Phosphorus Whey Protein Powder On Maintenance Hemodialysis Patients

Objective:Low phosphorus whey protein powder was used to enteral nutrition in patients with maintenance hemodialysis comorbid with protein-energy wasting.The changes of nutritional status,renal function and blood phosphate level were observed.It aims at exploring enteral nutrition strategies for MHD patients with protein energy wasting,improving their nutritional status,maintaining blood phosphate homeostasis,and ultimately providing practical basis to reduce mortality risk and to improve quality of life in MHD patients.Method:90 cases of MHD patients combined with protein energy wasting in the dialysis clinic of the second hospital of Shanxi Medical University were chosen,and randomly divided into intervention group and control group,45 cases separately.On the basis of routine dialysis care,two groups of patients were given individualized nutrition support with equal calorie and equal nitrogen according to the dietary guidelines for MHD patients.Making whole day dietary recipes for both groups of patients(30~35kcal/kg·d for energy,1.2g/kg·d for protein,and protein of high biological value accounted for 50%).50% of protein in the patients of intervention group were provided by low phosphorus whey protein powder,and the whole intervention process lasted for 12 weeks.During this process,nutritional status and the SGA scores for tow groups of patients were assessed,their body weight and BMI were measured.Fasting venous blood were sampled to test biochemical parameters before intervention,4 weeks and 12 weeks after intervention.Nutritional indexes included total protein(TP),serum albumin(ALB),prealbumin(PA),and transferrin(TF).Phosphate related indexes included serum phosphate(PHOS),andparathyroid hormone(PTH).Renal function indexes included serum creatinine(Scr),and blood urea nitrogen(BUN).Results:1.Nutritional status and body composition:before intervention,SGA score between two groups had no statistical difference(P>0.05).Compared to before,SGA score of intervention group were significantly improved at the fourth weekend and twelfth weekend(P<0.05).Compared to control group,SGA score in the intervention group were significantly improved at the fourth weekend and twelfth weekend(P<0.05).2.body composition: before intervention,the body weight and BMI between two groups had no statistical difference(P>0.05).Compared to before,the body weight and BMI of intervention group were significantly improved at the fourth weekend and twelfth weekend(P<0.05).Compared to control group,the body weight and BMI of the intervention group were significantly improved at the fourth weekend and twelfth weekend(P<0.05).3.Nutritional indexes:before intervention,TP,ALB,PA,and TF between two groups had no statistical difference(P>0.05).Compared to before,TP,ALB,PA,and TF in the intervention group were significantly improved at the fourth weekend and twelfth weekend(P<0.05).Compared to control group,TP,ALB,PA,and TF of intervention group were significantly improved at the fourth weekend and twelfth weekend(P<0.05).4.Phosphate related indexes:before intervention,PHOS and PTH between two groups had no statistical difference(P>0.05).Compared to before,PHOS and PTH of intervention group were significantly lowered at the fourth weekend and twelfth weekend(P<0.05).Compared to control group,PHOS and PTH of the intervention group were significantly lowered at the fourth weekend and twelfth weekend(P<0.05).5.Renal function indexes: before intervention,Scr and BUN between two groups had no statistical difference(P>0.05).Compared to before,Scr and BUN of intervention group at the fourth weekend were not lowered(P>0.05),but which at the twelfth weekend were significantly lowered(P<0.05).Compared to control group,Scr andBUN of intervention group at the fourth weekend were not lowered(P>0.05),but which at the twelfth weekend were significantly lowered(P<0.05).Conclusion:Enteral nutrition support with low phosphorus whey protein powder can improve the nutritional status of maintenance hemodialysis patients,elevate serum levels of TP,ALB,PA,TF,reduce hypoalbuminemia and protein energy wasting,maintain blood phosphate homeostasis,and mitigate renal burden of phosphate excretion without elevating PTH.It can promote metabolism of calcium and phosphorus,which is beneficial for the prevention and treatment of secondary hyperparathyroidism and renal osteodystrophy.The use of low phosphorus whey protein powder can improve the quality of life of MHD patients,reduce hyperphosphatemia and other related complications.