Can oral supplementation with a collagen-casein-based liquid protein improve serum albumin levels in hemodialysis patients?

BACKGROUND: Decreased synthesis of albumin (Alb) results in hypoalbuminemia and occurs because of the interrelationship of inflammation and malnutrition (uremic malnutrition) observed in chronic hemodialysis (CHD) patients. Improving the nutrition status of CHD patients is necessary to prevent and treat uremic malnutrition. The issue remains of how to achieve this goal in CHD patients given the barriers to adequate and appropriate intake such as anorexia, impaired nutrient absorption, and necessary diet modifications. OBJECTIVE: To determine if oral supplementation with a collagen-casein-based hydrolyzed liquid protein can improve Alb levels in hypoalbuminemic CHD patients. PATIENTS AND METHODS: The study patients were adult outpatients on hemodialysis for at least 1 year whose serum Alb was between 2.8 and 3.7 g/dL and who had given written consent. Patients (age = 31-90 years) were divided into 2 groups according to days they had dialysis. Controls (n = 21; dialysis days Tuesday, Thursday, Saturday) received standard nutritional counseling. The study group (n = 29; dialysis days Monday, Wednesday, Friday) received 30 mL of liquid protein at the beginning and end of treatment. The main outcome measures were baseline and monthly Alb for 3 months and a subjective assessment of tolerance. RESULTS: Five subjects in the control group (final n = 16 [49%]) and 12 subjects in the study group (final n = 17 [51%]) did not complete the study. There was not a statistically significant correlation between baseline Alb and baseline CRP, r = -0.30 (p = 0.093), or between baseline Alb and baseline URR, r = 0.27 (p = 0.14). Average Alb of the control group did not differ between the baseline (3.43 g/dL) and final (3.44 g/dL) measurements, t = -0.54; df = 15; p = 0.60. In the study group, however, the final average Alb (SD) of 3.73 (0.28) was statistically significantly greater than the baseline average of 3.49 (0-20), t = -4,19; df = 16; p = 0.001. CONCLUSION: These statistically significant results indicate that oral supplementation with a collagen-casein-based hydrolyzed liquid protein can improve serum albumin levels of hypoalbuminemic CHD patients.