Effect of Oral Nutritional Supplementation on Oxidative Stress in Protein-energy Wasting Patients With Peritoneal Dialysis

NCT ID: NCT04628117

Last Updated: 2020-11-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

22 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-10-04

Study Completion Date

2023-03-11

Brief Summary

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End-stage kidney disease (ESKD) represents a serious public health problem in Mexico. Data from the United States Renal Data System (USRDS) have reported that the region of Jalisco (Mexico) is one of the places with the highest incidence rate of treated ESKD and use of peritoneal dialysis (PD). In patients with ESKD, oxidative stress (OS) has been recognized as a potential source of morbidity and mortality, since it is involved in the pathogenesis of atherosclerosis and other complications of ESRD. This can induce damage to DNA (nucleic acid), proteins, carbohydrates, and lipids.

Another common complication in ESKD patients receiving PD is protein-energy wasting (PEW), which is characterized by the decline in the body stores of protein and energy fuels (that is, body protein and fat masses) due to the multiple nutritional and catabolic alterations that occur in this condition. Diverse factors can affect the nutritional and metabolic status of patients with PD, for which they require interventions to reverse protein and energy depletion. Nutritional counseling can be a useful tool in PD patients in order to improve compliance with nutritional recommendations. The strategies more used for PEW include oral nutritional supplementation. Therefore, the purpose of this study is assess the effect of oral nutritional supplementation on OS in PEW patients with PD.

Detailed Description

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The detection of patients is carried out in the Nephrology Service of the Hospital Civil de Guadalajara Dr. Juan I. Menchaca where the selection and exclusion criteria are evaluated.

The probabilistic group assignment is carried out using a sealed and opaque envelope.

Control group: only nutritional counselling for 8 weeks. Intervention group: nutritional counselling plus 237 mls per day of oral nutritional supplement for kidney disease.

Initial evaluation includes, anthropometric parameters and dietary intake. Demographic characteristics and OS levels, such as oxidants, antioxidants and oxidative DNA damage.

All nutritional counselling, dietary intake, medical nutrition theraphy (oral nutritional supplementation), assessment of OS levels, and anthropometric parameters will perform at 0, 4 and 8 weeks of follow up. Protein-energy wasting assessment only in the 0 and 8 weeks.

Conditions

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Oxidative Stress Protein-Energy Wasting Malnutrition Protein-Energy Malnutrition Oral Nutritional Supplements Peritoneal Dialysis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized clinical trial with two-parallel-group in stable continuous ambulatory peritoneal dialysis patients.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Control

Nutritional counselling by individualized nutritional plan for 8 weeks.

Group Type NO_INTERVENTION

No interventions assigned to this group

Oral nutritional supplementation

Nutritional counselling by individualized nutritional plan plus oral nutritional supplementation for renal disease (237 mls per day) for 8 weeks.

Group Type EXPERIMENTAL

Oral nutritional supplementation for kidney disease

Intervention Type DIETARY_SUPPLEMENT

237 mls per day for 8 weeks.

Interventions

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Oral nutritional supplementation for kidney disease

237 mls per day for 8 weeks.

Intervention Type DIETARY_SUPPLEMENT

Eligibility Criteria

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Inclusion Criteria

* Diagnosis of protein-energy wasting evaluated by 7-point Subjective Global Assessment (moderate/severe), and Malnutrition-inflammation Score (a score ≥ 6).
* Male and female patients
* Age ≥ 18 and \<60 years
* Receive continuous ambulatory peritoneal dialysis with at least 3 months of initiation of renal replacement therapy
* Patients without clinical or biochemical evidence of any infectious process (peritonitis, urosepsis, endocarditis, soft tissue infection, pneumonia, etc) or inflammatory systemic disease (systemic lupus erythematosus, vasculitis, connective tissue disease)
* Written informed consent

Exclusion Criteria

* Supplementation with exogenous antioxidants 2 months prior
* Smoking less than 1 year
* Intermittent peritoneal dialysis or automated peritoneal dialysis
* PD catheter dysfunction
* Known allergy or intolerance to oral nutritional supplement for renal disease
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospital Civil Juan I. Menchaca

OTHER

Sponsor Role lead

Responsible Party

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Francisco Gerardo Yanowsky Escatell

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

References

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Sung CC, Hsu YC, Chen CC, Lin YF, Wu CC. Oxidative stress and nucleic acid oxidation in patients with chronic kidney disease. Oxid Med Cell Longev. 2013;2013:301982. doi: 10.1155/2013/301982. Epub 2013 Aug 24.

Reference Type BACKGROUND
PMID: 24058721 (View on PubMed)

Liakopoulos V, Roumeliotis S, Gorny X, Eleftheriadis T, Mertens PR. Oxidative Stress in Patients Undergoing Peritoneal Dialysis: A Current Review of the Literature. Oxid Med Cell Longev. 2017 Dec 27;2017:3494867. doi: 10.1155/2017/3494867. eCollection 2017.

Reference Type BACKGROUND
PMID: 29750088 (View on PubMed)

Roumeliotis S, Eleftheriadis T, Liakopoulos V. Is oxidative stress an issue in peritoneal dialysis? Semin Dial. 2019 Sep;32(5):463-466. doi: 10.1111/sdi.12818. Epub 2019 May 1.

Reference Type BACKGROUND
PMID: 31044475 (View on PubMed)

Kochlik B, Grune T, Weber D. New findings of oxidative stress biomarkers in nutritional research. Curr Opin Clin Nutr Metab Care. 2017 Sep;20(5):349-359. doi: 10.1097/MCO.0000000000000388.

Reference Type BACKGROUND
PMID: 28562491 (View on PubMed)

Domenici FA, Vannucchi MT, Jordao AA Jr, Meirelles MS, Vannucchi H. DNA oxidative damage in patients with dialysis treatment. Ren Fail. 2005;27(6):689-94. doi: 10.1080/08860220500242678.

Reference Type BACKGROUND
PMID: 16350819 (View on PubMed)

Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, Franch H, Guarnieri G, Ikizler TA, Kaysen G, Lindholm B, Massy Z, Mitch W, Pineda E, Stenvinkel P, Trevino-Becerra A, Wanner C. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int. 2008 Feb;73(4):391-8. doi: 10.1038/sj.ki.5002585. Epub 2007 Dec 19.

Reference Type BACKGROUND
PMID: 18094682 (View on PubMed)

Carrero JJ, Stenvinkel P, Cuppari L, Ikizler TA, Kalantar-Zadeh K, Kaysen G, Mitch WE, Price SR, Wanner C, Wang AY, ter Wee P, Franch HA. Etiology of the protein-energy wasting syndrome in chronic kidney disease: a consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). J Ren Nutr. 2013 Mar;23(2):77-90. doi: 10.1053/j.jrn.2013.01.001.

Reference Type BACKGROUND
PMID: 23428357 (View on PubMed)

Ikizler TA, Cano NJ, Franch H, Fouque D, Himmelfarb J, Kalantar-Zadeh K, Kuhlmann MK, Stenvinkel P, TerWee P, Teta D, Wang AY, Wanner C; International Society of Renal Nutrition and Metabolism. Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney Int. 2013 Dec;84(6):1096-107. doi: 10.1038/ki.2013.147. Epub 2013 May 22.

Reference Type BACKGROUND
PMID: 23698226 (View on PubMed)

Mah JY, Choy SW, Roberts MA, Desai AM, Corken M, Gwini SM, McMahon LP. Oral protein-based supplements versus placebo or no treatment for people with chronic kidney disease requiring dialysis. Cochrane Database Syst Rev. 2020 May 11;5(5):CD012616. doi: 10.1002/14651858.CD012616.pub2.

Reference Type BACKGROUND
PMID: 32390133 (View on PubMed)

Prasad N, Gupta A, Sinha A, Sharma RK, Kumar A, Kumar R. Changes in nutritional status on follow-up of an incident cohort of continuous ambulatory peritoneal dialysis patients. J Ren Nutr. 2008 Mar;18(2):195-201. doi: 10.1053/j.jrn.2007.08.002.

Reference Type BACKGROUND
PMID: 18267212 (View on PubMed)

Martin-Del-Campo F, Gonzalez-Espinoza L, Rojas-Campos E, Ruiz N, Gonzalez J, Pazarin L, Cueto-Manzano AM. Conventional nutritional counselling maintains nutritional status of patients on continuous ambulatory peritoneal dialysis in spite of systemic inflammation and decrease of residual renal function. Nephrology (Carlton). 2009 Aug;14(5):493-8. doi: 10.1111/j.1440-1797.2008.01081.x.

Reference Type BACKGROUND
PMID: 19674317 (View on PubMed)

Ikizler TA, Burrowes JD, Byham-Gray LD, Campbell KL, Carrero JJ, Chan W, Fouque D, Friedman AN, Ghaddar S, Goldstein-Fuchs DJ, Kaysen GA, Kopple JD, Teta D, Yee-Moon Wang A, Cuppari L. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. Am J Kidney Dis. 2020 Sep;76(3 Suppl 1):S1-S107. doi: 10.1053/j.ajkd.2020.05.006.

Reference Type BACKGROUND
PMID: 32829751 (View on PubMed)

Other Identifiers

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HospitalCJIM

Identifier Type: -

Identifier Source: org_study_id