Effect of a Specialized Oral Supplement on Nutritional Status and Quality of Life in Non-dialysis CKD

NCT ID: NCT06576479

Last Updated: 2024-12-18

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

RECRUITING

Clinical Phase

NA

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-07-10

Study Completion Date

2025-03-31

Brief Summary

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Patients whit chronic kidney disease (CKD) there is a high prevalence of nutritional disorders and negative changes in body composition, which is strongly associated with an increased risk of morbidity and mortality.

Detailed Description

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Epidemiological studies have reported that between 30 and 50% of patients with kidney disease show signs of malnutrition and that specifically in patient with CKD in stages 4-5 without replacement therapy, the prevalence of protein energy wasting (PEW) can be up to 45%.

Many factors influence the development of PEW, however, one main factor is insufficient intake of energy and macronutrients. The main obstacle that prevents the patient from meeting their nutritional requirements is the presence of gastrointestinal symptoms. In addition to this, dietary restrictions, lack of adherence to eating plans and the presence of digestive and psychological abnormalities of the patient, contribute directly to the patient directly contribute to insufficient energy and protein intake. Therefore, there is a need for evidence-based nutritional treatment strategies that facilitate the patient's achievement of their nutritional requirements and maintain or improve their nutritional supplements in patients with CKD has been shown to be a good treatment strategy.

Specifically in patients with CKD without replacement therapy, it has been observed that the use of specialized nutritional supplements can contribute to increasing their energy, fat, and fiber intake, while at the same time achieving a decrease in protein intake without causing any change in serum minerals or electrolytes.

This project will provide practical information for the validation of the therapeutic effect of a new specialized food supplement on the nutritional status and quality of life in patients with CKD without replacement therapy, which will be useful both for health professionals and for the patients themselves.

MAIN OBJETIVE:

To assess the effect and safety of the use of a specialized food supplement on the nutritional status and quality of life of patients with CKD and PEW without replacement therapy.

STUDIO DESING:

Randomized, blinded clinical trial with an intervention period of 4 months.

PROCESS:

1. Identify those patients who are candidates to participate in the clinical trial.
2. Review the inclusion and exclusion criteria.
3. Invite identified patients to participate in the clinical trial.

Pre - Nutritional wash out appointment - nutritionist

1. Evaluate inclusion criteria.
2. Review and sign the informed consent.
3. Perform evaluation to indicate a personalized meal plan.
4. Deliver a meal plan.
5. Schedule in 30 days for your next nutritional appointment.

0 - Full Assessment Nutritional Appointment - Nutritionist

1. Evaluate adherence to the meal plan (percentage of adequacy of energy and protein consumption from 70% to 130%).
2. Assign an intervention group randomly (sealed envelope).
3. Perform an evaluation of nutritional status, quality of life and body composition.

Offer nutritional treatment according to the assigned intervention group.
4. Schedule an immediate appointment for laboratory tests of blood and urine.
5. Schedule in 30 days for your next nutritional appointment.

month 1 - Nutritional monitoring appointment - nutritionist

1. Evaluate adherence to the eating plan.
2. Offer nutritional treatment according to the assigned intervention group.
3. Schedule in 30 days for your next nutritional appointment.
4. Make an appointment a few days before your next nutritional appointment to perform blood and urine lab tests.

month 2 - Full Assessment Nutritional Appointment - Nutritionist

1. Perform an evaluation of nutritional status, quality of life and body composition.
2. Offer nutritional treatment according to the assigned intervention group.
3. Schedule in 30 days for your next nutritional appointment.

month 3 - Nutritional monitoring appointment - nutritionist

1. Evaluate adherence to the eating plan.
2. Offer nutritional treatment according to the assigned intervention group.
3. Schedule in 30 days for your next nutritional appointment. 4.3 - Nutritional monitoring appointment - nutritionist

5.Evaluate adherence to the eating plan. 6.Offer nutritional treatment according to the assigned intervention group. 7.Schedule in 30 days for your next nutritional appointment. 7.1Schedule a few days before your nutritional appointment for blood and urine lab tests.

month 4 - Full Assessment Nutritional Appointment - Nutritionist

1. Perform an evaluation of nutritional status, quality of life and body composition.
2. Offer nutritional treatment according to the assigned intervention group.

SAMPLE SIZE: 50 participants

STATISTIC ANALYSIS:

For the comparison of proportions between the groups, it will be done with X2 or Fisher's exact test and to compare quantitative variables, Student's T or Mann-Whitney U will be used. For the intra-group comparisons, Mc Nemar will be used for the qualitative variables and Anova for repeated samples or Friedman's Anova for the quantitative variables. For the analysis of the interaction or intervening variables, a stratified statistical analysis will be carried out, using contingency tables and the Mantel-Haenszel method. The results will be considered statistically significant if the value of p \<0.05.

Conditions

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Chronic Kidney Diseases Protein-Energy Malnutrition

Keywords

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chronic kidney disease PEW nutrition

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

The intervention group receives specialized oral nutritional supplements plus nutritional counseling, the control group only receives nutrition counseling. Both groups receive laboratory studies (blood and urine) as well as body composition analysis with the use of electronic bioimpedance.
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Investigators
The participant takes a random envelope without seeing, which the researcher receives and is automatically assigned the group in which he will remain until satisfactorily finished.

Study Groups

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Arm Intervention

Intervention group: The specialized oral supplement is provided, with the consumption of 1 serving (70g-dissolved in 237 ml natural water) per day in conjunction with individualized nutritional counseling. For 4 months

Group Type EXPERIMENTAL

Nutritious Shake

Intervention Type DIETARY_SUPPLEMENT

Powder 70 g/d diluted in 237 ml natural water

Arm no Intervention

Control group: They receive specialized nutrition considering the recommendations of the clinical practice guidelines for CKD. For 4 months

Group Type OTHER

Nutritional counseling

Intervention Type BEHAVIORAL

Specialized nutritional recommendations for CKD

Interventions

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Nutritious Shake

Powder 70 g/d diluted in 237 ml natural water

Intervention Type DIETARY_SUPPLEMENT

Nutritional counseling

Specialized nutritional recommendations for CKD

Intervention Type BEHAVIORAL

Other Intervention Names

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NIN

Eligibility Criteria

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Inclusion Criteria

* Patients over 18 years of age
* Patients with diabetic kidney with eGFR \<60 ml / min / 1.73m2 and ≥15 ml / min / 1.73m2, (stage G3a, G3b and G4 respectively)
* Patients with protein energy expenditure (defined by serum albumin \< 3.8 g/dl)
* Patients with protein energy expenditure (defined by 24-hour recall less than a dietary protein intake \<0.6 g/kg/d or have a consumption \<25 kcal/kg/d
* Patients who can read and write (or primary caregiver)
* Domicile within the metropolitan area

Exclusion Criteria

* Previous hospitalizations in the last month
* Patients with serious complications (chronic infection, septicemia, cancer, HIV, Alzheimer's, uncontrolled heart failure, liver failure, cerebrovascular syndrome, malabsorption syndrome, or allergy to any ingredient in the nutritional supplement)
* Patients with actual consumption of food supplements and / or keto analogues.

Elimination Criteria:

* Failure to attend nutritional assessment and biochemical testing at baseline, 2 months, and end of the study.
* Failure to take the supplement \>10% (\>12 failed doses).
* Diagnosis of any comorbidity during the intervention period.
* Initiation of replacement therapy.
* Identification of adverse effects.
* Withdrawal of voluntary participation by the patient.
* Death.
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospital Civil de Guadalajara

OTHER

Sponsor Role collaborator

NIN Institute

INDUSTRY

Sponsor Role lead

Responsible Party

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Ari Cisneros-Hernández

Investigador Principal

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Paola Azucena Alvarado Pelayo, Bachelor

Role: PRINCIPAL_INVESTIGATOR

Hospital Civil Fray Antonio Alcalde

Locations

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Hospital Civil Fray Antonio Alcalde

Guadalajara, Jalisco, Mexico

Site Status RECRUITING

Countries

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Mexico

Central Contacts

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Paola Azucena Alvarado Pelayo, Bachelor

Role: CONTACT

Phone: 011 52 3320587471

Email: [email protected]

Ari Cisneros Hernández, Master

Role: CONTACT

Phone: 011 52 3335762299

Email: [email protected]

Facility Contacts

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Paola Alvarado, Bachelor

Role: primary

Ari Cisneros, Master

Role: backup

References

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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)

Riella MC. Nutritional evaluation of patients receiving dialysis for the management of protein-energy wasting: what is old and what is new? J Ren Nutr. 2013 May;23(3):195-8. doi: 10.1053/j.jrn.2013.01.023.

Reference Type BACKGROUND
PMID: 23611546 (View on PubMed)

Perez-Torres A, Gonzalez Garcia ME, San Jose-Valiente B, Bajo Rubio MA, Celadilla Diez O, Lopez-Sobaler AM, Selgas R. Protein-energy wasting syndrome in advanced chronic kidney disease: prevalence and specific clinical characteristics. Nefrologia (Engl Ed). 2018 Mar-Apr;38(2):141-151. doi: 10.1016/j.nefro.2017.06.004. Epub 2017 Jul 26. English, Spanish.

Reference Type BACKGROUND
PMID: 28755901 (View on PubMed)

Kovesdy CP, Kopple JD, Kalantar-Zadeh K. Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: reconciling low protein intake with nutritional therapy. Am J Clin Nutr. 2013 Jun;97(6):1163-77. doi: 10.3945/ajcn.112.036418. Epub 2013 May 1.

Reference Type BACKGROUND
PMID: 23636234 (View on PubMed)

Zhang X, Bansal N, Go AS, Hsu CY. Gastrointestinal symptoms, inflammation and hypoalbuminemia in chronic kidney disease patients: a cross-sectional study. BMC Nephrol. 2015 Dec 11;16:211. doi: 10.1186/s12882-015-0209-z.

Reference Type BACKGROUND
PMID: 26651991 (View on PubMed)

Paes-Barreto JG, Silva MI, Qureshi AR, Bregman R, Cervante VF, Carrero JJ, Avesani CM. Can renal nutrition education improve adherence to a low-protein diet in patients with stages 3 to 5 chronic kidney disease? J Ren Nutr. 2013 May;23(3):164-71. doi: 10.1053/j.jrn.2012.10.004. Epub 2012 Nov 27.

Reference Type BACKGROUND
PMID: 23194841 (View on PubMed)

Tomayko EJ, Kistler BM, Fitschen PJ, Wilund KR. Intradialytic protein supplementation reduces inflammation and improves physical function in maintenance hemodialysis patients. J Ren Nutr. 2015 May;25(3):276-83. doi: 10.1053/j.jrn.2014.10.005. Epub 2014 Nov 25.

Reference Type BACKGROUND
PMID: 25455421 (View on PubMed)

Kalantar-Zadeh K, Cano NJ, Budde K, Chazot C, Kovesdy CP, Mak RH, Mehrotra R, Raj DS, Sehgal AR, Stenvinkel P, Ikizler TA. Diets and enteral supplements for improving outcomes in chronic kidney disease. Nat Rev Nephrol. 2011 May 31;7(7):369-84. doi: 10.1038/nrneph.2011.60.

Reference Type BACKGROUND
PMID: 21629229 (View on PubMed)

Cheu C, Pearson J, Dahlerus C, Lantz B, Chowdhury T, Sauer PF, Farrell RE, Port FK, Ramirez SP. Association between oral nutritional supplementation and clinical outcomes among patients with ESRD. Clin J Am Soc Nephrol. 2013 Jan;8(1):100-7. doi: 10.2215/CJN.13091211. Epub 2012 Oct 18.

Reference Type BACKGROUND
PMID: 23085729 (View on PubMed)

Satirapoj B, Prapakorn J, Punpanich D, Pongsuparbchon C, Supasyndh O. The effect of ONCE Renal on minerals and electrolytes in predialysis patients with chronic kidney disease. Int J Nephrol Renovasc Dis. 2016 Apr 5;9:81-6. doi: 10.2147/IJNRD.S98179. eCollection 2016.

Reference Type BACKGROUND
PMID: 27103839 (View on PubMed)

Other Identifiers

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NI0001/24

Identifier Type: -

Identifier Source: org_study_id