Are oral protein supplements helpful in the management of malnutrition in dialysis patients?

A randomized study was planned to compare the effects of whey and egg albumin protein supplements in dialysis patients. Fifty adult patients were randomized to receive either whey protein or egg albumin as per their deficit calculated from K/DOQI recommendations. Actual intake was calculated from three-day dietary diary. Assessment of nutritional status was done by serum albumin and bioelectric impedance analysis (BIA). Repeat evaluation was done after 6 months. The mean initial intake of protein in whey and egg albumin group was 0.74 ± 0.3 vs. 0.69 ± 0.2 g/kg/day, (P = 0.5) and calorie intake was 20 ± 5.6 vs. 20.5 ± 5.1 kcal/kg/day, (P = 0.8), respectively. Out of 50 patients, two died within 2 months and were excluded from the study and 14 (28%) dropped out within one month because of side effects. The most common side effect in drop-outs was nausea and vomiting (43%). Out of remaining 34 patients who completed the study, 80% could not consume >50% of the recommended supplement because of side effects. The protein and calorie intake remained similar at baseline and 6 months in both the groups. The main side effects in whey group were bloating and nausea with vomiting, and in egg protein group were nausea with vomiting, bloating and anorexia. Oral protein supplements were not tolerated in dialysis patients and side effects resulted in high degree of non-compliance.