Glycaemic Response to Oral Nutrition Support During Haemodialysis

Patients with end stage kidney disease requiring dialysis are at the highest risk for cardiovascular disease, and many of our dialysis population also have diabetes. Malnutrition is common in patients undergoing dialysis and causes are multifactorial. Oral nutrition support is the first line treatment for malnutrition, and often includes the use of liquid nutrition supplements, especially in dialysis patients due to the already restricted diet required to maintain electrolyte balance. Oral nutrition supplements (ONS) can raise serum blood glucose levels and optimal control for diabetes may be difficult when ONS are required. This study aims to evaluate the post-prandial response to a newly re-formulated slow release carbohydrate renal specific oral nutrition supplement, compared to standard and macro-nutrient matched ONS products, during haemodialysis, using a randomised cross-over trial design. 28 patients with diabetes and end stage kidney disease undergoing haemodialysis will be recruited to the study, including 8 in the pilot phase and 20 in the study. Patients will be randomised in a crossover design to 3 study treatments over 3 weeks - slow release CHO ONS, macronutrient matched ONS, and standard ONS. Central blood glucose levels will be measured over 3 hours and the peak and mean incremental area under the curve (iAUC) of the post prandial blood glucose response will be calculated for each study treatment. Differences between treatments will be determined with repeated measures analysis of co-variance (ANCOVA). The acute effect of different nutritional supplements on blood glucose will be discussed in the context of maintaining optimal blood glucose control during dialysis.

Inclusion criteria

• Type 1 or type 2 diabetes
• End stage kidney disease on haemodialysis
• Body mass index 18.5-35kg/m2
• Able to provide written informed consent

Exclusion criteria

• Infection or course of antibiotics in the last month