Efficacy of beta-hydroxy-beta-methylbutyrate (HMB) supplementation in hemodialysis patients

hemodialysis;muscle;kidney disease;end stage renal disease;Beta-hydroxy-beta-methylbutyrate (HMB)

Fitschen, Peter J

关键词: hemodialysis;    muscle;    kidney disease;    end stage renal disease;    Beta-hydroxy-beta-methylbutyrate (HMB);   

Others  :  https://www.ideals.illinois.edu/bitstream/handle/2142/89177/FITSCHEN-DISSERTATION-2015.pdf?sequence=1&isAllowed=y

美国|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

Patients with renal failure undergoing maintenance hemodialysis (MHD) therapy suffer from a number of co-morbidities including skeletal muscle loss, reduced physical function, a significantly increased fall risk, and reduced quality of life (QOL).Therefore, interventions to combat these co-morbidities are needed.Beta-hydroxy-beta-methylbutyrate (HMB) is a metabolite of the amino acid leucine that has been shown to improve lean mass and physical function in the elderly and clinical populations, but had not previously been studied in MHD patients.Approximately 25 percent of supplemental HMB is cleared by the kidney; therefore, we first performed an acute study to determine the clearance of supplemental HMB in hemodialysis patients.MHD patients (n=8) consumed 3g HMB prior to a standard hemodialysis session.Following supplementation with HMB, a majority of supplemental HMB was cleared within 48hrs and plasma HMB levels returned to baseline within 7 days in all participants.These results suggest that supplemental HMB is cleared in patients with impaired renal function.Based upon these results, we performed a double blind, placebo controlled, randomized trial to assess the effects of daily HMB supplementation on co-morbidities in MHD patients.MHD patients were recruited and assigned to either daily supplementation with HMB (n=16) or placebo (n=17) for 6 months.No significant effects of HMB on lean mass, strength, physical function, fall risk, or quality of life were found using an intent-to-treat analysis.However, upon analysis of plasma HMB concentrations, 5 of 16 patients (31%) who completed the study in the HMB group were found to be non-compliant at 3 or 6 months.Therefore, we performed a per-protocol analysis with compliant participants only.Although this analysis was underpowered, we observed a trend for improvements in chair stand and timed up-and-go tests with HMB supplementation.However, no effects of HMB were observed for lean mass, strength, fall risk, or quality of life.As a whole, these results do not support the efficacy of HMB to attenuate muscle loss and declines in physical function in MHD patients.However, the observed low-compliance with study pills may have affected results.Moreover, it highlights the need for future interventions targeted at reducing pill burden and improving pill compliance in this population.