Nutritional Intervention Incorporating Expedited 10？g Protein Counter (EP-10) to Improve the Albumin and Transferrin of Chronic Hemodialysis Patients

Objective. The expedited 10？g protein counter (EP-10) is a quick and valid clinical tool for dietary protein quantification. This study aims to assess the clinical effectiveness of the EP-10 in improving serum albumin and transferrin in chronic hemodialysis patients. Methods. Forty-five patients with low serum albumin (<38？g/L) were enrolled in this study. Parameters measured included dry weight, height, dietary intake, and levels of serum albumin, transferrin, potassium, phosphate, and kinetic modeling (Kt/V). The nutritional intervention incorporated the EP-10 in two ways (1) to quantify protein intake of patients and (2) to educate patients to meet their protein requirements. Mean values of the nutritional parameters before and after intervention were compared using paired t-test. Results. Three months after nutritional intervention, mean albumin levels increased significantly from 32.2？±？4.8？g/L to 37.0？±？3.2？g/L . Thirty-eight (84%) patients showed an increase in albumin levels, while two (4%) maintained their levels. Of the thirty-six (80%) patients with low transferrin levels (<200？mg/dL), 28 (78%) had an increase and two maintained their levels after intervention. Mean transferrin levels increased significantly from 169.4？±？39.9？mg/dL to 180.9？±？38.1？mg/dL . Conclusion. Nutritional intervention incorporating the EP-10 method is able to make significant improvements to albumin and transferrin levels of chronic hemodialysis patients. 1. Introduction Protein-energy malnutrition (PEM) is highly prevalent in chronic kidney disease (CKD) patients on hemodialysis (HD) [1–4]. Low serum albumin and transferrin are surrogate markers of PEM, with low serum albumin being one of the most commonly used in CKD [5]. The progressive deterioration of kidney function in CKD leads to retention of many substances that are normally excreted by the kidney [6]. The retention of uremic toxins and other comorbid conditions can lead to a lowered appetite and a decrease in protein and energy intake, which is often compounded by ill-advised imposition of various dietary restrictions [7]. Among the causes of malnutrition in HD patients, inadequate dietary protein intake appears to be one of the most common and important [8]. Low protein intake and low serum albumin have been shown to be independently associated with increased risk of mortality in patients on dialysis [9, 10]. Mortality increases significantly as albumin levels fall below 39？g/L [11]. In the United States, it has been projected that interventions to improve serum albumin by just 2？g/L in 50% of