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Protein energy wasting (PEW) is a condition in which the body's energy and protein retention is reduced. More common in patients with advanced chronic kidney disease (CKD). The mechanism that causes protein energy wasting in kidney disease patients is complicated, consisting of limiting food and leading to inappropriate nutritional state, increasing in leptin, increasing in inflammatory markers and various types of free radicals. Current studies have shown that zinc supplementation is beneficial in chronic kidney disease patients with malnutrition, who can increase appetite and reduce the level of inflammatory markers. The purpose of this study is to investigate the effects of zinc on PEW in non-dialysis CKD patients.
A prospective, randomized controlled trial was studied on patients with CKD who did not receive renal replacement therapy with PEW in Outpatient Department, Vajira Hospital, from August 2019 to March 2020. Participants were randomized and divided into 2 groups. The first group received a daily supplement of 30 mg elementary zinc comparing with the control group that received placebo with the same character as the zinc supplement. Within a 60-day study period, both groups received standard of care together with nutrition recommendations by a dietitian. The main objective of this study was to assess nutritional status by measuring changes in serum albumin level and have a before-after- comparison study. For a secondary purpose, it consisted of changes of the percentage of muscle mass, changes in dietary protein intake and changes in inflammatory markers.
A total of twenty participants were divided into ten participants receiving zinc and ten participants in the control group. The serum albumin level was not different between the two groups (3.05 ± 0.33 g / dl compared to 3.28. ± 0.29 g / dl , p = 0.112). In the zinc group, the serum zinc level increased from 55.20 ± 8.61 mcg / dl to 58.83 ± 6.31 mcg / dl (p = 0.031), which was different from the control group where the serum zinc level showed a statistically significance decrease.
A 60-day zinc supplementation with nutritional advice in non-dialysis CKD patients did not have effect on nutritional status compared to the control group that received only nutritional advice. However, in the receiving zinc supplementation group, the serum zinc levels increase which was different from the control group, where the level of zinc showed a statistically significance decrease.