In recent years numerous studies, including research from our own laboratory, have demonstrated that patients with kidney failure may benefit by receiving nutrition supplementation during their dialysis treatments. However, this practice has not been adopted by many clinics in the United States.

The adoption of nutrition supplementation has been limited primarily due to concerns that it may cause a clinically significant drop in blood pressure or reduce dialysis efficiency (toxin removal). However, very little has been done to assess if these concerns are legitimate. We plan to undertake a crossover design in which patients will receive three treatments in a random order: 1) normal dialysis with no intervention; 2) normal dialysis in which they will consume an 8 fluid ounce can of Nepro, a nutritional supplement designed especially for dialysis patients; and 3) The consumption of an 8 fluid ounce can of Nepro without hemodialysis treatment (on a “non- dialysis” day). While all sessions are voluntary, participants will be allowed to continue participation in the study if they choose not to participate in the session in our laboratory (session 3). During these treatments we will measure blood pressure, and attempt to determine the mechanism by which blood pressure is regulated during the treatment by use of continuous blood pressure monitoring, as well as measurement of heart rate variability, and estimation of cardiac output and stroke volume by thoracic impedance. In addition, we will measure the efficiency of solute removal by taking samples of blood during the treatment.  We expect to find no change in dialysis efficiency with nutritional supplementation. In addition, we expect to find only a transient drop in blood pressure that will be smaller in magnitude than the drop in blood pressure caused by the hemodialysis treatment. Therefore, the lowest blood pressure the patient will reach, the greatest determinant of clinical risk, will be no different between the treatment and control condition. This will be an important finding because it will provide evidence that intradialytic nutritional supplementation is safe and could be widely adopted to help improve patient’s nutritional status.