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Saturday, 07 May 2016 18:11

Clinical Research: ESRD patients receiving chronic renal replacement therapy are more likely to have an improved lipid profile after including plant sterols as part of their dietary intake for eight weeks

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image ribeiroName: Nicole Pereira Ribeiro

Hospital / Affiliation: University of Stellenbosch / University of the Witwatersrand / Charlotte Maxeke Johannesberg Academic Hospital

Home Country: South Africa

Host Country: South Africa

Year: 2015

Status of your program: IN PROGRESS


Title of the project: 

A prospective, cross-over randomized controlled trial to determine whether ESRD patients receiving
chronic renal replacement therapy at Charlotte Maxeke Johannesburg Academic Hospital are more likely to have an improved lipid profile
after including plant sterols as part of their dietary intake for eight weeks


Hemodialysis, Peritoneal Dialysis, Chronic Kidney Disease


Short description of the project or abstract:

Dyslipidaemia, specifically raised total cholesterol and low density lipoprotein (LDL) cholesterol levels, is very common amongst end stage renal disease (ESRD) patients. The cholesterol-lowering effectiveness of plant sterol therapy as recommended by the various guidelines for treating dyslipidaemia in ESRD patients receiving renal replacement therapy (RRT), has not been fully tested in this population group. The aim of this study was to assess whether ESRD patients receiving RRT at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) are more likely to improve lipid profiles during eight weeks of including plant sterols as part of their dietary recommendations. Adult hemodialysis (HD) and peritoneal dialysis (PD) patients attending CMJAH who met the inclusion criteria were included in the study. The 20 weeks trial was a randomised, double-blind, prospective cross-over trial - whereby the primary researcher, randomly selected two groups based on HD or PD treatment modality being received to either receive ‘Tub A’ (test: Floro Proactive, Unilever, South Africa) or ‘Tub B’ (control: Floro extra light). Weight, height, body mass index (BMI) and waist circumference (WC, where applicable) were measured, lipograms and activity levels were evaluated, dietary assessments were completed using 24-hour recall.There was no statistically significant association between total-cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride levels of participants and the appropriate use of the respective margarines (test versus control).
In turn,  the test margarine had a non-significant positive association with reduced total cholesterol (p=0.66 and p=0.16) and LDL cholesterol (p=0.89 and p=0.57) in ESRD patients receiving PD or HD respectively. Body mass index, waist circumference, activity level and extent of dietary compliance in accordance to the guidelines did not play a significant role in the change in total-cholesterol and LDL-cholesterol levels of participants.

Overall, dietary assessment illustrated that their habitual intake was not appropriate for cardioprotective effects regarding fibre and fat. This could have decreased the efficacy of the sterol-enriched margarine when incorporated into their habitual dietary intake, and resulted in a decrease in HDL cholesterol levels. ESRD patients may be hyper-responders, as the inclusion of the phytosterol-enriched margarine did show a trend towards decreasing both total and LDL cholesterol levels, even though not statistically significant. A tailored nutritional intervention according to each patient’s age, diagnosis, treatment modality including pharmacological treatment, lipid levels, and other medical conditions present is necessary; and possibly a longer trial period is necessary to see an effect in this population group. Sterols as part of a fat-modified diet may decrease total cholesterol and LDL cholesterol levels beyond statin therapy alone. Thus, the general use of 2–3 g of sterols as an adjunctive therapy to a diet low in saturated fat, trans fat and dietary cholesterol, as well as the use of statins in CKD patients receiving renal replacement therapy also to lower total cholesterol and LDL cholesterol levels may still be advocated, but additional research is necessary to evaluate this further.


Learning or Research objectives:

The aim of this study is to measure the effectiveness of including plant sterol-enriched margarine in the usual diet of ESRD patients receiving peritoneal dialysis and haemodialysis treatment at CMJAH.

  • To determine whether the addition of 25 g/d (2-3 g/d plant sterol) plant sterol-enriched margarine to the usual diet of patients with ESRD will reduce LDL cholesterol levels
  • To capture the patient’s demographic information, as well as gather information regarding the diagnosis, progression and risk factors for developing kidney failure
  • To determine the patient’s nutritional status in terms of body weight and height, body mass index and waist circumference where applicable, in relation to their risk for cardiovascular disease
  • To determine if the patients’ receiving renal replacement therapy (RRT) usual intake, assessed using a 24hour recall, is adequate or not, and meets the criteria for being cardioprotective in terms of the Kidney-disease outcome quality initiative (K/DOQI) and TLC guidelines


Additional Info

  • Year: 2015
  • Status: In progress
  • Partners: ISN only
  • Region: Africa
  • Country: South Africa
  • Topics: CKD, Hemodialysis, Peritoneal Dialysis
Read 7022 times Last modified on Saturday, 07 May 2016 18:49

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