Effect of supplementation with L-leucine, L-arginine, and L-carnitine on body composition in patients undergoing chronic hemodialysis

INTRODUCTION: patients with chronic kidney disease (CKD) undergoing hemodialysis have a high prevalence of nutritional deterioration, characterized by loss of muscle mass and function, which is associated with poorer clinical outcomes. Oral nutritional supplementation (ONS) is a commonly used strategy in this population; however, comparative evidence among different supplements remains limited. OBJECTIVE: to evaluate the effect of ONS with L-arginine, L-leucine, or L-carnitine on body composition and muscle strength in patients with CKD undergoing hemodialysis. MATERIAL AND METHODS: a randomized, open-label, controlled clinical trial with three parallel groups was conducted in adult patients with stage 5 CKD receiving chronic hemodialysis. ONS was administered for 90 days. Anthropometric, muscle strength, and bioimpedance parameters were assessed. Dietary intake was estimated using 24-hour dietary recalls. Longitudinal analysis was performed using linear mixed-effects models. A total of 158 patients were included in the final analysis. RESULTS: energy and protein intake was insufficient in more than 80 % of patients. Significant intragroup improvements were observed in body weight, muscle mass, and handgrip strength (p < 0.05), with no statistically significant differences between supplement types (p > 0.05). Moderate positive correlations were observed between muscle mass, handgrip strength, and phase angle. CONCLUSION: ONS was associated with improvements in anthropometric and functional parameters in patients with CKD undergoing hemodialysis, regardless of the type of supplement used. Functional assessment plays a key role in the early detection of nutritional deterioration in this population.