Please select the eligibility criteria that correspond to the clinical trial below.
Title: Protein Supplementation in Dialysis Patients
Brief Summary: The mortality rate in chronic hemodialysis (CHD) patients remains excessively high and approaches 21% per year. Among the many factors that adversely affects patient outcome is uremic malnutrition, a unique form of deranged nutritional status. It is associated with increased hospitalization and death risk in CHD patients. Several measures have been identified to prevent uremic malnutrition in CHD patients, including efforts to optimize dialysis regimen and dietary protein and energy intake. A large number of CHD patients suffer from uremic malnutrition in spite of these aggressive measures. The inevitable protein catabolic effects of the hemodialysis procedure are important factors leading to increased prevalence of uremic malnutrition. Preliminary data suggest that oral nutritional supplementation administered during the hemodialysis procedure counteracts these protein catabolic effects and leads to net protein anabolism in the acute setting. In this proposal, we hypothesize that Pro-Stat, a high nitrogen, enzyme-hydrolyzed, tryptophan-fortified, collagen protein supplement will reverse the net protein catabolism observed during hemodialysis procedure.


Options:
A: Inclusion Criteria:

* At least 3 months on maintenance hemodialysis,
* Last 3-month averaged serum albumin \<4.0 g/dl,
* Average monthly Kt/V\>1.2,
* Dialysis time between 3 and 5 hours,
* Functioning AV graft or fistula or tunnel catheter that will not switch for 6 months,
* Standardized dialysis treatment per DaVita protocol.
* In case the averaged 3-month is not \<4.0 g/dl but last month serum albumin \<4.0 g/dl (worsening hypoalbuminemia) patient will be qualified, if 3-month averaged nPNA \< 0.8 g/kg/day or a BMI \< 20 kg/m2.

Exclusion Criteria:

* Peritoneal dialysis
* Terminal illnesses with life expectancy\<6 months
* Maintenance hemodialysis less than 5 months
* Concurrent appetite stimulants
* Use of IDPN in the past 2-3 months
* Inability to follow and to comply with the instructions and guidelines
* Likelihood of pregnancy or intention to become pregnant
* Acute wasting condition or active systemic disease
* Pulse chemo therapy
* Non-compliance with dialysis treatment
* Dialysis catheter that may switch soon.
B: Inclusion Criteria:

* Type 1 or type 2 diabetes
* End stage kidney disease on haemodialysis
* Body mass index 18.5-35kg/m2
* Able to provide written informed consent

Exclusion Criteria:

• Infection or course of antibiotics in the last month
C: Inclusion criteria:

* On hemodialysis for more than 3 months, on a thrice weekly hemodialysis program.
* Adequately dialyzed (Kt/V \> 1.2).
* Age 18-75

Exclusion criteria:

* Pregnant women.
* Severe unstable underlying disease besides commonly associated with end stage renal disease. Cardiac patients that are stable will be included.
* Patients hospitalized within the last month prior to the study.
* Patients with malfunctioning arterial-venous access \[recirculation and/or blood flow \< 500 ml/min for an arterial-venous graft (AVG) or \<400 ml/min for an arterial-venous fistula (AVF)\] Patients receiving steroids and/or other immunosuppressive agents.
D: Inclusion Criteria:

1. Receipt of in-center hemodialysis in a facility participating in the trial
2. Able to consume oral nutritional supplements
3. Age ≥18 years

Exclusion Criteria:

1. Tube feed or intravenous feed dependent
2. Unable to feed oneself or request help with feeding if a supplement is provided
3. Known allergy to ingredient(s) of the supplement

Answer: C