What is Nepro?
Nepro is a disease-specific oral nutritional supplement (ONS) specifically formulated for patients with renal failure, particularly those on dialysis, designed to provide concentrated energy and protein while managing electrolyte and fluid restrictions inherent to kidney disease. 1
Classification and Regulatory Status
Nepro is classified as a nutritionally incomplete, disease-specific oral nutritional supplement under the category of Foods for Special Medical Purposes (FSMP). 1 This means:
- It is specifically modified to meet the metabolic demands of renal failure patients 1
- It is not suitable as the sole source of nutrition when used alone, as it is adapted to contain specific nutrients in modified amounts 1
- It must be used under medical supervision 1
Nutritional Composition
Based on clinical studies, Nepro provides approximately:
- 475 calories per 237 mL can 2
- 16.7 grams of protein per can 2
- High-oleic safflower oil, corn syrup solids, and fructo-oligosaccharides 2
- 62 mg L-carnitine per can 2
- Modified electrolyte content appropriate for dialysis patients 3
The formulation is designed with controlled potassium and phosphorus levels to accommodate the metabolic restrictions of chronic kidney disease patients. 3
Clinical Indications
Nepro is indicated for:
- Malnourished patients on maintenance hemodialysis who cannot meet nutritional requirements through regular diet alone 1
- Patients with chronic renal failure requiring dialysis with evidence of protein-energy wasting 4, 5
- Hypoalbuminemic hemodialysis patients (serum albumin <3.8 g/dL) as part of nutritional intervention 2
Evidence-Based Clinical Outcomes
Nutritional Status Improvements
Clinical trials demonstrate that Nepro supplementation results in:
- Significant improvement in malnutrition inflammation score (MIS) with a 23.9% reduction over 30 days 4
- Increase in serum albumin levels from 3.44 g/dL to 3.68 g/dL after 4 weeks (P = .001) 2
- Maintenance of serum albumin in patients receiving peridialytic supplementation versus decline in control groups 6
- Statistically significant improvements in body weight and hemoglobin levels over 3 months 5
Safety Profile
Important safety considerations include:
- Serum potassium and phosphorus levels remain stable with Nepro supplementation, not increasing significantly despite additional nutrient intake 3, 5
- Well-tolerated with >80% adherence in clinical trials 6
- Minimal adverse effects, with occasional reports of diarrhea 2
- No serious adverse effects reported in controlled studies 4
Administration Protocol
The most effective administration approach based on clinical evidence:
- Peridialytic dosing: One can (237 mL) consumed during each hemodialysis session, three times weekly 6
- Alternative regimen: Daily predialytic supplementation 5
- Can be combined with other nutritional interventions (e.g., Oxepa for anti-inflammatory effects) in hypoalbuminemic patients 2
Common Pitfall to Avoid
Do not use Nepro as a fluid-based supplement in severely fluid-restricted patients without accounting for the 237 mL volume per can. 3 Consider alternative solid protein supplements (such as sports protein bars) in patients with strict fluid limitations, though these lack the renal-specific electrolyte modifications. 3
Position in Nutritional Therapy Hierarchy
According to ESPEN guidelines, the treatment algorithm for malnourished dialysis patients follows this sequence:
- Oral nutritional supplements (ONS) like Nepro are the first-line intervention when medical nutrition is indicated 1
- ONS should be used as supplemental therapy in addition to normal food intake 1
- If oral feeding remains insufficient, enteral nutrition via tube feeding should be considered 1
- Parenteral nutrition is reserved for situations where oral or enteral routes are inadequate or contraindicated 1
Intra-dialytic parenteral nutrition (IDPN) is not a routine technique and should only be considered when other methods, including ONS like Nepro, have proven insufficient. 1