Abstract
Low-grade chronic inflammation is prevalent in patients undergoing haemodialysis (HD) treatment and is linked to the development of premature atherosclerosis and mortality. The non-pharmacological approach to treat inflammation in HD patients through nutritional intervention is well cited. We aimed to assess the efficacy of different nutritional interventions at improving inflammatory outcomes in HD patients, based on markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumour necrosis factor-α (TNF-α). We searched PubMed, Cochrane Library, and Embase for randomized controlled trials (RCT) published before June 2017. Inclusion criteria included RCTs on adult patients on maintenance HD treatment with duration of nutritional interventions for a minimum 4 weeks. Risk of bias was assessed using the Jadad score. In total, 46 RCTs experimenting different nutritional interventions were included in the review and categorized into polyphenols rich foods, omega-3 fatty acids, antioxidants, vitamin D, fibres, and probiotics. Meta-analyses indicated significant reduction in CRP levels by omega-3 fatty acids (Random model effect: −0.667 mg/L, p < 0.001) and vitamin E (fixed model effect: −0.257 mg/L, p = 0.005). Evidence for other groups of nutritional interventions was inconclusive. In conclusion, our meta-analysis provided evidence that omega-3 fatty acids and vitamin E could improve inflammatory outcomes in HD patients.
Highlights
Haemodialysis (HD) patients experience a 3 to 4 times a higher mortality rate compared to their peers without chronic kidney disease (CKD)
The nutrition interventions were categorized into 6 main groups: (i) polyphenols [22,23,24,25,26,27,28,29]; (ii) omega-3 fatty acids [30,31,32,33,34,35,36,37,38,39,40,41,42]; (iii) antioxidants [39,43,44,45,46,47,48,49,50,51,52,53,54,55]; (iv) vitamin D [56,57,58,59]; (v) fibre and probiotics [60,61,62,63]; and (vi) combinations of more than one type of nutrition intervention [39,47,64,65,66,67]
C-reactive protein (CRP) was reported in 44 studies, whereas IL-6 and tumour necrosis factor-α (TNF-α) were reported in 19 and 9 studies, respectively
Summary
Haemodialysis (HD) patients experience a 3 to 4 times a higher mortality rate compared to their peers without chronic kidney disease (CKD). Cardiovascular disease (CVD) is cited as the main cause of mortality [1]. Epidemiological studies show that traditional CVD risk factors such as obesity, hypercholesterolemia, and high blood pressure exhibit paradoxical relationships with mortality risk in this population [2,3]. Chronic low-grade inflammation is a major contributing factor to the pathogenesis of atherosclerosis and has been reported in 30 to 50% of HD patients [4]. Acute inflammation is an adaptive response towards injury and infection, but a dysregulated on-going inflammatory state detrimentally affects the physiological process [5]. Chronic systemic inflammation in HD patients as indicated by increased levels of inflammatory markers such as C-reactive protein (CRP)
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