The effects of oral nutritional supplements in patients with maintenance dialysis therapy: A systematic review and meta-analysis of randomized clinical trials.

Peng Ju Liu,Shu Li He,Qi Yan Wang,Fang Ma,Pasqual Barretti

doi:10.1371/journal.pone.0203706

Abstract

Background/objectiveThis systematic review aims to determine the potential effects of oral nutritional supplements (ONS) in patients receiving maintenance dialysis therapy (MDT).MethodsElectronic databases were searched without language limits through to July 2018. Randomized controlled trials (RCTs) that involved comparisons of ONS versus placebo or routine care are included in this meta-analysis. RevMan 5.3 statistical software was used for meta-analysis.Results15 articles with 589 subjects were included in our study. There are insufficient comparable data of randomized trials to allow meta-analysis of mortality. Albumin levels may be improved by the macronutrient blends or protein/amino acid supplements in MDT patients. Compared with the control group, serum albumin levels and BMI in the ONS group were increased by 1.58 g/L (95% CI, 0.52–2.63, P = 0.003; I2 = 85%) and 0.40 kg/m2 (95% CI, 0.10–0.71, P = 0.01; I2 = 49%), respectively. In the subgroup analysis of patients receiving hemodialysis, albumin levels in ONS group were increased by 2.17 g/L (95% CI, 0.89–3.45, P<0.001; I2 = 90%). ONS may not influence serum phosphorus and potassium levels.ConclusionsVery low-quality evidence suggests that Short-term oral energy or protein/amino acid supplements may improve nutritional status by increasing serum albumin levels and BMI in MDT patients, without influence on serum potassium levels. High-quality and large RCTs, particularly regarding the effects of ONS on mortality and quality of life, are needed to further validate our findings.

Highlights

Chronic kidney disease (CKD) is a prevalent chronic condition and the incidence of end-stage renal disease (ESRD) is expected to increase over the few decades [1]
Albumin levels may be improved by the macronutrient blends or protein/amino acid supplements in maintenance dialysis therapy (MDT) patients
Compared with the control group, serum albumin levels and body mass index (BMI) in the oral nutritional supplements (ONS) group were increased by 1.58 g/L and 0.40 kg/m2, respectively

Summary

Introduction

Chronic kidney disease (CKD) is a prevalent chronic condition and the incidence of end-stage renal disease (ESRD) is expected to increase over the few decades [1]. PEW, showing a high prevalence (up to 50–75%) in patients with CKD stages 4–5, is closely associated with both increased morbidity/mortality risk and worsens quality of life [4] This term was introduced by the International Society of Renal Nutrition and Metabolism in 2008 to describe the status of decreased body stores of protein and energy fuels. Several nutrition-related tests have been proposed to assess nutritional status in patients receiving MDT, such as subjective global assessment [5,6,7], the malnutrition inflammation score [8,9,10], body mass index (BMI) [11], serum albumin [12,13,14], and so on. A low serum albumin level, which may indicate poor nutritional status and heightened inflammation, is a strong predictor of increased mortality risk [12,15,16,17], and appears to be better and simpler than others in reflecting nutritional status for patients receiving MDT[18,19]

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Conclusion