Abstract

BACKGROUND
This systematic review aims to determine the potential benefits of enteral multinutrient support (oral or tube) in patients with chronic kidney disease (CKD) receiving maintenance dialysis.
METHODS
Studies of multinutrient oral supplements and enteral tube feeding that involved comparisons of nutritional support versus routine care (ie, usual diet), disease-specific formulae (with adapted macronutrient and micronutrient composition for use in maintenance dialysis patients) versus standard formulae, and enteral tube feeding versus parenteral nutrition are included in this review. The outcome measures sought were clinical (quality of life, complications, and mortality), biochemical (albumin and electrolyte levels), and nutritional (dietary intake and anthropometry). Meta-analyses were performed when possible.
RESULTS
This review of 18 studies (5 randomized controlled trials [RCTs], 13 non-RCTs) suggests that enteral nutritional support increased total (energy and protein) intake and increased serum albumin concentration by 0.23 g/dL (2.3 g/L; 95% confidence interval, 0.037 to 0.418 g/dL [0.37 to 4.18 g/L]; 1 RCT, 2 non-RCTs), with little effect on electrolyte status (serum phosphate and potassium). Few studies reported clinical outcome, and there was insufficient information to compare disease-specific versus standard formulae or enteral versus parenteral nutrition.
CONCLUSION
This systematic review suggests that enteral multinutrient support significantly increases serum albumin concentrations and improves total dietary intake. This may improve clinical outcome, especially in malnourished patients, but insufficient published data exist to examine this. Additional research is required to investigate clinical, economic, and nutritional consequences of using oral supplements and tube feeding (using standard or disease-specific feeds) in patients with CKD receiving maintenance dialysis.

Links

Publisher Full Text

Authors

Stratton RJ, Bircher G, Fouque D, Stenvinkel P, de Mutsert R, Engfer M, Elia M

Institution

Institute of Human Nutrition, University of Southampton, UK. r.j.stratton@soton.ac.uk

Source

American journal of kidney diseases : the official journal of the National Kidney Foundation 46:3 2005 Sep pg 387-405

MeSH

Adult
Aged
Body Weight
Dietary Supplements
Enteral Nutrition
Female
Food, Formulated
Humans
Kidney Failure, Chronic
Male
Malnutrition
Middle Aged
Nutritional Support
Parenteral Nutrition
Peritoneal Dialysis
Phosphates
Potassium
Randomized Controlled Trials as Topic
Renal Dialysis
Research Design
Serum Albumin
Treatment Outcome

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

16129200