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Multinutrient oral supplements and tube feeding in maintenance dialysis: a systematic review and meta-analysis.

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.

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  • Authors+Show Affiliations

    ,

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

    , , , , ,

    Source

    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
    Systematic Review

    Language

    eng

    PubMed ID

    16129200

    Citation

    Stratton, Rebecca J., et al. "Multinutrient Oral Supplements and Tube Feeding in Maintenance Dialysis: a Systematic Review and Meta-analysis." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 46, no. 3, 2005, pp. 387-405.
    Stratton RJ, Bircher G, Fouque D, et al. Multinutrient oral supplements and tube feeding in maintenance dialysis: a systematic review and meta-analysis. Am J Kidney Dis. 2005;46(3):387-405.
    Stratton, R. J., Bircher, G., Fouque, D., Stenvinkel, P., de Mutsert, R., Engfer, M., & Elia, M. (2005). Multinutrient oral supplements and tube feeding in maintenance dialysis: a systematic review and meta-analysis. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 46(3), pp. 387-405.
    Stratton RJ, et al. Multinutrient Oral Supplements and Tube Feeding in Maintenance Dialysis: a Systematic Review and Meta-analysis. Am J Kidney Dis. 2005;46(3):387-405. PubMed PMID: 16129200.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Multinutrient oral supplements and tube feeding in maintenance dialysis: a systematic review and meta-analysis. AU - Stratton,Rebecca J, AU - Bircher,Gemma, AU - Fouque,Denis, AU - Stenvinkel,Peter, AU - de Mutsert,Renée, AU - Engfer,Meike, AU - Elia,Marinos, PY - 2005/02/23/received PY - 2005/04/27/accepted PY - 2005/9/1/pubmed PY - 2005/10/26/medline PY - 2005/9/1/entrez SP - 387 EP - 405 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 46 IS - 3 N2 - 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. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/16129200/Multinutrient_oral_supplements_and_tube_feeding_in_maintenance_dialysis:_a_systematic_review_and_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(05)00739-0 DB - PRIME DP - Unbound Medicine ER -