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

Abstract

BACKGROUND/OBJECTIVE

This systematic review aims to determine the potential effects of oral nutritional supplements (ONS) in patients receiving maintenance dialysis therapy (MDT).

METHODS

Electronic 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.

RESULTS

15 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.

CONCLUSIONS

Very 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.

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  • Authors+Show Affiliations

    ,

    Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, PR China.

    ,

    Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, PR China.

    ,

    Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, PR China.

    Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, PR China.

    Source

    PloS one 13:9 2018 pg e0203706

    MeSH

    Body Mass Index
    Databases, Factual
    Dietary Supplements
    Humans
    Kidney Failure, Chronic
    Nutritional Status
    Quality of Life
    Randomized Controlled Trials as Topic
    Renal Dialysis
    Serum Albumin

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Systematic Review

    Language

    eng

    PubMed ID

    30212514

    Citation

    Liu, Peng Ju, et al. "The Effects of Oral Nutritional Supplements in Patients With Maintenance Dialysis Therapy: a Systematic Review and Meta-analysis of Randomized Clinical Trials." PloS One, vol. 13, no. 9, 2018, pp. e0203706.
    Liu PJ, Ma F, Wang QY, et al. The effects of oral nutritional supplements in patients with maintenance dialysis therapy: A systematic review and meta-analysis of randomized clinical trials. PLoS ONE. 2018;13(9):e0203706.
    Liu, P. J., Ma, F., Wang, Q. Y., & He, S. L. (2018). The effects of oral nutritional supplements in patients with maintenance dialysis therapy: A systematic review and meta-analysis of randomized clinical trials. PloS One, 13(9), pp. e0203706. doi:10.1371/journal.pone.0203706.
    Liu PJ, et al. The Effects of Oral Nutritional Supplements in Patients With Maintenance Dialysis Therapy: a Systematic Review and Meta-analysis of Randomized Clinical Trials. PLoS ONE. 2018;13(9):e0203706. PubMed PMID: 30212514.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The effects of oral nutritional supplements in patients with maintenance dialysis therapy: A systematic review and meta-analysis of randomized clinical trials. AU - Liu,Peng Ju, AU - Ma,Fang, AU - Wang,Qi Yan, AU - He,Shu Li, Y1 - 2018/09/13/ PY - 2018/07/09/received PY - 2018/08/25/accepted PY - 2018/9/14/entrez PY - 2018/9/14/pubmed PY - 2019/2/28/medline SP - e0203706 EP - e0203706 JF - PloS one JO - PLoS ONE VL - 13 IS - 9 N2 - BACKGROUND/OBJECTIVE: This systematic review aims to determine the potential effects of oral nutritional supplements (ONS) in patients receiving maintenance dialysis therapy (MDT). METHODS: Electronic 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. RESULTS: 15 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. CONCLUSIONS: Very 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. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/30212514/The_effects_of_oral_nutritional_supplements_in_patients_with_maintenance_dialysis_therapy:_A_systematic_review_and_meta_analysis_of_randomized_clinical_trials_ L2 - http://dx.plos.org/10.1371/journal.pone.0203706 DB - PRIME DP - Unbound Medicine ER -