Nutritional Status in Nocturnal Hemodialysis Patients: A Systematic Review with Meta-Analysis

Karin J. R. Ipema*, Simone Struijk, Annet van der Velden, Ralf Westerhuis, Cees P. van der Schans, Carlo A. J. M. Gaillard, Wim P. Krijnen, Casper F. M. Franssen

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

11 Citations (Scopus)
305 Downloads (Pure)

Abstract

Background

Hemodialysis patients experience an elevated risk of malnutrition associated with increased morbidity and mortality. Nocturnal hemodialysis (NHD) results in more effective removal of waste products and fluids. Therefore, diet and fluid restrictions are less restricted in NHD patients. However, it is ambiguous whether transition from conventional hemodialysis (CHD) to NHD leads to improved intake and nutritional status. We studied the effect of NHD on protein intake, laboratory indices of nutritional status, and body composition.

Study design

Systematic review with meta-analysis.

Population

NHD patients.

Search strategy

Systematic literature search from databases, Medline, Cinahl, EMBASE and The Cochrane Library, to identify studies reporting on nutritional status post-transition from CHD to NHD.

Intervention

Transition from CHD to NHD.

Outcomes

Albumin, normalized protein catabolic rate (nPCR), dry body weight (DBW), body mass index (BMI), phase angle, protein intake, and energy intake.

Results

Systematic literature search revealed 13 studies comprising 282 patients that made the transition from CHD to NHD. Meta-analysis included nine studies in 229 patients. In control group controlled studies (n = 4), serum albumin increased significantly from baseline to 4-6 months in NHD patients compared with patients that remained on CHD (mean difference 1.3 g/l, 95% CI 0.02; 2.58, p = 0.05). In baseline controlled studies, from baseline to 4-6 months of NHD treatment, significant increases were ascertained in serum albumin (mean difference (MD) 1.63 g/l, 95% CI 0.73-2.53, p

Limitations

Most studies had moderate sample sizes; some had incomplete dietary records and relatively brief follow-up period. Studies markedly differed with regard to study design.

Conclusions

NHD is associated with significantly higher protein and energy intake as well as increases in serum albumin and nPCR. However, the data on body composition are inconclusive.

Original languageEnglish
Article numbere0157621
Number of pages19
JournalPLoS ONE
Volume11
Issue number6
DOIs
Publication statusPublished - 20-Jun-2016

Keywords

  • QUALITY-OF-LIFE
  • IN-CENTER CONVERSION
  • STAGE RENAL-DISEASE
  • BODY-MASS INDEX
  • HOME HEMODIALYSIS
  • FREQUENT HEMODIALYSIS
  • CONVENTIONAL HEMODIALYSIS
  • PHYSICAL FUNCTION
  • PROTEIN-INTAKE
  • 3 TIMES

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