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

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.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Flow diagram of study selection…
Fig 1. Flow diagram of study selection process.
Fig 2. Forest plots depicting the effect…
Fig 2. Forest plots depicting the effect of ONS on serum albumin level.
Fig 3. Forest plots depicting the effect…
Fig 3. Forest plots depicting the effect of ONS on body mass index.
Fig 4. Forest plots depicting the effect…
Fig 4. Forest plots depicting the effect of ONS on serum phosphorus.
Fig 5. Forest plots depicting the effect…
Fig 5. Forest plots depicting the effect of ONS on serum potassium.
Fig 6. Funnel plots of studies included…
Fig 6. Funnel plots of studies included in meta-analysis on the effects of ONS on serum albumin level.

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