Nutritional status in nocturnal hemodialysis patients: a systematic review with meta-analysis

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

Research output: Contribution to journalReview articleAcademicpeer-review

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<0.001); nPCR (MD 0.16 g/kg/day; 95% CI 0.04-0.29, p = 0.01); protein intake (MD 18.9 g, 95% CI 9.7-28.2, p<0.001); and energy intake (MD 183.2 kcal, 95% CI 16.8-349.7, p = 0.03). Homogeneity was rejected only for nPCR (baseline versus 4-6 months). DBW, BMI, and phase angle did not significantly change. Similar results were obtained for comparison between baseline and 8-12 months of NHD treatment.

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
JournalPLOS one
Volume11
Issue number6
DOIs
Publication statusPublished - 2016

Keywords

  • malnutrition

Cite this

Ipema, K., Struijk, S., van der Velden, A., Westerhuis, R., van der Schans, C., Gaillard, C. A. J. M., ... Franssen, C. F. M. (2016). Nutritional status in nocturnal hemodialysis patients: a systematic review with meta-analysis. PLOS one, 11(6). https://doi.org/10.1371/journal.pone.0157621
Ipema, Karin ; Struijk, Simone ; van der Velden, Annet ; Westerhuis, Ralf ; van der Schans, Cees ; Gaillard, Carlo A J M ; Krijnen, Wim ; Franssen, Casper F M. / Nutritional status in nocturnal hemodialysis patients : a systematic review with meta-analysis. In: PLOS one. 2016 ; Vol. 11, No. 6.
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title = "Nutritional status in nocturnal hemodialysis patients: a systematic review with meta-analysis",
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<0.001); nPCR (MD 0.16 g/kg/day; 95{\%} CI 0.04-0.29, p = 0.01); protein intake (MD 18.9 g, 95{\%} CI 9.7-28.2, p<0.001); and energy intake (MD 183.2 kcal, 95{\%} CI 16.8-349.7, p = 0.03). Homogeneity was rejected only for nPCR (baseline versus 4-6 months). DBW, BMI, and phase angle did not significantly change. Similar results were obtained for comparison between baseline and 8-12 months of NHD treatment.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.",
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author = "Karin Ipema and Simone Struijk and {van der Velden}, Annet and Ralf Westerhuis and {van der Schans}, Cees and Gaillard, {Carlo A J M} and Wim Krijnen and Franssen, {Casper F M}",
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Nutritional status in nocturnal hemodialysis patients : a systematic review with meta-analysis. / Ipema, Karin; Struijk, Simone; van der Velden, Annet; Westerhuis, Ralf; van der Schans, Cees; Gaillard, Carlo A J M; Krijnen, Wim; Franssen, Casper F M.

In: PLOS one, Vol. 11, No. 6, 2016.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - Nutritional status in nocturnal hemodialysis patients

T2 - a systematic review with meta-analysis

AU - Ipema, Karin

AU - Struijk, Simone

AU - van der Velden, Annet

AU - Westerhuis, Ralf

AU - van der Schans, Cees

AU - Gaillard, Carlo A J M

AU - Krijnen, Wim

AU - Franssen, Casper F M

PY - 2016

Y1 - 2016

N2 - 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<0.001); nPCR (MD 0.16 g/kg/day; 95% CI 0.04-0.29, p = 0.01); protein intake (MD 18.9 g, 95% CI 9.7-28.2, p<0.001); and energy intake (MD 183.2 kcal, 95% CI 16.8-349.7, p = 0.03). Homogeneity was rejected only for nPCR (baseline versus 4-6 months). DBW, BMI, and phase angle did not significantly change. Similar results were obtained for comparison between baseline and 8-12 months of NHD treatment.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.

AB - 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<0.001); nPCR (MD 0.16 g/kg/day; 95% CI 0.04-0.29, p = 0.01); protein intake (MD 18.9 g, 95% CI 9.7-28.2, p<0.001); and energy intake (MD 183.2 kcal, 95% CI 16.8-349.7, p = 0.03). Homogeneity was rejected only for nPCR (baseline versus 4-6 months). DBW, BMI, and phase angle did not significantly change. Similar results were obtained for comparison between baseline and 8-12 months of NHD treatment.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.

KW - malnutrition

KW - ondervoeding

UR - http://www.mendeley.com/research/nutritional-status-nocturnal-hemodialysis-patients-systematic-review-metaanalysis-1

U2 - 10.1371/journal.pone.0157621

DO - 10.1371/journal.pone.0157621

M3 - Review article

VL - 11

JO - PLOS one

JF - PLOS one

SN - 1932-6203

IS - 6

ER -