Nutritional status improvement in elderly CKD patients: a systematic review

Abstract

Purpose

Almost all CKD patients have a poor nutritional status, while elderly CKD patients are specifically frail and malnourished. Our aim is to conduct a systematic review of the up to date primary studies that look at methods of improving nutritional status in CKD patients in the elderly demographic.

Methods

A focussed and sensitive search strategy was applied to the PUBMED database to identify relevant English language articles. Once articles were identified a detailed quality and bias assessment was performed. Two independent researchers (MZ and SM) then subsequently carried out detailed data extraction and analysis and this was subsequently verified by a third researcher (IN).

Results

A total of 19 studies were included in our systematic review which included 7 non-randomised control trials and 15 randomised controlled trials. The outcomes that we considered to be most relevant for our subject title were: mortality data, SGA, albumin, total protein, isoleucine, leucine, prealbumin, transferrin, leptin, valine, TAG, HDL, LDL and total amino acids. Detailed bias analysis of the different studies was also conducted.

Conclusion

This is the first systematic review of the literature, so far, on the subject, involving elderly CKD patients. The quality of trials is low, very heterogenic in patients, methods and outcomes. However, we found a positive effect of dietary interventions on the nutritional status of most patients studied, highlighted by improvement in serum albumin and SGA, the most measured outcomes.

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Correspondence to Ionut Nistor.

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Adelina Mihaescu and Emmad Masood have contributed equally to the article.

Appendix: Flow diagram of the search strategy for the articles

Appendix: Flow diagram of the search strategy for the articles

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Mihaescu, A., Masood, E., Zafran, M. et al. Nutritional status improvement in elderly CKD patients: a systematic review. Int Urol Nephrol (2021). https://doi.org/10.1007/s11255-020-02775-6

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Keywords

  • Elderly patients
  • Chronic kidney disease
  • Nutritional status
  • Malnutrition
  • Frailty
  • Serum albumin
  • SGA