Nutritional status improvement in elderly CKD patients: a systematic review



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.


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).


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.


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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  1. 1.

    Hood W (2018) Nutritional status assessment in adults laboratory medicine [cited 23 November 2018].

  2. 2.

    Zheng X (2018) Progress in research of nutrition and life expectancy [cited 23 November 2018].

  3. 3.

    Hyun Y, Lee K, Han S, Kim Y, Kim Y, Lee S et al (2017) Nutritional status in adults with predialysis chronic kidney disease: KNOW-CKD Study. J Korean Med Sci 32(2):257

    Article  Google Scholar 

  4. 4.

    Piccoli G, Capizzi I, Vigotti F, Leone F, D’Alessandro C, Giuffrida D et al (2016) Low protein diets in patients with chronic kidney disease: a bridge between mainstream and complementary-alternative medicines? BMC Nephrol 17(1):76

    Article  Google Scholar 

  5. 5.

    Rhee C, Ahmadi S, Kovesdy C, Kalantar-Zadeh K (2017) Low-protein diet for conservative management of chronic kidney disease: a systematic review and meta-analysis of controlled trials. J Cachexia Sarcopenia Muscle 9(2):235–245

    Article  Google Scholar 

  6. 6.

    NICE (2018) Chronic kidney disease in adults: assessment and management ‘guidance and guidelines’ NICE [Internet]. [cited 23 November 2018].

  7. 7.

    Campitelli M, Bronskill S, Hogan D, Diong C, Amuah J, Gill S et al (2016) The prevalence and health consequences of frailty in a population-based older home care cohort: a comparison of different measures. BMC Geriatr 16(1):133

    Article  Google Scholar 

  8. 8.

    Nixon A, Bampouras T, Pendleton N, Woywodt A, Mitra S, Dhaygude A (2017) Frailty and chronic kidney disease: current evidence and continuing uncertainties. Clin Kidney J 11(2):236–245

    Article  Google Scholar 

  9. 9.

    Garcia-Canton C, Rodenas A, Lopez-Aperador C et al (2019) Frailty in hemodialysis and prediction of poor short-term outcome: mortality, hospitalization and visits to hospital emergency services. Ren Fail 41(1):567–575.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Ballew S, Chen Y, Daya N, Godino J, Windham B, McAdams-DeMarco M et al (2017) Frailty, kidney function, and polypharmacy: the atherosclerosis risk in communities (ARIC) study. Am J Kidney Dis 69(2):228–236

    Article  Google Scholar 

  11. 11.

    Bolasco P, Caria S, Cupisti A, Secci R, SaverioDioguardi F (2011) A novel amino acids oral supplementation in hemodialysis patients: a pilot study. Ren Fail 33(1):1–5

    CAS  Article  Google Scholar 

  12. 12.

    Caglar K, Fedje L, Dimmitt R, Hakim R, Shyr Y, Ikizler T (2002) Therapeutic effects of oral nutritional supplementation during hemodialysis. Kidney Int 62(3):1054–1059

    CAS  Article  Google Scholar 

  13. 13.

    Czekalski S, Hożejowski R (2004) Intradialytic amino acids supplementation in hemodialysis patients with malnutrition: results of a multicenter cohort study. J Ren Nutr 14(2):82–88

    Article  Google Scholar 

  14. 14.

    Eiam-Ong S, Buranaosot S, Eiam-Ong S, Wathanavaha A, Pansin P (2007) Nutritional effect of nandrolone decanoate in predialysis patients with chronic kidney disease. J Ren Nutr 17(3):173–178

    Article  Google Scholar 

  15. 15.

    Ewers B, Riserus U, Marckmann P (2009) Effects of unsaturated fat dietary supplements on blood lipids, and on markers of malnutrition and inflammation in hemodialysis patients. J Ren Nutr 19(5):401–411

    CAS  Article  Google Scholar 

  16. 16.

    Garibotto G, Barreca A, Russo R, Sofia A, Araghi P, Cesarone A, Malaspina M, Fiorini F, Minuto F, Tizianello A (1997) Effects of recombinant human growth hormone on muscle protein turnover in malnourished hemodialysis patients. J Clin Invest 99(1):97–105

    CAS  Article  Google Scholar 

  17. 17.

    Hiroshige K (1998) Prolonged use of intradialysis parenteral nutrition in elderly malnourished chronic haemodialysis patients. Nephrol Dial Transplant 13(8):2081–2087

    CAS  Article  Google Scholar 

  18. 18.

    Hiroshige K, Sonta T, Suda T, Kanegae K, Ohtani A (2001) Oral supplementation of branched-chain amino acid improves nutritional status in elderly patients on chronic haemodialysis. Nephrol Dial Transplant 16(9):1856–1862

    CAS  Article  Google Scholar 

  19. 19.

    Hung S, Tung T, Yang C, Tarng D (2005) High-calorie supplementation increases serum leptin levels and improves response to rHuEPO in long-term hemodialysis patients. Am J Kidney Dis 45(6):1073–1083

    CAS  Article  Google Scholar 

  20. 20.

    Iglesias P, Diez J, Fernandez-Reyes M, Aguilera A, Burgues S, Martinez-Ara J, Miguel J, Gomez-Pan A, Selgas R (1998) Recombinant human growth hormone therapy in malnourished dialysis patients: a randomized controlled study. Am J Kidney Dis 32(3):454–463

    CAS  Article  Google Scholar 

  21. 21.

    Kalantar-Zadeh K, Braglia A, Chow J, Kwon O, Kuwae N, Colman S, Cockram D, Kopple J (2005) An anti-inflammatory and antioxidant nutritional supplement for hypoalbuminemic hemodialysis patients: a pilot/feasibility study. J Ren Nutr 15(3):318–331

    Article  Google Scholar 

  22. 22.

    Liu Y, Xiao X, Qin D, Tan R, Zhong X, Zhou D, Liu Y, Xiong X, Zheng Y (2016) Comparison of intradialytic parenteral nutrition with glucose or amino acid mixtures in maintenance hemodialysis patients. Nutrients 8(6):220

    Article  Google Scholar 

  23. 23.

    Małgorzewicz S, Rutkowski P, Jankowska M, Dębska- Ślizień A, Rutkowski B, Łysiak-Szydłowska W (2011) Effects of renal-specific oral supplementation in malnourished hemodialysis patients. J Ren Nutr 21(4):347–353

    Article  Google Scholar 

  24. 24.

    Mortelmans A, Duym P, Vandenbroucke J, De Smet R, Dhondt A, Lesaffer G, Verwimp H, Vanholder R (1999) Intradialytic parenteral nutrition in malnourished hemodialysis patients: a prospective long-term study. J Parenter Enteral Nutr 23(2):90–95

    CAS  Article  Google Scholar 

  25. 25.

    Slinin Y, Guo H, Gilbertson D, Mau L, Ensrud K, Collins A, Ishani A (2011) Prehemodialysis care by dietitians and first-year mortality after initiation of hemodialysis. Am J Kidney Dis 58(4):583–590

    Article  Google Scholar 

  26. 26.

    Steiber A, Handu D, Cataline D, Deighton T, Weatherspoon L (2003) The impact of nutrition intervention on a reliable morbidity and mortality indicator: the hemodialysis-prognostic nutrition index. J Ren Nutr 13(3):186–190

    Article  Google Scholar 

  27. 27.

    Szeto C (2003) Oral sodium bicarbonate for the treatment of metabolic acidosis in peritoneal dialysis patients: a randomized placebo-control trial. J Am SocNephrol 14(8):2119–2126

    CAS  Google Scholar 

  28. 28.

    Verove C, Maisonneuve N, El Azouzi A, Boldron A, Azar R (2002) Effect of the correction of metabolic acidosis on nutritional status in elderly patients with chronic renal failure. J Ren Nutr 12(4):224–228

    Article  Google Scholar 

  29. 29.

    Wu H, Sung J, Kao M, Wang M, Tseng C, Chen S (2013) Nonprotein calorie supplement improves adherence to low-protein diet and exerts beneficial responses on renal function in chronic kidney disease. J Ren Nutr 23(4):271–276

    CAS  Article  Google Scholar 

  30. 30.

    National Kidney Foundation (2018) Nutrition in CKD, National Kidney Foundation [cited 27 November 2018].

  31. 31.

    Stang A (2010) Critical evaluation of the Newcastle–Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605

    Article  Google Scholar 

  32. 32.

    Higgins JPT, Green S (eds) (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration

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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).

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