Adelina Mihaescu1,2, Emmad Masood3, Mohammed Zafran3, Hassan Tahir Khokhar3, Arlyn Maria Augustine3, Aucella Filippo4, Wim Van Biesen5, Ken Farrigton6, Juan Jesus Carrero7, Adrian Covic8,9, Ionut Nistor10,11,12,13. 1. V Babes" University of Medicine and Pharmacy, Timișoara, Romania. 2. Nephrology Department, "P Brinzeu" Emergency County Hospital, Timișoara, Romania. 3. Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iași, Romania. 4. Scientific Institute for Research and Health Care, "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy. 5. Department of Internal Medicine - Nephrology, Ghent University, Ghent, Belgium. 6. East and North Hertfordshire NHS Trust, Lister Hospital, Stevenage, England. 7. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 8. University of Medicine and Pharmacy "Grigore T. Popa", Iași, Romania. 9. Nephrology Department, "Dr. C.I. Parhon Hospital", Iasi, Romania. 10. Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iași, Romania. ionut.nistor@umfiasi.ro. 11. University of Medicine and Pharmacy "Grigore T. Popa", Iași, Romania. ionut.nistor@umfiasi.ro. 12. Nephrology Department, "Dr. C.I. Parhon Hospital", Iasi, Romania. ionut.nistor@umfiasi.ro. 13. Methodological Center for Medical Research and Evidence-Based Medicine, University of Medicine and Pharmacy "Gr. T. Popa", Iași, Romania. ionut.nistor@umfiasi.ro.
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.
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.