title: Multinutrient oral supplements and tube feeding in maintenance dialysis: a systematic review and meta-analysis.
abstract: BACKGROUND
  This systematic review aims to determine the potential benefits of enteral multinutrient support (oral or tube) in patients with chronic kidney disease (CKD) receiving maintenance dialysis.
  
  
  METHODS
  Studies of multinutrient oral supplements and enteral tube feeding that involved comparisons of nutritional support versus routine care (ie, usual diet), disease-specific formulae (with adapted macronutrient and micronutrient composition for use in maintenance dialysis patients) versus standard formulae, and enteral tube feeding versus parenteral nutrition are included in this review. The outcome measures sought were clinical (quality of life, complications, and mortality), biochemical (albumin and electrolyte levels), and nutritional (dietary intake and anthropometry). Meta-analyses were performed when possible.
  
  
  RESULTS
  This review of 18 studies (5 randomized controlled trials [RCTs], 13 non-RCTs) suggests that enteral nutritional support increased total (energy and protein) intake and increased serum albumin concentration by 0.23 g/dL (2.3 g/L; 95% confidence interval, 0.037 to 0.418 g/dL [0.37 to 4.18 g/L]; 1 RCT, 2 non-RCTs), with little effect on electrolyte status (serum phosphate and potassium). Few studies reported clinical outcome, and there was insufficient information to compare disease-specific versus standard formulae or enteral versus parenteral nutrition.
  
  
  CONCLUSIONS
  This systematic review suggests that enteral multinutrient support significantly increases serum albumin concentrations and improves total dietary intake. This may improve clinical outcome, especially in malnourished patients, but insufficient published data exist to examine this. Additional research is required to investigate clinical, economic, and nutritional consequences of using oral supplements and tube feeding (using standard or disease-specific feeds) in patients with CKD receiving maintenance dialysis.
authors.affiliation: Institute of Human Nutrition, University of Southampton, UK. r.j.stratton@soton.ac.uk
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Stratton
authors.forename: Gemma
authors.initials: G
authors.lastname: Bircher
authors.forename: Denis
authors.initials: D
authors.lastname: Fouque
authors.forename: Peter
authors.initials: P
authors.lastname: Stenvinkel
authors.forename: Renée
authors.initials: R
authors.lastname: de Mutsert
authors.forename: Meike
authors.initials: M
authors.lastname: Engfer
authors.forename: Marinos
authors.initials: M
authors.lastname: Elia
mesh_terms: D000328:Adult; D000368:Aged; D001835:Body Weight; D019587:Dietary Supplements; D004750:Enteral Nutrition; D005260:Female; D005526:Food, Formulated; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D008297:Male; D044342:Malnutrition / Q000178:diet therapy / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D018529:Nutritional Support; D010288:Parenteral Nutrition; D010530:Peritoneal Dialysis / Q000009:adverse effects; D010710:Phosphates / Q000097:blood; D011188:Potassium / Q000097:blood; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis / Q000009:adverse effects; D012107:Research Design; D012709:Serum Albumin / Q000032:analysis; D016896:Treatment Outcome
chemical_list: D010710:Phosphates; D012709:Serum Albumin; D011188:Potassium