Nutritional Status in Nocturnal Hemodialysis Patients - A Systematic Review with Meta-Analysis.
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.


METHODS
Systematic review with meta-analysis.


METHODS
NHD patients.


METHODS
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.


METHODS
Transition from CHD to NHD.


RESULTS
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.


CONCLUSIONS
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.
Dialysis Center Groningen, Groningen, The Netherlands.|Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University Groningen, University of Applied Sciences, Groningen, the Netherlands.
Karin J R
KJ
Ipema
Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University Groningen, University of Applied Sciences, Groningen, the Netherlands.
Simone
S
Struijk
Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University Groningen, University of Applied Sciences, Groningen, the Netherlands.
Annet
A
van der Velden
Dialysis Center Groningen, Groningen, The Netherlands.|Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Ralf
R
Westerhuis
Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University Groningen, University of Applied Sciences, Groningen, the Netherlands.|Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Cees P
CP
van der Schans
Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Carlo A J M
CA
Gaillard
Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University Groningen, University of Applied Sciences, Groningen, the Netherlands.
Wim P
WP
Krijnen
Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Casper F M
CF
Franssen
D000328:Adult; D000418:Albumins / Q000378:metabolism; D001823:Body Composition; D015992:Body Mass Index; D001835:Body Weight; D016022:Case-Control Studies; D002940:Circadian Rhythm; D002149:Energy Intake; D005260:Female; D005502:Food; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D006435:Renal Dialysis
D000418:Albumins