The effect of extended hemodialysis on nutritional parameters: a systematic review

Abstract

Objective: This systematic review provides an up-to-date synthesis on the effects of extended hemodialysis on nutritional outcomes.

Design and methods: Ten databases were searched. Inclusion criteria were: randomised and non-randomised studies of extended hemodialysis (defined by > 15 h/week) with a comparator group which received conventional in-centre hemodialysis (usually ≤ 12 h per week). Outcomes of interest included lean body mass, protein and carbohydrate intake, body mass index, dry lean mass, water-soluble vitamin levels, serum levels of appetite hormones, and nutritional status as assessed by the PEW and SGA scoring tools.

Results: Five studies were eligible. All investigated extended nocturnal hemodialysis (one with the addition of short daily), three were in-centre and two were at home. Range of duration for the included studies was 2-18 months. These studies reported data on lean body mass, protein and carbohydrate intake, body mass index, dry lean mass and water-soluble vitamin levels. There was insufficient homogeneity between the studies to meta-analyse the data. Extended hemodialysis had no significant effects on any of the reported outcomes except for lean body mass, where a significant increase was found, and water-soluble vitamin levels, where deficiency was identified in one of the included studies.

Conclusion: There is currently no evidence to suggest that extended hemodialysis modalities impact nutritional parameters, although the quality of the available evidence is low.

Keywords: Body mass index; Dialysis; Extended haemodialysis; Nutrition; Systematic review.

Fig. 1

PRISMA flow diagram summarising search results

Fig. 2

Risk of bias assessments for non-randomised trials using ROBINS-I tool

Fig. 3

Risk of bias assessment for the included randomised control trial using ROB-2 tool