Influencing Factors for Malnutrition in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis

Zhu Shengrui, Dariah Mohd Yusoff, Kueh Yee Cheng, Hafzan Yusoff, Chen Hongfang, Tang Wenzhen

Abstract

This study reviewed the evidence on influencing factors for malnutrition in Chronic Kidney Disease (CKD) patients. A systematic search of PubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data Knowledge Service Platform for English and Chinese language observational studies published from 1966 to 2022 was conducted. RevMan 5.4.1 software was used for statistical analysis. A total of 13 observational studies with 7,790 study participants were included in the systematic review and meta-analysis. Seven risk factors and two protective factors related to malnutrition were identified. Age (OR=1.29; 95% CI:1.03–1.61), required feeding assistance (OR=3.33: 95% CI:2.55–4.35), living status (with family) (OR=0.49; 95% CI:0.34–0.71), protein intake (OR=0.89; 95% CI:0.85–0.94), comorbidities (OR=1.78; 95% CI:1.03–3.07), long dialysis duration (OR=1.61; 95% CI:1.16–2.24), inadequate dialysis (OR=1.25; 95% CI:1.12–1.40), hemoglobin level (OR=1.84; 95% CI:0.92–3.66), and depression (OR=3.44; 95% CI:2.21–5.34) were associated with an increased influence of malnutrition among CKD patients. This review provides comprehensive evidence of potential influencing factors of malnutrition among CKD patients

References

Bataille S, Landrie JF, Astier J, Cado S, Sallette J, Giaime P, Sampol J, Sichez H, Ollier J, Gugliotta J, Serveaux M, Cohen, J, & Darmon, P. 2017.
Hemodialysis patients with diabetes eat less than those without: a plea for a permissive diet. Nephrology (Carlton), 22(9), 712-719.
https://doi:10.1002/NEP.12837
Becker PJ, Nieman Carney L, Corkins MR, Monczka J, Smith E, Smith SE, White JV. 2014. Consensus statement of the Academy of Nutrition and
Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of
pediatric malnutrition (undernutrition). J Acad Nutr Diet, 114(12), 1988-2000. https://doi:10.1016/j.jand.2014.08.026
Bikbov B, Purcell CA, Levey AS, Smith M, Abdoli A, Abebe M, Vos T. 2020. Global, regional, and national burden of chronic kidney disease, 1990–
2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 395(10225), 709-733. https://doi:10.1016/s0140-
6736(20)30045-3
Boaz M, Azoulay O, Kaufman-Shriqui V, & Weinstein T. 2021. Status of Nutrition In Hemodialysis Patients Survey (SNIPS): Malnutrition risk by
diabetes status. Diabet Med, 38(6), e14543. https://doi:10.1111/dme.14543
Boaz M, Azoulay O, Schwart IF, Schwartz D, Assady S, Kristal B, Weinstein T. 2019. Malnutrition Risk in Hemodialysis Patients in Israel: Results of
the Status of Nutrition In Hemodialysis Patients Survey Study. Nephron, 141(3), 166-176. https://doi:10.1159/000495150
Burrowe JD, Larive B, Cockram DB, Dwyer J, Kusek JW, McLeroy S, Rocco MV. 2003. Effects of dietary intake, appetite, and eating habits on
dialysis and non-dialysis treatment days in hemodialysis patients: cross-sectional results From the HEMO study. Journal of Renal
Nutrition, 13(3), 191-198. https://doi:10.1016/s1051-2276(03)00069-4
Carrero JJ, Thomas F, Nagy K, Arogundade F, Avesani CM, Chan M, Kovesdy CP. 2018. Global Prevalence of Protein-Energy Wasting in Kidney
Disease: A Meta-analysis of Contemporary Observational Studies From the International Society of Renal Nutrition and Metabolism. J
Ren Nutr, 28(6), 380-392. https://doi:10.1053/j.jrn.2018.08.006
Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, Singer P. 2017. ESPEN guidelines on definitions and terminology of clinical
nutrition. Clin Nutr, 36(1), 49-64. https://doi:10.1016/j.clnu.2016.09.004
Czira ME, Lindner AV, Szeifert L, Molnar MZ, Fornadi K, Kelemen A, Novak M. 2011. Association between the Malnutrition-Inflammation Score
and depressive symptoms in kidney transplanted patients. Gen Hosp Psychiatry, 33(2), 157-165.
https://doi:10.1016/j.genhosppsych.2011.01.012
Dahl H, Warz SI, Welland NL, Arnesen I, Marti HP, Dierkes J. 2022. Factors associated with nutritional risk in patients receiving haemodialysis
assessed by Nutritional Risk Screening 2002 (NRS2002). J Ren Care, 48(2), 112-118. https://doi:10.1111/jorc.12374
Efe D, Kocaoz S. 2015. Adherence to diet and fluid restriction of individuals on hemodialysis treatment and affecting factors in Turkey. Jpn J
Nurs Sci, 12(2), 113-123. https://doi:10.1111/jjns.12055
Fouque D, Vennegoor M, Ter Wee P, Wanner C, Basci A, Canaud B, Vanholder R. 2007. EBPG Guideline on Nutrition. Nephrology Dialysis
Transplantation, 22(Supplement 2), ii45-ii87. https://doi:10.1093/ndt/gfm020
Gebrie MH, Ford J. 2019. Depressive symptoms and dietary non-adherence among end stage renal disease patients undergoing hemodialysis
therapy: systematic review. BMC Nephrol, 20(1), 429. https://doi:10.1186/s12882-019-1622-5
Gerogianni G, Babatsikou F, Polikandrioti M, Grapsa E. 2019. Management of anxiety and depression in haemodialysis patients: the role of
non-pharmacological methods. Int Urol Nephrol, 51(1), 113-118. https://doi:10.1007/s11255-018-2022-7
Guligowska A, Corsonello A, Pigłowska M, Roller-Wirnsberger R, Wirnsberger G, Ärnlöv J, Kostka T. 2020. Association between kidney function,
nutritional status and anthropometric measures in older people : The Screening for CKD among Older People across Europe (SCOPE)
study. BMC Geriatr, 20(Suppl 1), 366. https://doi:10.1186/s12877-020-01699-1
Hahn D, Hodson EM, Fouque D. 2020. Low protein diets for non-diabetic adults with chronic kidney disease. Cochrane Database Syst Rev, 10,
CD001892. https://doi:10.1002/14651858.CD001892.pub5
Hanafusa N, Tsuchiya K, Nitta K. 2019. Malnutrition-Wasting Conditions in Older Dialysis Patients: An Individualized Approach. Contrib Nephrol,
198, 12-20. https://doi:10.1159/000496304
Hara H, Nakamura Y, Hatano M, Iwashita T, Shimizu T, Ogawa T, Hasegawa H. 2018. Protein Energy Wasting and Sarcopenia in Dialysis
Patients. Contrib Nephrol, 196, 243-249. https://doi:10.1159/000485729
Hill N R, Fatoba ST, Oke JL, Hirst JA, O'Callaghan CA, Lasserson DS, Hobbs FD. 2016. Global Prevalence of Chronic Kidney Disease - A Systematic
Review and Meta-Analysis. PLoS One, 11(7), e0158765. https://doi:10.1371/journal.pone.0158765
Hwang JY, Cho JH, Lee YJ, Jang SP, Kim WY. 2009. Family history of chronic renal failure is associated with malnutrition in Korean hemodialysis
patients. Nutr Res Pract, 3(3), 247-252. https://doi:10.4162/nrp.2009.3.3.247
Hyun YY, Lee KB, Han SH, Kim YH, Kim YS, Lee SW, et al. Nutritional Status in Adults with Predialysis Chronic Kidney Disease: KNOW-CKD Study.
2017. J Korean Med Sci. 32(2):257-63. https://doi.org/10.3346/jkms.2017.32.2.257
Iorember FM. 2018. Malnutrition in Chronic Kidney Disease. Front Pediatr, 6, 161. https://doi:10.3389/fped.2018.00161
Jankowska M, Rutkowski B, Debska-Slizien A. 2017. Vitamins and Microelement Bioavailability in Different Stages of Chronic Kidney Disease.
Nutrients, 9(3). https://doi:10.3390/nu9030282
Kalantar-Zadeh K, McAllister CJ, Lehn RS, Lee GH, Nissenson AR, Kopple JD. 2003. Effect of malnutrition-inflammation complex syndrome on
EPO hyporesponsiveness in maintenance hemodialysis patients. Am J Kidney Dis, 42(4), 761-773. https://doi:10.1016/s0272-
6386(03)00915-6
Kiajamali M, Hosseini M, Estebsari F, Nasiri M, Ashktorab T, Abdi A, Salimi Akin Abadi A. 2017. Correlation between social support, self-efficacy
and health-promoting behavior in hemodialysis patients hospitalized in Karaj in 2015. Electronic Physician, 9(7), 4820-4827.
https://doi:10.19082/4820
Kiuchi A, Ohashi Y, Tai R, Aoki T, Mizuiri S, Ogura T, Sakai K. 2016. Association between Low Dietary Protein Intake and Geriatric Nutrition Risk
Index in Patients with Chronic Kidney Disease: A Retrospective Single-Center Cohort Study. Nutrients, 8(10).
https://doi:10.3390/nu8100662
Li ZY, Zheng X, Lou XP, Ding R, Zhang XX, Ma S, Zhao ZZ. 2018. Nutrition status and its influencing factors of patients undergoing peritoneal
dialysis in rural area. Chinese Journal of Modern Nursing, 24(10), 1180-1183. https://doi:10.3760/cma.j.issn.1674-2907.2018.10.012
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Moher D. 2009. The PRISMA statement for reporting systematic reviews
and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol, 62(10), e1-34.
https://doi:10.1016/j.jclinepi.2009.06.006
Lynch KE, Lynch R, Curhan GC, Brunelli SM. 2013. Altered taste perception and nutritional status among hemodialysis patients. J Ren Nutr,
23(4), 288-295 e281. https://doi:10.1053/j.jrn.2012.08.009
Mills KT, Xu Y, Zhang W, Bundy JD, Chen CS, Kelly TN, He J. 2015. A systematic analysis of worldwide population-based data on the global
burden of chronic kidney disease in 2010. Kidney Int, 88(5), 950-957. https://doi:10.1038/ki.2015.230
Moraes, C, Marinho S, Lobo JC, Stockler-Pinto MB, Barros AF, Jacobson LV, Denise M. (2015). Effects of resistance exercise training on acyl-
ghrelin and obestatin levels in hemodialysis patients. Ren Fail, 37(5), 851-857. https://doi:10.3109/0886022X.2015.1033634
Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C. 2015. Methodological guidance for systematic reviews of observational epidemiological studies
reporting prevalence and cumulative incidence data. Int J Evid Based Healthc, 13(3), 147-153.
https://doi:10.1097/XEB.0000000000000054
Namuyimbwa L, Atuheire C, Okullo J, Kalyesubula R. 2018. Prevalence and associated factors of protein- energy wasting among patients with
chronic kidney disease at Mulago hospital, Kampala-Uganda: a cross-sectional study. BMC Nephrol, 19(1), 139.
https://doi:10.1186/s12882-018-0920-7
Noce A, Vidiri MF, Marrone G, Moriconi E, Bocedi A, Capria A, Di Daniele N. 2016. Is low-protein diet a possible risk factor of malnutrition in
chronic kidney disease patients? Cell Death Discov, 2, 16026. https://doi:10.1038/cddiscovery.2016.26
Omari AM, Omari LS, Dagash HH, Sweileh WM, Natour N, Zyoud SH. 2019. Assessment of nutritional status in the maintenance of
haemodialysis patients: a cross-sectional study from Palestine. BMC Nephrol, 20(1), 92. https://doi:10.1186/s12882-019-1288-z
Pérez-Torres A, González Garcia ME, San José-Valiente B, Bajo Rubio MA, Celadilla Diez O, López-Sobaler AM, Selgas R. 2018. Protein-energy
wasting syndrome in advanced chronic kidney disease: Prevalence and specific clinical characteristics. Nefrología (English Edition),
38(2), 141-151. https://doi:10.1016/j.nefroe.2017.11.018
Rimbawan R, Nasution Z, Giriwono PE, Tamimi K, Fadly K, Noviana A. 2022. Effect of Locally Produced Ready-to-Use Therapeutic Food on
Children under Five Years with Severe Acute Malnutrition: A Systematic Review. Jurnal Gizi dan Pangan, 17(2), 123-138.
https://doi.org/10.25182/jgp.2022.17.2.123-138
Rhee JJ, Ding VY, Rehkopf DH, Arce CM, Winkelmayer WC. 2015. Correlates of poor glycemic control among patients with diabetes initiating
hemodialysis for end-stage renal disease. BMC Nephrol, 16, 204. https://doi:10.1186/s12882-015-0204-4
Sahathevan S, Khor BH, Ng HM, Gafor AHA, Mat Daud ZA, Mafra D, Karupaiah T. 2020. Understanding Development of Malnutrition in
Hemodialysis Patients: A Narrative Review. Nutrients, 12(10). https://doi:10.3390/nu12103147
Salame C, Eaton S, Grimble G, Davenport A. 2018. Protein Losses and Urea Nitrogen Underestimate Total Nitrogen Losses in Peritoneal Dialysis
and Hemodialysis Patients. J Ren Nutr, 28(5), 317-323. https://doi:10.1053/j.jrn.2018.01.016
Silva SM, Braido NF, Ottaviani AC, Gesualdo GD, Zazzetta MS, Orlandi Fde S. 2016. Social support of adults and elderly with chronic kidney
disease on dialysis. Rev Lat Am Enfermagem, 24, e2752. https://doi:10.1590/1518-8345.0411.2752
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. https://doi 10.1007/s10654-010-9491-z
Stevens PE. 2013. Evaluation and Management of Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2012
Clinical Practice Guideline. Ann Intern Med, 158(11), 825-831. https:// doi.org/10.7326/0003-4819-158-11-201306040-00007
Takahashi H, Inoue K, Shimizu K, Hiraga K, Takahashi E, Otaki K, Ito Y. 2017. Comparison of Nutritional Risk Scores for Predicting Mortality in
Japanese Chronic Hemodialysis Patients. J Ren Nutr, 27(3), 201-206. https://doi:10.1053/j.jrn.2016.12.005
Toledo FR, Antunes AA, Vannini FC, Silveira LV, Martin LC, Barretti P, Caramori, JC. 2013. Validity of malnutrition scores for predicting mortality
in chronic hemodialysis patients. Int Urol Nephrol, 45(6), 1747-1752. https://doi:10.1007/s11255-013-0482-3
Turk I, Cuzdan N, Ciftci V, Arslan D, Dogan MC, Unal I. 2020. Malnutrition, associated clinical factors, and depression in systemic sclerosis: a
cross-sectional study. Clin Rheumatol, 39(1), 57-67. https://doi:10.1007/s10067-019-04598-y
Wang L, Zhong XQ, Zhu AJ, Zhu SL, Zeng HY. 2016. Nutritional status and its influence factors in maintenance hemodialysis patients: a case-
control study. Journal of Nursing (China),23(10),1-4. https://doi:10.16460/j.issn1008-9969.2016.10.001
Wang SP, Yang L, Zhao LN, Wu HJ, Shao L. 2012. Nutritional Status of Elderly Maintenance Hemodialysis Patients and Its Influencing Factors.
Journal of Nursing (China),19(20), 21-24. https://doi:10.16460/j.issn1008-9969.2012.20.015
Weir MR. 2021. Managing Anemia across the Stages of Kidney Disease in Those Hyporesponsive to Erythropoiesis-Stimulating Agents. Am J
Nephrol, 52(6), 450-466. https://doi:10.1159/000516901
Windahl K, Faxén Irving G, Almquist T, Lidén MK, van de Luijtgaarden M, Chesnaye NC, Evans M. 2018. Prevalence and Risk of Protein-Energy Wasting Assessed by Subjective Global Assessment in Older Adults With Advanced Chronic Kidney Disease: Results From the EQUAL Study. J
Ren Nutr, 28(3), 165-174. https://doi:10.1053/j.jrn.2017.11.002
Khan YH, Mallhi TH, Sarriff A, Khan AH, Tanveer N. 2018. Prevalence of chronic kidney disease in Asia: A systematic review of population-based
studies. Journal of the College of Physicians and Surgeons Pakistan, 28(12), 960-6. https://10.29271/jcpsp.2018.12.960
Zhu JJ, Chen YJ, Chen LL, Zhao X. 2020. Analysis of nutritional status and influencing factors of elderly patients on maintenance hemodialysis.
Preventive Medicine, 32(03), 284-288. https://doi:10.19485/j.cnki.issn2096-5087.2020.03.017

Authors

Zhu Shengrui
Dariah Mohd Yusoff
dariah@usm.my (Primary Contact)
Kueh Yee Cheng
Hafzan Yusoff
Chen Hongfang
Tang Wenzhen
ShengruiZ., Mohd YusoffD., ChengK. Y., YusoffH., HongfangC., & WenzhenT. (2024). Influencing Factors for Malnutrition in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis. Jurnal Gizi Dan Pangan, 19(1), 51-60. https://doi.org/10.25182/jgp.2024.19.1.51-60

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