Nutrition Supplements and Serum Albumin in Hemodialysis: A Meta-Analysis

The present meta-analysis was designed to examine the effect of oral nutrition supplements (ONS) and/or intradialytic parenteral nutrition (IDPN) therapy on serum albumin, a marker of malnutrition risk in adults on hemodialysis (HD).

Meta-analysis.

The EMBASE, PubMed, Google Scholar, Cochrane Collaboration, ClinicalTrials.gov, and Australia New Zealand Clinical Trials Registry databases were queried using the search terms malnutrition , albumin , hemodialysis , oral nutrition supplement , and intradialytic parenteral nutrition . Studies published or registered from 2019 to 2024 were reviewed and scored by 2 investigators using the Critical Appraisal Skills Programme checklist. Only studies with a mean score of 9 or greater (70% of the total possible score) were included. Data were analyzed using MedCalc software 20.210. The Q and I 2 tests were calculated; a forest plot was generated, and the pooled standardized mean differences (SMDs) with 95% CIs were calculated using a random-effects model.

Of the originally identified 137 studies, 8 randomized clinical trials were included, involving 382 adult HD patients. The SMD in serum albumin between the active treatment group (ONS or IDPN) and the control group in the random-effects model was 0.372 g/dL (95% CI, 0.103-0.641; P = .007). Findings were robust in the fixed-effects model. Publication bias was not detected.

ONS/IDPN significantly improved serum albumin in this random-effects meta-analysis model, and findings were consistent in the fixed-effects model. It can be concluded that ONS/IDPN improves serum albumin levels, which can serve as a marker of malnutrition risk in patients on maintenance HD.