Effectiveness of Nutritional Education for Hemodialysis Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis Nutritional Education in Haemodialysis: A Review and Meta-Analysis

Article Sidebar

PDF
Published: Aug 8, 2024
DOI: https://doi.org/10.61919/jhrr.v4i3.1324
Keywords:
Chronic Kidney Disease (CKD) Nutrition Patient Counseling Educational Interventions Haemodialysis

Main Article Content

Tazeem Akhtar
Department of Nursing, Shifa College of Nursing & Midwifery, Shifa Tameer-e-Millat University, Islamabad, Pakistan
Erika Sivarajan Froelicher
Professor Emeritus, Department of Physiological Nursing, Schools of Nursing; Department of Epidemiology & Biostatistics, Schools of Medicine, University of California San Francisco, San Francisco, Califorinia, USA
Gideon Victor
Assistant Professor, Educationist, Cardiac Specialist Nurse, Faculty of Nursing & Midwifery, Shifa Tameer-e-Millat University, Islamabad, Pakistan

Abstract

Background: Chronic kidney disease (CKD) is an escalating public health issue with increasing incidence and prevalence. This meta-analysis aimed to evaluate the effectiveness of nutritional education interventions for CKD patients undergoing hemodialysis, focusing on renal and nutritional outcomes compared to usual care.


Objective: This meta-analysis evaluates the effectiveness of nutritional education interventions in hemodialysis patients, assessing their impact on renal and nutritional outcomes.


Method: The systematic review with meta-analysis was conducted through literature search was conducted from January 2011 to December 2023 using databases like CINAHL, PubMed, Science Direct, Academia, and Google Scholar. This systematic review and meta-analysis included only randomized controlled trials (RCTs) and quasi-experimental studies (QES) per PRISMA criteria, with the JBI tool used to assess the risk of bias.


Results: Analysis of pooled data from nine RCTs and four QES revealed no statistically significant improvements in key biochemical markers, despite the intervention favoring the experimental group. Changes in serum albumin levels were -0.07 g/L (95% CI: -0.24 to 0.10, p = 0.44), Hb levels changed by 0.22 mg/dl (95% CI: -0.75 to 1.18, p = 0.66), eGFR by -1.47 (95% CI: -4.04 to 1.10, p = 0.26), serum creatinine by 0.00 mg/dl (95% CI: -0.13 to 0.13, p = 0.99), and serum urea levels by -10.49 mg/dl (95% CI: -35.73 to 14.76, p = 0.42). Significant improvement was noted when nurses and nutritionists worked together and involved patients in meal preparation.


Conclusion: Nutritional education interventions favored the experimental group. Nurse-dietitian collaboration, consideration of dietary preferences, and patient involvement in meal preparation improved outcomes. The review highlights the importance of nutritional education for hemodialysis patients and the need for patient-centered, high-quality research

Article Details

How to Cite
Tazeem Akhtar, Erika Sivarajan Froelicher, & Gideon Victor. (2024). Effectiveness of Nutritional Education for Hemodialysis Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis: Nutritional Education in Haemodialysis: A Review and Meta-Analysis. Journal of Health and Rehabilitation Research, 4(3), 1–8. https://doi.org/10.61919/jhrr.v4i3.1324
Issue
Vol. 4 No. 3 (2024): Volume 4, Issue 3 - July to September 2024
Section
Articles
Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Author Biographies

Tazeem Akhtar, Department of Nursing, Shifa College of Nursing & Midwifery, Shifa Tameer-e-Millat University, Islamabad, Pakistan

Department of Nursing, Shifa College of Nursing & Midwifery, Shifa Tameer-e-Millat University, Islamabad, Pakistan.

Erika Sivarajan Froelicher, Professor Emeritus, Department of Physiological Nursing, Schools of Nursing; Department of Epidemiology & Biostatistics, Schools of Medicine, University of California San Francisco, San Francisco, Califorinia, USA

i. Professor Emeritus, Department of Physiological Nursing, Schools of Nursing; Department of Epidemiology & Biostatistics, Schools of Medicine, University of California San Francisco, San Francisco, CA 94143-, USA
ii. Visiting Professor, Shifa College of Nursing & Midwifery, Shifa Tameer-e-Millat University, Islamabad, Pakistan, Erika.Froelicher@ucsf.edu, https://orcid.org/0000-0003-1852-8922

References

Geldine CG, Bhengu B, Manwere A. Adherence of Adult Chronic Kidney Disease Patients With Regard to Their Dialysis, Medication, Dietary, and Fluid Restriction. Res J Heal Sci. 2017;5(1):3-17. doi:10.4314/rejhs.v5i1.2.

Provenzano M, Coppolino G, Faga T, Garofalo C, Serra R, Andreucci M. Epidemiology of Cardiovascular Risk in Chronic Kidney Disease Patients: The Real Silent Killer. Rev Cardiovascular Med. 2019;20(4):209-20. doi:10.31083/j.rcm.2019.04.548.

Jo IY, Kim WJ, Park HC, Choi HY, Lee JE, Lee SM. Effect of Personalized Nutritional Counseling on the Nutritional Status of Hemodialysis Patients. Clin Nutr Res. 2017;6(4):285-95.doi:10.7762/cnr.2017.6.4.285.

Ng JKC, Li PKT. Chronic Kidney Disease Epidemic: How Do We Deal With It? Nephrology (Carlton). 2018;23(Suppl 4):116-20. doi:10.1111/nep.13464.

Finkelstein FO, Wuerth D, Finkelstein SH. Health-Related Quality of Life and the CKD Patient: Challenges for the Nephrology Community. Kidney Int. 2009;76(9):946-52. doi:10.1038/ki.2009.307.

Volpp KG, Berkowitz SA, Sharma SV, Anderson CAM, Brewer LC, Elkind MSV, et al. Food Is Medicine: A Presidential Advisory From the American Heart Association. Circulation. 2023;148(18):1417-39.doi:10.1161/CIR.0000000000001182.

Munuo AE, Mugendi BW, Kisanga OA, Otieno GO. Nutrition Knowledge, Attitudes and Practices Among Healthcare Workers in the Management of Chronic Kidney Diseases in Selected Hospitals in Dar es Salaam, Tanzania; A Cross-Sectional Study. BMC Nutr. 2016;2:1-7. doi:10.1186/s40795-016-0045-y.

Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, et al. Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PLoS One. 2016;11(7). doi:10.1371/journal.pone.0158765.

Gottlieb R, Joshi A. Food Justice. MIT Press; 2010.

Molina P, Gavela E, Vizcaíno B, Huarte E, Carrero JJ. Optimizing Diet to Slow CKD Progression. Front Med. 2021;8:654250. doi:10.3389/fmed.2021.654250.

Lynch R. Dialysis Patients’ Perceptions of Factors Associated With the Renal Diet. J Kidney Care. 2018;3(3):142-55. doi:10.12968/jokc.2018.3.3.142.

Lambert K, Mansfield K, Mullan J. How Do Patients and Carers Make Sense of Renal Dietary Advice? A Qualitative Exploration. J Ren Care. 2018;44(4):238-50. doi:10.1111/jorc.12260.

Sukartini T, Efendi F, Putri NS. A Phenomenological Study to Explore Patient Experience of Fluid and Dietary Restrictions Imposed by Hemodialysis. J Vasc Nurs. 2022;40(2):105-11. doi:10.1016/j.jvn.2022.05.003.

Beto JA, Schury KA, Bansal VK. Strategies to Promote Adherence to Nutritional Advice in Patients With Chronic Kidney Disease: A Narrative Review and Commentary. Int J Nephrol Renovasc Dis. 2016;9:21-33. doi:10.2147/IJNRD.S76831.

Vijaya KL, Aruna M, Narayana Rao SVL, Mohan PR. Dietary Counseling by Renal Dietician Improves the Nutritional Status of Hemodialysis Patients. Indian J Nephrol. 2019;29(3):179-85. doi:10.4103/ijn.IJN_272_16.

Kurniawan AL, Yang YL, Chin MY, Hsu CY, Paramastri R, Lee HA, et al. Association of Nutrition Education and Its Interaction With Lifestyle Factors on Kidney Function Parameters and Cardiovascular Risk Factors Among Chronic Kidney Disease Patients in Taiwan. Nutrients. 2021;13(2). doi:10.3390/nu13020298.

Parsons TJ, Sartini C, Ash S, Lennon LT, Wannamethee SG, Lee IM, et al. Objectively Measured Physical Activity and Kidney Function in Older Men; A Cross-Sectional Population-Based Study. Age Ageing. 2017;46(6):1010-4. doi:10.1093/ageing/afx091.

Howden EJ, Coombes JS, Isbel NM. The Role of Exercise Training in the Management of Chronic Kidney Disease. Curr Opin Nephrol Hypertens. 2015;24(6):480-7.doi:10.1097/MNH.0000000000000165.

Pereira RA, Alvarenga MS, Avesani CM, Cuppari L. Strategies Designed to Increase the Motivation for and Adherence to Dietary Recommendations in Patients With Chronic Kidney Disease. Nephrol Dial Transplant. 2021;36(12):2173-81. doi:10.1093/ndt/gfaa177.

Palmer SC, Maggo JK, Campbell KL, Craig JC, Johnson DW, Sutanto B, et al. Dietary Interventions for Adults With Chronic Kidney Disease. Cochrane Database Syst Rev. 2017;4(4). doi:10.1002/14651858.CD011998.pub2.

Brown TJ, Williams H, Mafrici B, Jackson HS, Johansson L, Willingham F, et al. Dietary Interventions With Dietitian Involvement in Adults With Chronic Kidney Disease: A Systematic Review. J Hum Nutr Diet. 2021;34(4):747-57.doi:10.1111/jhn.12870.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews. Br Med J. 2021;372(n71):1-11.doi:10.1186/s13643-021-01626-4.

Cumpston MS, McKenzie JE, Welch VA, Brennan SE. Strengthening Systematic Reviews in Public Health: Guidance in the Cochrane Handbook for Systematic Reviews of Interventions, 2nd edition. J Public Health (Oxf). 2022;44(4).doi:10.1093/pubmed/fdac036.

Richardson WS, Wilson MC, Nishikawa J, Hayward RS. The Well-Built Clinical Question: A Key to Evidence-Based Decisions. ACP J Club. 1995;123(3). doi:10.7326/ACPJC-1995-123-3-A12.

Tufanaru C, Munn Z, Aromataris E, Campbell J, Hopp L. JBI Critical Appraisal Checklist for Randomized Controlled Trials. Chapter 3: Systematic Reviews of Effectiveness. 2020.

CASP J. The Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental (Non-Randomized Experimental Studies). Joanna Briggs Inst. 2020.

de Fornasari MLL, Dos Santos Sens YA. Replacing Phosphorus-Containing Food Additives With Foods Without Additives Reduces Phosphatemia in End-Stage Renal Disease Patients: A Randomized Clinical Trial. J Ren Nutr.2017;27(2):97-105.doi:10.1053/j.jrn.2016.08.009.

Rouhani MH, Mortazavi Najafabadi M, Surkan PJ, Esmaillzadeh A, Feizi A, Azadbakht L. The Impact of Oat (Avena Sativa) Consumption on Biomarkers of Renal Function in Patients With Chronic Kidney Disease: A Parallel Randomized Clinical Trial. Clin Nutr. 2018;37(1):78-84.doi:10.1016/j.clnu.2016.11.022.

Paes-Barreto JG, Silva MIB, Qureshi AR, Bregman R, Cervante VF, Carrero JJ, et al. Can Renal Nutrition Education Improve Adherence to a Low-Protein Diet in Patients With Stages 3 to 5 Chronic Kidney Disease? J Ren Nutr. 2013;23(3):164-71.doi:10.1053/j.jrn.2012.10.004.

Shi YX, Fan XY, Han HJ, Wu QX, Di HJ, Hou YH, et al. Effectiveness of a Nurse-Led Intensive Educational Programme on Chronic Kidney Failure Patients With Hyperphosphataemia: Randomised Controlled Trial. J Clin Nurs. 2013;22(7-8):1189-97. doi:10.1111/jocn.12159.

Małgorzewicz S, Rutkowski P, Jankowska M, Dębska-Ślizień A, Rutkowski B, Łysiak-Szydłowska W. Effects of Renal-Specific Oral Supplementation in Malnourished Hemodialysis Patients. J Ren Nutr. 2011;21(4):347-53. doi:10.1053/j.jrn.2010.07.001.

Guida B, Parolisi S, Coco M, Ruoppo T, Veccia R, di Maro M, et al. The Impact of a Nutritional Intervention Based on Egg White for Phosphorus Control in Hemodialysis Patients. Nutr Metab Cardiovasc Dis. 2019;29(1):45-50. doi:10.1016/j.numecd.2018.09.010.

Howden EJ, Leano R, Petchey W, Coombes JS, Isbel NM, Marwick TH. Effects of Exercise and Lifestyle Intervention on Cardiovascular Function in CKD. Clin J Am Soc Nephrol. 2013;8(9):1494-501. doi:10.2215/CJN.10141012.

Molfino A, Chiappini MG, Laviano A, Ammann T, Bollea MR, Alegiani F, et al. Effect of Intensive Nutritional Counselling and Support on Clinical Outcomes of Hemodialysis Patients. Nutrition. 2012;28(10):1012-5. doi:10.1016/j.nut.2012.01.008.

Wu HL, Sung JM, Kao MD, Wang MC, Tseng CC, Chen ST. Nonprotein Calorie Supplement Improves Adherence to Low-Protein Diet and Exerts Beneficial Responses on Renal Function in Chronic Kidney Disease. J Ren Nutr. 2012;23(4):271-6. doi:10.1053/j.jrn.2012.09.003.

Duzalan OB, Pakyuz SC. Educational Interventions for Improved Diet and Fluid Management in Haemodialysis Patients: An Interventional Study. J Pak Med Assoc. 2018;68(4):532-7.

Mersal FA, El-Sedawy D, Mersal NA. Effect of Nursing Guideline on Dietary and Fluid Compliance Among Patients Undergoing Hemodialysis. J Heal Med Nurs. 2016;26:35-47.

Jahanpeyma P, Makhdoomi K, Sajadi SA. The Effect of a Nutrition Education Program on Biochemical Parameters Among Patients With Chronic Kidney Disease Undergoing Hemodialysis. J Crit Care Nurs. 2017;10(3)doi:10.5812/ccn.12453.

Bahadori M, Ghavidel F, Mohammadzadeh S, Ravangard R. The Effects of an Interventional Program Based on the Self-Care Model on Health-Related Quality of Life Outcomes in Hemodialysis Patients. J Educ Health Promot. 2014;3:110. doi:10.4103/2277-9531.145899. Cochrane. Review Manager: RevMan Web. 2020.

Liu PJ, Ma F, Wang QY, He SL. The Effects of Oral Nutritional Supplements in Patients With Maintenance Dialysis Therapy: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. PLoS One. 2018;13(9).doi:10.1371/journal.pone.0203706.

Barili F, Parolari A, Kappetein PA, Freemantle N. Statistical Primer: Heterogeneity, Random- or Fixed-Effects Model Analyses? Interact Cardiovasc Thorac Surg. 2018;27(3):317-21.doi:10.1093/icvts/ivy163.

Ioannidis JPA. Interpretation of Tests of Heterogeneity and Bias in Meta-Analysis. J Eval Clin Pract. 2008;14(5):951-7. doi:10.1111/j.1365-2753.2008.00986.x.

Clinical Practice Guidelines for Nutrition in Chronic Renal Failure. K/DOQI, National Kidney Foundation. Am J Kidney Dis. 2000;35(6 Suppl 2). doi:10.1053/ajkd.2000.v35.aajkd03517.

Michels WM, Grootendorst DC, Verduijn M, Elliott EG, Dekker FW, Krediet RT. Performance of the Cockcroft-Gault, MDRD, and New CKD-EPI Formulas in Relation to GFR, Age, and Body Size. Clin J Am Soc Nephrol. 2010;5(6):1003-9. doi:10.2215/CJN.06870909.