Efficacy of Nutritional Interventions on Inflammatory Markers in Haemodialysis Patients: A Systematic Review and Limited Meta-Analysis

Khor, Ban-Hock; Narayanan, Sreelakshmi Sankara; Sahathevan, Sharmela; Gafor, Abdul Halim Abdul; Daud, Zulfitri Azuan Mat; Khosla, Pramod; Sabatino, Alice; Fiaccadori, Enrico; Chinna, Karuthan; Karupaiah, Tilakavati

doi:10.3390/nu10040397

Cited by 29 publications

(24 citation statements)

References 110 publications

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“…This is likely due to the dietary diversity related to food choices as well as fats and oils consumption across nations [ 77 ]. We have previously shown in a meta-analysis that n -3 PUFA supplementations were able to reduce C-reactive protein (CRP) in HD patients [ 78 ]. Therefore, the regional variations of blood n -3 PUFA status in dialysis patients could be a plausible explanation for the differences in CRP levels reported in the Dialysis Outcomes and Practice Patterns Study, where Japanese HD patients exhibited lower CRP levels (1.0 mg/L) than their counterparts from other countries (6.0 mg/L) [ 79 ].…”

Section: Discussionmentioning

confidence: 99%

Blood Fatty Acid Status and Clinical Outcomes in Dialysis Patients: A Systematic Review

et al. 2018

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Blood fatty acids (FAs) are derived from endogenous and dietary routes. Metabolic abnormalities from kidney dysfunction, as well as cross-cultural dietary habits, may alter the FA profile of dialysis patients (DP), leading to detrimental clinical outcomes. Therefore, we aimed to (i) summarize FA status of DP from different countries, (ii) compare blood FA composition between healthy controls and DP, and (iii) evaluate FA profile and clinical endpoints in DP. Fifty-three articles from 1980 onwards, reporting FA profile in hemodialysis and peritoneal DP, were identified from PubMed, Embase, and the Cochrane library. Studies on pediatric, predialysis chronic kidney disease, acute kidney injury, and transplant patients were excluded. Moderate to high levels of n-3 polyunsaturated fatty acids (PUFA) were reported in Japan, Korea, Denmark, and Sweden. Compared to healthy adults, DP had lower proportions of n-3 and n-6 PUFA, but higher proportion of monounsaturated fatty acids. Two studies reported inverse associations between n-3 PUFAs and risks of sudden cardiac death, while one reported eicosapentaenoic acid + docosahexaenoic acid)/arachidonic acid ratio was inversely associated with cardiovascular events. The relationship between all-cause mortality and blood FA composition in DP remained inconclusive. The current evidence highlights a critical role for essential FA in nutritional management of DP.

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Section: Discussionmentioning

confidence: 99%

Blood Fatty Acid Status and Clinical Outcomes in Dialysis Patients: A Systematic Review

et al. 2018

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“…Three open-label trials in maintenance HD patients also reported a beneficial antioxidant effect of oral intake of vitamin E at a dose of 500-800 mg/day [50, 52, 56]. A meta-analysis of 46 randomized controlled trials showed that among various nutritional interventions, only omega-3 fatty acids and vitamin E resulted in a significant decrease in circulating inflammatory markers [57].…”

Section: Exogenous Antioxidant Supplementation In Hd and Pd Patientsmentioning

confidence: 99%

Antioxidant Supplementation in Renal Replacement Therapy Patients: Is There Evidence?

Liakopoulos

Roumeliotis

Bozikas

et al. 2019

Oxidative Medicine and Cellular Longevity

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The disruption of balance between production of reactive oxygen species and antioxidant systems in favor of the oxidants is termed oxidative stress (OS). To counteract the damaging effects of prooxidant free radicals, all aerobic organisms have antioxidant defense mechanisms that are aimed at neutralizing the circulating oxidants and repair the resulting injuries. Antioxidants are either endogenous (the natural defense mechanisms produced by the human body) or exogenous, found in supplements and foods. OS is present at the early stages of chronic kidney disease, augments progressively with renal function deterioration, and is further exacerbated by renal replacement therapy. End-stage renal disease patients, on hemodialysis (HD) or peritoneal dialysis (PD), suffer from accelerated OS, which has been associated with increased risk for mortality and cardiovascular disease. During HD sessions, the bioincompatibility of dialyzers and dialysate trigger activation of white blood cells and formation of free radicals, while a significant loss of antioxidants is also present. In PD, the bioincompatibility of solutions, including high osmolality, elevated lactate levels, low pH, and accumulation of advanced glycation end-products trigger formation of prooxidants, while there is significant loss of vitamins in the ultrafiltrate. A number of exogenous antioxidants have been suggested to ameliorate OS in dialysis patients. Vitamins B, C, D, and E, coenzyme Q10, L-carnitine, a-lipoic acid, curcumin, green tea, flavonoids, polyphenols, omega-3 polyunsaturated fatty acids, statins, trace elements, and N-acetylcysteine have been studied as exogenous antioxidant supplements in both PD and HD patients.

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“…Sensitivity analysis was not performed based on our stringent criteria to include only high-quality studies with Jadad score ≥ 3 which carry a very low risk for bias 34 35 36 .…”

Section: Resultsmentioning

confidence: 99%

Cap-assisted colonoscopy: a meta-analysis of high-quality randomized controlled trials

et al. 2018

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Background and study aims Standard colonoscopy (SC) is the preferred modality for screening for colon cancer; however, it carries a significant polyp/adenoma miss rate. Cap-assisted colonoscopy (CC) has been shown to improve polyp/adenoma detection rate, decrease cecal intubation time and increase cecal intubation rate when compared to standard colonoscopy (SC). However, data on adenoma detection rate (ADR) are conflicting. The aim of this meta-analysis was to compare the performance of CC with SC for ADR among high-quality randomized controlled trials. Patients and methods We performed an extensive literature search using MEDLINE, EMBASE, Scopus, Cochrane and Web of Science databases and abstracts published at national meetings. Only comparative studies between CC and SC were included if they reported ADR, adenoma per person (APP), cecal intubation rate, and cecal intubation time. The exclusion criterion for comparing ADR was studies with Jadad score ≤ 2. The odds ratio (OR) was calculated using Mantel-Haenszel method. I 2 test was used to measure heterogeneity among studies. Results Analysis of high-quality studies (Jadad score ≥ 3, total of 7 studies) showed that use of cap improved the ADR with the results being statistically significant (OR 1.18, 95 % CI 1.03 – 1.33) and detection of 0.16 (0.02 – 0.30) additional APP. The cecal intubation rate in the CC group was 96.3 % compared to 94.5 % with SC (total of 17 studies). Use of cap improved cecal intubation (OR 1.61, 95 % CI 1.33 – 1.95) when compared to SC ( P value < 0.001). Use of cap decreased cecal intubation time by an average of 0.88 minutes (95 % CI 0.37 – 1.39) or 53 seconds. Conclusions Meta-analysis of high-quality studies showed that CC improved the ADR compared to SC.

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Efficacy of Nutritional Interventions on Inflammatory Markers in Haemodialysis Patients: A Systematic Review and Limited Meta-Analysis

Cited by 29 publications

References 110 publications

Blood Fatty Acid Status and Clinical Outcomes in Dialysis Patients: A Systematic Review

Blood Fatty Acid Status and Clinical Outcomes in Dialysis Patients: A Systematic Review

Antioxidant Supplementation in Renal Replacement Therapy Patients: Is There Evidence?

Cap-assisted colonoscopy: a meta-analysis of high-quality randomized controlled trials

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