Estimates of malnutrition associated with chronic kidney disease patients globally and its contrast with India: An evidence based systematic review and meta-analysis

Abstract

Background: Malnutrition is one of the most serious complications of chronic kidney disease due to its devastating consequences in terms of quality of life, morbidity, hospitalization and mortality. This study aims to evaluate the prevalence of malnutrition among chronic kidney disease patients globally and its contrast with India. Methods: Articles reporting the prevalence of malnutrition associated with CKD patients were retrieved from PubMed/Medline, ScienceDirect, Cochrane library & Google scholar. The quality assessment of studies was performed by using Newcastle-Ottawa scale. The pooled prevalence was reported with effect size considering the random effect model using comprehensive meta-analysis version 2.0. Results: The results from 61 observational studies containing 21119 patients are presented. The global prevalence of malnutrition associated with CKD was found to be 42.7%. The prevalence of malnutrition in peritoneal dialysis group was found to be (45.3%, 95%CI; 29.5-62.1) higher as compared to hemodialysis group (43.1%, 95% CI; 32.2-54.7) followed by non-dialysis group (38.5%, 95% CI; 24.0-55.3). The prevalence of malnutrition in India was found to be 56.7% (95% CI: 42.4-70.0%). Males were predominantly affected with malnutrition as compared to females. The prevalence in India was reported to be higher as compared to all the included countries, except Mexico and Jordan. Conclusions: Globally, India occupies the highest share of prevalence studies followed by Brazil. The geographical stratification of results revealed that the highest prevalence of malnutrition was observed in India except Mexico and Jordan. Given the high prevalence of malnutrition among CKD patients, evaluation of interventions for malnutrition with patient centered outcomes are warranted.

Malnutrition Among Pre-Dialysis Patients of Chronic Kidney Disease

“…[22][23] Regarding gender dominance, male cases had higher malnutrition than females but not significantly different, it is consistent with a recent Indian study. [24] A worse quality of life, sleep disorders, depression, hyporesponsiveness to erythropoietin, greater susceptibility to infections, and worsening of heart failure are all potential outcomes of malnutrition. [25][26][27][28] As a result of the findings of this research, which demonstrated that malnutrition begins at an early stage in the progression of CKD, there is reason for including nutritional evaluation as part of the management of CKD patients even in the early stages.…”

Nutritional status, symptom burden, and predictive validity of the Pt-Global web tool/PG-SGA in CKD patients: A hospital based cross sectional study

“…Poor nutritional status or malnutrition is an under-recognized and undertreated condition that has a high clinical impact on patients across different healthcare settings [10][11][12]. Patients with chronic renal disease frequently have this complication [13,14]. According to the available research, there is a clear connection between poor nutritional status and morbidity, the geriatric population, and gender [15,16].…”

“…Nutrition shares a strong bond with the renal outcomes. India has reported a huge prevalence of malnutrition (56.7%) among chronic kidney disease patients [13]. The prevalence of malnutrition, however, varies depending on the stages of CKD, gender, and dialysis status [19].…”

Changes in body composition in relation to estimated glomerular filtration rate and physical activity in predialysis chronic kidney disease

“…Globally, India occupies the third position in malnourished CKD patients with a pooled prevalence of 56.7%, among hemodialysis, peritoneal dialysis, and nondialysis CKD. 1 , 2 Even so, predialysis CKD patients are an understudied population as compared to hemodialysis in the Indian subcontinent.…”