CKD: Protein Energy Supplements: Oral Nutrition Supplements (2018)

Intervention
What is the effect of oral nutrition supplementation on hard outcomes in adults with CKD 5D?
- Conclusion
  Oral nutrition supplementation (ONS) did not affect mortality (one study) in patients on hemodialysis (HD) with hypoalbuminemia, but evidence was limited. In patients on HD, ONS did not affect bodily pain, physical functioning or general health quality of life (QOL) scores.The effects of ONS on hospitalizations/length of stay were inconsistent, but pooled analysis suggests no effect of ONS on odds of hospitalizations in patients on dialysis.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of oral nutrition supplementation on hard outcomes in adults with CKD 5D?
- Search Plan and Results: CKD: Macronutrients : Nutritional Supplements (2018)
What is the effect of oral nutrition supplementation on lipid profile in adults with CKD 3-5D?
- Conclusion
  Oral nutrition supplementation (ONS) did not affect total cholesterol, triglyceride or LDL or HDL levels.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of oral nutrition supplementation on lipid profile in adults with CKD 3-5D?
- Search Plan and Results: CKD: Macronutrients : Nutritional Supplements (2018)
What is the effect of oral nutrition supplementation on eGFR and creatinine levels in adults with CKD 3-4?
- Conclusion
  A non-protein oral nutrition supplementatin (ONS) for 24 weeks did not affect creatinine levels or GFR in Stages 3-4 CKD patients (one study).
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of oral nutrition supplementation on eGFR and creatinine levels in adults with CKD 3-4?
- Search Plan and Results: CKD: Macronutrients : Nutritional Supplements (2018)
What is the effect of oral nutrition supplementation on anthropometric measures in adults with CKD 3-5D?
- Conclusion
  High-protein and protein-energy supplements did not affect body mass index (BMI), but non-protein energy supplements may increase BMI in hemodialysis (HD) patients. Oral nutrition supplementation (ONS) increased body weight by 2.77 (1.19, 4.36) kg, and this was largely driven by non-protein energy supplements, as there were no significant differences in studies utilizing protein or protein-energy ONS in HD patients. Protein-energy supplements did not affect dry body weight in HD participants. In patients on HD, energy and protein-energy supplements increased body fat mass, though there was no effect of protein supplements only on body fat mass. Overall, ONS increased lean body mass/fat free mass in HD patients compared to the control groups, but in sub-group analysis, this effect was only significant for those receiving an energy supplement for six months, not in those consuming protein or protein-energy supplements. Overall, ONS increased skinfold measurements compared to the control groups, but in sub-group analysis, this effect was only significant for those receiving an non-protein energy supplement for 6 months, not in those consuming protein or protein-energy supplements. There was no effect of protein, energy or protein-energy supplements for 3-12 months on arm/muscle circumference measurements in patients on HD or PD.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of oral nutrition supplementation on anthropometric measures in adults with CKD 3-5D?
- Search Plan and Results: CKD: Macronutrients : Nutritional Supplements (2018)
What is the effect of oral nutrition supplementation on CRP levels in adults with CKD 3-5D?
- Conclusion
  The preponderance of evidence suggests that there is no effect of oral nutrition supplementation (ONS) on CRP levels in CKD patients, non-dialyzed or on hemodialyis.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of oral nutrition supplementation on CRP levels in adults with CKD 3-5D?
- Search Plan and Results: CKD: Macronutrients : Nutritional Supplements (2018)
What is the effect of oral nutrition supplementation on nutritional status indicators in adults with CKD 3-5D?
- Conclusion
  Overall, participants receiving oral nutrition supplementation (ONS) had increased albumin levels compared to control groups.In sub-group analysis, this difference was only significant for participants receiving protein-energy ONS, not for those receiving an energy or protein supplement only. Protein supplementation may increase total protein levels compared to control groups, but there was no effect of energy supplementation only. ONS did not affect SGA or transferrin levels in patients on hemodialysis. Evidence was limited.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of oral nutrition supplementation on nutritional status indicators in adults with CKD 3-5D?
- Search Plan and Results: CKD: Macronutrients : Nutritional Supplements (2018)
What is the effect of oral nutrition supplementation on protein and energy intake in adults with CKD 3-5D?
- Conclusion
  Protein-energy supplements increased PNA/PCR and protein intake in CKD participants, but non-protein supplements or general protein-energy oral nutrition supplementation (ONS) did not affect this measure. Overall, ONS increased energy intake in CKD patients, but in sub-group analyses, findings varied according to ONS type (protein energy ONS were effective) and population.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of oral nutrition supplementation on protein and energy intake in adults with CKD 3-5D?
- Search Plan and Results: CKD: Macronutrients : Nutritional Supplements (2018)