CKD: Medical Nutrition Therapy (2018)

Intervention
What is the effect of MNT provided by a dietitian on quality of life in adults with CKD 1-5D and post-transplant?
- Conclusion
  The effects of individualized counselling/medical nutrition therapy (MNT) with a registered dietitian nutriitonist (RDN) on quality of life (QoL) outcomes were unclear. Further research is warranted to understand the effect of MNT on QoL in this 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 MNT provided by a dietitian on quality of life in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Medical Nutrition Therapy (2018)
What is the effect of MNT provided by a dietitian on lipid profile in adults with CKD 1-5D and post-transplant?
- Conclusion
  Compared to controls,medical nutrition therapy (MNT) interventions lasting four weeks-four months did not affect total cholesterol, triglyceride or HDL levels in CKD patients. Though individual study results regarding LDL levels were mixed, in pooled analysis, MNT decreased LDL 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 MNT provided by a dietitian on lipid profile in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Medical Nutrition Therapy (2018)
What is the effect of MNT provided by a dietitian on blood pressure in adults with CKD 1-5D and post-transplant?
- Conclusion
  The effect of medical nutriiton therapy (MNT) interventions lasting four weeks-four months on blood pressure in CKD patients was unclear.
- 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 MNT provided by a dietitian on blood pressure in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Medical Nutrition Therapy (2018)
What is the effect of MNT provided by a dietitian on blood glucose in adults with CKD 1-5D and post-transplant?
- Conclusion
  The effects of medical nutriiton thereapy (MNT) on blood glucose parameters in pre-dialysis patients were unclear, but glucose levels were increased in hemodialysis patients receiving MNT compared to an oral nutrient supplement based on 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 MNT provided by a dietitian on blood glucose in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Medical Nutrition Therapy (2018)
What is the effect of MNT provided by a dietitian on eGFR in adults with CKD 1-5D and post-transplant?
- Conclusion
  Medical Nutrition Therapy (MNT) did not affect eGFR in non-dialyzed patients.
- 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 MNT provided by a dietitian on eGFR in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Medical Nutrition Therapy (2018)
What is the effect of MNT provided by a dietitian on serum creatinine levels in adults with CKD 1-5D and post-transplant?
- Conclusion
  The effects of medical nutrition therapy (MNT) interventions on serum creatinine levels in pre-dialysis CKD patients was unclear.
- 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 MNT provided by a dietitian on serum creatinine levels in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Medical Nutrition Therapy (2018)
What is the effect of MNT provided by a dietitian on calcium, potassium or sodium levels or calcium-phosphorus product in adults with CKD 1-5D and post-transplant?
- Conclusion
  In patients with CKD on hemodialysis, provision of phosphate-focused education materials in addition to nutrition counseling did not affect calcium levels, but levels were increased following a 12 month multi-disciplinary nutrition education program compared to an oral nutrient supplement (ONS). In addition, medical nutrition therapy (MNT) decreased CaXP product in participants receiving counselling and educational games for eight weeks, but there was no change in a study with phosphate-focused education for six months. In one study, there was no effect of MNT on sodium levels. In a range of CKD patients, MNT did not affect potassium levels. Further research is warranted.
- 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 MNT provided by a dietitian on calcium, potassium or sodium levels or calcium-phosphorus product in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Medical Nutrition Therapy (2018)
What is the effect of MNT provided by a dietitian on phosphorus/phosphate levels in adults with CKD 1-5D and post-transplant?
- Conclusion
  Medical nutrition therapy (MNT) decreased phosphorus/phosphate levels in hemodialysis patients, but evidence was limited in other CKD populations.
- 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 MNT provided by a dietitian on phosphorus/phosphate levels in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Medical Nutrition Therapy (2018)
What is the effect of MNT provided by a dietitian on anemia indices in adults with CKD 1-5D and post-transplant?
- Conclusion
  There is insufficient evidence to conclude if medical nutrition therapy (MNT) interventions impact ferritin and hemoglobin levels in CKD participants.
- 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 MNT provided by a dietitian on anemia indices in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Medical Nutrition Therapy (2018)
What is the effect of MNT provided by a dietitian on body composition in adults with CKD 1-5D and post-transplant?
- Conclusion
  Evidence regarding the effect of medical nutrition therapy (MNT) on body composition in CKD patients was unclear, and evidence was too limited to draw conclusions.
- 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 MNT provided by a dietitian on body composition in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Medical Nutrition Therapy (2018)
What is the effect of MNT provided by a dietitian on waist circumference in adults with CKD 1-5D and post-transplant?
- Conclusion
  Results regarding the effect of medical nutrition therapy (MNT) provided by a registered dietitian nutritionist on waist circumference in CKD patients were unclear, with one study demonstrating a decrease in waist circumference and two studies concluding no effect.
- 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 MNT provided by a dietitian on waist circumference in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Medical Nutrition Therapy (2018)
What is the effect of MNT provided by a dietitian on arm circumference in adults with CKD 1-5D and post-transplant?
- Conclusion
  The effect of medical nutrition therapy (MNT) provided by a registered dietitian nutritionist (RDN) on arm circumference measurements was unclear, as 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 MNT provided by a dietitian on arm circumference in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Medical Nutrition Therapy (2018)
What is the effect of MNT provided by a dietitian on BMI in adults with CKD 1-5D and post-transplant?
- Conclusion
  Medical nutrition therapy (MNT) provided by a registered dietitian nutritionist (RDN) decreased BMI in patients who were non-dialyzed, but evidence was limited in other CKD populations.
- 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 MNT provided by a dietitian on BMI in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Medical Nutrition Therapy (2018)
What is the effect of MNT provided by a dietitian on body weight in adults with CKD 1-5D and post-transplant?
- Conclusion
  Results regarding the effect of medical nutrition therapy (MNT) provided by a registered dietitian nutritionist (RDN) on weight in CKD patients were unclear, with the preponderance of evidence suggesting no effect.
- 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 MNT provided by a dietitian on weight in in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Medical Nutrition Therapy (2018)
What is the effect of MNT provided by a dietitian on CRP levels in adults with CKD 1-5D and post-transplant?
- Conclusion
  Medical nutrition thereapy (MNT) provided in an individual, group or multidisciplinary setting (at least two sessions in 3-4 months) in predialysis or hemodialysis patients, decreased C-reactive protein (CRP) level. However, evidence is limited and further research is warranted to understand the effect of MNT on CRP levels in this 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 MNT provided by a dietitian on CRP levels in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Medical Nutrition Therapy (2018)
What is the effect of MNT provided by a dietitian on nutritional status indicators in adults with CKD 1-5D and post-transplant?
- Conclusion
  Findings were unclear regarding the effect of medical nutrition therapy (MNT) provided by a registered dietitian nutritionist (RDN) on albumin levels and SGA in patients with CKD, non-dialyzed and on hemodialysis, with the preponderance of evidence suggesting no effect. Meta-analysis of five studies demonstrated no effect of MNT on albumin levels, but data had a high level of heterogeneity and should be interpreted with caution.
- 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 MNT provided by a dietitian on nutritional status indicators in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Medical Nutrition Therapy (2018)
What is the effect of MNT provided by a dietitian on protein and energy intake in adults with CKD 1-5D and post-transplant?
- Conclusion
  The results regarding the effect of medical nutrition therapy (MNT) interventions on protein and energy intake were unclear, with the preponderance of evidence demonstrating no effect. However, effect may be dependent of each study’s target outcomes 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 MNT provided by a dietitian on protein and energy intake in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Medical Nutrition Therapy (2018)