RESUMO
AIM: determine the effect of intradialytic oral nutrition (ION) on clinical and safety outcomes. DESIGN: Systematic Review with conventional Meta-analysis, and a Network Meta-analysis (NMA) as sensitivity analysis. We searched on MEDLINE, LILACS, CENTRAL, and EMBASE in June 2020, and the last update was until August 2022. We selected observational and randomized controlled trials with ION for at least four weeks. Primary outcomes were all-cause mortality and quality of life (QoL); adverse events, physical performance, and appetite were secondary outcomes. RESULTS: Seven clinical trials and three observational studies were selected. Even when we did not obtain significant differences in physical performance and gastrointestinal symptoms, we identified a clinical improvement in the QoL's physical role, bodily pain, and physical performance domains. After pooling the data on mortality, a protection rate trend was observed in the ION group without statistical significance. The home-prepared ION was the best nutritional supplementation when assessing the appetite outcome through NMA. CONCLUSIONS: ION seems to have a protective trend in mortality risk; the current evidence is insufficient to establish a relationship with adverse events or other clinical outcomes. The lack of homogeneity in the trials makes it difficult to generalize these results. PROSPERO REGISTRATION: CRD42020186311.
Assuntos
Suplementos Nutricionais , Qualidade de Vida , Humanos , Metanálise em RedeRESUMO
BACKGROUND: Intradialytic oral nutrition (ION) has been shown to improve many clinical outcomes, including lowering mortality, in hemodialysis (HD) patients. Despite the benefits, ION is underused in many countries. OBJECTIVE: The objective of our study was to determine the perception of health-care professionals (HCP) in our environment of the use of ION in patients undergoing HD. METHODS: Survey applied to HCP in Mexico who worked or had worked in an HD unit in their locality. RESULTS: From 272 HCP who answered the survey, 74.3% believed that the use of ION has at least one beneficial effect; of these, the most frequently mentioned were an improvement in quality of life (QoL) (54.7%) followed by an improvement in serum albumin (37.9%) and muscle anabolism (31.6%). However, 49% consider that its use involves some risks. Of the respondents, 22% reported that their HD units allowed patients to consume food or supplements during HD sessions; the main reason given to forbid the introduction of food or supplements was the clinic's policy (41%). CONCLUSIONS: The personnel surveyed heterogeneous opinions regarding ION, but most believe that it may improve the QoL or the nutritional status of the patients. Nevertheless, the use of ION is uncommon in our country as it is against the internal regulations of most HD units.
Assuntos
Suplementos Nutricionais , Pessoal de Saúde/estatística & dados numéricos , Estado Nutricional , Diálise Renal/métodos , Adulto , Atitude do Pessoal de Saúde , Criança , Estudos Transversais , Humanos , México , Qualidade de Vida , Albumina Sérica/análise , Inquéritos e QuestionáriosRESUMO
Abstract Background Intradialytic oral nutrition (ION) has been shown to improve many clinical outcomes, including lowering mortality, in hemodialysis (HD) patients. Despite the benefits, ION is underused in many countries. Objective The objective of our study was to determine the perception of health-care professionals (HCP) in our environment of the use of ION in patients undergoing HD. Methods Survey applied to HCP in Mexico who worked or had worked in an HD unit in their locality. Results From 272 HCP who answered the survey, 74.3% believed that the use of ION has at least one beneficial effect; of these, the most frequently mentioned were an improvement in quality of life (QoL) (54.7%) followed by an improvement in serum albumin (37.9%) and muscle anabolism (31.6%). However, 49% consider that its use involves some risks. Of the respondents, 22% reported that their HD units allowed patients to consume food or supplements during HD sessions; the main reason given to forbid the introduction of food or supplements was the clinics policy (41%). Conclusions The personnel surveyed heterogeneous opinions regarding ION, but most believe that it may improve the QoL or the nutritional status of the patients. Nevertheless, the use of ION is uncommon in our country as it is against the internal regulations of most HD units.