Incidence of Mortality and the Impact of Malnutrition on Chronic Kidney Disease Patients Undergoing Dialysis: A Systematic Review and Meta-Analysis

OBJECTIVES: This meta-analysis aimed to explore the incidence of mortality among patients with CKD-associated malnutrition and the added mortality risk compared to patients with CKD and normal nutrition status.

METHODS: This meta-analysis was designed and performed in accordance with the PRISMA guidelines (PROSPERO-CRD42023394584). A systematic electronic literature search was conducted in PubMed, ScienceDirect, Embase, and the Cochrane Library to identify relevant cohort studies. The generic inverse variance method was used to pool the hazard ratio effect estimates by employing a random effects model. The Newcastle-Ottawa scale was used for the quality assessment. The statistical analysis was performed by utilizing RevMan and CMA 2.0.

RESULTS: A sample of 19303 patients with CKD whose nutritional status was assessed in 38 studies were eligible for quantitative analysis. Based on a comparison between the "malnutrition" category and the reference "normal nutrition status" category, the results showed that the overall pooled hazard risk (HR) for mortality was [1.52, 95% CI: 1.40–1.66, P<0.00001]. The worldwide incidence of mortality among CKD patients was estimated to be 23.5% [95% CI, 20.6-26.6%]. In the subgroup analysis, it was determined that CKD patients in the hemodialysis subgroup had higher hazards of mortality (1.56, 95% CI: 1.41–1.71), P<0.00001), than the peritoneal dialysis subgroup (1.26, 95% CI: 1.15–1.37), P<0.0001). However, the peritoneal dialysis subgroup 25.5% (95% CI, 17.9–35.0%) had a higher incidence of mortality than the hemodialysis subgroup 22.5% (95% CI, 19.0–26.3%).

CONCLUSIONS: The study results indicate that the incidence of mortality among CKD patients linked to malnutrition is relatively high, regardless of the dialysis category. Furthermore, the results demonstrated that malnutrition is a strong predictor of mortality among CKD patients on dialysis, with the hemodialysis group having the highest risk. The findings of this study advocate for early nutritional evaluation and timely dietary interventions to halt the progression of CKD and death.