Miss Natalie Li Xuan Tan1, MAYA YOUNG2, KELLY LAMBERT1, JESSICA DAWSON2,3
1School of Medical, Indigenous and Health Sciences, University Of Wollongong, Wollongong, Australia, 2Department of Nutrition and Dietetics, St George Hospital, Kogarah, Australia, 3NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
Biography:
Natalie is a dietitian with a strong interest in research who aims to align her clinical practice with evidence-based nutrition care to improve patient outcomes.
Jess is a research fellow and renal dietitian with over 10 years clinical experience. Jess’s goal is to combine her clinical practice with innovative research in nutritional management to improve care and outcomes in people with chronic kidney disease. Jess’s interests and experience are in novel interventions to improve dietary behaviours and for the management of people choosing Conservative Kidney Management.
Aim:
To evaluate the impact of zinc supplementation on nutrition-related outcomes in adults with chronic kidney disease (CKD), including kidney replacement therapies.
Background:
Zinc deficiency affects 40-78% of haemodialysis (HD) population and has significant clinical implications such as anorexia and alterations in gastrointestinal function and absorption. Previous systematic reviews have been limited to evaluating the impact of zinc on biochemical outcomes only in people receiving HD.
Methods:
A systematic search was conducted across Cochrane, MEDLINE, CINAHL, PubMed, Scopus and Google Scholar to identify randomised controlled trials assessing nutrition-related outcomes in adults with CKD. Three authors independently assessed trial eligibility, extracted data, and risk of bias using Cochrane Risk of Bias Tool and quality of evidence using GRADE. Revman was used to perform random effects meta-analysis.
Results:
Of the 41 studies, 176 outcomes were identified in CKD (two studies), HD (37 studies) and peritoneal dialysis (one study). Nutrition-related outcomes (n=74) were reported by 38 studies, with six included in meta-analyses. Zinc supplementation was associated with increases in body weight (WMD: 2.52kg; 95% CI: 1.58 to 3.45; P<0.00001), serum zinc (WMD: 24.96µg/dL; 95% CI: 20.43 to 29.50; P<0.00001) and dietary energy intake (WMD: 272kcal; 95% CI: 172.70 to 370.90; P<0.00001). No association was observed with zinc supplementation and body mass index, dietary protein intake or dietary zinc intake.
Conclusions:
The current body of evidence is of low quality due to high risk of bias and is limited by small sample sizes and a lack of studies in non-HD CKD populations. There is a need for high quality clinical trial data to determine whether zinc supplementation is an effective treatment for nutrition-related care in people with CKD.
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