Effect of protein supplementation on health-related quality of life in individuals with advanced chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials.

Abstract

Objective: We performed a systematic review and meta-analysis to evaluate the effect of protein/amino acid supplementation on health-related quality of life (HRQOL) in advanced chronic kidney disease (CKD) including individuals on dialysis.

Methods: Medline, Cochrane Central, Embase and CINAHL were searched from (establishment until August 2022) for randomized controlled trials evaluating the effect of protein or amino acid supplementation (> 5 g/day) in individuals with advanced CKD (eGFR < 30 ml/min and/or on dialysis). Primary outcome was change in HRQOL. Secondary outcomes included biochemical, anthropometric measures, and physical function. Two reviewers independently screened articles for inclusion based on pre-specified criteria, extracted data and assessed risk of bias. Meta-analysis was performed by pooling mean difference or standardized mean difference using a random effects model if at least 3 included studies reported our pre-specified outcomes.

Results: Of 5699 articles, 17 were included for analysis. We found no improvement in HRQOL in qualitative synthesis of 4 studies. Protein and/or amino acid supplementation was associated with an improvement in serum albumin (MD = 1.76 g/L, 95% CI [0.67, 2.84], P=0.002, I² = 88%) and body mass index (MD = 0.29 kg/m², 95%CI [0.10, 0.49], P=0.004, I²=0%), as compared with controls.

Conclusion: Small number of studies prevented meta-analysis for HRQOL. Statistically significant improvements in serum albumin and BMI were observed with protein supplementation compared to controls. Small number of studies, high risk of bias and heterogeneity of included studies support the need for rigorous clinical trials investigating the effect of protein supplementation on patient-relevant outcomes.