Combined Nutritional Supplementation/Exercise Training Intervention in CKD

A study by Fan Zhang and others investigated whether a combined intervention comprising nutritional supplementation and exercise training could help treat frailty and improve health outcomes in a population with chronic kidney disease (CKD). The researchers assessed the effectiveness of nutritional supplementation combined with an exercise training intervention on frailty characteristics, physical function, and health-related quality of life in these patients.

Their study included data from the PubMed, Embase, Web of Science, and Scopus databases from inception to October 22, 2022; the search was updated in May 2023. Included studies were randomized controlled trials that compared nutritional supplementation combined with exercise training with usual care/single nutritional supplementation or exercise training to assess the effect on Fried-based frailty characteristics and physical function in patients with CKD.

Two authors chose the literature, extracted data, and assessed the risk of bias using the Cochrane risk of bias tool 2. To analyze the outcome, the researchers used a random-effects model according to the Hartung-Knapp-Sidik-Jonkman method or a fixed-effects model with restricted maximum likelihood. They used the leave-one-out method for sensitivity analyses.

Seven articles, including 9 trials and 324 patients, were included in the meta-analysis, which showed that nutritional supplementation combined with an exercise training intervention may improve frailty characteristics of patients receiving dialysis. These characteristics include walking speed (mean difference [MD], 0.09 m/s²; 95% CI, 0.02-0.16); physical functioning, such as cardiorespiratory fitness (standardized MD [SMD], 0.56; 95% CI, 0.20-0.93); and lower extremity mobility as measured by the Timed Up and Go test (MD, –1.11 seconds; 95% CI, –1.79 to –0.43). The effect of combined nutritional and exercise interventions on characteristics such as body weight (MD, 1.28 kg; 95% CI, –2.06 to 4.62), fatigue (SMD, 0.57; 95% CI –1.44 to 0.30), and health-related quality of life is unclear.

Although they acknowledged the heterogeneity of the included studies and the relatively small sample size as limitations of the study, the authors concluded that, “An intervention strategy of nutritional supplementation combined with exercise training may help improve frailty and physical functioning in CKD patients, particularly walking speed, cardiorespiratory fitness, and lower extremity mobility.” Confirmatory studies with larger sample sizes and longer follow-up are needed.

Source: Journal of Renal Nutrition