(P-209) Estimates of Malnutrition Associated with Chronic Kidney Disease Globally and Its Contrast with India: A Systematic Review and Meta-analysis

Background: Chronic kidney disease (CKD) is increasingly recognized as a global public health problem and is highly linked with nutritional derangements. Malnutrition is one of the most serious complications of CKD and it's consequences, particularly for patients on hemodialysis as well as on continuous ambulatory peritoneal dialysis, are devastating in terms of quality of life, morbidity, hospitalization and mortality. Screening of malnutrition among chronic kidney disease patients is one of the important aspects for raising awareness about associated complications and medical cost.

Objectives: This study was an attempt to evaluate the prevalence of malnutrition among CKD patients (Hemodialysis, Peritoneal-dialysis & Non-dialysis) globally and its contrast with India.

Methods: Setting: Articles reporting the prevalence of malnutrition associated with CKD were retrieved from PubMed/Medline, Science direct, Cochrane library & Google scholar.
Main outcome measure: The pooled prevalence of malnutrition among CKD patients. Subgroup analysis based on patient type (Hemodialysis, Peritoneal dialysis & Non dialysis), Gender, Assessment tool used, and geography.
Statistical analysis: The pooled prevalence was reported with effect size considering the random effect model using comprehensive meta-analysis version 2.0. Meta-regression analysis also was performed. The value of I squared statistics (I2) was determined to access the variability due to heterogeneity. The quality assessment of studies was performed by using Newcastle-Ottawa scale. The publication bias was determined using funnel plot.

Results: A total of 21119 samples from 61 studies were potentially eligible for quantitative analysis. The prevalence of malnutrition associated with CKD in India was found to be 56.7% (95% CI: 42.4-70.0). The prevalence in peritoneal-dialysis group (69.2%, 995% CI; 42.7%-87.2%) was higher as compared to hemodialysis group (56.8%, 95% CI; 25.3-83.6) followed by non-dialysis group (44.2%, 95% CI; 20.7-70.6).
The males (20.7%) were predominantly affected with malnutrition as compared to females (16.4%). The global prevalence of malnutrition associated with CKD was found to be 43.1% (95% CI: 35.2–50.6). The prevalence in India was reported to be higher as compared to all the included countries except Mexico and Jordan. Meta-regression analysis showed a region and gender based prediction of malnutrition.

Conclusions: India has reported highest prevalence (9) studies globally. The prevalence of malnutrition among CKD patients varies geographically. This evidence shall serve as a base for policymakers, & physicians to manage malnutrition associated CKD which in turn can save enormous amount of healthcare spending and also retard the CKD progression.