Impact of Zinc Supplementation in Adults With Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Natalie L X Tan; Maya Young; Kelly Lambert; Jessica Dawson

doi:10.1093/nutrit/nuaf285

Impact of Zinc Supplementation in Adults With Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Nutr Rev. 2026 Feb 6:nuaf285. doi: 10.1093/nutrit/nuaf285. Online ahead of print.

Authors

Natalie L X Tan¹, Maya Young², Kelly Lambert¹, Jessica Dawson^{2

3}

Affiliations

¹ School of Medical, Indigenous and Health Sciences, University of Wollongong, New South Wales, Wollongong, Australia.
² Department of Nutrition and Dietetics, St George Hospital, Kogarah, Australia.
³ NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia.

PMID: 41651464
DOI: 10.1093/nutrit/nuaf285

Abstract

Context: Zinc deficiency is prevalent in people with chronic kidney disease (CKD) and has significant clinical implications. Previous systematic reviews have only evaluated the impact of zinc supplementation on a limited range of biochemical outcomes in people receiving hemodialysis.

Objective: In this analysis we sought to evaluate the impact of zinc supplementation on all outcomes in adults with CKD, including kidney replacement therapies.

Data sources: We conducted a systematic search across Cochrane, MEDLINE, CINAHL, PubMed, Scopus, and Google Scholar to identify randomized controlled trials assessing any outcomes in adults with CKD.

Data extraction: Three authors independently assessed trial eligibility, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias Tool and the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.

Data analyses: We identified 41 studies, with 23 included in meta-analyses. In total, 176 outcomes were reported, of which 11 were meta-analyzed. Zinc supplementation resulted in a significant increase in body weight (weighted mean difference [WMD], 2.52 kg; 95% CI, 1.58-3.45; P < .00001), serum zinc (WMD, 24.96 µg/dL; 95% CI, 20.43-29.50; P < .00001), high density lipoprotein cholesterol (HDL-C; WMD, 8.05 mg/dL; 95% CI, 0.22-15.88; P = .04), albumin (WMD, 0.38 g/dL; 95% CI, 0.07-0.69; P = .02), and dietary energy intake (WMD, 271.80 kcal; 95% CI, 172.70-370.90; P < .00001). No significant difference was observed in body mass index, total cholesterol, triglycerides, creatinine, and dietary protein and zinc intakes. Qualitative synthesis suggests that zinc supplementation may improve gastrointestinal symptoms, intensity of pruritus, quality of life, and quality of sleep.

Conclusions: In patients with CKD, znc supplementation is associated with increases in body weight, serum zinc, high-density lipoprotein-cholesterol (HDL-C), albumin, and dietary energy intake. The current body of evidence is of low quality, highlighting the need for further high-quality research to substantiate these findings and for the translation of findings into clinical practice.

Systematic review registration: PROSPERO registration no. CRD42024574253.

Keywords: chronic kidney disease; diet; meta-analysis; systematic review; zinc.

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