Clinical Nutritional Approach in Kidney Diseases

Abstract

Chronic kidney disease (CKF) is a state of permanent decrease in glomerular filtration rate (GFH) that will cause established changes in kidney functions. End stage renal disease (ESRD) is characterized with irreversible loss of renal functions, and this constitutes a clinical state that requires renal replacement treatments such as dialysis and transplantation in order to be protected from harmful and life threatening effects of uremia. The incidence and prevalence of ESRD is increasing globally. Uremia decreases appetite and causes reduced food intake that is related with its negative effects on the gastrointestinal system function, metabolic asidosis, uremic toxicity, and induction of protein catabolism. Malnutrition is an important problem in ESRD. Protein energy malnutrition in ESRD is strongly related with increased morbidity and mortality. Since malnutrition is a common problem, periodic assessment of nutritional status should be part of the routine care of dialysis patients to permit early recognition and the institution of appropriate therapy. The first step is the modification of the diet for each individual. Nutritional support is indicated in undernourished ESRD patients as defined by low nutritional indices, mainly body mass index less than 20 kg/m2, body weight loss more than 10% over 6 months, serum albumin less than
3.5 g/dL and serum prealbumin less than 30 mg/dL and in cases where normal food intake is inadequate. If the patients can not tolerate oral nutritional support, tube feeding is recommended. If the patients can not tolerate enteral nutrition with tube feeding, then parenteral nutrition or intradialytic parenteral nutrition in hemodialysis patients is offered. In this review article, nutritional support in kidney diseases will be focused.