[Malnutrition and chronic renal failure].

Area of Science:

• Nephrology
• Nutritional Science
• Metabolic Disorders

Context:

• Chronic renal failure (CRF) is associated with significant morbidity and mortality, often exacerbated by malnutrition.
• Nutrient metabolism abnormalities in peripheral and hepatosplanchnic tissues contribute to malnutrition in renal insufficiency.
• Protein and energy intake typically decline as renal insufficiency progresses.

Purpose:

• To highlight the critical role of malnutrition in chronic renal failure and its impact on patient outcomes.
• To discuss the challenges in nutritional management, including protein restriction and the need for adequate intake during dialysis.
• To emphasize the importance of monitoring nutritional markers and providing appropriate nutritional support in dialysis patients.

Summary:

• Malnutrition significantly increases morbidity and mortality in chronic renal failure, driven by decreased nutrient intake and abnormal metabolism.
• While protein restriction is common before dialysis, malnutrition suggests initiating dialysis and increasing protein intake.
• Severe malnutrition affects 25% of dialysis patients, compromising prognosis; protein catabolic rate, serum albumin, and prealbumin are key prognostic indicators.

Impact:

• Highlights the need for integrated nutritional assessment and management in dialysis patients.
• Underscores the importance of individualized nutritional support to meet estimated requirements (35-40 kcal/kg/day and 1.2-1.4g protein/kg/day).
• Emphasizes that addressing malnutrition is vital for improving the prognosis of patients with end-stage renal disease undergoing dialysis.