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Nutritional requirements in maintenance hemodialysis
1Nephrology Department, Human Nutrition Research Center, Lyon Cedex, France. denis.fouque@chu-lyon.fr
Advances in Renal Replacement Therapy
|January 7, 2004
Summary
Maintenance hemodialysis patients often suffer from nutritional disorders, with low protein and energy intake common. Increased dialysis may not improve nutrition, and inflammation can worsen anorexia and protein balance.
Area of Science:
- Nephrology
- Clinical Nutrition
Background:
- High prevalence of nutritional disorders in maintenance hemodialysis (MHD) patients is increasingly recognized.
- Routine body composition assessments confirm low protein and energy intake in many MHD patients.
- Inflammation contributes to anorexia and disrupts protein metabolism in MHD patients.
Purpose of the Study:
- To discuss the management of nutritional abnormalities in maintenance hemodialysis patients.
- To emphasize strategies for optimizing energy, protein, vitamin, and trace element intake.
- To highlight the role of calcium, phosphorus, enteral, and parenteral nutrition in MHD patient care.
Main Methods:
- Analysis of food records and dietary interviews to assess patient intake.
- Review of the impact of dialysis dose (Kt/V) on nutritional status.
- Consideration of inflammatory markers and their effect on protein balance and appetite.
Main Results:
- Spontaneous low intakes of protein and energy are frequently observed in MHD patients.
- Elevated dialysis dose (Kt/V > 1.5) may not enhance nutritional intake.
- Inflammation negatively impacts protein synthesis, catabolism, and appetite.
Conclusions:
- Nutritional management in MHD patients requires a comprehensive approach.
- Addressing energy, protein, vitamin, and trace element deficiencies is crucial.
- Specific focus on calcium, phosphorus, and nutritional support (enteral/parenteral) is essential for improving MHD patient outcomes.