Nutritional Management in Elderly CKD Patients in Japan

The munber of chronic kidney disease (CKD) patients is increasing globally because kidney function is affected by aging and lifestyle habits. Malnutrition, muscle weakness, and a decline in activities of daily living (ADL) are often observed in elderly CKD patients and dialysis patients, and are related to their CKD prognosis and life prognoses. Chronic inflammation and atherosclerotic disease are associated with malnutrition. Because malnutrition and its related factors affect patients' prognoses, it is necessary to identify and treat patients with malnutrition at an early stage. The state in which the stored protein and energy sources are reduced in CKD is called protein energy wasting (PEW). PEW is diagnosed on the basis of biochemical test findings such as hypoalbuminemia, unhealthy physique, and decreased muscle mass and dietary intake. For evaluating PEW, a complex nutritional index taking into account the pathophysiology specific to CKD patients is useful. Not only nutritional therapy but also exercise therapy is necessary to stop the vicious cycle associated with PEW and the decline in ADL.