Causes and interventions for malnutrition in patients undergoing maintenance dialysis

Maintenance dialysis (MD) patients frequently present mild to severe malnutrition. Food intake is often reduced by anorexia. A state of persistant catabolism may be caused by chronic acidosis, resistance to anabolic factors such as growth hormone, insulin and insulin-like growth factor-1. Losses of nutrients including glucose, amino acids and vitamins occur during the dialysis treatment, and negative nitrogen balance has been reported during hemodialysis. Intradialytic parenteral nutrition containing lipids, glucose and amino acids has been administered to malnourished MD patients when oral supplements have failed to improve their nutritional status. Amino acid infusion into the peritoneal cavity induces positive nitrogen balance in malnourished continuous ambulatory peritoneal dialysis patients. Anabolism has been observed during administration of recombinant growth hormone and insulin-like growth factor-1 in malnourished MD patients. In the fight against catabolic events, an increase in nutrient intake or delivery by dialysis and promotion of anabolism simultaneously may be prerequisite for correcting malnutrition in MD patients.