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ABSTRACT
Year : 2018  |  Volume : 4  |  Issue : 2  |  Page : 50

Enteral nutrition in dialysis


Consultant Nutritionist, Cumballa Hill Hospital, Mumbai, Maharashtra, India

Date of Web Publication6-Dec-2018

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2395-1540.246994

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How to cite this article:
Desai N. Enteral nutrition in dialysis. J Renal Nutr Metab 2018;4:50

How to cite this URL:
Desai N. Enteral nutrition in dialysis. J Renal Nutr Metab [serial online] 2018 [cited 2018 Dec 17];4:50. Available from: http://www.jrnm.in/text.asp?2018/4/2/50/246994



Nutrition therapy is one of the pillars of CKD treatment especially in the later stages because of the increasing prevalence of protein energy wasting (PEW) with declining renal function. The causes of PEW in CKD are multifactorial but all lead to higher susceptibility to infections, fraility and lower quality of life. PEW is also amongst the strongest predictors of mortality. Evidence is growing for benefits of enteral nutrition therapy on morbidity and mortality of patients on dialysis.

Enteral nutrition by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility of increasing or ensuring nutrient intake. Enteral nutrition by TF is the preferred route for nutritional support in acute renal failure and is more often used in infants and children who as a rule are treated with peritoneal dialysis. Enteral nutrition has been extensively used as the treatment of choice when artificial nutrition support is needed in dialyzed infants and children, as a supplement to low oral intakes, or in infants as the sole nutrient supply. It is generally possible to reach recommended intake levels for age using enteral nutrition. Some studies also report maintenance of or increase in growth rate. ONS is the preferred way of refeeding adult patients on dialysis.

Malnutrition at the start of dialysis carries an unfavorable prognosis. Dialysis patients tend to have increased requirements for protein, however, many of these patients may develop malnutrition because their intakes of protein and energy are far below the recommended requirements. Anorexia may be caused by uremia and various medical complications and psychosocial factors may also contribute to food aversion and inability to ingest food orally. Patients with chronic renal failure may be hypercatabolic for a variety of reasons (acidosis, infection, heart failure, andother comorbidity). If measures taken to increase the oral intake of nutrients fail, artificial nutrition is indicated.

Nutrition by nasogastric tube, gastrostomy tube, or gastrostomy button are obvious alternatives to intravenous or intraperitoneal nutrition in patients with chronic renal failure, who, for a variety of reasons, do not have an adequate oral nutrient supply.

Enteral nutrition has potential advantages over intravenous nutrition as it can be given more slowly (than IDPN), enables the patient to be ambulatory, may provide more balanced nutrition (for example, intravenous solutions contain too little tyrosine, which is an indispensable amino acid in uremia), and is considerably less expensive.






 

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