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ABSTRACT
Year : 2018  |  Volume : 4  |  Issue : 4  |  Page : 120-121

Kidney disease: Impact on metabolism and nutrition


Dietician, Bhaktivedanta Hospital, Mumbai, Maharashtra, India

Date of Web Publication19-Sep-2019

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrnm.jrnm_24_19

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How to cite this article:
Nawathe VA. Kidney disease: Impact on metabolism and nutrition. J Renal Nutr Metab 2018;4:120-1

How to cite this URL:
Nawathe VA. Kidney disease: Impact on metabolism and nutrition. J Renal Nutr Metab [serial online] 2018 [cited 2019 Oct 21];4:120-1. Available from: http://www.jrnm.in/text.asp?2018/4/4/120/267194



Multiple mechanisms in the body are altered due to impaired kidney disease. The right approach is to understand disease pathogenesis and clinical assessment (including nutritional screening and assessment) followed by planning and execution of treatment rationale, such as potential pharmacological, nutritional, and exercise therapies.

Chronic kidney disease (CKD) is associated with multiple metabolic disturbances such as hypertension, dyslipidemia, insulin resistance, cardiovascular disease (CVD), and anorexia-cachexia syndrome, which are linked to poor outcomes. There are additional other hormonal, inflammatory, and nutritional–metabolic factors such as raised pro-inflammatory cytokines, such as interleukin-1 and -6, altered hepatic proteins, including low albumin, raised C-reactive protein, changes in anabolic hormone responses with reduced insulin-like growth factor-1 activity, hyperactivation of the renin-angiotensin-aldosterone system, promotion of insulin resistance due to abnormal leptin levels, poor Vitamin D status, leading to CVD risk and increased glucocorticoid activities leading to hypertension, diabetes risk, and cachexia. There are alterations in physiological functions including accumulation of uremic toxins, termed “uremia,” metabolic acidosis, abnormalities in lipid, amino acid, mineral, bone, and homocysteine metabolism; anemia; and skeletal muscle dysfunction [Table 1]. Lee et al., 2007 found that in nondiabetic ESRD patients, insulin resistance correlated with muscle wasting potentially indicating the importance of insulin-sensitive anabolic/anti-catabolic pathways in the regulation of protein turnover in skeletal muscle.
Table 1: Cachexia - burden on poor health

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  Why is Good Nutrition Important for People With Kidney Disease? Top


As the body is under metabolic, hormonal, and physiological stress, there is need for extra nutritional care, so that malnutrition can be prevented or reversed for better tolerance of treatment modality (conservative medical management/dialysis/kidney transplant).

Treatment modalities

The precise relationship between these many factors in kidney disease is being rapidly investigated as the burden of poor health in this patient group is high. Understanding the causal mechanisms involved in the promotion of metabolic dysfunction and risk of CVD and mortality in CKD is critical. Clinicians are recognizing the importance of understanding this complex disease, its nutritional implications, assessment, and treatment modalities and the potential to modify health and outcome by pharmacological and nonpharmacological means, e.g., by nutritional therapies.

Nutrition goals in kidney disease

The well-defined goals include reducing workload on kidneys, restoring/maintaining optimal nutritional status, controlling the accumulation of uremic toxins, modifying diet with respect to biochemical profile, management of symptoms such as anorexia, breathlessness, distended abdomen, anuria, and weakness, and frequent monitoring and modification of diet.

Diet approach in CKD is often complex. [Table 2] shows a standard approach to clinical case. Apart from pharmacological and nutritional interventions, psychological factor is equally important. Psychological interventions begin at diagnosis and are a team approach of health professionals, relatives, friends/caretakers, and a patient. It is extremely important to make the patient understand his/her role in taking the responsibility for own health. Constant positive and encouraging support plays a very important role.
Table 2: Standard approach to evaluation - a clinical case

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  Challenges in Transforming Theory Into a Bed-side Practice Top


  1. Making the patient understand the importance of preventing malnutrition
  2. Overcoming uremic symptoms such as anorexia and dry mouth.


Anorexia

Small amounts of frequent meal on scheduled mealtimes as per patient's demand. Energy bomb mini– calorie dense meal when the patient is hungry, limit fluids during meals. Create a pleasant mealtime atmosphere, make meals more appealing. Protected meal timing, i.e., preserving meal timings without any interference also, is very effective in hospitalized patients as well as at home.

Dry mouth

Foods which will help you to produce saliva are ginger, lemon, saunf, and elaichi.

Low salt: – Since salt promotes thirst, replace salt with spices or seasonings to Make up for the taste. Use of curry leaves, pudina, green chilies, kasuri methi, shepu or onion powder, garlic powder, orageno, thyme, basil, chilli flakes, pepper or mustard seeds, paprika, saunf, jeera, methi seeds, and ajwain mixes can enhance taste.

A well-planned nutritional approach will definitely help the patient in coping up with the challenges. A practical application is any time workable based on theory.





 
 
    Tables

  [Table 1], [Table 2]



 

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