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This article discusses the importance of nutrition intervention and management in clinical dietetic practice with the aid of nutrition care process (NCP) in a Stage 5 chronic renal failure, hypertensive outdoor patient. The objective was to provide medical nutrition therapy to the patient to delay the progression of the disease and improve the quality of life. Patient education was emphasized during every diet counseling session. The patient progressed through nutrition care as indicated in the plan of care, with improvement. NCP was used to document and manage nutrition care and involves four steps: nutrition assessment and reassessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring and evaluation.

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In view of the coronavirus disease 19 (COVID-19) pandemic, most health-care resources focused on testing capability and increasing hospital beds and ventilators. Lockdown and reallocation of resources are two major interventions done by the government to tackle with the COVID outbreak. However, this is at the cost of patients living with noncommunicable diseases (NCDs) such as diabetes, hypertension, cancer, cardiovascular emergencies, and chronic kidney disease (CKD). Nevertheless, all health-care services related to NCD are impacted, but patients with CKD, especially those on dialysis, are affected mostly. People living with NCDs especially with CKD are at higher risk of severe COVID-19-related illness and death. It is vital that countries find innovative ways to ensure that essential services for CKD continue, even as they fight COVID-19.

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Studies report a high prevalence of protein-energy malnutrition in patients with chronic kidney disease (CKD) and in dialysis-dependent end-stage kidney disease (ESKD) patients. The strongest evidence comes from the Modification of Diet in Renal Disease study, which showed that, in patients with CKD, as renal function decreases, dietary protein and energy intake, anthropometric parameters, and biochemical markers of nutrition progressively decline. Even we have observed that the calorie and protein intake of Indian patients with CKD and ESRD is poor. This article discusses the methods to assess dietary intake in CKD and ESKD on maintenance dialysis.

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Malnutrition is prevalent in patients on hemodialysis. About 18%–75% of patients with chronic kidney disease, undergoing maintenance dialysis, show evidence of wasting. The genesis of malnutrition in hemodialysis patients is multifactorial and comprises reduced dietary nutrient intake, metabolic derangements associated with uremia, and the adverse effects of hemodialysis and other concurrent morbid conditions. In spite of much progress done in recent years in recognizing the pathomechanistic link between malnutrition and mortality, consensus regarding the therapeutic strategies to deal with nutrition-related clinical problems is lacking. Protein–energy wasting (PEW) is the most influential risk factor for adverse outcomes and death. Nutritional supplementation (orally or parenterally) is useful in the management of PEW.

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Background: Chronic kidney disease (CKD) is a growing health problem worldwide. Uremic toxin buildup caused by protein bacterial metabolites such as indoleamines, urea, and indoxyl sulfate contribute to dysbiosis in the gut microbiome in hemodialysis patients, which contributes to a pro-infiammatory environment. Aims: This systematic review of the literature considers the confiicting evidence on probiotic supplementation and infiammatory status in CKD patients receiving hemodialysis. Methods: PubMed, EBSCO, and Google Scholar were all used to search for control/clinical trials demonstrating the effects of probiotic supplementation on these protein bacterial metabolites and C-reactive protein (CRP) levels. Results: Four of the five studies observed no significant findings in the reduction of infiammatory status in this population. One study demonstrated a significant reduction in CRP levels after 3 months of probiotic supplementation. Many articles varied between using single and multiple strains of bacteria which contributed to limitations to the studies. There was limited supporting evidence to suggest that probiotic supplementation could reduce infiammatory status in hemodialysis patients. Conclusions: Based on the findings, more research is needed before any conclusive recommendations can be made on whether probiotic supplementation would be beneficial for patients receiving hemodialysis treatments.

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Role of ethics in organ transplantation has been increasing with increasing number of organ transplants. Doing an ethical transplantation is of crucial importance. It is the liability of transplant team to follow the international and national ethical standards. Often, it is perceived that ethical and legal issues are the same. With the introduction of various ethical guidelines by international community, it is prudent that transplant team and the public abide by the existing regulations to avoid unanticipated outcomes of a successful transplant. Transplantation activity should be carried out with the premise that it is within the legal and ethical perspectives of that particular country. Transnational or transcontinental understanding of ethical perspectives by the nations actively involved in organ transplantation would definitely curb unethical and illegal elements.

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Malnutrition inevitably accompanies chronic kidney disease and dialysis. Markers of malnutrition such as low-serum albumin have been shown to correlate independently with higher mortality in dialysis patients.^[1] Malnutrition is seen in both hemodialysis and peritoneal dialysis (PD) patients. Nutritional management of PD patients is challenging and vital to the patients' long-term survival and well-being. A multidisciplinary approach with a patient-centric plan is necessary to achieve long-term compliance and success. Consideration to cultural, economic, and medical issues is paramount to develop a workable plan, especially in a country as large and diverse as India. This article reviews nutritional management of PD patient.

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Patients with chronic kidney disease, both predialysis and those on dialysis, are vulnerable to the onslaught if disease which presents in the form of malnutrition and muscle wasting. These two conditions are associated with increased morbidity and mortality which mandates thorough assessment and intervention with the progression of the disease, keeping in mind comorbidities, infection, and intercurrent illness. As no single tool alone can assess the nutritional status of these patients, a systematic approach for the assessment of nutritional status and monitoring dietary prescription with timely follow-up is a prerequisite for mending the quality of life of these patients.

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This article address issues on what is an elimination diet? What is the scientific background and the evidence for it? The use of elimination diet in gastrointestinal diseases and in IgA nephropathy. In this article, I share my experience on elimination diet in the clinical practice and an ongoing clinical study, the pitfalls and my advices.

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Malnutrition refers to abnormalities induced by an inadequate diet, whereas wasting refers to abnormalities that cannot be corrected solely by increasing the diet.^[6] Although these entities are different in their etiopathogenesis somewhat, both share some common features such as low serum albumin, prealbumin, and body mass index. Although these entities are different in their etiopathogenesis somewhat, both share some common features such as low serum albumin, prealbumin, and body mass index. Hence, subjective and objective assessment of PEW and intervention for correctible factors must be carried out routinely.

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During COVID-19 pandemic. the practice of peritoneal dialysis is better understood as dealing with behaviour, management, and prevention of infection in end-stage-renal-disease. Adequate supplies should be stocked for at least 2 to 3 weeks in case of quarantine or break in supply chain due to transport breakdown. This article briefly covers acute PD in COVID patients with acute kidney injury (AKI) stable PD patients in pandemic (not infected) an PD patients with COVID infection.

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Overnutrition is associated with impaired renal function. In renal disease, high protein load acutely increases glomerular filtration rate (GFR) in predialysis stage. Excess protein alters hemodynamics and is converted into urea and other nitrogenous wastes which not only accumulate in the body causing uremic syndrome, but also cause a rapid decline of renal function through increased hyperfiltration and intraglomerular hypertension, severity of micro albuminuria and, over the long term, glomerulosclerosis. This article highlights important studies on very low protein diet.

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Chronic kidney disease (CKD) has evolved into a major noncommunicable disease in India due to both increased incidence and diagnosis. It is believed to affect <10% of adult population who are at excess risk of cardiovascular (CV) and renal morbidity and mortality. The incidence of end-stage renal disease is about 152 per million which is driven by diabetes, hypertension, and chronic glomerulonephritis. In later stages of CKD, phosphate (P) retention is the rule with its myriad pathological links to vascular calcification and CV mortality. This article focuses on protein intake and P restriction in CKD.

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Headings are not required in this abstract as material and methods results etc are not involved. Patients undergoing hemodialysis (HD) have a high prevalence of protein–energy malnutrition and inflammation. As these two conditions occur concomitantly with mild-to-severe atherosclerosis in CKD, these three conditions collectively have been referred to as malnutrition-inflammation-atherosclerosis syndrome (MIA syndrome). but later studies showed that syndrome also exists in preterminal renal failure patients and PD patients. The three components not only coexist but also interact with each other. This article briefly discusses potential nutritional management of MIA syndrome.

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