Journal of Renal Nutrition and Metabolism

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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.

A 62-year-old lady having autosomal dominant polycystic kidney disease (ADPKD) with gradual progression of chronic kidney disease (CKD) to end-stage renal disease presented with anorexia and dull-aching continuous abdominal discomfort. She had no response to conservative management and was started on maintenance hemodialysis. She followed up 3 months later. Her symptoms had only marginally improved initially despite continuing dialysis, and she continued to be malnourished. She presented to the emergency department with worsening abdominal pain and obstipation. Contrast-enhanced computed tomography abdomen was done which showed signs of abdominal tuberculosis with bowel obstruction. She was taken up for surgery. On postoperative day 2, she had refractory septic shock and cardiac arrest and could not be revived. Dull-aching chronic abdominal pain in ADPKD is common and is attributed to increased kidney sizes. With progression of CKD to uremia, anorexia is common. However, other causes of abdominal pain and malnutrition may be overlooked. In our case, the patient had abdominal tuberculosis which was the cause of persistent anorexia and malnutrition. Close follow-up of nutritional status and evaluation of malnutrition in patients with CKD is of paramount importance.

Online since 1^st November 2017.