28 JOURNAL OF RENAL NUTRITION AND METABOLISM (2015) 1: 28-30


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REVIEW ARTICLE


Nutritional Challenges in Dialysis Patients

DS Rana

Chairman, Department of Nephrology, Sir Ganga Ram Hospital, New Delhi.



T

T

he term "protein-energy-wasting" (PEW) has been proposed to describe conditions such as protein­ energy-malnutrition, malnutrition-inflammation complex syndrome, malnutrition-inflammation atherosclerosis syndrome, kidney wasting disease and uremic cachexia which are associated with inadequate nutrient intake, decreased body protein and/or reduced energy reserves. PEW defines loss of somatic and circulating body protein mass and energy reserves. Malnutrition per se is defined as an imbalance between nutrient intake and nutrient


inflammatory response syndrome. About 20-70% patients on maintenance dialysis show signs of protein energy wasting (PEW). Malnutrition is multifactorial and if present at initiation of dialysis is a strong predictor of subsequent increase in relative risk of death (Figure 1).

Early identification of PEM is the key to rehabilitating malnourished dialysis patients and avoiding poor outcome. Problems unique to Indian patients are given in Table 1.


Table 1 : Problems Unique To Indian Patients

requirement which results in altered metabolism. Uremia

per se is the main causes of malnutrition which causes loss of appetite (anorexia) and consequently decreased food intake (energy and protein). This entire metabolic derangement is complicated by presence of metabolic acidosis which causes protein catabolism and contributes to development of malnutrition in CKD patients. Comorbidities (associated illnesses) like hypertension, diabetes mellitus, arthritis which affect organ systems again contribute to development of malnutrition. As renal function declines, spontaneous dietary protein restriction occurs. Uremia causes systemic


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Figure 1 :Malnutrition is multifactorial.

JOURNAL OF RENAL NUTRITION AND METABOLISM (2015) 1: 28-30


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References:

  1. Carrero JJ, J Etiology of Protein energy wasting syndrome in chronic

    kidney disease Renal Nutr 2013 Vol 23, issue 2, Pages 77-90

  2. NKF/ KDOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure Guideline 15 Dietary protein Intake in hemodialysis patients 2000 AJKD Vol 35 No 6 Suppl 2

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