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NDT Plus Advance Access published online on October 19, 2009
NDT Plus, doi:10.1093/ndtplus/sfp147
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© The Author 2009. Published by Oxford University Press [on behalf of ERA-EDTA]. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Nutritional problems in adult patients with stage 5 chronic kidney disease on dialysis (both haemodialysis and peritoneal dialysis)

Anne-Elisabeth Heng1,2 and Noël J. M. Cano2,3,4,5

1 CHU Clermont-Ferrand, Service de Néphrologie, Hôpital G Montpied, F-63003 Clermont-Ferrand
2 Inra, UMR 1019 Nutrition Humaine, F-63122 Saint Genès Champanelle
3 CHU Clermont-Ferrand, Service de Nutrition, Hôpital G Montpied, F-63003 Clermont-Ferrand
4 Univ Clermont1, UFR Médecine, UMR 1019 Nutrition Humaine, F-63000 Clermont-Ferrand
5 CRNH Auvergne, F-63009, Clermont-Ferrand, France

Correspondence: Noël J. M. Cano; E-mail: noel.cano@clermont.inra.fr

Received for publication November 3, 2008. Accepted for publication September 20, 2009.

The first 150 words of the full text of this article appear below.

Nutritional problems in adult patients with stage 5 chronic kidney disease (CKD) on dialysis can be classified into three categories: protein–energy wasting (PEW), obesity and diabetes. The prevalence of obesity in dialysis is strikingly increasing [1]. In a European cohort of incident dialysis patients from the Netherlands (1997–2004), the average BMI was found to be 25.3 kg/m2 showing that more than half of patients were overweight or obese [2]. The relationship of obesity with haemodialysis (HD) patient outcome is discussed in another article of this issue. Diabetes type 2 which prevalence was less 10% in French HD patients ten years ago [3] is now found in ~20% and associated with a 2-fold increase in mortality rate [4,5]. Its impact on nutritional status and on the responsiveness to nutritional therapies will be discussed below. The present article focuses on PEW in dialysis patients. The . . . [Full Text of this Article]


   Causes of PEW in HD and PD patients
 
Inadequate food intake
Abnormal nutrient metabolism
Energy metabolism.
Amino acid and protein metabolism.
Role of renal residual function and dialysis dose

   Nutritional management of dialysis patients
 
Recommendations for nutritional monitoring
Nutritional requirements
Energy requirements.
Protein requirements.
Micronutrient requirements.
Methods for nutritional support
Dietician counselling.
Oral nutritional supplements.
Intradialytic parenteral nutrition.
Oral supplements or intradialytic parenteral nutrition: criteria of choice.
Tube feeding.
Intraperitoneal parenteral nutrition.
Strategy for nutritional support in HD and PD patients.
How to improve the efficacy of nutritional support

   Conclusion
 

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