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Malnutrition in Dialysis

  • Raj Kumar Sharma
  • Sonia Mehrotra
Living reference work entry

Abstract

Malnutrition continues to be a problem in chronic kidney disease (CKD) patients on hemodialysis (HD), resulting in increased morbidity and mortality. Factors that reduce food intake and increase hypercatabolism play important role in malnutrition seen in dialysis patients. Various factors contributing to malnutrition syndrome in dialysis are anorexia due to uremia with electrolyte and hormone imbalances, metabolic abnormalities, gastrointestinal disorders, psychological factors, severe dietary restriction, social problems, increased inflammation, hypercatabolism, and nutrient losses during hemodialysis and peritoneal dialysis. Detecting malnutrition in CKD patients is very challenging. Dialysis patients commonly show protein depletion and energy deficit. The term protein-energy wasting (PEW) syndrome describes the loss of body protein mass and reduction in calorie reserves in dialysis patients. Some dialysis patients can also get overweight or obese and do not appear to have energy deficit but may have protein malnutrition. PEW syndrome is associated with a poor prognosis. The pathogenesis of PEW is incompletely understood and has multifactorial etiopathogenesis. Comorbidities and under-dialysis also contribute to anorexia and malnutrition in dialysis. Intra-dialysis hyperalimentation may be provided for patients who continue to lose weight despite oral supplementation (at least 50% or more of the prescribed caloric intake).

Keywords

Chronic kidney disease Dialysis Malnutrition syndrome Protein-energy wasting Malnutrition management 

List of Abbreviations

BMI

Body mass index

CKD

Chronic kidney disease

ESRD

End-stage renal disease

GFR

Glomerular filtration rate

IDPN

Intradialytic Parenteral Nutrition

MHD

Maintenance hemodialysis

PEW

Protein-energy wasting

PNA

Protein nitrogen appearance

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NephrologySanjay Gandhi Post Graduate Institute of Medical SciencesLucknowIndia

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