Severe Wasting and Malnutrition in a Patient Undergoing Maintenance Dialysis

Feinstein, Eben I.; Kopple, Joel D.

doi:10.1159/000166970

Cited by 23 publications

(4 citation statements)

References 34 publications

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“…In the collective imagination, when we think about malnutrition on dialysis, the "skeleton man" is probably the first image that comes to mind; this evocative and somehow crude definition dated to the early dialysis era in which cachexia was frequently an effect of under-dialysis in a young person with high metabolic needs. The combination of insufficient depuration, by itself exerting a catabolic effect, and of multiple alimentary restrictions led to protein energy wasting, resulting in a metabolic disaster [68][69][70].…”

Section: From the "Skeleton Man" To The Obese Sarcopenic Patientmentioning

confidence: 99%

“…The experiments reported in the literature are protean, and the foods included vary. They seem to have been chosen mainly for their high protein content (for example, a preparation based on egg white in a recent Chinese study) or, less frequently, because of their cultural acceptance and higher palatability, as in a Brazilian experiment in which patients were given red meat snacks during dialysis [65][66][67][68][106][107][108][109][110]. Combination with phosphate binders is sometimes a choice, similarly to what is advised in phosphate-rich meals for people who are not on dialysis [108].…”

Section: Eating "Normal" Food During Dialysismentioning

confidence: 99%

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Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

et al. 2020

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Dialysis and nutrition are two sides of the same coin—dialysis depurates metabolic waste that is typically produced by food intake. Hence, dietetic restrictions are commonly imposed in order to limit potassium and phosphate and avoid fluid overload. Conversely, malnutrition is a major challenge and, albeit to differing degrees, all nutritional markers are associated with survival. Dialysis-related malnutrition has a multifactorial origin related to uremic syndrome and comorbidities but also to dialysis treatment. Both an insufficient dialysis dose and excessive removal are contributing factors. It is thus not surprising that dialysis alone, without proper nutritional management, often fails to be effective in combatting malnutrition. While composite indexes can be used to identify patients with poor prognosis, none is fully satisfactory, and the definitions of malnutrition and protein energy wasting are still controversial. Furthermore, most nutritional markers and interventions were assessed in hemodialysis patients, while hemodiafiltration and peritoneal dialysis have been less extensively studied. The significant loss of albumin in these two dialysis modalities makes it extremely difficult to interpret common markers and scores. Despite these problems, hemodialysis sessions represent a valuable opportunity to monitor nutritional status and prescribe nutritional interventions, and several approaches have been tried. In this concept paper, we review the current evidence on intradialytic nutrition and propose an algorithm for adapting nutritional interventions to individual patients.

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Section: From the "Skeleton Man" To The Obese Sarcopenic Patientmentioning

confidence: 99%

Section: Eating "Normal" Food During Dialysismentioning

confidence: 99%

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

et al. 2020

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“…Complications of kidney transplantation may promote wasting and malnutrition via several mechanisms [83], Corticosteroid therapy promotes catabolism, and immu nosuppression in general places the transplant recipient at increased risk of infectious diseases that can drastically increase energy requirements. However, correction of uremia by successful engraftment may result in improved appetite, and an improved sense of general well-being.…”

Section: Transplantationmentioning

confidence: 99%

Nutrition and the Dialysis Prescription

1996

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Malnutrition is common among patients with acute and chronic renal failure. The efficiency of modern dialytic techniques has allowed for more liberal administration of nutrients to patients with renal failure, particularly with regard to protein and amino acids. Protein restriction is not indicated for patients on dialysis, and should be employed cautiously, if at all, in patients with renal insufficiency. The ‘nutrition prescription’ should be considered a vital part of the comprehensive medical, surgical, and dialytic care provided to patients with renal disease.

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“…Un 'e videnza chiara della presenza di malnutrizione prot eica puo esse re tro vata nella mag gior parte degli studi sui pazienti in dialisi e una sindrome di grave malnut rizione risult a essere present e nel 10-15% dei pazienti (9). La malnutrizione rappresenta un fattor progn ostic o negati vo per i risultati c1inici a lungo termine ed es tata infatt i trovata un ' assoc iaz ione tra un basso introi to proteico (10 , I I) 0 basse albuminemie ( I I , 12) e un aumento delle ospedalizzazi oni e dell a mort alita.…”

Section: Npcr E Risultati Cliniciunclassified

Significato Clinico Della Cinetica Dell'urea Nel Paziente in Dialisi

Panzetta¹

1996

G Clin Nefrol Dial

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Severe Wasting and Malnutrition in a Patient Undergoing Maintenance Dialysis

Cited by 23 publications

References 34 publications

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

Nutrition and the Dialysis Prescription

Significato Clinico Della Cinetica Dell'urea Nel Paziente in Dialisi

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