search for




 

Nutritional Support in Renal Failure
신부전 환자의 영양 지원
THE KOREAN SOCIETY FOR PARENTERAL AND ENTERAL NUTRITION 2013;5:50-56
Published online August 31, 2013
© 2013 The Korean Society for Parenteral and Enteral Nutrition.

Dong-Seok Han, M.D.1,2, Dong Ki Kim, M.D., Ph.D.3,4, Hyuk-Joon Lee, M.D., Ph.D.1,4
한동석1,2ㆍ김동기3,4ㆍ이혁준1,4

1Department of Surgery, Seoul National University College of Medicine, 2Department of Surgery, Konkuk University Medical Center, 3Department of Internal Medicine, Seoul National Univer-sity College of Medicine, 4Nutritional Support Team, Seoul Natio-nal University Hospital, Seoul, Korea
1서울대학교 의과대학 외과학교실, 2건국대학교병원 외과, 3서울대학교 의과대학 내과학교실, 4서울대학교병원 영양집중지원팀
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
The kidney is the organ responsible for clearing nitro-genous and metabolic waste from the body as well as for regulating fluid, electrolyte, and acid-base balance in the body. Because of kidney's important role in the hu-man body, renal insufficiency could exert a significant ef-fect on the nutritional and metabolic status of patients. Renal insufficiency includes a variety of areas of disease. Disease extent can be categorized as acute kidney injury (AKI), chronic kidney disease (CKD), and end-stage renal disease (ESRD) requiring renal replacement therapy (RRT). Most patients with AKI require continuous RRT. Nutritional support in renal insufficiency plays an essential role in im-proving the survival and quality of life in patients. AKI is a frequent complication affecting many critically ill pa-tients, who are in hypermetabolic state presenting with hyperglycemia, insulin resistance, hypertriglyceridemia and increased protein catabolism. The optimal nutritional man-agement of AKI includes providing adequate macro-nutrients to correct the underlying conditions and prevent ongoing loss as well as supplementing micronutrients and vitamins during RRT. As a result of the inflammatory me-diators, protein-calorie malnutrition may develop in pa-tients with CKD. Uremia also can secondarily worsen pro-tein-calorie malnutrition through the development of ano-rexia and nausea. The pre-dialysis CKD patients require low-protein diet with caloric supplementation of 35 kcal/kg/day. However, ESRD patients on dialysis should receive 1.2∼1.3 g/kg of protein daily. An appropriate nu-trition delivery, tailored to the patient's clinical presenta-tion, is important to good nutritional care. Energy require-ments must be assessed and supplementation of macro-nutrients and micronutrients based on the disease cat-egory and type of RRT must be performed. (JKSPEN 2013;5(2):50-56)
Keywords : Nutritional support, Acute kidney injury, Chronic kidney disease
References
  1. Strejc JM. Considerations in the nutritional management of patients with acute renal failure. Hemodial Int 2005;9(2):13542.
    Pubmed CrossRef
  2. Thurau K. Pathophysiology of the acutely failing kidney. Clin Exp Dial Apheresis 1983;7(1-2):9-24.
    CrossRef
  3. Star RA. Treatment of acute renal failure. Kidney Int 1998;54(6):1817-31.
    Pubmed CrossRef
  4. Kopple JD. Dietary protein and energy requirements in ESRD patients. Am J Kidney Dis 1998;32(6 Suppl 4):S97-104.
    CrossRef
  5. Btaiche IF, Mohammad RA, Alaniz C, Mueller BA. Amino acid requirements in critically ill patients with acute kidney injury treated with continuous renal replacement therapy. Pharmacotherapy 2008;28(5):600-13.
    Pubmed CrossRef
  6. Wiesen P, Van Overmeire L, Delanaye P, Dubois B, Preiser JC. Nutrition disorders during acute renal failure and renal replacement therapy. JPEN J Parenter Enteral Nutr 2011;35(2):217-22.
    Pubmed CrossRef
  7. Kopple JD. Nutritional therapy in kidney failure. Nutr Rev 1981;39(5):193-206.
    Pubmed CrossRef
  8. Abel RM. Nutritional support in the patient with acute renal failure. J Am Coll Nutr 1983;2(1):33-44.
    Pubmed CrossRef
  9. Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 2008;73(4):391-8.
    Pubmed CrossRef
  10. Marin A, Hardy G. Practical implications of nutritional support during continuous renal replacement therapy. Curr Opin Clin Nutr Metab Care 2001;4(3):219-25.
    Pubmed CrossRef
  11. Brown RO, Compher C; American Society for Parenteral and Enteral Nutrition Board of Directors. A.S.P.E.N. clinical guidelines: nutrition support in adult acute and chronic renal failure. JPEN J Parenter Enteral Nutr 2010;34(4):366-77.
    Pubmed CrossRef
  12. Cano NJ, Aparicio M, Brunori G, Carrero JJ, Cianciaruso B, Fiaccadori E, et al; ESPEN. ESPEN Guidelines on Parenteral Nutrition: adult renal failure. Clin Nutr 2009;28(4):401-14.
    Pubmed CrossRef
  13. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al; Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11(2):R31.
    Pubmed KoreaMed CrossRef
  14. Gervasio JM, Cotton AB. Nutrition support therapy in acute kidney injury: distinguishing dogma from good practice. Curr Gastroenterol Rep 2009;11(4):325-31.
    CrossRef
  15. Li Y, Tang X, Zhang J, Wu T. Nutritional support for acute kidney injury. Cochrane Database Syst Rev 2010;(1):CD005426.
    CrossRef
  16. Fall P, Szerlip HM. Continuous renal replacement therapy:cause and treatment of electrolyte complications. Semin Dial 2010;23(6):581-5.
    Pubmed CrossRef
  17. Klein CJ, Moser-Veillon PB, Schweitzer A, Douglass LW, Reynolds HN, Patterson KY, et al. Magnesium, calcium, zinc, and nitrogen loss in trauma patients during continuous renal replacement therapy. JPEN J Parenter Enteral Nutr 2002;26(2):77-92.
    Pubmed CrossRef
  18. Kent PS. Integrating clinical nutrition practice guidelines in chronic kidney disease. Nutr Clin Pract 2005;20(2):213-7.
    Pubmed CrossRef
  19. Walser M, Mitch WE, Maroni BJ, Kopple JD. Should protein intake be restricted in predialysis patients? Kidney Int 1999;55(3):771-7.
    Pubmed CrossRef
  20. Stratton RJ, Bircher G, Fouque D, Stenvinkel P, de Mutsert R, Engfer M, et al. Multinutrient oral supplements and tube feeding in maintenance dialysis: a systematic review and meta-analysis. Am J Kidney Dis 2005;46(3):387-405.
    Pubmed CrossRef
  21. Bistrian BR. Role of the systemic inflammatory response syndrome in the development of protein-calorie malnutrition in ESRD. Am J Kidney Dis 1998;32(6 Suppl 4):S113-7.
    CrossRef
  22. Stenvinkel P, Heimb?rger O, Paultre F, Diczfalusy U, Wang T, Berglund L, et al. Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 1999;55(5):1899-911.
    Pubmed CrossRef
  23. Leavey SF, Strawderman RL, Jones CA, Port FK, Held PJ. Simple nutritional indicators as independent predictors of mortality in hemodialysis patients. Am J Kidney Dis 1998;31(6):997-1006.
    Pubmed CrossRef
  24. Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. Canada-USA (CANUSA) Peritoneal Dialysis Study Group. J Am Soc Nephrol 1996;7(2):198-207.
    Pubmed
  25. Owen WF Jr, Lew NL, Liu Y, Lowrie EG, Lazarus JM. The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. N Engl J Med 1993;329(14):1001-6.
    Pubmed CrossRef
  26. Clinical practice guidelines for nutrition in chronic renal failure. K/DOQI, National Kidney Foundation. Am J Kidney Dis 2000;35(6 Suppl 2):S1-140.
    Pubmed
  27. Williams B, Hattersley J, Layward E, Walls J. Metabolic acidosis and skeletal muscle adaptation to low protein diets in chronic uremia. Kidney Int 1991;40(4):779-86.
    Pubmed CrossRef
  28. Ihle BU, Becker GJ, Whitworth JA, Charlwood RA, KincaidSmith PS. The effect of protein restriction on the progression of renal insufficiency. N Engl J Med 1989;321(26):1773-7.
    Pubmed CrossRef
  29. Mehrotra R, Nolph KD. Treatment of advanced renal failure:low-protein diets or timely initiation of dialysis? Kidney Int 2000;58(4):1381-8.
    Pubmed CrossRef

 

June 2019, 11 (1)