MALNUTRITION IN RENAL FAILURE

"MALNUTRITION occurs in up to 40% of patient with renal failure, and is associated with increased morbidity and mortality."

"The cause of malnutrition in renal failure is multifactorial, but gastrointestinal symptoms frequently contribute to decreased food intake. Treatment of GI manifestations of renal failure and co-existing conditions can improve nutrition status. Providing calories and protein that are appropriate for a kidney's stage of kidney disease allows adequate nutrition and avoids unnecessary diet restrictions."
Dr Joe Krenitsky, MS, RD, Nutrition Support Specialist, Digestive Health Center of Excellence, University of Virginia Health System. VA.

Indicators of nutrition status include reduced nutrient intake and muscle mass. Gastrointestinal complaints contribute to decreased intake and malnutrition. Research suggests that increasing GI issues in patients with renal failure may improve nutritional status.

Factors contributing to malnutrition in renal failure

• Decreased intake
  • Anorexia
  • Gastroparesis
  • Intraperitoneal instillation of dialysate in CAPD
  • Uremia
  • Increased Leptin
• Diet Restrictions
• Loss of nutrients in dialysate
• Concurrent illness and hospitalization
• Increase inflammatory and catabolic cytokines
• Chronic Blood Loss
• Acidosis
• Accumulation of toxins such as aluminium
• Endocrine disorders
  • Insulin resistance
  • Hyperglucogonemia

Increased Nutrient Losses

1. Dialysis
   Patients who are on maintenance haemodialysis experience a loss of 6-12 gms of amino acids, 2-3 gms of peptides, and negligible amounts of proteins per dialysis session .
   
   Patients on peritoneal dialysis lose 2-4 gms of amino acids but a total loss of 8-9 gms of proteins a day (including 5-6 gms of albumin). During peritonitis, PD patients can lose up to 15gms of proteins a day, which can still continue after peritonitis is treated.
   
   Patients on haemodialysis also lose proteins due to frequent blood sampling for lab tests, about 16 gms of proteins with each 100ml of blood removed.
   
   
2. Malabsorption due to bacterial overgrowth is another route for nutrient loss in some patients.