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Nutritional management of maintenance dialysis patients: why aren't we doing better?

Abstract

About 40% of patients undergoing maintenance dialysis suffer from varying degrees of protein-energy malnutrition. This is a problem of substantial importance because many measures of nutritional status correlate with the risk of morbidity and mortality. There are many causes of protein-energy malnutrition in maintenance dialysis patients. Evidence indicates that nutritional decline begins even when the reduction in glomerular filtration rate is modest, and it is likely that the observed decrease in dietary protein and energy intake plays an important role. The nutrient intake of patients receiving maintenance dialysis also is often inadequate, and several lines of evidence suggest that toxins that accumulate with renal failure suppress appetite and contribute to nutritional decline once patients are on maintenance dialysis. Recent epidemiologic studies have suggested that both increased serum levels of leptin and inflammation may reduce nutrient intake and contribute to the development of protein-energy malnutrition. It is likely that associated illnesses, which are highly prevalent, contribute to malnutrition in maintenance dialysis patients. Recent data from the United States Renal Data System registry suggest that in the United States, the mortality rate of dialysis patients is improving. However, it remains high. We offer suggestions for predialysis and dialysis care of these patients that can result in improvement in their nutritional status. Whether this improvement will result in a decrease in patient morbidity and mortality is unknown.

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  • Authors+Show Affiliations

    ,

    Division of Nephrology and Hypertension, UCLA School of Medicine, Harbor-UCLA Medical Center and Research and Education Institute, Torrance, California 90509, USA. rmehrotra@rei.edu

    Source

    Annual review of nutrition 21: 2001 pg 343-79

    MeSH

    Anorexia
    Diet
    Humans
    Inflammation
    Kidney Failure, Chronic
    Nutritional Physiological Phenomena
    Nutritional Requirements
    Nutritional Status
    Peritoneal Dialysis
    Protein-Energy Malnutrition
    Renal Dialysis

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    11375441

    Citation

    Mehrotra, R, and J D. Kopple. "Nutritional Management of Maintenance Dialysis Patients: Why Aren't We Doing Better?" Annual Review of Nutrition, vol. 21, 2001, pp. 343-79.
    Mehrotra R, Kopple JD. Nutritional management of maintenance dialysis patients: why aren't we doing better? Annu Rev Nutr. 2001;21:343-79.
    Mehrotra, R., & Kopple, J. D. (2001). Nutritional management of maintenance dialysis patients: why aren't we doing better? Annual Review of Nutrition, 21, pp. 343-79.
    Mehrotra R, Kopple JD. Nutritional Management of Maintenance Dialysis Patients: Why Aren't We Doing Better. Annu Rev Nutr. 2001;21:343-79. PubMed PMID: 11375441.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Nutritional management of maintenance dialysis patients: why aren't we doing better? AU - Mehrotra,R, AU - Kopple,J D, PY - 2001/5/26/pubmed PY - 2002/1/5/medline PY - 2001/5/26/entrez SP - 343 EP - 79 JF - Annual review of nutrition JO - Annu. Rev. Nutr. VL - 21 N2 - About 40% of patients undergoing maintenance dialysis suffer from varying degrees of protein-energy malnutrition. This is a problem of substantial importance because many measures of nutritional status correlate with the risk of morbidity and mortality. There are many causes of protein-energy malnutrition in maintenance dialysis patients. Evidence indicates that nutritional decline begins even when the reduction in glomerular filtration rate is modest, and it is likely that the observed decrease in dietary protein and energy intake plays an important role. The nutrient intake of patients receiving maintenance dialysis also is often inadequate, and several lines of evidence suggest that toxins that accumulate with renal failure suppress appetite and contribute to nutritional decline once patients are on maintenance dialysis. Recent epidemiologic studies have suggested that both increased serum levels of leptin and inflammation may reduce nutrient intake and contribute to the development of protein-energy malnutrition. It is likely that associated illnesses, which are highly prevalent, contribute to malnutrition in maintenance dialysis patients. Recent data from the United States Renal Data System registry suggest that in the United States, the mortality rate of dialysis patients is improving. However, it remains high. We offer suggestions for predialysis and dialysis care of these patients that can result in improvement in their nutritional status. Whether this improvement will result in a decrease in patient morbidity and mortality is unknown. SN - 0199-9885 UR - https://www.unboundmedicine.com/medline/citation/11375441/full_citation L2 - http://arjournals.annualreviews.org/doi/full/10.1146/annurev.nutr.21.1.343?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -