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Optimal nutrition in hemodialysis patients.
Adv Chronic Kidney Dis 2013; 20(2):181-9AC

Abstract

Protein-energy wasting (PEW) is highly prevalent in patients undergoing maintenance hemodialysis (MHD). It is important to note that there is a robust association between the extent of PEW and the risk of hospitalization and death in these patients, regardless of the nutritional marker used. The multiple etiologies of PEW in advanced kidney disease are still being elucidated. Apart from the multiple mechanisms that might lead to PEW, it appears that the common pathway for all of the derangements is related to exaggerated protein degradation along with decreased protein synthesis. The hemodialysis procedure per se is an important contributor to this process. Metabolic and hormonal derangements such as acidosis, inflammation, and resistance to anabolic properties of insulin resistance and growth hormone are all implicated for the development of PEW in MHD patients. Appropriate management of MHD patients at risk for PEW requires a comprehensive combination of strategies to diminish protein and energy depletion and to institute therapies that will avoid further losses. The mainstay of nutritional treatment in MHD patients is provision of an adequate amount of protein and energy, using oral supplementation as needed. Intradialytic parenteral nutrition should be attempted in patients who cannot efficiently use the gastrointestinal tract. Other anabolic strategies such as exercise, anabolic hormones, anti-inflammatory therapies, and appetite stimulants can be considered as complementary therapies in suitable patients.

Authors+Show Affiliations

Department of Medicine, Division of Nephrology, Vanderbilt University School of Medicine, Nashville, TN 37232-2372, USA. alp.ikizler@vanderbilt.edu

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

23439378

Citation

Ikizler, T Alp. "Optimal Nutrition in Hemodialysis Patients." Advances in Chronic Kidney Disease, vol. 20, no. 2, 2013, pp. 181-9.
Ikizler TA. Optimal nutrition in hemodialysis patients. Adv Chronic Kidney Dis. 2013;20(2):181-9.
Ikizler, T. A. (2013). Optimal nutrition in hemodialysis patients. Advances in Chronic Kidney Disease, 20(2), pp. 181-9. doi:10.1053/j.ackd.2012.12.002.
Ikizler TA. Optimal Nutrition in Hemodialysis Patients. Adv Chronic Kidney Dis. 2013;20(2):181-9. PubMed PMID: 23439378.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optimal nutrition in hemodialysis patients. A1 - Ikizler,T Alp, PY - 2012/09/05/received PY - 2012/12/03/revised PY - 2012/12/06/accepted PY - 2013/2/27/entrez PY - 2013/2/27/pubmed PY - 2013/9/26/medline SP - 181 EP - 9 JF - Advances in chronic kidney disease JO - Adv Chronic Kidney Dis VL - 20 IS - 2 N2 - Protein-energy wasting (PEW) is highly prevalent in patients undergoing maintenance hemodialysis (MHD). It is important to note that there is a robust association between the extent of PEW and the risk of hospitalization and death in these patients, regardless of the nutritional marker used. The multiple etiologies of PEW in advanced kidney disease are still being elucidated. Apart from the multiple mechanisms that might lead to PEW, it appears that the common pathway for all of the derangements is related to exaggerated protein degradation along with decreased protein synthesis. The hemodialysis procedure per se is an important contributor to this process. Metabolic and hormonal derangements such as acidosis, inflammation, and resistance to anabolic properties of insulin resistance and growth hormone are all implicated for the development of PEW in MHD patients. Appropriate management of MHD patients at risk for PEW requires a comprehensive combination of strategies to diminish protein and energy depletion and to institute therapies that will avoid further losses. The mainstay of nutritional treatment in MHD patients is provision of an adequate amount of protein and energy, using oral supplementation as needed. Intradialytic parenteral nutrition should be attempted in patients who cannot efficiently use the gastrointestinal tract. Other anabolic strategies such as exercise, anabolic hormones, anti-inflammatory therapies, and appetite stimulants can be considered as complementary therapies in suitable patients. SN - 1548-5609 UR - https://www.unboundmedicine.com/medline/citation/23439378/Optimal_nutrition_in_hemodialysis_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1548-5595(12)00222-4 DB - PRIME DP - Unbound Medicine ER -