Dietary protein and nutritional supplements in conventional hemodialysis

Alice Sabatino, Giovanni Piotti, Carmela Cosola, Ilaria Gandolfini, Jeroen P. Kooman, Enrico Fiaccadori*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Protein energy wasting (PEW) is a condition commonly occurring among patients with ESRD on hemodialysis. PEW is characterized by depletion of protein and energy stores and is caused by multiple factors related to chronic kidney disease, acute and chronic comorbidities and by renal replacement therapy itself. Anorexia is central in the pathogenesis of PEW; it is frequently observed in these patients whose protein and energy intakes are typically lower than guidelines recommendations. If untreated, PEW invariably leads to major complications, and may activate a vicious circle with further worsening of nutritional status. Dietary counseling and nutritional status monitoring play a key role in the prevention and treatment of PEW, since they allow an early identification of high risk patients, as well as the assessment of the response to nutritional intervention. Different nutritional approaches can be implemented following thorough nutritional counseling. These are chosen on the basis of patients' spontaneous dietary intake, severity of PEW and acute comorbidities. Initially, regular encounters with the dietitian allow patients to clarify doubts and strengthen basic concepts on nutrition to improve dietary intake and prevent PEW. When PEW is present or the patient is at high risk, the clinician may opt for the administration of oral intradialytic or daily supplements, aiming at increasing energy and protein intake, while in selected cases intradialytic parenteral nutrition may be used. This review addresses the main issues of nutritional status in ESRD patients on hemodialysis-its evaluation and monitoring, as well as at describing the available nutritional interventions.
Original languageEnglish
Pages (from-to)583-591
Number of pages9
JournalSeminars in Dialysis
Volume31
Issue number6
DOIs
Publication statusPublished - 1 Nov 2018

Keywords

  • end-stage renal disease
  • hemodialysis
  • malnutrition
  • nutrient intake
  • nutritional status
  • protein energy wasting
  • CHRONIC KIDNEY-DISEASE
  • INTRADIALYTIC PARENTERAL-NUTRITION
  • RESTING ENERGY-EXPENDITURE
  • STAGE RENAL-DISEASE
  • DIALYSIS PATIENTS
  • MUSCLE PROTEIN
  • MAINTENANCE HEMODIALYSIS
  • INTERNATIONAL SOCIETY
  • CONSENSUS STATEMENT
  • PERITONEAL-DIALYSIS

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