J Korean Soc Parenter Enter Nutr.  2013 Aug;5(2):50-56. 10.15747/jkspen.2013.5.2.50.

Nutritional Support in Renal Failure

Affiliations
  • 1Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. appe98@snu.ac.kr
  • 2Department of Surgery, Konkuk University Medical Center, Seoul, Korea.
  • 3Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
  • 4Nutritional Support Team, Seoul National University Hospital, Seoul, Korea.

Abstract

The kidney is the organ responsible for clearing nitrogenous 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 human body, renal insufficiency could exert a significant effect 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 improving the survival and quality of life in patients. AKI is a frequent complication affecting many critically ill patients, who are in hypermetabolic state presenting with hyperglycemia, insulin resistance, hypertriglyceridemia and increased protein catabolism. The optimal nutritional management of AKI includes providing adequate macronutrients to correct the underlying conditions and prevent ongoing loss as well as supplementing micronutrients and vitamins during RRT. As a result of the inflammatory mediators, protein-calorie malnutrition may develop in patients with CKD. Uremia also can secondarily worsen protein-calorie malnutrition through the development of anorexia 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 nutrition delivery, tailored to the patient's clinical presentation, is important to good nutritional care. Energy requirements must be assessed and supplementation of macronutrients and micronutrients based on the disease category and type of RRT must be performed.

Keyword

Nutritional support; Acute kidney injury; Chronic kidney disease

MeSH Terms

Acid-Base Equilibrium
Acute Kidney Injury
Anorexia
Critical Illness
Dialysis
Diet, Protein-Restricted
Human Body
Humans
Hyperglycemia
Hypertriglyceridemia
Insulin Resistance
Kidney
Kidney Failure, Chronic
Metabolism
Micronutrients
Nausea
Nitrogen
Nutritional Support*
Protein-Energy Malnutrition
Quality of Life
Renal Insufficiency*
Renal Insufficiency, Chronic
Renal Replacement Therapy
Uremia
Vitamins
Micronutrients
Nitrogen
Vitamins
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