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KMID : 1034120130050020050
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Journal of Clinical Nutrition
2013 Volume.5 No. 2 p.50 ~ p.56
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Nutritional Support in Renal Failure
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Han Dong-Seok
Kim Dong-Ki
Lee Hyuk-Joon
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Abstract
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The kidney is the organ responsible for clearing nitro-genous 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 hu-man body, renal insufficiency could exert a significant ef-fect 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 im-proving the survival and quality of life in patients. AKI is a frequent complication affecting many critically ill pa-tients, who are in hypermetabolic state presenting with hyperglycemia, insulin resistance, hypertriglyceridemia and increased protein catabolism. The optimal nutritional man-agement of AKI includes providing adequate macro-nutrients to correct the underlying conditions and prevent ongoing loss as well as supplementing micronutrients and vitamins during RRT. As a result of the inflammatory me-diators, protein-calorie malnutrition may develop in pa-tients with CKD. Uremia also can secondarily worsen pro-tein-calorie malnutrition through the development of ano-rexia 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 nu-trition delivery, tailored to the patient’s clinical presenta-tion, is important to good nutritional care. Energy require-ments must be assessed and supplementation of macro-nutrients and micronutrients based on the disease cat-egory and type of RRT must be performed.
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KEYWORD
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Nutritional support, Acute kidney injury, Chronic kidney disease
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