Nutrition and Chronic Kidney Disease

Denis Fouque; Solenne Pelletier; Denise Mafra; Philippe Chauveau

Disclosures

Kidney Int. 2011;80(4):348-357. 

In This Article

Abstract and Introduction

Abstract

The incidence of malnutrition disorders in chronic kidney disease (CKD) appears unchanged over time, whereas patient-care and dialysis techniques continue to progress. Despite some evidence for cost-effective treatments, there are numerous caveats to applying these research findings on a daily care basis. There is a sustained generation of data confirming metabolic improvement when patients control their protein intake, even at early stages of CKD. A recent protein–energy wasting nomenclature allows a simpler approach to the diagnosis and causes of malnutrition. During maintenance dialysis, optimal protein and energy intakes have been recently challenged, and there is no longer an indication to control hyperphosphatemia through diet restriction. Recent measurements of energy expenditure in dialysis patients confirm very low physical activity, which affects energy requirements. Finally, inflammation, a common state during CKD, acts on both nutrient intake and catabolism, but is not a contraindication to a nutritional intervention, as patients do respond and improve their survival as well as do noninflamed patients.

Introduction

After the first hemodialysis sessions in the early sixties,[1] Dr Scribner rapidly pointed out key questions that emerged after these first treatments: how to better control blood pressure, how to manage chronic anemia, and which nutrients should be recommended to these patients. Fifty years later in 2010, the two first issues have been largely solved. By contrast, there is still much to do to fight protein–energy wasting as present epidemiological studies report between 30 and 50% of patients with signs of malnutrition.[2–5] What are the signs or protein–energy wasting? Are these symptoms already present before dialysis? Is this possible to correct these abnormalities and how? In this review, we will try to answer some of these important points.

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