x%20Nutrition%20in%20Renal%20Failure - NUTRITION ISSUES IN...

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PRACTICAL GASTROENTEROLOGY • SEPTEMBER 2004 40 INTRODUCTION A high prevalence of malnutrition exists in patients with renal failure. Several surveys have reported protein-calorie malnutrition in up to 40% of this patient population (1,2). Malnutrition in renal failure is multifactorial, but surveys consistently report inade- quate oral intake as a major contributing factor (1,2). Indicators of nutrition status including reduced nutri- ent intake and muscle mass are each independently associated with increased 12-month mortality (2). Gas- trointestinal complaints are frequently seen in this patient population and likely contribute to decreased intake and malnutrition (3–5). Research suggests that addressing GI issues in patients with renal failure may improve nutritional status (5). Although the traditional surrogate markers of mal- nutrition, such as decreased muscle mass or serum pro- teins have been associated with increased mortality, research is ongoing to determine if improving nutri- tional status will alter patient outcomes. Decreased mus- cle mass or serum proteins can also be attributed to acti- Nutrition in Renal Failure: Myths and Management NUTRITION ISSUES IN GASTROENTEROLOGY, SERIES #20 Carol Rees Parrish, R.D., MS, Series Editor Joe Krenitsky, MS, RD, Nutrition Support Specialist, Digestive Health Center of Excellence, University of Virginia Health System, Charlottesville, VA. Malnutrition occurs in up to 40% of patients with renal failure, and is associated with increased morbidity and mortality in this population. The cause of malnu- trition in renal failure is multifactorial, but gastrointestinal symptoms frequently contribute to decreased food intake. Treatment of the GI manifestations of renal failure and co-existing conditions can improve nutrition status. Providing calo- ries and protein that are appropriate for a patient’s stage of kidney disease allows adequate nutrition and avoids unnecessary diet restrictions. This article reviews factors that frequently impair nutrition status in patients with renal fail- ure, and provides suggestions for diet, supplements, and specialized nutrition support. Nutrition assessment, monitoring, and guidelines for vitamin and min- eral supplements are discussed. (continued on page 42) Joe Krenitsky
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PRACTICAL GASTROENTEROLOGY • SEPTEMBER 2004 42 NUTRITION ISSUES IN GASTROENTEROLOGY, SERIES #20 Nutrition in Renal Failure vation of the acute-phase response related to co-morbid conditions. In addition, it is possible that co-morbid conditions result in increased inflammatory cytokines and are the cause of both malnutrition and the increased m o r t a l i t y. However, there are several studies that demonstrate that the provision of increased nutrition to patients with malnutrition and renal failure may improve patient outcomes (1,6). This article will review some of the factors that affect nutrition status in patients with renal failure, discuss appropriate nutritional needs, and offer strategies for optimizing nutritional intake. DECREASED NUTRIENT INTAKE
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This note was uploaded on 10/04/2009 for the course NTR 371 taught by Professor Southworth during the Spring '09 term at University of Texas.

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x%20Nutrition%20in%20Renal%20Failure - NUTRITION ISSUES IN...

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