Regardless of the parameters used in nutritional assessment, chronic renal patients on dialysis have some degree of malnutrition. From 10% to 70% of patients on dialysis therapy are malnourished and among the causes that contribute to the progression of this condition are: inadequate/insufficient diet, losses due to the dialysis process itself, associated pathologies and inflammation (1).
Chronic renal patients may manifest some symptoms that are visible on physical examination. Their history can likewise aid in completion of the nutritional diagnosis. In a less invasive way, the Nutritional Condition of chronic renal patients can be checked by using the Subjective Global Assessment (SGA) adapted to renal patients and, by using the assessment results, whatever needs correction can be corrected by using the ONT (2).
Although all enteral and parenteral therapy options may be indicated, the reinforcement of conventional oral diet and, when needed, the use of supplements, seem to be the most effective and well tolerated options for the prevention and nutritional recovery of patients on hemodialysis (3,4).
Maintaining adequate nutritional condition in chronic renal patients through conventional diet alone is a challenge for both the professional and the patient. The patient who makes use of hemodialysis can lose about 40 g of amino acids/peptides per week (2,4).
Patients who make use of peritoneal dialysis can suffer a deficit of amino acids/peptides of up to 30 g/week, 15 g protein/day, aside from water-soluble vitamins. Current recommendations advise protein intake from 1.0 to 1.2 g/kg for ideal weight. It is desirable for maintenance of the nutritional condition, at least 20 g of fibers/day and 25 to 35 kcal/day depending on the chosen dialysis process. The graph below shows the size of nutrient loss in accordance with the dialysis process (2,4).
Source: Adapted from K/DOQI, National Kidney Foundation, 2000 e Martins, C. In: Nefrologia: rotinas, diagnóstico e tratamento, 2006
1. Calado, IL et al. Diagnóstico nutricional de pacientes em hemodiálise na cidade de São Luis (MA). Rev de Nutr Cli Campinas. 22(5):687-696. 2009.
2. K/DOQI, National Kidney Foundation, 2000 e Martins, C. In: Nefrologia: Rotinas, Diagnóstico e Tratamento, 2006.
3. Dong J, Ikizler TA. New insights into the role of anabolic interventions in dialysis patients with protein energy wasting. Curr Opin Nephrol Hypertens 2009;18:469-75.
4. DITEN – Projeto Diretrizes. Terapia Nutricional para Pacientes em Hemodiálise Crônica. 2011. (http://www.projetodiretrizes.org.br/9_volume/terapia_nutricional_para_pacientes_em_hemodialise_cronica.pdf)