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Nutritional therapy and chronic kidney disease patients

The impact of dialysis procedures, combined with the specific characteristics of the disease such as hyporexia or subclinical inflammation, causes significant changes in patients' nutritional status. The Subjective Global Assessment shows that 50% of hemodialysis patients are diagnosed with malnutrition. In this context, nutritional therapy (NT) is essential for controlling alterations in the protein and energy metabolism of chronic kidney patients, helping to increase their quality of life.

In general, calorie recommendations for HD patients differ little from those for healthy individuals. However, before making any dietary restrictions, you need to know what the patient eats and their clinical condition. For Carla Avesani, a nutritionist specializing in chronic kidney disease, restrictive and unpalatable diets are the main cause of these patients remaining malnourished. Today, nutritionists are so focused on the clinical side that they end up forgetting about the dietary side, says Carla.

Oral feeding is still the most common diet used to manage metabolic changes in kidney patients. However, in view of the changes in routine due to dialysis treatment, nutritional adaptations are necessary, usually made with supplements. On hemodialysis days, patients spend a lot of time away from home and this has an impact on their diet, especially because the procedure is very catabolic and causes loss of appetite, explains Carla.

Oral supplements are indicated after attempts to increase food intake with diet alone, especially in cases of malnutrition and energy intake below requirements. Tube feeding is indicated for hypercatabolic or unconscious patients. Parenteral NT is reserved for cases of dysfunction or impediment of the gastrointestinal tract.

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