Approximately 40% of dialysis patients exhibit some degree of protein and energy malnutrition and this is associated with an increased risk of morbidity and mortality. In the Modification in Renal Disease Feasibility Study (MDRD) in which 840 patients were prospectively studied, 42% of CAPD patients and 30% of HD patients were considered to be malnourished (15). Contributing factors to protein energy malnutrition occurring in dialysed patients are shown in Table 15.1.
Table 15.1 Factors implicated in protein-energy malnutrition in dialysis patients
Reduced nutritional intake Energy and protein intakes consistently lower than requirements
Uraemic symptoms can continue for upto three months after starting dialysis
Co-morbidity and infections
Nutritional intake deteriorates with inadequate dialysis
Abdominal discomfort with infusion of PD dialysate Protein losses, 6-12 g amino acids during one HD session Daily protein losses on CAPD of 5-15 g/day Peritonitis protein losses up to 20 g/day
Hyperparathyroidism Hyperglucagonaemia Insulin resistance Vitamin D deficiency
IHD and episodes of hypotension limiting dialysis time PVD can limit vascular access for HD Infections of vascular access in HD patients and peritonitis in PD
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