Factors Influencing Nutritional Status In Dialysis Patients

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

Factors

Comments

Reduced nutritional intake Energy and protein intakes consistently lower than requirements

Uraemic symptoms can continue for upto three months after starting dialysis

Underdialysis Gastroparesis

Dialysis-related effects

Metabolic/endocrine factors

Co-morbidity and infections

Nutritional intake deteriorates with inadequate dialysis

Abdominal distension

Vomiting

Early satiety

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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