34 - Nutritional Management of Hemodialysis Patients

Abstract

Protein-energy wasting (PEW) is a common comorbid condition in patients on maintenance hemodialysis (MHD). MHD patients with signs and symptoms of PEW are known to have a poor physical, quality life and are at increased rates of hospitalization and death. The unique aspects of advanced kidney disease and unintended consequences of hemodialysis confound reliable screening for PEW and assessment of nutritional status, complicating the management of this comorbid condition. Several measures can be applied to prevent the development of PEW in patients on MHD by targeting etiologic factors such as appropriate dietary nutrient intake, avoiding and counteracting the catabolic effects of hemodialysis, and treating systemic inflammation, metabolic acidosis, and hormonal derangements. In patients in whom preventive measures and oral dietary intake from regular meals cannot maintain adequate nutritional status, nutritional supplementation, administered orally, enterally, or parenterally, is shown to be effective in replenishing protein and energy stores. The advantages of oral nutritional supplements, especially when administered during hemodialysis, include proven efficacy, safety, and compliance. Anabolic steroids and exercise, in combination with nutritional supplementation or alone, have been shown to improve protein stores and represent potential additional approaches for the treatment of PEW in patients on MHD. Appetite stimulants, anti-inflammatory interventions, and newer anabolic agents can be used as adjunctive therapies when indicated, although data are limited with these emerging therapies.