Abstract
This review aims to highlight the strengths and weaknesses emerging from diagnostic evaluations and prescriptions in an intent to prevent progression over time of malnutrition and/or protein-energy wasting (PEW) in hemodialysis (HD) patients. In particular, indications of the most effective pathway to follow in diagnosing a state of malnutrition are provided based on a range of appropriate chemical-clinical, anthropometric and instrumental analyses and monitoring of the nutritional status of HD patients. Finally, based on the findings of recent studies, therapeutic options to be adopted for the purpose of preventing or slowing down malnutrition have been reviewed, with particular focus on protein-calorie intake, the role of oral and/or intravenous supplements and efficacy of some classes of amino acids. A new determining factor that may lead inexorably to PEW in hemodialysis patients is represented by severe amino acid loss during hemodialysis sessions, for which mandatory compensation should be introduced.
Highlights
Technological advances in the field and an increased clinical tolerability to treatment have heralded a significant rise in the age-specific rates of incidence and prevalence of hemodialysis (HD) treatment, regardless of the presence of a range of comorbid conditions [1]
Whilst estimation of urea nitrogen appearance (UNA) remains a valid parameter [30] in the assessment of chronic kidney disease (CKD) patients, when using a urea kinetic model equilibrated normalized protein catabolic rate in HD patients should only be estimated in the presence of steady-state metabolism
Chronic kidney disease is characterized by an accumulation of protein-bound uremic toxins (PBUTs) such as p-cresyl sulfate, p-cresyl glucuronide, indoxyl sulfate (IxS), and indole-3-acetic acid (IAA)
Summary
Technological advances in the field and an increased clinical tolerability to treatment have heralded a significant rise in the age-specific rates of incidence and prevalence of hemodialysis (HD) treatment, regardless of the presence of a range of comorbid conditions [1]. Nutritional disorders are frequently manifested during the first stage of chronic kidney disease (CKD), classified according to the degree of Glomerular Filtration Rate (GFR, mL/min/1.73 m2 ) [5]. End-stage kidney disease (ESKD) patients are frequently affected by loss of appetite, anorexia and gastrointestinal complaints as a result of severe dysbiosis and associated significant imbalance of uremic microbiota [13], together with increased gut mucosal permeability to protein-bound uremic toxins [14]. This situation may deteriorate further when an ESKD patient starts hemodialysis treatment. The aim of this paper is to highlight diagnosis and therapeutic procedures based on the most recent knowledge
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