Interventions to treat malnutrition in dialysis patients: the role of the dose of dialysis, intradialytic parenteral nutrition, and growth hormone.
Protein and calorie malnutrition often starts before initiation of dialysis, and reflects the anorexia and the catabolic state of chronic renal failure. In the face of inadequate dialysis, which perpetuates the uremic state, malnutrition often worsens. Several studies, though not all, suggest that optimal dialysis improves nutritional status of dialysis patients. Such optimal dialysis now must include the use of biocompatible membranes to deliver Kt/V > 1.4 (urea reduction ratio > 65%). Additional interventions can include the use of enteral or intravenous hyperalimentation, and recombinant growth factors such as growth hormone or insulin-like growth factor-1. Importantly, studies to document the improvement in the morbidity and mortality of patients with these interventions are still needed and require large multicenter trials.
Ikizler
T A
TA
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-2372, USA.
Wingard
R L
RL
Hakim
R M
RM
D013006:Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008567:Membranes, Artificial; D009748:Nutrition Disorders / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D010288:Parenteral Nutrition; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D011994:Recombinant Proteins / Q000627:therapeutic use; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods
D008567:Membranes, Artificial; D011994:Recombinant Proteins; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone