Adequate nutrition is very important for dialysis patients for a better overall outcome.
Protein energy malnutrition is highly prevalent (25-50%) among dialysis patients and is associated with increased morbidity and mortality. Causes of
malnutrition in dialysis patients include
anorexia (inadequate calorie or
protein intake),
metabolic acidosis (stimulation of
amino acid and protein degradation), and
infection/
inflammation (stimulation of protein degradation).
Anorexia resulting into decreased intake is probably the most important factor. Nutritional assessment can be done by anthropometric measurements, laboratory parameters, subjective global assessment, dialysis
malnutrition score, near infra-red interactance and other methods. Subjective global assessment is currently the most accepted one and classifies patients into three nutritional categories: Well nourished, moderately malnourished, and severely malnourished. Prevention of
malnutrition by proper dietary counselling and adequate dietary intake starting from redialysis days is probably the most effective therapeutic approach. Other therapeutic approaches include adequate dialysis delivery, avoidance of acidaemia, aggressive treatment of catabolic illnesses and food supplements: Oral, enteral or parenteral, particulary intradialytic
parenteral nutrition. Experimental approaches for treatment of
malnutrition in dialysis patients include
amino acids in peritoneal or haemodialysate,
appetite stimulants and use of recombinant
human growth hormone and
insulin like growth factor I. There are few randomised controlled trials unequivocally proving the efficacy of any treatment modality. Large scale, randomised trials are urgently needed to establish effective
therapy for
malnutrition in dialysis patients. This applies more so for Indian patients.