There is a high prevalence of
protein-energy malnutrition in patients with
chronic renal failure who are undergoing maintenance dialysis
therapy. The high prevalence of
malnutrition is a potentially serious problem because indexes of
protein-energy malnutrition are powerful predictors of mortality in maintenance dialysis patients. Although the data do not prove that improving nutritional intake will reduce mortality, nonrandomized studies suggest that provision of addition
amino acids and energy to such patients is associated with reduced mortality. There are many causes for
protein-energy malnutrition in maintenance dialysis patients. Among the three most important factors are the nutritional status of the patient before commencing dialysis
therapy, inadequate
protein and energy intakes after they become dialysis patients, and acute and
chronic illnesses. Improving the nutrient intake of maintenance dialysis patients is a challenging task because most
chronic renal failure patients with
malnutrition are
anorectic, and dietary counseling has had limited success at increasing their nutrient intake. Other methods for improving nutritional status in adults, infants, and children with
chronic renal failure that have been tried with varying degrees of success include increasing the dose of dialysis and the use of food supplements and
tube feeding. Less well-proven techniques for the treatment of
protein-energy malnutrition include intradialytic
parenteral nutrition. The use of
appetite stimulants and such
growth factors as rhGH and rhIGF-I are still in the experimental stage.