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2. Obese ++ + + ++
* first 3 months
Malnutrition in CKD
Type II
Type I
uremic malnutrition/wasting
Pupim L, Ikizler TA: Uremic malnutrition: New insights into old problem.
Semin Dial 2003; 16: 224-232
Type of Malnutrition in Kidney Disease
Factors Type 1 Type 2
Associated with uremic Associated with MIA
syndrome syndrome
Lack of compliance
Enteral Nutrition
Dietary Oral
IDPN If EN is not possible:
counselling supplements Central venous PN
No improvement No improvement
Clinical Nutrition.2009;28:401-414
Interventions to prevent and/or treat PEW in CKD patients
(1) Pre-dialysis patients
- Optimal dietary protein and calorie intake
- Optimal timing for initiation of dialysis, before onset of indices of malnutrition
(2) Dialysis patients
- Appropriate amount of dietary protein intake (> 1.2 g/kg/day) along with nutritional counseling to
encourage increased intake
- Optimal dose of dialysis (Kt/V > 1.4 or URR > 65%)
- Use of biocompatible dialysis membranes
- Enteral or intradialytic parenteral nutritional supplements (hemodialysis) and amino acid dialysate
(peritoneal dialysis) if oral intake is not sufficient
- Growth factors (experimental):
Recombinant human growth hormone
Recombinant human insulin-like growth factor-I
(3) Transplant patients:
- Appropriate amount of dietary protein intake
- Avoidance of excessive use of immunosuppressives
- Early reinitiation of dialytic therapy with proper steroid tapering in patients with chronic rejection
Kidney Int. 1996;50:343-357
What are the nutritional
requirement of patients with
CKD ?
0.6/kg/day protein for CKD patients whose GFR < 60 ml/min/1.73m2. Ketoacid is
supplemented at the dosage of 0.12/kg/day (1 tablet/5kg/day).
0.3/kg/day protein for CKD patients whose GFR < 30 ml/min/1.73m2. Ketoacid is
supplemented at the dosage of 0.2/kg/day (2 tablet/5kg/day).