A Nephro-Nutrition Approach in Patients with Chronic Kidney Disease and Dialysis

Dear Colleagues,

The incidence of protein-energy wasting (PEW) increases as chronic kidney disease (CKD) progresses. However, PEW is more frequently detected in dialysis, and with a different profile depending on the dialysis technique used in the CKD patient, including either hemodialysis (HD) or peritoneal dialysis (PD).

In HD patients, protein loss will not generally be a problem, although the different HD techniques involve high energy consumption, which must be carefully monitored.  Thus, it is common in clinical practice to observe that the different HD schedules (incremental, online hemodiafiltration, HFR, daily HD, or high cut-off HD) modify patients' protein and energy requirements depending on the HD schedule.

When the renal patient is on PD, glucose absorption through the peritoneum makes it difficult for energy intake to be deficient. However, protein loss through the peritoneum, especially in episodes of peritonitis, makes it a priority to maintain sufficient protein intake.

From the initial stages of CKD, mainly in advanced chronic kidney disease, it is necessary to assess nutritional status so that renal patients start renal replacement therapy in the best possible nutritional status, as this is a predictor of morbidity and mortality in the first two years of dialysis.

The prevention of PEW, from the different stages of CKD, the correction of inflammation, and the adequacy of the different dialysis schedules together with nutritional intervention with oral nutritional supplements or intradialytic parenteral nutrition in HD and the use of protein modules require a comprehensive nephrology-nutrition approach within the holistic care of dialysis patients.

Prof. Dr. Guillermina Barril
Dr. Mar Ruperto Lopez
Guest Editors

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