Alteraciones de la nutrición en la enfermedad renal

Abstract

One of the most frequent problems for people undergoing renal replacement therapy is adequate nutrition. Malnutrition is very relevant and is an important predictor of morbidity and mortality regardless of the underlying disease^1-2. In different studies, it is reflected that between 30 and 70% of dialysis patients are malnourished and malnutrition has been correlated with mortality in any form of substitution treatment^3-4. Malnutrition can not only be observed in a subjective overall assessment, but can be objectively assessed by different parameters such as albumin, prealbumin, cholesterol, BUN, creatinine and lean mass levels^1-4. Although the causes of malnutrition are very numerous, the main factor is reduced intake, with uremic toxicity playing an important role^3-5. These patients are often prescribed a salt-free, low-potassium diet with fluid restriction, which makes it unattractive and interferes with their lifestyle, this may be aggravated if it coexists with depression or negative socioeconomic conditions^1-6. On the other hand, kidney failure leads to digestive and hormonal disorders that also favour anorexia and both haemodialysis and peritoneal dialysis lead to nutrient loss. It should also be noted that systemic inflammation is often associated with malnutrition and arteriosclerosis, which has been called MIA¹ syndrome. To avoid malnutrition it is essential to correct and periodically evaluate the nutritional status and correct the metabolic imbalance through adequate dialysis and to provide nutritional support with individualized dietary advice, administering oral supplements when protein intake is inadequate^6,7. The importance of following an adequate diet, which may be important to supplement, the risk of limiting protein consumption or how nutrition is related to different circumstances of treatment, are important for the health education of the renal patient, so some of these aspects are covered in the following articles.