Liječnički vjesnik, Vol. 137 No. 1-2, 2015.
Stručni rad
CROATIAN GUIDELINES FOR SCREENING, PREVENTION AND TREATMENT OF PROTEIN-ENERGY WASTING IN CHRONIC KIDNEY DISEASE PATIENTS
Nikolina Bašić-Jukić
Josipa Radić
Dragan Klarić
Marko Jakić
Božidar Vujičić
Marijana Gulin
Željko Krznarić
Eva Pavić
Petar Kes
Bojan Jelaković
Sanjin Rački
Sažetak
There is a high incidence of cardiovascular morbidity and mortality among patients with chronic kidney disease (CKD) and malnutrition is a powerful predictor of cardiovascular morbidity and mortality in this population of patients. A multitude of factors related to CKD and renal replacement therapy can affect the nutritional status of CKD patients and lead to the development of malnutrition. In patients with CKD, protein energy wasting (PEW) is a condition that is distinct from undernutrition and is associated with inflammation, increased resting energy expenditure, low serum levels of albumin and prealbumin, sarcopenia, weight loss and poor clinical outcomes. Nutritional and metabolic derangements are implicated for the development of PEW in CKD and leading to the development of chronic catabolic state with muscle and fat loss. Prevention is the best way in treating PEW. Appropriate management of CKD patients at risk for PEW requires a comprehensive combination of strategies to diminish protein and energy depletion, and to institute therapies that will avoid further losses. The mainstay of nutritional treatment in MHD patients is nutritional counselling and provision of an adequate amount of protein and energy, using oral supplementation as needed. Intradialytic parenteral nutrition and total enteral nutrition should be attempted in CKD patients who cannot use the gastrointestinal tract efficiently. Other strategies such as anemia correction, treatment of secondary hyperparathyroidism and acidosis, delivering adequate dialysis dose can be considered as complementary therapies in CKD patients. Multidisciplinary work of nephrologists, gastroenterologist and dietician is needed to achieve best therapeutic goals in treating CKD patients with PEW.
Ključne riječi
Renal insufficiency, chronic – metabolism, complications, therapy; Protein-energy malnutrition – etiology, diagnosis, therapy, prevention and control; Nutritive support – methods; Energy intake; Dietary supplements; Renal dialysis; Kidney transplantation; Practice guidelines as topic; Croatia
Hrčak ID:
172665
URI
Datum izdavanja:
26.2.2015.
Posjeta: 2.351 *