Diets and enteral supplements for improving outcomes in chronic kidney disease

• Published in: Nature reviews. Nephrology Vol. 7; no. 7; pp. 369 - 384
• Main Authors: Kalantar-Zadeh, Kamyar, Cano, Noël J, Budde, Klemens, Chazot, Charles, Kovesdy, Csaba P, Mak, Robert H, Mehrotra, Rajnish, Raj, Dominic S, Sehgal, Ashwini R, Stenvinkel, Peter, Ikizler, T. Alp
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 01.07.2011
• Subjects: Anti-inflammatory agents; Care and treatment; Chronic Disease; Chronic illnesses; Chronic kidney failure; Diagnosis; Dietary Supplements; Enteral Nutrition - methods; Food and nutrition; Food, Formulated; Health aspects; Hemodialysis; Humans; Hyperlipidemia; Hypertension; Kidney diseases; Kidney Diseases - diet therapy; Meals; Medicin och hälsovetenskap; Mortality; Nutrition; Nutritional status; Obesity; Older people; Organ transplant recipients; Parenteral nutrition; Patient outcomes; Patients; Peritoneal dialysis; Proteins; Quality of life; Reorganization and restructuring; Risk factors; Sarcopenia; Treatment Outcome; United States; Weight control; United States; France; United States > US
• ISSN: 1759-5061; 1759-507X; 1759-507X
• DOI: 10.1038/nrneph.2011.60

Protein-energy wasting (PEW), which is manifested by low serum levels of albumin or prealbumin, sarcopenia and weight loss, is one of the strongest predictors of mortality in patients with chronic kidney disease (CKD). Although PEW might be engendered by non-nutritional conditions, such as inflammation or other comorbidities, the question of causality does not refute the effectiveness of dietary interventions and nutritional support in improving outcomes in patients with CKD. The literature indicates that PEW can be mitigated or corrected with an appropriate diet and enteral nutritional support that targets dietary protein intake. In-center meals or oral supplements provided during dialysis therapy are feasible and inexpensive interventions that might improve survival and quality of life in patients with CKD. Dietary requirements and enteral nutritional support must also be considered in patients with CKD and diabetes mellitus, in patients undergoing peritoneal dialysis, renal transplant recipients, and in children with CKD. Adjunctive pharmacological therapies, such as appetite stimulants, anabolic hormones, and antioxidative or anti-inflammatory agents, might augment dietary interventions. Intraperitoneal or intradialytic parenteral nutrition should be considered for patients with PEW whenever enteral interventions are not possible or are ineffective. Controlled trials are needed to better assess the effectiveness of in-center meals and oral supplements.