Información del artículo
Abstract
Protein-calorie malnutrition is common in hemodialysis patients and is a powerful predictor of morbidity and mortality. Nutritional supplementation, administered orally or parenterally, especially during dialysis, may compensate for a relatively inadequate protein and energy intake and improve net protein anabolism in chronic hemodialysis patients. Intradialytic oral nutrition seems preferable to intradialytic parenteral nutrition (IDPN) due to its lower cost and the persistence of its anabolic effects after infusion is stopped, and because IDPN induces a higher increase in serum glucose and insulin levels and a greater reduction in serum ghrelin concentrations. Further larger scale randomized, controlled trials of nutritional interventions should be performed in maintenance dialysis patients to assess their efficacy in terms of quality of life, morbidity, and mortality.
Keywords:
Protein-energy wasting
Hemodialysis
Morbidity and mortality
Nutritional supplementation
Anabolism
Nutritional therapy
Intradialytic parenteral nutrition
Intradialytic oral nutrition
Resumen
En los pacientes en hemodiálisis (HD) es frecuente la malnutrición calórico-proteica y además es un buen predictor de la morbilidad y mortalidad. La suplementación nutricional mediante la administración oral o parenteral especialmente en el momento de la diálisis puede compensar la ingesta inadecuada de proteínas y de energía y mejorar el anabolismo proteico neto en los pacientes en hemodiálisis crónica. Pero la vía oral parece ser preferible debido al menor coste, a que sus efectos anabólicos persisten una vez que la infusión ha cesado, y a que la nutrición parenteral intradiálisis produce una mayor elevación de las concentraciones de glucemia e insulina séricas, y una mayor reducción de las concentraciones de ghrelina. Son necesarios más estudios sobre las diferentes intervenciones nutricionales en los pacientes de diálisis, para evaluar su eficacia en cuanto a calidad de vida, morbilidad y mortalidad.
Palabras clave:
Malnutrición calóricoproteica
Morbilidad
Mortalidad
Suplementación nutricional
Tratamiento nutricional
Nutrición parenteral intradiálisis
Nutrición oral intradiálisis
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References
[1.]
T.B. Pifer, K.P. McCullough, F.K. Port, D.A. Goodkin, B.J. Maroni, P.J. Held, et al.
Mortality risk in hemodialysis patients and changes in nutritional indicators: DOPPS.
Kidney Int, 62 (2002), pp. 2238-2245
[2.]
L.B. Pupim, T.A. Ikizler.
Uremic malnutrition: New insights into an old problem.
Semin Dial, 16 (2003), pp. 224-232
[3.]
K. Kalantar-Zadeh, G. Block, C.J. McAllister, M.H. Humphreys, J.D. Kopple.
Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients.
Am J Clin Nutr, 80 (2004), pp. 299-307
[4.]
E.G. Lowrie, W.H. Huang, N.L. Lew.
Death risk predictors among peritoneal dialysis and hemodialysis patients: A preliminary comparison.
Am J Kidney Dis, 26 (1995), pp. 220-228
[5.]
V.S. Lim, T.A. Ikizler, D.S. Raj, M.J. Flanigan.
Does hemodialysis increase protein breakdown? Dissociation between whole-body amino acid turnover and regional muscle kinetics.
J Am Soc Nephrol, 16 (2005), pp. 862-868
[6.]
T.A. Ikizler, L.B. Pupim, J.R. Brouillette, D.K. Levenhagen, K. Farmer, R.M. Hakim, et al.
Hemodialysis stimulates muscle and whole body protein loss and alters substrate oxidation.
Am J Physiol Endocrinol Metab, 282 (2002), pp. E107-E116
[7.]
P. Riobó, A. Ortiz, O. Sánchez-Vilar, N. GP de Villar.
Nutrición en la insuficiencia renal crónica.
Tratado de nutrición artificial, pp. 595-611
[8.]
D. Fouque, M. Vennegoor, P. ter Wee, C. Wanner, A. Basci, B. Canaud, et al.
EBPG guideline on nutrition.
Nephrol Dial Transplant, 22 (2007), pp. ii45-ii87
[9.]
R.A. Lama, M. Navarro, A. Alonso.
Soporte nutricional en la insuficiencia renal crónica en pediatría.
Casos clínicos en Nutrición Artificial, Pilar Riobó Serván Ed, Alpe Editores, (1997),
[10.]
J.P. Capelli, H. Kushner, T.C. Carmiscioli, S.M. Chen, M.A. Torres.
Effect of intradialytic parenteral nutrition on mortality rates in end-stage renal disease.
Am J Kidney Dis, 23 (1994), pp. 808-816
[11.]
G.M. Chertow, J. Ling, N.L. Lew, J.M. Lazarus, E.G. Lowrie.
The association of intradialiytic parenteral nutrition with survival in hemodialysis patients.
Am J Kidney Dis, 24 (1994), pp. 912-920
[12.]
N. Cano, J. Labastie-Coeyrehourq, P. Lacombe, P. Stroumza, J. di Costanzo-Dufetel, J.P. Durbec, et al.
Perdialytic parenteral nutrition with lipids and amino acids in malnourished hemodialysis patients.
Am J Clin Nutr, 52 (1990), pp. 726-730
[13.]
J.F. Navarro, C. Mora, C. León, R. Martin-del Río, M.L. Macía, E. Gallego, et al.
Amino acid losses during hemodialysis with polyacrylonitrile membranes: effect of intradialytic amino acid supplementation on plasma amino acid concentrations and nutritional variables in nondiabetic patients.
Am J Clin Nutr, 71 (2000), pp. 765-773
[14.]
L.B. Pupim, P.J. Flakoll, J.R. Brouillette, D.K. Levenhagen, R.M. Hakim, T.A. Ikizler.
Intradialytic parenteral nutrition improves protein and energy homeostasis in chronic hemodialysis patients.
J Clin Invest, 110 (2001), pp. 483-492
[15.]
A. García de Lorenzo, J. Arrieta, A. Ayúcar, G. Barril, E. Huarte.
Nutrición parenteral intradiálisis en el enfermo renal crónico: Consenso SEN-SENPE.
Nutr Hosp, 25 (2010), pp. 375-377
[16.]
E. Moore, J. Celano.
Challenges of providing nutrition support in the outpatient dialysis setting.
Nutr Clin Pract, 20 (2005), pp. 202-212
[17.]
M.K. Sigrist, A. Levin, A.M.J. Tejani.
Systematic review of evidence for the use of intradialytic parenteral nutrition in malnourished hemodialysis patients.
Ren Nutr, 20 (2010), pp. 1-7
[18.]
R. Dukkipati, K. Kalantar-Zadeh, J.D. Kopple.
Is there a role for intradialytic parenteral nutrition? A review of the evidence.
Am J Kidney Dis, 55 (2010), pp. 352-364
[19.]
R.J. Stratton, G. Bircher, D. Fouque, P. Stenvinkel, R. de Mutsert, M. Engfer, et al.
Multinutrient oral supplements and tube feeding in maintenance dialysis: a systematic review and metaanalysis.
Am J Kidney Dis, 46 (2005), pp. 387-405
[20.]
N. Cano, E. Fiaccadori, P. Tesinsky, G. Toigo, W. Druml, M. Kuhlmann, et al.
DGEM (German Society for Nutritional Medicine) ESPEN Guidelines on Enteral Nutrition: Adult renal failure.
Clin Nutr, 25 (2006), pp. 295-310
[21.]
M.K. Kuhlmann, F. Schmidt, H. Kohler.
Oral nutritional support in malnourished patients on HD: preliminary results of a randomised controlled study (abstract).
J Am Soc Nephrol, 8 (1997), pp. 199A
[22.]
D.B. Cockhram, M.K. Hensley, M. Rodríguez, G. Agarwal, A. Wennberg, P. Ruey, et al.
Safety and tolerance of medical nutritional products as sole sources of nutrition in people on hemodialysis.
J Ren Nutr, 8 (1998), pp. 25-33
[23.]
M. Sharma, M. Rao, S. Jacob, C.K. Jacob.
A controlled trial intermittent enteral nutrient supplementation in maintenance hemodialysis patients.
J Ren Nutr, 12 (2002), pp. 229-237
[24.]
D. Fouque, J. McKenzie, R. de Mutsert, R. Azar, D. Teta, M. Plauth, et al.
Use of a renal-specific oral supplement by haemodialysis patients with low protein intake does not increase the need for phosphate binders and may prevent a decline in nutritional status and quality of life.
Nephrol Dial Transplant, 23 (2008), pp. 2902-2910
[25.]
L. Cuppari, F.A.M. Medeiros, H.F. Pappini, M. Cendorolo Neto, M.E.F. Canziani, L. Martini, et al.
Effectiveness of oral energyprotein supplementation in severely malnourished hemodialysis patients.
Journal of Renal Nutrition, 4 (1994), pp. 127-135
[26.]
K.T. Beutler, G.K. Park, M.J. Wilkowsky.
Effect of oral supplementation on nutrition indicators in hemodialysis patients.
J Ren Nutr, 7 (1997), pp. 77-82
[27.]
M.G. Patel, S. Kitchen, P.J. Milligan.
Effect of dietary supplements on the nPCR in stable hemodialysis patients.
J Ren Nutr, 10 (2000), pp. 69-75
[28.]
B. Wilson, A. Fernández-Madrid, A. Hayes, K. Hermann, J. Smith, A. Wassell, et al.
Comparison of the effects of two early intervention strategies on the health outcomes of malnourished hemodialysis patients.
J Ren Nutr, 11 (2001), pp. 166-171
[29.]
K. Caglar, L. Fedje, R. Dimmitt, R.M. Hakim, Y. Shyr, T.A. Ikizler.
Therapeutic effects of oral nutritional supplementation during hemodialysis.
Kidney Int, 62 (2002), pp. 1054-1059
[30.]
K. Kalantar-Zadeh, A. Braglia, J. Chow, O. Kwon, N. Kuwae, S. Colman, et al.
An anti-inflammatory and antioxidant nutritional supplement for hypoalbuminemic hemodialysis patients: a pilot/feasibility study.
J Ren Nutr, 15 (2005), pp. 318-331
[31.]
M. Bossola, L. Tazza, S. Giungi, F. Rosa, G. Luciani.
Artificial nutritional support in chronic hemodialysis patients: a narrative review.
J Ren Nutr, 20 (2010), pp. 213-223
[32.]
L.B. Pupim, K.M. Majchrzak, P.J. Flakoll, T.A. Ikizler.
Intradialytic oral nutrition improves protein homeostasis in chronic hemodialysis patients with deranged nutritional status.
J Am Soc Nephrol, 17 (2006), pp. 3149-3157
[33.]
J. Bohe, J.F. Low, R.R. Wolfe, M.J. Rennie.
Latency and duration of stimulation of human muscle protein synthesis during continuous infusion of amino acids.
J Physiol, 532 (2001), pp. 575-579
[34.]
N.J. Cano, D. Fouque, H. Roth, M. Aparicio, R. Azar, B. Canaud, et al.
Intradialytic Parenteral Nutrition Does Not Improve Survival in Malnourished Hemodialysis Patients: A 2-Year Multicenter, Prospective. Randomized Study.
J Am Soc Nephrol, 18 (2007), pp. 2583-2591
[35.]
J.D. Kopple.
National kidney foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure.
Am J Kidney Dis, 37 (2001), pp. S66-S70
[36.]
J. Dong, T.A. Ikizler.
New insights into the role of anabolic interventions in dialysis patients with protein energy wasting.
Curr Opin Nephrol Hypertens, 18 (2009), pp. 469-475
[37.]
M.J. Fernández-Reyes, R. Sánchez, L. García, C. Grande, R. Codoceo, M. Heras, et al.
Acute responses of gastrointestinal hormones to both oral and parenteral intradialytic nutrition.
Am J Nephrol, 32 (2010), pp. 272-278
[38.]
J. Dong, M.B. Sundell, L.B. Pupim, P. Wu, A. Shintani, T.A. Ikizler.
The Effect of Resistance exercise to augment long-term benefits of intradialytic oral nutritional supplementation in chronic hemodialysis patients.
J Ren Nutr, (2010), pp. 1-11
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