Introduction
A significant risk of malnutrition, which is characterized by protein energy wasting and micronutrient deficiencies, exists in patients with chronic renal disease. Researchers have found that malnutrition affects people with chronic renal disease at a high prevalence rate in both adults and children. Stunted growth, a typical symptom of chronic renal disease in children, is not only caused by anomalies in the growth hormone-insulin-like growth factor axis but also by starvation. Several pathophysiologic changes, such as decreased appetite and nutrient intake, hormonal imbalances, metabolic imbalances, inflammation, increased catabolism, and abnormalities related to dialysis, interact to form the complex pathogenic mechanisms of malnutrition in chronic kidney disease. The likelihood of morbidity, death, and the total burden of disease is elevated in these patients due to malnutrition. The complex and varied derangements impacting nutritional status in patients with chronic renal disease mean that simple interventions such as providing adequate intake of calories and protein are ineffective in treating malnutrition.
What Metabolic Changes Occur in CKD Patients?
The kidneys support the health of the bones. They achieve this by maintaining normal levels of parathyroid hormone, calcium, phosphorus, and vitamin D. Low calcium and vitamin D levels and elevated parathyroid hormone and phosphorus levels can result from chronic kidney disease (CKD).
These alterations may cause the bones to weaken and become more prone to breaking. Heart attacks and heart failure can result from calcium and phosphorus deposits in the blood arteries supplying the heart due to changes in these elements. Low hemoglobin levels can result from renal failure. Since urine cannot adequately eliminate potassium, high blood potassium levels and acid buildup also happen. In patients with kidney failure, malnutrition with muscle wasting (protein energy wasting) can occur.
Patients with chronic renal illness often experience protein energy wasting (PEW). The loss of bodily protein and energy storage occurs simultaneously, which is its defining feature. Even people with CKD in lower stages, such as stage 3, can exhibit it. Malnutrition rises in tandem with the severity of renal illness. Certain research has demonstrated that malnutrition affects up to 90 percent of dialysis patients in the lower-income category. Malnutrition affects more than 60 percent of dialysis patients from the middle-class demographic.
What Causes Protein Energy Wasting in CKD Patients?
Protein-energy wasting (PEW) has numerous causes, some of which are listed below.
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Anorexia: A rise in hormones that restrict appetite is observed in people with chronic kidney disease. This results in malnutrition and a reduction in caloric intake.
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Acidosis: When the kidneys cannot eliminate acid in the urine, it builds up and causes muscle protein deterioration. This resulted in STO (skeletal tissue oxygenation) lean mass.
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Increased Energy Expenditure: CKD patients use more energy when they are at rest for a variety of reasons, which increases energy consumption.
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Prolonged Inflammation: These individuals' bodies have a higher level of inflammation, which causes the liver to produce less albumin and break down proteins.
What Is the Importance of Nutritional Management in Chronic Kidney Disease Patients?
For individuals suffering from renal disease, nutritional therapy is crucial since it provides several benefits, including the following:
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Protein-energy wasting is prevented by nutritional therapy, which also aids in its treatment in cases where it has already happened.
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It assists in treating the signs of renal failure brought on by waste product buildup.
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It assists in adjusting electrolyte levels.
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It aids in restoring the acid-base equilibrium.
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It supports healthy bones, keeps the body from accumulating salt and water, and aids in slowing the advancement of renal disease.
What Are the Guidelines for Nutrition Therapy?
1. Protein in the Diet
Nephrons, the kidney's functional units, are functioning at a lower rate in patients with impaired renal function than in a kidney with normal function. The remaining glomeruli will experience increased pressure from consuming more protein, especially animal protein. Eating too much protein increases blood flow to the glomeruli, damaging those remaining glomeruli and exacerbating renal disease. It is recommended that individuals with non-dialysis-dependent CKD consume of 0.0211 ounces protein per kg (kilograms) of body weight every day.
Reduced protein consumption lowers the synthesis of waste products in the body, lowers the pressure in the glomeruli, produces less acid, and reduces the amount of protein lost in the urine. Bacteria in the intestines break down animal proteins, producing toxins that can harm the body. This can be avoided by choosing plant-based protein, which has lower salt and acid production than animal protein. Protein intake of 0.0352 ounce per day is recommended for dialysis patients because of their higher risk of protein loss and breakdown throughout the process.
2. Energy Requirements
Those with chronic kidney disease (CKD) should consume at least 0.137 ounce of body weight daily, of which 50 to 60 percent should come from carbohydrates. Less than 30 percent of calories should come from fats, and there should be less saturated fat in fats overall. 10 percent or less of total fat consumption should come from saturated fats. Steer clear of high fructose foods such as sugar-sweetened fruit juices, soft drinks, etc. Foods high in fructose have been linked to heart disease, elevated uric acid levels, and insulin resistance.
3. Sodium Restriction
In individuals with chronic kidney disease (CKD), sodium restriction lowers blood pressure, slows the illness's course, and enhances the patient's cardiovascular results. Patients undergoing dialysis who consume too much sodium gain too much weight because sodium keeps water in the body. Removing this extra water might cause problems like weakness and a dip in blood pressure during dialysis. Less than 0.194 ounce of salt is the recommended daily allowance (less than 0.081 ounce of sodium). Approximately 0.014 ounce of sodium are included in one gram of salt.
Conclusion
One frequent CKD consequence that significantly negatively influences a patient's quality of life is malnutrition. Malnutrition in individuals with chronic kidney disease (CKD) has several causes, including decreased food absorption, metabolic impairments brought on by decreased kidney function that accumulate waste products, and increased nutrient loss and energy waste during dialysis. Patients with chronic renal disease should pay close attention to their overall diet. Diets high in plants and low in protein can assist in halting the course of renal disease. Complications from CKD can be avoided by limiting sodium intake and avoiding constipation.
