Identify, and briefly explain, five factors that may contribute to malnutrition

Question

Identify, and briefly explain, five factors that may contribute to malnutrition in a patient with chronic renal failure receiving dialysis?

What are the differences in protein requirements/ recommendations among patients with stages 1 and 2 CKD, stage 3 and 4 CKD? Explain the rationale for the protein requirements/ recommendations.

Identify five (5) specific alterations in the absorption, excretion, or metabolism of nutrients in patients with chronic kidney disease. Briefly explain why this occurs for each individual nutrient.

Identify the diet prescription for calcium and phosphorus for a patient receiving hemodialysis. Explain, in detail, the rationale for these values and the influence of these nutrients on parathyroid hormone.

"In detail"

Outline the stages of CKD and include the distinguishing signs and symptoms.

Explanation / Answer

1. The factors that contribute to malnutrition in a patient with chronic renal failure receiving dialysis are Loss of appetite, Diabetic gastroparesis, Inadequate dietary recommendations, depression, socio-economic factors, chronic inflammation, Inadequate dialysis dose etc. Several other factors can predispose chronic kidney disease patients to malnutrition such as low protein and calorie intake. These factors also include hormonal changes and metabolic damages leading to kidney disease. Metabolic acidosis is also one of the causes which are responsible for increasing protein catabolism in the CKD patients which occur due to degradation of the essential, branched-chain amino acids and muscle protein.

2. Damaged or unhealthy kidneys unable to remove the nitrogenous wastes produced during metabolism of protein.Thus protein restriction during the initial stage of a kidney is recommended so that it can slow down the progression of the disease. Also sometimes, the presence of other factors, such as decubitus ulcers, will complicate protein needs of a patient with chronic kidney disease. Though Protein needs for those undergoing dialysis (Stage 5 kidney disease) are increases due to the protein losses that occur during dialysis.

Different stage of Kidney Disease

Protein Intake recommended

1–4

0.6–0.75 g/kg body weight
(50% high biological value)

4 (hemodialysis)

1.2 g/kg body weight
(50% high biological value)

5 (peritoneal dialysis)

1.2–1.5 g/kg body weight
(50% high biological value)

3.

4.

5. Kidney function is analysed based on the glomerular filtration rate, or GFR. The GFR is reflected in clearance tests that measure the rate at which substances are cleared from the plasma by the glomeruli. Different stages of CKD are Stage 1: A person with stage 1 chronic kidney disease (CKD) has kidney damage with a normal or increased glomerular filtration rate (GFR). Range of >90 mL/min/1.73m². The presence of physical symptoms is usually absent.Higher than normal levels of creatinine or urea in the blood by a biochemical analysis is observed.Stage 2 patients have kidney damage with a mild decrease in GFR of 60-89 mL/min Elevated serum creatinine and protein in the urine by a biochemical analysis is observed.Stage 3 patients have kidney damage with a are fatigue moderate decrease in GFR. The range of 30-59 mL/min/1.73m². Symptoms are fatigue, oedema, changes in urination for example changes in colour, consistency and frequency), changes in appetite, high blood pressure and high serum creatinine.Stage 4 have a severe decrease in GFR. The range of 15-29 mL/min/1.73m². are fatigue, oedema, kidney pain, sleeping problems, nausea/vomiting, taste changes, uremic breath, loss of appetite etc. Stage 5patient kidney is unable to sustain life and requires initiation of renal replacement theory. GFR = < 15 mL/min/1.73m².P Symptoms a loss of appetite, nausea/vomiting, headaches, fatigue, inability to concentrate, itching, producing little to    no urine, swelling, muscle cramps, tingling in the hands or feet, and changes in skin colour

Different stage of Kidney Disease

Protein Intake recommended

1–4

0.6–0.75 g/kg body weight
(50% high biological value)

4 (hemodialysis)

1.2 g/kg body weight
(50% high biological value)

5 (peritoneal dialysis)

1.2–1.5 g/kg body weight
(50% high biological value)

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