Document Detail

Dietary protein and energy requirements in ESRD patients.
MedLine Citation:
PMID:  9892375     Owner:  NLM     Status:  MEDLINE    
The published reports of dietary protein and energy intake and protein and energy requirements for maintenance hemodialysis (MHD) patients and chronic peritoneal dialysis (CPD) patients are reviewed. Evidence indicates that the dietary energy intake of patients undergoing MHD or continuous ambulatory peritoneal dialysis (CAPD) is less than normal. Dietary protein intake in various surveys averages approximately 1.0 g/kg/d. The energy expenditure of MHD patients appears to be normal or slightly increased during resting and normal during various other daily activities. Energy expenditure in CAPD patients appears normal. Nitrogen balance and anthropometric studies in MHD or CAPD patients ingesting controlled diets in a metabolic unit research ward also indicate that dietary energy requirements are normal and are approximately 35 to 38 kcal/kg/d in MHD patients. For CAPD patients, total energy requirements (from diet and dialysate) also appear to be 35 to 38 kcal/kg/d. These recommended energy intakes are for adult patients aged approximately 60 years or younger. Thus, the low dietary energy intakes of MHD and CPD patients are maladaptive. Nitrogen balance studies indicate that a safe dietary allowance for protein is approximately 1.2 g/kg/d for MHD patients and 1.2 to 1.3 g/kg/d for CAPD patients. Because the nutritional status of patients at the onset of chronic dialysis therapy is a strong predictor of both their nutritional status during the course of chronic dialysis treatment and their subsequent morbidity and mortality, it is important to maintain good nutritional status in patients with chronic renal failure before their development of end-stage renal disease (ESRD) and establishment on chronic dialysis. Evidence indicates that there is a reduction in dietary protein and energy intake and a gradual deterioration of nutritional status in patients with chronic renal insufficiency as the glomerular filtration rate (GFR) decreases progressively to less than 50 to 60 mL/min/1.73 m2. More studies are needed to assess dietary protein and energy requirements both for MHD and CPD patients who are clinically stable and for those who have sustained comorbid conditions that increase energy expenditure or protein nitrogen appearance.
J D Kopple
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  32     ISSN:  0272-6386     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  1998 Dec 
Date Detail:
Created Date:  1999-01-28     Completed Date:  1999-01-28     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  S97-104     Citation Subset:  IM    
Department of Medicine, Harbor-UCLA Medical Center, and the School of Medicine, Torrance, CA 90509, USA.
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MeSH Terms
Dietary Proteins / administration & dosage*
Energy Intake*
Energy Metabolism
Kidney Failure, Chronic / metabolism,  therapy*
Middle Aged
Nutritional Requirements
Nutritional Status
Peritoneal Dialysis*
Peritoneal Dialysis, Continuous Ambulatory
Renal Dialysis*
Reg. No./Substance:
0/Dietary Proteins

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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