NUTRITION

Introduction

Dietary intervention is of high importance for patients with chronic kidney disease (CKD), both for disease outcome and for prevention and treatment of malnutrition, which can be common in those living with kidney disease. Malnutrition is a general term that indicates a state of nutrition in which a deficiency or excess (or imbalance) of energy, protein, and other nutrients causes measurable adverse effects on body composition and function, and clinical outcome (Cederholm et al., 2017). The first and most important type is protein-energy malnutrition (PEM) or protein-energy wasting (PEW), which is defined as a lack in supply of sufficient energy or protein to meet the body's metabolic demands. (Fouque et al., 2008)

The causes of malnutrition are:

• an inadequate food intake secondary to anorexia caused by uremia and altered taste sensation
• increased demands due to disease or acute illness
• impaired ability to prepare food
• unpalatable prescribed diets (low salt, fluid restriction, low potassium, low phosphorus)
• the dialysis procedure itself due to nutrient losses (protein, water soluble vitamins etc)
• hypermetabolism due to chronic inflammation (Ikizler et al., 2020, Fiaccadori et al., 2021)

Early detection of malnutrition risk and a detailed nutritional assessment is therefore of paramount importance in providing optimal nutritional care to individuals with CKD of all disease stages.

Chronic Kidney disease (CKD) has a significant impact on the dietary needs. Malnutrition, i.e. the result of inadequate energy and protein intake that could alter negatively the body shape and function is can occur at some stage in patients living with CKD. (Fiaccadori et al., 2021, Ikizler et al., 2020)

The main reasons for this are:

1. The alterations in taste due to the increased levels of urea in the blood can limit the appetite and subsequently the food intake
2. The dietary advice often includes restrictions on salt intake that can lead to food tasting different
3. For patients undergoing hemodialysis and peritoneal dialysis there are significant losses in nutrients during the procedure, especially in proteins and water-soluble vitamins, which have a negative impact on nutritional status.
4. CKD is a disease that increases energy needs of patients

To detect and treat malnutrition, nutritional screening is of paramount importance. In cases where malnutrition is detected, a more detailed nutritional assessment will empower the medical nutrition team to take all the measures to provide the appropriate mode of nutritional support for optimal results in every stage of CKD.