Subscribe to RSS
DOI: 10.1055/a-0974-2636
Ernährungszustand bei Dialysepatienten
Wie gelingen die Aufrechterhaltung und Verbesserung?Publication History
Publication Date:
20 November 2019 (online)
![](https://www.thieme-connect.de/media/dialyseakt/201909/lookinside/thumbnails/10-1055-a-0974-2636-1.jpg)
ZUSAMMENFASSUNG
Die Erkennung und Behandlung der Mangelernährung gehört zum klinischen Standard, wie es sich auch an einer verbesserten Ernährungssituation von Dialysepatienten in rezenten Untersuchungen widerspiegelt. Noch relativ neu ist der etwas unhandliche Begriff „chronic disease related malnutrition“ (C-DRM), der den immer noch gebräuchlicheren Begriff des „protein-energy wasting“ (PEW) ablösen sollte, da er die bei Dialysepatienten auch zur Mangelernährung beitragenden Ursachen besser widerspiegelt. In diesem Artikel wird gezeigt, wie eine C-DRM diagnostiziert werden kann. Es wird auf die wesentlichen Stellparameter für eine gute Ernährung beim Dialysepatienten eingegangen. Neben dem allgemeinen Kalorienbedarf findet dabei als Makronährstoff ausschließlich das Eiweiß (und das darin immer auch vorhandene Phosphat) Erwähnung. An Mineralien wird außerdem auf Natrium und Kalium eingegangen. Beim Vitaminbedarf werden nicht nur die wasserlöslichen – und damit während einer Dialyse herausgewaschenen – Vitamine behandelt, sondern auch die fettlöslichen. Auch an Vitamin D und K mangelt es nämlich häufig. Abschließend wird auf die therapeutischen Möglichkeiten wie die Diätberatung bzgl. einer verbesserten natürlichen Kost, Nahrungsergänzungsmittel, enterale Ernährung via perkutane endoskopische Gastrostomie (PEG) und den Nutzen der parenteralen Ernährung eingegangen.
-
Literatur
- 1 Thunberg BJ, Swamy AP, Cestero RV. Cross-sectional and longitudinal nutritional measurements in maintenance hemodialysis patients. Am J Clin Nutr 1981; 34: 2005-2012 doi:10.1093/ajcn/34.10.2005
- 2 Schoenfeld PY, Henry RR, Laird NM, Roxe DM. Assessment of nutritional status of the National Cooperative Dialysis Study population. Kidney Int Suppl 1983: S80-S88
- 3 Aparicio M, Cano N, Chauveau P. et al. Nutritional status of haemodialysis patients: a French national cooperative study. French Study Group for Nutrition in Dialysis. Nephrol Dial Transplant 1999; 14: 1679-1686 doi:10.1093/ndt/14.7.1679
- 4 Koefoed M, Kromann CB, Hvidtfeldt D. et al. Historical Study (1986–2014): Improvements in Nutritional Status of Dialysis Patients. J Ren Nutr 2016; 26: 320-324 doi:10.1053/j.jrn.2016.04.005
- 5 Ikizler TA, Cano NJ, Franch H. et al. International Society of Renal Nutrition and Metabolism. Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney Int 2013; 84: 1096-1107 doi:10.1038/ki.2013.147
- 6 Brown R, Compher C. American Society for Parenteral and Enteral Nutrition Board of Directors. A. S. P. E. N. Clinical Guidelines: Nutrition Support in Adult Acute and Chronic Renal Failure. J Parent Ent Nutrition 2010; 34: 366-377 doi:10.1177/0148607110374577
- 7 Druml W, Contzen B, Joannidis M. et al. Committee DS. S1-Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der AKE, der GESKES und der DGfN Enterale und parenterale Ernährung von Patienten mit Niereninsuffizienz. Aktuel Ernährungsmed 2015; 40: 21-37 doi:10.1055/s-0034-1387537
- 8 Toigo G, Aparicio M, Attman PO. et al. Expert Working Group report on nutrition in adult patients with renal insufficiency (part 1 of 2). Clin Nutr 2000; 19: 197-207 doi:10.1054/clnu.1999.0130
- 9 Lynch KE, Lynch R, Curhan GC, Brunelli SM. Altered taste perception and nutritional status among hemodialysis patients. J Ren Nutr 2013; 23: 288-295.e1 doi:10.1053/j.jrn.2012.08.009
- 10 Fouque D, Pelletier S, Mafra D, Chauveau P. Nutrition and chronic kidney disease. Kidney Int 2011; 80: 348-357 doi:10.1038/ki.2011.118
- 11 Fouque D, Kalantar-Zadeh K, Kopple J. et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 2008; 73: 391-398 doi:10.1038/sj.ki.5002585
- 12 de Mutsert R, Grootendorst DC, Boeschoten EW. et al. Netherlands Cooperative Study on the Adequacy of Dialysis-2 Study Group. Subjective global assessment of nutritional status is strongly associated with mortality in chronic dialysis patients. Am J Clin Nutr 2009; 89: 787-793 doi:10.3945/ajcn.2008.26970
- 13 Clinical practice guidelines for nutrition in chronic renal failure K/DOQI, National Kidney Foundation. Am J Kidney Dis 2000; 35 (Suppl. 02) S1-S140
- 14 Rao M, Sharma M, Juneja R. et al. Calculated nitrogen balance in hemodialysis patients: influence of protein intake. Kidney Int 2000; 58: 336-345 doi:10.1046/j.1523-1755.2000.00171.x
- 15 Molina P, Vizcaino B, Molina MD. et al. The effect of high-volume online haemodiafiltration on nutritional status and body composition: the ProtEin Stores prEservaTion (PESET) study. Nephrol Dial Transplant 2018; 33: 1223-1235 doi:10.1093/ndt/gfx342
- 16 Komaba H, Kakuta T, Wada T. et al. Nutritional status and survival of maintenance hemodialysis patients receiving lanthanum carbonate. Nephrol Dial Transplant 2019; 34: 318-325 doi:10.1093/ndt/gfy090
- 17 Kuhlmann MK, Landthaler I, Höchst S. PEP – Das Phosphat-Einheiten-Programm. Ernährungs-Umschau 2005; 4: 152-154
- 18 Noori N, Kalantar-Zadeh K, Kovesdy CP. et al. Association of dietary phosphorus intake and phosphorus to protein ratio with mortality in hemodialysis patients. Clin J Am Soc Nephrol 2010; 5: 683-692 doi:10.2215/CJN.08601209
- 19 Lynch KE, Lynch R, Curhan GC, Brunelli SM. Prescribed dietary phosphate restriction and survival among hemodialysis patients. Clin J Am Soc Nephrol 2011; 6: 620-629 doi:10.2215/CJN.04620510
- 20 Chazot C, Gassia JP, Di Benedetto A. et al. Is there any survival advantage of obesity in Southern European haemodialysis patients?. Nephrol Dial Transplant 2009; 24: 2871-2876 doi:10.1093/ndt/gfp168
- 21 Movilli E, Gaggia P, Zubani R. et al. Association between high ultrafiltration rates and mortality in uraemic patients on regular haemodialysis. A 5-year prospective observational multicentre study. Nephrol Dial Transplant 2007; 22: 3547-3552 doi:10.1093/ndt/gfm466
- 22 Sherman RA, Cody RP, Rogers ME, Solanchick JC. Interdialytic weight gain and nutritional parameters in chronic hemodialysis patients. Am J Kidney Dis 1995; 25: 579-583 doi:10.1016/0272-6386(95)90126-4
- 23 Szeto CC, Wong TY, Chow KM, Leung CB, Li PK. Oral sodium bicarbonate for the treatment of metabolic acidosis in peritoneal dialysis patients: a randomized placebo-control trial. J Am Soc Nephrol 2003; 14: 2119-2126 doi:10.1097/01.asn.0000080316.37254.7a
- 24 Fouque D, Vennegoor M, ter Wee P. et al. EBPG guideline on nutrition. Nephrol Dial Transplant 2007; 22 (Suppl. 02) ii45-ii87 doi:10.1093/ndt/gfm020
- 25 Tattersall J, Martin-Malo A, Pedrini L. European best practice guidelines on haemodialysis. Nephrol Dial Transplant 2007; 22: S1-S40
- 26 Khajehdehi P, Mojerlou M, Behzadi S, Rais-Jalali GA. A randomized, double-blind, placebo-controlled trial of supplementary vitamins E, C and their combination for treatment of haemodialysis cramps. Nephrol Dial Transplant 2001; 16: 1448-1451 doi:10.1093/ndt/16.7.1448
- 27 Boaz M, Smetana S, Weinstein T. et al. Secondary prevention with antioxidants of cardiovascular disease in endstage renal disease (SPACE): randomised placebo-controlled trial. Lancet 2000; 356: 1213-1218 doi:10.1016/s0140-6736(00)02783-5
- 28 Yadav AK, Kumar V, Kumar V. et al. The Effect of Vitamin D Supplementation on Bone Metabolic Markers in Chronic Kidney Disease. J Bone Miner Res 2018; 33: 404-409 doi:10.1002/jbmr.3314
- 29 Manson JE, Cook NR, Lee IM. et al. VITAL Research Group. Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease. N Engl J Med 2019; 380: 33-44 doi:10.1056/NEJMoa1809944
- 30 Pittas AG, Dawson-Hughes B, Sheehan P. et al. D2d Research Group. Vitamin D Supplementation and Prevention of Type 2 Diabetes. N Engl J Med 2019; 381: 520-530 doi:10.1056/NEJMoa1900906
- 31 Aoun M, Makki M, Azar H. et al. High Dephosphorylated-Uncarboxylated MGP in Hemodialysis patients: risk factors and response to vitamin K2, A pre-post intervention clinical trial. BMC Nephrol 2017; 18: 191 doi:10.1186/s12882-017-0609-3
- 32 Feng Y, Ruan Y, He Q, Zhang W, Wang L. Suboptimal vitamin K status and its risk factors in a population of Chinese chronic haemodialysis patients. Nephrology (Carlton) 2015; 20: 625-631 doi:10.1111/nep.12494
- 33 Westenfeld R, Krueger T, Schlieper G. et al. Effect of vitamin K2 supplementation on functional vitamin K deficiency in hemodialysis patients: a randomized trial. Am J Kidney Dis 2012; 59: 186-195 doi:10.1053/j.ajkd.2011.10.041
- 34 Krueger T, Schlieper G, Schurgers L. et al. Vitamin K1 to slow vascular calcification in haemodialysis patients (VitaVasK trial): a rationale and study protocol. Nephrol Dial Transplant 2014; 29: 1633-1638 doi:10.1093/ndt/gft459
- 35 Sprenger K, Bunschau D, Lewis K. Improvement of uremic neuropathy and hypogeusia by dialysate zinc supplementation: a double blind study. Kidney Int 1983; 24: S315-S318
- 36 Dong J, Ikizler TA. New insights into the role of anabolic interventions in dialysis patients with protein energy wasting. Curr Opin Nephrol Hypertens 2009; 18: 469-475 doi:10.1097/MNH.0b013e328331489d
- 37 Stratton RJ, Bircher G, Fouque D. et al. Multinutrient oral supplements and tube feeding in maintenance dialysis: a systematic review and meta-analysis. Am J Kidney Dis 2005; 46: 387-405 doi:10.1053/j.ajkd.2005.04.036
- 38 Kalantar-Zadeh K, Ikizler TA. Let them eat during dialysis: an overlooked opportunity to improve outcomes in maintenance hemodialysis patients. J Ren Nutr 2013; 23: 157-163 doi:10.1053/j.jrn.2012.11.001
- 39 Lacson Jr E, Wang W, Zebrowski B. et al. Outcomes associated with intradialytic oral nutritional supplements in patients undergoing maintenance hemodialysis: a quality improvement report. Am J Kidney Dis 2012; 60: 591-600 doi:10.1053/j.ajkd.2012.04.019
- 40 Krishnamurthy VM, Wei G, Baird BC. et al. High dietary fiber intake is associated with decreased inflammation and all-cause mortality in patients with chronic kidney disease. Kidney Int 2012; 81: 300-306 doi:10.1038/ki.2011.355
- 41 Cano NJ, Fouque D, Roth H. et al. French Study Group for Nutrition in Dialysis. Intradialytic parenteral nutrition does not improve survival in malnourished hemodialysis patients: a 2-year multicenter, prospective, randomized study. J Am Soc Nephrol 2007; 18: 2583-2591 doi:10.1681/ASN.2007020184
- 42 Czekalski S, Hozejowski R. Malnutrition Working Group. Intradialytic amino acids supplementation in hemodialysis patients with malnutrition: results of a multicenter cohort study. J Ren Nutr 2004; 14: 82-88
- 43 Santos CP, Silva LF, Lopes MB. et al. Associations of physical activity energy expenditure with nutritional-inflammatory markers in hemodialysis patients. Int J Artif Organs 2017; 40: 670-675 doi:10.5301/ijao.5000632
- 44 Liao MT, Liu WC, Lin FH. et al. Intradialytic aerobic cycling exercise alleviates inflammation and improves endothelial progenitor cell count and bone density in hemodialysis patients. Medicine (Baltimore) 2016; 95: e4134 doi:10.1097/MD.0000000000004134
- 45 Sheng K, Zhang P, Chen L. et al. Intradialytic exercise in hemodialysis patients: a systematic review and meta-analysis. Am J Nephrol 2014; 40: 478-490 doi:10.1159/000368722
- 46 Radermacher J. Ernährungstherapie bei Nierenerkrankungen. Ernährungs Umschau 2013; 4: 232-241