CAUSES AND INTERVENTIONS FOR MALNUTRITION IN PATIENTS UNDERGOING MAINTENANCE DIALYSIS

Maintenance dialysis (MD) patients frequently present mild to severe m alnutrition. Food intake is often reduced by anorexia, A state of pers istant catabolism may be caused by chronic acidosis, resistance to ana bolic factors such as growth hormone: insulin and insulin-like growth factor-1. Losses of nutrients including glucose, amino acids and vitam ins occur during the dialysis treatment, and negative nitrogen balance has been reported during hemodialysis, Intradialytic parenteral nutri tion containing lipids, glucose and amino acids has been administered to malnourished MD patients when oral supplements have failed to impro ve their nutritional status, Amino acid infusion into the peritoneal c avity induces positive nitrogen balance in malnourished continuous amb ulatory peritoneal dialysis patients. Anabolism has been observed duri ng administration of recombinant growth hormone and insulin-like growt h factor-1 in malnourished MD patients. In the fight against catabolic events, an increase in nutrient intake or delivery by dialysis and pr omotion of anabolism simultaneously may be prerequisite for correcting malnutrition in MD patients.