MANAGEMENT OF DENUTRITION IN CHRONIC HEMODIALYZED PATIENTS

Malnutrition is an independent factor of morbidity and mortality in he modialysis patients. Therefore, the nutritional management must be inc luded in the follow-up and treatment of these patients. During hemodia lysis, estimated nutritional requirements are 35-40 kcal/kg/day and 1. 2-1.4 protein/kg/day. Dietary counseling, performed twice a year, make s it possible to detect the early signs of undernutrition. High risk m alnutrition can be identified by the following indicators: normalized catabolic rate < 1 g/kg/j, serum albumin < 35 g/l, serum prealbumin < 300 mg/l. A trimestrial measurement of these variables is recommended. A schematic diagram is proposed for the nutritional management of mal nourished hemodialysis patient. The occurence of malnutrition implies to look for any cause of anorexia or hypercatabolism such as inadequat e nutritional intakes, inadequate dialysis, severe anemia and depressi on. Nutritional supplementation must be adapted according to its abili ty to satisfy nutrional needs: oral supplements in patients with begin ing undernutrition; intradialytic parental nutrition in patients with severe malnutrition and spontaneous intakes more than 20 kcal/kg/day; daily enteral nutrition when spontaneous intakes are less than 20 kcal /kg/day.