Malnutrition and chronic renal failure.

During chronic renal failure, malnutrition is responsible for increased mor bidity and mortality. Both protein and energy intakes decrease during the c ourse of renal insufficiency. Abnormal nutrient metabolism which concerns b oth protein and energy metabolism, in peripheral as well as in hepatosplanc hnic tissues, contributes to the development of malnutrition. Before dialys is therapy is instituted, protein restriction is usually recommended. Howev er the occurrence of malnutrition argues for the initiation of dialysis the rapy and the increase of protein intake. During dialysis, severe malnutriti on in found in 25 % of patients and compromises the prognosis. Indicators o f protein nutrition such as protein catabolic rate, serum albumin and preal bumin, which are the best markers of the prognosis, must be integrated in t he follow-up of these patients. In dialysis patients, the estimated nutrito nal requirements are 35-40kcal et 1.2-1.4g protein/kg/day. In malnourished dialysis patients, after verification of the adequacy of dialysis therapy, nutritional support should be chosen according to its ability to satisfy th ese nutritional needs, taking into account the spontaneous intakes.