La nutrition artificielle ambulatoire chez le patient insuffisant rénal chronique | Ambulatory nutritional management in chronic kidney disease patients
2013
Deléaval, Patrik | Bernollin, Anne-Lise | Hurot, Jean-Marc | Lorriaux, Christie | Mayor, Brice | Jean, Guillaume | Chazot, Charles
Renal failure is proteiform, acute or chronic, requiring or not dialysis therapy. The nutritional management of these patients varies according to renal disease evolution. Protein energy wasting (PEW) is present in at least one third of chronic kidney disease (CKD) whatever the cause of nephropathy. It clearly alters patients’outcomes. Its origin is multifactorial and it is potentialized by metabolic disturbances associated to renal failure such as systemic inflammation, metabolic acidosis and resistance to insulin. Preventing or treating PEW, the dietary intervention aims to preserve the patient lean body mass. The nutritional evaluation relies on markers analysis compared to defined targets and it integrates the patient’ lifestyle and social habits. It allows a customized nutritional strategy for each patient. Several approaches are available. When the protein and energy intakes do not fulfil the guidelines, oral, enteral or parenteral supplementation will be prescribed. The follow-up of nutritional markers will evaluate the efficiency of these prescriptions and also will predict the patient's outcome.
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