People with chronic kidney disease (CKD) are at a higher risk for malnutrition than the general population1. There are many reasons CKD patients may become malnourished, including inadequate intake of protein and calories, loss of protein through the urine or dialysis, and other medical conditions. Malnourished patients have more frequent hospital admissions and a lower quality of life than well-nourished patients. Research has shown that well-nourished CKD patients not only live healthier, but also longer lives2. This article will identify some common risk factors and signs of malnutrition and suggest ways to prevent it.
What is malnutrition?
Malnutrition is the condition that occurs when a person’s body is not getting enough nutrients3. This may be due to a diet that is inadequate in protein and/or calories, or when a person is not able to use these nutrients appropriately or compensate for protein losses4. CKD often causes side effects such as nausea, vomiting and decreased appetite, which may lead to inadequate food intake. In addition to these side effects, CKD patients are often on a restricted diet, which makes it even more challenging to consume a nutritious diet. Furthermore, pre-dialysis patients typically lose protein through their urine while dialysis patients lose protein with each treatment. This can lead to low levels of protein and other nutrients in the blood, thus increasing the risk of malnutrition.
It is important to distinguish between acute and chronic malnutrition. Acute malnutrition occurs when a person’s nutrient intake or nutrient utilization has been disrupted for a short period of time. For example, if a person had surgery and ate poorly for a few weeks while they were healing, they may be acutely malnourished. Acute malnutrition may require some short-term diet modifications and other changes, but typically does not cause lasting complications if a person is able to return to their baseline food intake. It is important to focus on choosing foods high in calories and protein, such as meat and eggs, and maintaining consistent meal times during periods of acute malnutrition to prevent it from progressing to chronic malnutrition.
Chronic malnutrition occurs when the body has been deprived of nutrients for a long period of time. Someone who has had a poor appetite and inadequate intake of food for months or years may be chronically malnourished. Medications such as appetite stimulants, nutritional supplements (i.e. Suplena®, Nepro®, Ensure®, Boost®, Glucerna®, protein powders or bars etc.), special meal plans, nutrition counseling, and high calorie/high protein foods may be required to improve the nutritional status of a person who is chronically malnourished.
How can I prevent malnutrition?
Here are some general tips to improve nutritional status and/or prevent malnutrition. Keep in mind it is important for CKD patients to work closely with their dietitian and physician if they have risk factors for developing malnutrition.
• Take control of your health! Make sure you are seeing your health care providers regularly and following their recommendations.
• Eat regular meals at approximately the same time each day. Eat smaller meals more frequently if you get full quickly or don’t have much of an appetite.
• Practice good oral hygiene. See your dentist regularly to keep your mouth and teeth healthy.
• Take advantage of local and national food resources. Angel Food Ministries is one example of a national resource with no income requirements that provides grocery assistance. Visit their Web site at angelfoodministries.com or call 1-877-FOOD-MINISTRY (1-877-366-3646) for more information.
• Eat your meals with others when possible. Invite friends and family over for a potluck, or visit a community meal site in your neighborhood.
• If you need to gain weight, focus on high calorie, high protein foods such as eggs cooked in butter, or tuna salad made with mayonnaise.
• Ask your health care professional about drinking nutritional supplements (i.e.
Suplena®, Nepro®, Ensure®, Boost®, Glucerna®, protein powders or bars etc.).
Request a specific recommendation based on your dietary needs and medical conditions.
Summary
Although CKD patients are at a greater risk of being malnourished than the general population, there are many steps you can take to maintain a good nutritional status. Work closely with your health care providers and don’t be afraid to ask for help from family, friends and organizations. Eating well can not only be fun, but it also can help you to live a longer and healthier life.
Learn More
How will your health care provider know if you are malnourished? Visit www.aakp.org/newsletters/Renalife-Magazine/Renalife-Food/Malnutrition to find out!
References:
1. K/DOQI clinical practice guidelines for nutrition. Am J Kidney Dis 35(6 Supp2): S1-140, 2000.
2. Kopple JD: Effect of nutrition on morbidity and mortality in maintenance dialysis patients. Am J Kidney Dis 24:1002-9, 1994.
3. Medline Plus Medical Encyclopedia: Malnutrition. Accessed December 28, 2008: http://www.nlm.nih.gov/medlineplus/ency/article/000404.htm.
4. Protein Energy Malnutrition. Accessed December 19, 2008: http://medical-dictionary.thefreedictionary.com/Protein-Energy+Malnutrition.
5. Determine Your Nutritional Health Checklist. Accessed December 19, 2008: http://www.eatright.org/ada/files/Checklist.pdf.
Jennifer Tarantola, RD, LDN, currently works with peritoneal and hemo-dialysis patients at Fresenius Medical Care in Chicago. She is also involved with Treatment Options education for CKD patients.
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