Nutritional problems in adult patients with chronic kidney disease

Chronic renal failure (CRF) impairs not only appetite but also impairs immune function, resulting in increased susceptibility to infections and poor wound healing and may predispose to inflammatory diseases. Every strategy should be used to avoid complications of chronic kidney disease (CKD) manifested in uremic state including anorexia, nausea, vomiting leading to malnutrition, fluid and electrolyte imbalance leading to volume overload, hyperkalemia, metabolic acidosis, and hyperphosphatemia, as well as abnormalities related to hormonal or systemic dysfunction such as hypertension, anemia, hyperlipidemia, bone disease, pericarditis, peripheral neuropathy, and central nervous system abnormalities. With decline in GFR, nutrient requirements change. Nutritional status should be assessed periodically. Low protein diets are beneficial for CKD stages 1–5, but nutritional management should be such that the nutritional status is not compromised. In order to maintain proper nutritional status patients on maintenance dialysis require high protein diet. Timely diagnosis of protein-energy-wasting (PEW) is important for early initiation of nutritional intervention and treatment. Management of hypertension, bone mineral disease, fluid overload and gastroparesis should be given prime importance.