Zusammenfassung
Ernährungsempfehlungen bei Nierenerkrankungen richten sich nach dem Krankheitsstadium (CKD-Stadien [CKD: chronische Nierenerkrankung]), den Begleiterkrankungen und den Sekundärfolgen der Niereninsuffizienz. Diätetische Maßnahmen verfolgen primär präventive Ziele wie die Progressionshemmung der Niereninsuffizienz, die Aufrechterhaltung eines adäquaten Ernährungszustands und die Verhinderung von Hyperphosphatämie oder Hyperkaliämie. Zur Progressionshemmung chronischer Nierenerkrankungen wird neben den etablierten medikamentösen Interventionen nur noch in den CKD-Stadien 1–3 eine diätetische Eiweißrestriktion auf 0,6–0,8 g / kg / d empfohlen. Für das Management einer Hyperphosphatämie stehen sowohl diätetische als auch medikamentöse (Phosphatbinder) Behandlungsoptionen zur Verfügung. Diätetische Phosphatrestriktionen dürfen den Ernährungszustand allerdings nicht negativ beeinflussen. In den CKD-Stadien 4 und 5 besteht ein hohes Risiko für die Entwicklung einer Mangelernährung, die durch einen gesteigerten Proteinkatabolismus bei gleichzeitig gehemmter Proteinsynthese charakterisiert ist. Die Entwicklung einer Malnutrition muss frühzeitig erkannt und konsequent behandelt werden. Das Ziel ernährungsmedizinischer Maßnahmen bei Mangelernährung ist die komplette Abdeckung des individuellen Energie- und Eiweißbedarfs, im Bedarfsfall auch durch orale oder enterale (PEG [perkutane endoskopische Gastrostomie]) Verabreichung eiweißreicher und hochkalorischer Zusatznahrung.
Abstract
Dietary recommendations for patients with chronic renal disease need to take into consideration the CKD stage, the variety of comorbidities, and the plethora of secondary consequences of renal insufficiency. Primary aims of dietary interventions in kidney disease include retardation of disease progression, maintenance of a good nutritional state and prevention of hyperphosphatemia or hyperkalemia. In CKD stages 1–3 retardation of disease progression can be achieved by medicinal interventions in combination with dietary protein restriction to 0.6–0.8 g / kg / day. The management of hyperphosphatemia includes dietary as well as medicinal (phosphate binders) measures. However, dietary phosphate control should not compromise protein intake. There is an increased risk for development of malnutrition in CKD stages 4 and 5, which is characterized by stimulation of muscle proteolysis and inhibition of protein synthesis. The development of malnutrition needs to be recognized early and addressed with scrutiny. Any dietary interventions for the management of malnutrition aim at improving energy and protein intake, either by dietary counselling or, if required, by prescription of oral or enteral (PEG / PEJ) energy and protein supplements.
Schlüsselwörter
Mangelernährung - Hyperphosphatämie - arterielle Hypertonie - Hyperlipidämie
Keywords
malnutrition - hyperphosphatemia - arterial hypertension - hyperlipidemia
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41 D-A-CH .Referenzwerte für die Nährstoffzufuhr.. 1. Aufl. 3. korrigierter Nachdruck. Neustadt an der Weinstraße: Neuer Umschau Buchverlag; 2008
Prof. Dr. med. Martin K. Kuhlmann
Innere Medizin – Nephrologie, Vivantes Klinikum im Friedrichshain
Landsberger Allee 49
10249 Berlin
Email: Martin.kuhlmann@vivantes.de
