Download PDF
Dialyse aktuell 2014; 18(S 01): S6-S9
DOI: 10.1055/s-0034-1544014
Dialyse
© Georg Thieme Verlag Stuttgart · New York

Differenzialindikation oraler und parenteraler Ernährung – Was ist bei Dauerdialysepatienten zu beachten?

Differential indication of oral and parental nutrition – What needs to be considered in long-time dialysis patients
Tobias A Marsen
1   KfH – Kuratorium für Dialyse und Nierentransplantation, Nierenzentrum Köln-Lindenthal
› Author Affiliations
Further Information

Publication History

Publication Date:
15 January 2015 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die Behandlung der dialyseassoziierten Mangelernährung (PEW: „protein energy wasting“) verdient laut Leitlinien eine rasche und konsequente Intervention. Abhängig vom Grad der Mangelernährung und klinischen Parametern wie Körpergewichtsveränderungen, Präalbumin und Albumin sollte eine Stratifizierung der interventionellen Ernährungstherapien erfolgen. Bereits mit dem Beginn der Dialysepflicht ist in der Regel eine Ernährungsberatung notwendig. Bleibt sie ohne Erfolg, stehen bei moderater Mangelernährung mit oralen Nahrungsergänzungen (ONS) oder mit der intradialytischen parenteralen Ernährung (IDPE) potente Therapiemöglichkeiten zur Verfügung. Der Einsatz der IDPE ist bei schwerer Mangelernährung meist nicht von anhaltendem Erfolg, weshalb eine Kombination mit ONS gegeben werden sollte. Eine enterale Sondentherapie scheitert, obwohl laut Guidelines empfohlen, in der Regel an der Adhärenz der Betroffenen.

Summary

The treatment of dialysis-related malnutrition (PEW: protein energy wasting) according to guidelines deserves rapid and consistent intervention. Depending on the degree of malnutrition and clinical parameters such as body weight changes, prealbumin and albumin, a stratification of interventional nutrition therapies is necessary. With the start of dialysis treatment, the nutritional guidance is usually necessary. If guidance is unsuccessful at moderate malnutrition, oral nutritional supplements (ONS) and in particular intradialytic parenteral nutrition (IDPE) are potent treatment options available. In severe malnutrition, the use of IDPE is usually not of sustained success which is why a combination with ONS should be given. Enteral therapy through gastric tubes fails, although according to guidelines recommended, due to lack of adherence of those affected.

Key words

protein energy wasting - end-stage renal failure - nutrition - intradiaytic parenteral nutrition
 

  • Literatur

  • 1 Marsen TA. Pathogenese des PEW bei chronischer Niereninsuffizienz. In: Marsen TA, Hrsg. Ernährungskonzepte bei Dialysepatienten und intradialytische parenterale Ernährung (IDPE). Bremen: Uni-Med; 2014: 16-20
    Google Scholar
  • 2 Maroni BJ. Nutrition and renal disease. In: Greenberg A. ed. Primer on kidney diseases. Academic Press; 1998: 443-443
    Google Scholar
  • 3 Owen WF. Nutritional status and survival in end-stage renal disease patients. Miner Electrolyte Metab 1998; 24: 72-81
    CrossrefGoogle Scholar
  • 4 Ikizler TA, Hakim RM. Nutrition in end-stage renal disease. Kidney Int 1996; 50: 343-357
    CrossrefGoogle Scholar
  • 5 Cano NJ, Aparicio M, Brunori G et al. ESPEN. ESPEN Guidelines on Parenteral Nutrition: adult renal failure. Clin Nutr 2009; 28: 401-414
    CrossrefGoogle Scholar
  • 6 K/DOQI, National Kidney Foundation. Clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis 2000; 35 (Suppl. 2): S1-S140
    Google Scholar
  • 7 Fouque D, Vennegoor M, ter Wee P et al. EBPG guideline on nutrition. Nephrol Dial Transplant 2007; 22 (Suppl. 2): ii45-ii87
    CrossrefGoogle Scholar
  • 8 Fouque D, McKenzie J, de Mutsert R et al. Renilon Multicentre Trial Study Group. Use of a renal-specific oral supplement by haemodialysis patients with low protein intake does not increase the need for phosphate binders and may prevent a decline in nutritional status and quality of life. Nephrol Dial Transplant 2008; 23: 2902-2910
    CrossrefGoogle Scholar
  • 9 Stratton RJ, Bircher G, Fouque D et al. Multinutrient oral supplements and tube feeding in maintenance dialysis: a systematic review and meta-analysis. Am J Kidney Dis 2005; 46: 387-405
    CrossrefGoogle Scholar
  • 10 Czekalski S, Hozejowski R. Intradialytic amino acids supplementation in hemodialysis patients with malnutrition. Results of a multicenter cohort study. J Ren Nutr 2004; 14: 82-88
    CrossrefPubMedGoogle Scholar
  • 11 Chertow GM, Ling J, Lew NL et al. The association of intradialytic parenteral nutrition administration with survival in hemodialysis patients. Am J Kidney Dis 1994; 24: 912-920
    CrossrefGoogle Scholar
  • 12 Berneis K, Iseli-Schaub J, Garbani E et al. Effects of intradialytic parenteral nutrition in chronic haemodialysis patients with malnutrition: a pilot study. Wien Klin Wochenschr 1999; 111: 876-881
    Google Scholar
  • 13 Cano NJ, Labastie-Coeyrehourq J, Lacombe P et al. Perdialytic parenteral nutrition with lipids and amino acids in malnourished hemodialysis. Am J Clin Nutr 1990; 52: 726-730
    Google Scholar
  • 14 Capelli JP, Kushner H, Camiscioli TC et al. Effect of intradialytic parenteral nutrition on mortality rates in end-stage renal disease care. Am J Kidney Dis 1994; 23: 808-816
    CrossrefGoogle Scholar
  • 15 Cano NJ, Fouque D, Roth H et al. French Study Group for Nutrition in Dialysis. Intradialytic parenteral nutrition does not improve survival in malnourished hemodialysis patients: a 2-year multicenter, prospective, randomized study. J Am Soc Nephrol 2007; 18: 2583-2591
    CrossrefGoogle Scholar
  • 16 Marsen TA, Fiedler R, Mann H. for the IDPN Study Group Germany. Intradialytic parenteral nutrition (IDPN) increases serum prealbumin (PA) levels in malnourished hemodialysis (HD) patients – a prospective, multicenter, open, phase-IV-study. J Am Soc Nephrol 2011; 22: 242A-242A
    Google Scholar