EBPG Guideline on Nutrition

Extract

Guideline 1. Prevalence of malnutrition and outcome

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Rationale

Malnutrition is considered to be one of the late complications of chronic renal failure. A sub-analysis of the Modification of Diet in Renal Disease (MDRD) study, however, demonstrated that progressive renal insufficiency was associated with a spontaneous decline in protein intake. Predialysis patients appeared to have a spontaneous protein intake of <0.7 g/kg/day [1], which is below the minimal recommended daily intake. Thus, malnutrition in haemodialysis patients may already originate during stage IV of chronic renal failure.

It has been demonstrated that serum albumin and creatinine increase during the first half year of haemodialysis [2,3], suggesting an improvement of nutritional status after the initiation of dialysis. Nevertheless, many studies have reported on the presence of malnutrition in a large number of dialysis patients [4–7]. In the French national cooperative study [6], that included 7123 patients, nutritional status was determined by body mass index (BMI), normalized protein catabolic rate (nPCR) and several laboratory values. Life-threatening malnutrition was present in up to 36% of the patients. Low protein intake and low dialysis efficacy were associated with the presence of malnutrition. Several other studies demonstrated that haemodialysis patients eat less protein and fewer calories than prescribed, which is associated with a higher rate of malnutrition [4,5,7].