Dénutrition et insuffisance rénale chronique

Abstract

During chronic renal failure, malnutrition is responsible for increased morbidity and mortality. Both protein and energy intakes decrease during the course of renal insufficiency. Abnormal nutrient metabolism, which concerns both protein and energy metabolism, in peripheral as well as in hepatosplanchnic tissues, contributes to the development of malnutrition. Before dialysis therapy is instituted, protein restriction is usually recommended. However the occurrence of malnutrition argues for the initiation of dialysis therapy and the increase of protein intake. During dialysis, severe malnutrition in found in 25 % of patients and compromises the prognosis. Indicators of protein nutrition such as protein catabolic rate, serum albumin and prealbumin, which are the best markers of the prognosis, must be integrated in the follow-up of these patients. In dialysis patients, the estimated nutritonal requirements are 35-40 kcal et 1.2-1.4g protein/kg/day. In malnourished dialysis patients, after verification of the adequacy of dialysis therapy, nutritional support should be chosen according to its ability to satisfy these nutritional needs, taking into account the spontaneous intakes.