Correction of end-stage chronic renal failure (CRF) by active methods such as hemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation requires significant changes in the diet of patients.

Various processes associated with complications of chronic renal failure or with dialysis procedures have a further impact on the metabolism and nutritional status of patients (Table. 31. 3).

The following factors are added to the already existing changes in protein metabolism associated with chronic renal failure, proteinuria and loss of renal function, increased levels of catabolic and resistance to anabolic hormones, hyperglycemia and hyperinsulinemia, hyperlipidemia and dyslipoproteinemia:.

- catabolic effects of secondary complications, primarily intercurrent infections;

- an increase in catabolism with peritonitis (with PD);

- loss of nutrients during dialysis;

- catabolic effects of dialysis procedure (with HD);

- frequent blood loss (with hemodialysis);

- anorexia due to constant absorption of glucose from the abdominal cavity (with peritoneal dialysis);

- obesity (with PD);

- effects of corticosteroid and immunosuppressive therapy (with transplantation).

Table 31. The main catabolic effects of dialysis procedure (according to B. Lindholm, 1994) Indicators Peritoneal dialysis Hemodialysis Loss of amino acids Loss of glucose Loss of protein 2-4 g / day 14-28 g / week absorption 5-15 g / day (increases with peritonitis) Catabolic effect of peritonitis 9-13 g / dialysis 27-39. For patients receiving HD treatment, a diet containing 1.2 g / kg of protein is adequate.

With peritoneal dialysis, the protein requirement reaches 1.2-1.5 g / kg body weight. The existing significant metabolic disorders and the loss of amino acids during dialysis require that the protein component of the diet be represented mainly by protein of high biological value.

The energy needs of patients continue to average 35 kcal / kg of body weight per day (increase with significant physical activity). Permanent absorption of glucose from the abdominal cavity occurring during PD allows dialysate to provide 15-30% of total calories.

To prevent excessive weight gain, excess extracellular fluid, edema, hypertension, cardiovascular disorders in patients receiving dialysis treatment, a low sodium diet should be maintained (3-6 g / day). Recommendations to limit phosphorus and potassium, to increase the consumption of water-soluble vitamins remain relevant.

The high need for protein, combined with the requirement to preserve the restriction of essential macronutrients in the diet, the catabolic effects of the dialysis procedure itself lead to a high risk of developing protein-energy malnutrition in dialysis patients.

The problem of the development of protein-energy malnutrition is especially relevant for patients on peritoneal dialysis.. Numerous studies show that nutritional deterioration is one of the main problems of peritoneal dialysis..

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