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Part 7: Nutrition in PD |
Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
Correspondence to: P. Stenvinkel, Karolinska University Hospital at Huddinge, K56, Stockholm 14186 Sweden. peter.stenvinkel{at}ki.se
Protein–energy malnutrition (PEM) is highly prevalent among
peritoneal dialysis (PD) patients and is a strong predictor of morbidity and
mortality. A wide range of factors can lead to PEM and associated wasting
(PEM/W) in PD patients, but persistent inflammation and the presence of
diabetes have been identified as the two main reasons. An important body of
literature has been reporting studies of methods suitable for detecting
malnutrition in its early phase so that appropriate intervention can be
provided. Although assessment of nutrition status has been substantially
improved, no definitive single method of assessing nutrition status has been
decided. Rather, several different markers of nutrition should be evaluated
together. Because of the complexity of treating malnutrition in PD patients,
nontraditional strategies such as appetite stimulants, anti-inflammatory
diets, and anti-inflammatory pharmacologic agents are recommended to be
combined with more traditional forms of nutritional support, so as to provide
a better chance of recovery. The present review briefly discusses the causes
of PEM/W, the methods most commonly used to identify the condition, and the
new management strategies available.
KEY WORDS: Malnutrition; inflammation; diabetes mellitus.
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