hemodialysis patients prevention of malnutrition

hemodialysis

Malnutrition is common in hemodialysis patients, incidence of about one-third, leading to hospitalization rate and mortality was significantly increased, and often in chronic inflammation, fatigue, difficult healing wounds. Its causes are mainly the following three aspects:

(1) reducing the absorption of nutrients: excessive dietary restrictions, so that reduced intake of nutrients or uneven; inadequate dialysis; urinary toxins and drug use, depression and other factors to stimulate delayed gastric emptying or often makes diarrhea, absorption of nutrients obstacles.

(2) increasing loss of nutrients: In dialysis detoxification, drainage, while some of the small molecules of nutrients such as amino acids, vitamin B12, etc. are not simultaneously discharged, such as hemodialysis 5 hours will lose 6 ~ 8g amino acid, if gastrointestinal bleeding existence, which is equivalent to 14 ~ 17g protein 100ml.

(3) increased protein breakdown: metabolic acidosis, endocrine disorders such as growth hormone, insulin-like growth factor, hormone, adrenocorticotropic hormone, glucagon, etc. as well as an increase in patients with chronic inflammatory state can cause increased protein degradation, leading to nutritional bad happened.

Two, hemodialysis malnutrition prevention measures
Uremic malnutrition merger should be possible to find and correct the cause of malnutrition reversible factors associated with the treatment of a variety of complications, emphasizing early dialysis and adequate dialysis, and give malnutrition, including oral and parenteral two complementary method.

(1) oral supplement: oral essential amino acid is the most simple and most physiological methods, dialysis patients every day to add 15 ~ 20g of essential amino acids; second request is reasonable, balanced diet of high quality protein, high-calorie, multi-vitamins, etc., in order to strengthen the use of protein catabolism and decrease.

(2) parenteral supplement: for not eating well or poor gastrointestinal absorption, and poor nutritional status in dialysis patients, or high resolution status in dialysis patients. Intravenous administration of amino acids, fat emulsion, high sugar, and the addition of an appropriate electrolyte and vitamin supplement L-carnitine, so total calories daily to the body between 100 ~ 140kg / (kg.d), in order to ensure that the body of the the need to avoid a negative nitrogen balance.