Nutrition and Appetite Regulation in Children and Adolescents with End-Stage Renal Failure
Victor R. Preedy in Handbook of Nutrition and Diet in Palliative Care, 2019
In adolescents, most patients prefer hemodialysis. One reason certainly is that adolescents worry about stigmatizing effects of the peritoneal dialysis catheter more than small children. In addition, peritoneal dialysis is considered to interfere more with “normal everyday life” of adolescents than hemodialysis. A significant number of the patients are oligo-anuric. However, the major problem with adolescents in puberty is malcompliance. As HD is a discontinuous method, the patients are threatened by decompensation before dialysis. Significant issues are excessive hyperhydration, leading to severe cardiovascular complications, and hyperkalemia resulting in cardiac arrhythmia and arrest. An elevated calcium phosphate product promotes atherosclerosis. Uremic toxins promote inappetence and uremia. Consequently, the patients are trained to assess their state of hydration by weighing and blood pressure measurement, to identify food that contains high amounts of potassium and phosphorus and to pay attention to a sufficient caloric intake (see Tables 27.1–27.5 for dietary recommendations). Fluid intake has to be restricted in oligo-anuric patients, food poor in potassium and phosphorus is mandatory for all patients. Because of potential malcompliance, parameters have to be checked frequently and periodic training is necessary. Unhealthy diet and associated obesity is a common issue in adolescents (Chen et al. 2017). Intradialytic parenteral nutrition is an option to improve nutritional status in case of PEW (Dukkipati et al. 2010).
Diabetes
Maria A. Fiatarone Singh, John Sutton Chair in Exercise, Nutrition, and the Older Woman, 2000
Once a diagnosis of early renal disease has been made, there is evidence that dietary protein restriction can delay the progressive decline in glomerular filtration rate that may ultimately result in dialysis. During this period, we have shown that progressive resistance training can prevent the muscle wasting due to a low protein diet in patients with renal failure. This is caused by the anabolic effect of resistance training, which has been shown to improve nitrogen balance in older adults, thus reducing dietary protein requirements for balance. Once dialysis has begun, there is evidence that aerobic exercise provides substantial benefit in terms of improved cardiovascular fitness, decreased cardiovascular risk factor profile, improved depressive symptoms, and improved overall quality of life compared to usual care controls. This type of exercise has been shown to be safe in this population, despite the potential problems related to significant vascular disease, ischemia, fluid shifts with dialysis, and electrolyte abnormalities for example. There are no studies of resistance training in dialysis patients. The need for protein restriction is now gone obviously, but many of these patients who have suffered with many years of uremia and restricted activity due to illness will present at dialysis quite wasted and deconditioned. Therefore, resistance training may offer complementary benefits to those of aerobic exercise in these patients. Outcomes of clinical trials in this setting, and direct comparison of benefits of various exercise modalities are needed to develop optimal exercise treatment protocols for diabetics and others on dialysis.
Kidney Function and Uremia
Sirshendu De, Anirban Roy in Hemodialysis Membranes, 2017
The precursor to toxin buildup in the human body is kidney malfunction, and this clinical syndrome is referred to as uremia resembling systemic poisoning. There is an overall decline in the performance of various organs of the human body. This can manifest itself through decline in the performance of the cardiovascular system (hypertension, hypotension, etc.), the nervous system (loss of memory, sleep disorders), the hematological system (anemia, bleeding), and the immunological system (susceptible to cancer and infection). Various other complications such as bone diseases (amyloidosis, osteoporosis), skin diseases, gastrointestinal diseases (gastritis, nausea), weight loss, and hypothermia can also arise due to uremia.
Neutrophil/lymphocyte ratio elevation in renal dysfunction is caused by distortion of leukocyte hematopoiesis in bone marrow
Published in Renal Failure, 2019
Satoyasu Ito, Yoshiya Ohno, Toshiyuki Tanaka, Shuhei Kobuchi, Kazuhide Ayajiki, Eri Manabe, Tohru Masuyama, Sakamoto Jun-Ichi, Takeshi Tsujino
It is thought that uremia symptoms are caused by uremic toxins accumulated in the body of renal disorder patients. IS is the most studied substance as a representative of uremic substances among about 90 uremic substances. In patients with CKD, the total mortality rate and the CVD mortality rate were high in the serum IS high-level group [21]. In other words, IS was involved in high morbidity and mortality of CVD in patients with CKD. IS has been reported to activate NADPH oxidase, induce reactive oxygen species (ROS), and promote CKD progression [22–25]. Oxidative stress is deeply involved in pathogenesis of inflammation [26–28], which accelerates the progression of CKD [28,29]. In order to examine how IS is involved in NLR elevation, we focused on leukocyte hematopoiesis in bone marrow.
Red blood cell distribution width at admission predicts outcome in critically ill patients with kidney failure: a retrospective cohort study based on the MIMIC-IV database
Published in Renal Failure, 2022
Rongqian Hua, Xuefang Liu, Enwu Yuan
The progression to kidney failure (also called end-stage kidney disease ESKD) is one of the most important disease-related complications for patients with CKD. There may be no obvious discomfort in the early stage of kidney failure, but with the progressive decline of kidney function, the toxin further accumulates in the body, which can cause various symptoms of uremia, such as nausea, vomiting, poor appetite, skin pruritus, ammonia odor, edema, and anemia [7,8]. Kidney replacement treatment (KRT) such as dialysis or kidney transplant is required for the survival of kidney failure patients [9]. In many high-income countries, kidney failure patients account for approximately 0.1% of the total population, but 1–2% of health care expenditures [4]. Prognostic biomarkers can provide useful information for more elaborate risk classification, effective health care management, and delivery of the best patient care possible .
Neurologic conditions and disorders of uremic syndrome of chronic kidney disease: presentations, causes, and treatment strategies
Published in Expert Review of Clinical Pharmacology, 2019
The normal kidney functions to regulate body fluids volume and electrolytes, maintain pH, concentrate urine above plasma, secrete important hormones (erythropoietin [EPO] and renin), control blood pressure, and excrete waste products, metabolites, toxins, and drugs. Kidney failure is defined as inadequate excretory, regulatory, and endocrine function of the kidneys that cannot be explained by extracellular volume derangements, inorganic ion concentrations, or lack of known renal synthetic products. Uremia or uremic syndrome is a term used to describe the clinical, metabolic, and hormonal abnormalities accompanying kidney failure. Uremic syndrome is diagnosed when renal glomerular filtration rate (GFR) becomes equal or less than 15 ml/min. In end stage kidney disease (ESKD), the GFR is equal to or less than 7% of the normal value which necessitates renal replacement therapy by regular dialysis or kidney transplantation. Because uremia is mostly a consequence of kidney failure, its signs and symptoms often occur concomitantly with other signs and symptoms of kidney failure [1]. The Uremia or uremic syndrome of chronic kidney disease (CKD) is frequent and worldwide rapidly growing public health problem particularly with ESKD, with an estimated prevalence of 13–35% [2]. Diabetic nephropathy is the commonest CKD in developed countries [2] whereas in the developing world, inflammatory diseases of the kidney, particularly glomerulonephritis and tubulointerstitial nephritis, remain also on the top of the commonest causes of CKD in addition to diabetes [3].
Related Knowledge Centers
- Azotemia
- Kidney Failure
- Protein Metabolism
- Urea
- Urine
- Amino Acid
- Creatinine
- Assessment of Kidney Function
- Glomerular Filtration Rate
- Kidney Dialysis