Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, 10100 Torino, Italy.
Centre Hospitalier Le Mans, 72037 Le Mans, France.
Nutrients. 2020 Mar 16;12(3):785. doi: 10.3390/nu12030785.
Dialysis and nutrition are two sides of the same coin-dialysis depurates metabolic waste that is typically produced by food intake. Hence, dietetic restrictions are commonly imposed in order to limit potassium and phosphate and avoid fluid overload. Conversely, malnutrition is a major challenge and, albeit to differing degrees, all nutritional markers are associated with survival. Dialysis-related malnutrition has a multifactorial origin related to uremic syndrome and comorbidities but also to dialysis treatment. Both an insufficient dialysis dose and excessive removal are contributing factors. It is thus not surprising that dialysis alone, without proper nutritional management, often fails to be effective in combatting malnutrition. While composite indexes can be used to identify patients with poor prognosis, none is fully satisfactory, and the definitions of malnutrition and protein energy wasting are still controversial. Furthermore, most nutritional markers and interventions were assessed in hemodialysis patients, while hemodiafiltration and peritoneal dialysis have been less extensively studied. The significant loss of albumin in these two dialysis modalities makes it extremely difficult to interpret common markers and scores. Despite these problems, hemodialysis sessions represent a valuable opportunity to monitor nutritional status and prescribe nutritional interventions, and several approaches have been tried. In this concept paper, we review the current evidence on intradialytic nutrition and propose an algorithm for adapting nutritional interventions to individual patients.
透析和营养是同一枚硬币的两面——透析清除的代谢废物通常是由食物摄入产生的。因此，通常会限制饮食中的钾和磷摄入以避免液体超负荷。相反，营养不良是一个主要挑战，尽管程度不同，但所有营养指标都与生存相关。透析相关的营养不良有多种因素引起，与尿毒症综合征和合并症有关，但也与透析治疗有关。透析剂量不足和过度清除都会导致营养不良。因此，透析本身如果没有适当的营养管理，往往无法有效地对抗营养不良，这并不奇怪。虽然复合指标可用于识别预后不良的患者，但没有一个指标是完全令人满意的，而且营养不良和蛋白质能量消耗的定义仍存在争议。此外，大多数营养指标和干预措施都在血液透析患者中进行了评估，而血液透析滤过和腹膜透析的研究则相对较少。这两种透析方式中白蛋白的大量丢失使得解释常见的指标和评分变得极其困难。尽管存在这些问题，但血液透析治疗仍提供了监测营养状况和制定营养干预措施的宝贵机会，并且已经尝试了几种方法。在本概念论文中，我们回顾了关于透析中营养的现有证据，并提出了一种针对个体化患者的营养干预措施的适应算法。
