Pérez-Torres Almudena, Caverni Muñoz Alberto, Lou Arnal Luis Miguel, Sanz Paris Alejandro, Vidal Peracho Concepción, la Torre Catalá Juan, Sánchez Villanueva Rafael, Cigarrán Guldris Secundino, Trocoli González Filomeno, Nogueira Pérez Ángel, Sanjurjo Amado Ana, González García M Elena, Barril Cuadrado Guillermina
Servicio de Nefrología, Hospital Universitario La Paz, IdiPaz, Madrid, España.
Unidad de Nutrición, Hospital Universitario Santa Cristina, Madrid, España.
Nefrologia. 2021 Jul-Aug;41(4):453-460. doi: 10.1016/j.nefro.2020.12.009. Epub 2021 Jan 28.
The presence of malnutrition in patients with chronic kidney disease (CKD) is high, it can be made worse by SARS-CoV-2 infection.The nutritional assessment should be adapted to minimize the infection, recommending monitoring: weight loss percentage, body mass index (BMI), loss of appetite, analytical parameters and functional capacity using the dynamometer. As well as the sarcopenia assessment using the SCARF scale, and the possibility of using the GLIM criteria in those patients who have been tested positive by MUST.It is important to adapt the nutritional recommendations in the caloric and protein intake, to the CKD stage and to the SARS-CoV-2 infection stage. In patients with hypercatabolism, to prioritize preserving the nutritional status (35 kcal/kg weight/day, proteins up to 1.5 g/kg/day). The rest of the nutrients will be adapted to CKD stage and the analytical values.In the post-infection stage, a complete nutritional assessment is recommended, including sarcopenia. The energy and protein requirements in this phase will be adapted to the nutritional status, with special attention to the loss of muscle mass.Dietary recommendations need to be tailored to side effects of SARS-CoV-2 infection: anorexia, dysphagia, dysgeusia, and diarrhea.Anorexia and hypercatabolism makes it difficult to meet the requirements through diet, therefore the use of oral nutritional supplements is recommended as well as the enteral or parenteral nutrition in severe phases.
慢性肾脏病（CKD）患者中营养不良的发生率很高，感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）会使其情况恶化。营养评估应进行调整以尽量减少感染，建议监测：体重减轻百分比、体重指数（BMI）、食欲不振情况、分析参数以及使用握力计评估功能能力。还应使用SCARF量表评估肌肉减少症，并对通过营养不良通用筛查工具（MUST）检测呈阳性的患者使用全球营养不良领导倡议（GLIM）标准。根据CKD阶段和SARS-CoV-2感染阶段调整热量和蛋白质摄入方面的营养建议非常重要。对于分解代谢亢进的患者，应优先维持营养状况（35千卡/千克体重/天，蛋白质摄入量最高可达1.5克/千克/天）。其余营养素将根据CKD阶段和分析值进行调整。在感染后阶段，建议进行全面的营养评估，包括肌肉减少症评估。此阶段的能量和蛋白质需求将根据营养状况进行调整，特别要关注肌肉量的减少。饮食建议需要根据SARS-CoV-2感染的副作用进行调整：食欲不振、吞咽困难、味觉障碍和腹泻。食欲不振和分解代谢亢进使得难以通过饮食满足需求，因此建议使用口服营养补充剂，严重阶段还可采用肠内或肠外营养。
