McCollum Award Lecture, 1996: protein-energy malnutrition in maintenance dialysis patients.

There is a high prevalence of protein-energy malnutrition in patients with chronic renal failure who are undergoing maintenance dialysis therapy. The high prevalence of malnutrition is a potentially serious problem because indexes of protein-energy malnutrition are powerful predictors of mortality in maintenance dialysis patients. Although the data do not prove that improving nutritional intake will reduce mortality, nonrandomized studies suggest that provision of addition amino acids and energy to such patients is associated with reduced mortality. There are many causes for protein-energy malnutrition in maintenance dialysis patients. Among the three most important factors are the nutritional status of the patient before commencing dialysis therapy, inadequate protein and energy intakes after they become dialysis patients, and acute and chronic illnesses. Improving the nutrient intake of maintenance dialysis patients is a challenging task because most chronic renal failure patients with malnutrition are anorectic, and dietary counseling has had limited success at increasing their nutrient intake. Other methods for improving nutritional status in adults, infants, and children with chronic renal failure that have been tried with varying degrees of success include increasing the dose of dialysis and the use of food supplements and tube feeding. Less well-proven techniques for the treatment of protein-energy malnutrition include intradialytic parenteral nutrition. The use of appetite stimulants and such growth factors as rhGH and rhIGF-I are still in the experimental stage.