Hemodiyaliz Hastasında İntradiyalitik Parenteral Beslenme: Bir Olgu Sunumu

Son dönem böbrek yetmezliği (SDBY), endojen renal işlevinin irreversibl kaybı ile karakterize ve hayatı tehdit eden üremiden korunmak için hastaya devamlı olarak hemodiyaliz, sürekli ayaktan periton diyaliz veya transplantasyon gibi renal replasman tedavilerinin uygulandığı klinik tabloyu oluşturur. SDBY tanısı konmuş hastalarda malnutrisyonun görülme oranı hemodiyaliz (HD) hastalarında %18-75, sürekli ayaktan periton diyaliz (SAPD) hastalarında %10-50 arasındadır. Hastalarda beslenme durumunun periyodik olarak değerlendirilmesi, erken tanı ve tedavide diyaliz hastalarının rutin bakımının bir parçasıdır. Öncelikle tıbbi beslenme tedavisi bireysel olarak hastalara düzenlenmeli, ağızdan besin alımı arttırılmalıdır. Oral yolla yeterli enerji ve besin ögesi alamayan hastalar ve beden kütle indeksi

A Case Report: Intradialytic Parenteral Nutrition in Hemodialysis Patient

End Stage Renal Disease (ESRD) is characterized with irreversible loss of renal functions and this constitutes a clinical state that requires renal replacement treatments such as hemodialysis, continuous ambulatory peritoneal dialysis and transplantation in order to be protected from harmful and life threatening effects of uremia. Malnutrition rates of the hemodialysis and continuous ambulatory peritoneal dialysis patients are 18-75% and 10-50%, respectively. Periodic assessment of nutritional status should be part of the routine care of dialysis patients to permit early recognition and the institution of appropriate therapy. The first step is to modify the diet for each individual, and increase oral food intake. Nutritional support must be recommended in undernourished ESRD patients as defined by low nutritional indices, mainly body mass index less than 20 kg/m2, body weight loss more than 10% over 6 months, serum albumin less than 3.5 g/dL and serum prealbumin less than 30 mg/dL and in cases where normal food intake is inadequate. Oral nutritional supplement (ONS) is suggested in patiens in addition to diet therapy. If the patients cant tolerate ONS, intradialytic parenteral nutrition in hemodialysisis is recommended. If ONS and IDPN is not well tolerated, enteral tube feeding should be offered In this case report we discussed via a case strategies of intradialytic parenteral nutrition in hemodialysis patient.

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1.Tanrıverdi M.H, Karadağ A, Hatipoğlu E.Ş. Kronik böbrek yetmezliği. Konuralp Tıp Dergisi 2010;2(2):27- 32.
2.Süleymanlar G, Seyami N, Altıparmak M. Türkiyede Nefroloji- Diyaliz ve Transplantasyon. Türk Nefroloji Derneği kayıt sistemi 2011 Yılı rapor özeti. Türk Nefroloji Derneği Yayınları, İstanbul, 2012.
3.Wilkens Kg, Juneja V, Shanaman E. Medical nutrition therapy for renal disorders. Ed. Mahan LK, Escott- Stump S, Raymond J. Krauses Food and Nutrition Care Process. 13th Ed, USA: Saunders Elsevier; 2012, p.799- 831.
4.Lindholm B, Heimbürger O, Stenvinkel P. What are the causes of protein energy malnutrition in chronic renal insufficiency? Am J Kid Dis 2002;39(2):422-425.
5.Pupim LB, İkizler A. Assessment and monitoring of uremic malnutrition. J Ren Nutr 2004;14:6-9.
6.Mehrotra R, Kopple JD. Nutritional management of maintance dialysis patients. why arent we going better? Ann Rev Nutr 2001;21:343-379.
7.Cano NJ, Aparici M, Brunori G,Carrero JJ, Cianciaruso B, Fiaccador E, et al. ESPEN guidelines on parenteral nutrition: adult renal failure. Clin Nutr 2009; 28:401- 414.
8.Bolluk S, Yıldıran H. Hemodiyaliz hastalarında intradiyalitik parenteral beslenme 2014;9(1):13-18.
9.Fouque D, Vennegoor M, Ter Wee P,Wanner C, Baser A, Vennegoor M, et al. EBPG guideline on nutrition. Nephrol Dial Transplant 2007;22(Suppl 2):ii45-ii87.
10.Cano N, Fiaccadori E, Tesinsky P, Toigo G, Druml W, Kuhlmann M, et al. ESPEN guidelines on enteral nutrition: adult renal failure. Clin Nutr 2006;25:295- 310.
11.Seyit M. Mercanlıgil, Böbrek hastalıklarında beslenme. Eds. Baysal A, Aksoy M, Besler T, Bozkurt N, Keçecioğlu S,Mercanlıgil S ve arkadaşları. Diyet El Kitabı (6 bs.)(s.67-143).Ankara: Hatiboğlu Yayınevi,2011.
12.Kopple JD. K/DOQI clinical practice guidelines for nutrition for chronic dialysis patients. AJKD 2001;37(1):S66-S70.
13.Serna-Thome MG, Padilla-Rosciano AE, Suchil-Bernal L. Practical aspects of intradialytic nutritional support. Current Opinion in Clinical Nutrition and Metabolic Care 2002;5:293-296.
14.Oğuzhan N, Utaş C. Kronik böbrek yetmezliğinde malnutrisyon. Türkiye Klinikleri J Nephrol-Special Topics 2009;2(2):26-33.
15.Young GA, Koople JD, Lindholm B, Vonesh EF, De Vecchi A, Scalamogna A, et al. Nutritional assessment of continuous peritoneal dialysis patients: An international study. Am J Kid Dis 1991;17:462-471.
16.Mortelmans AK, Vanhoder R. Intradialytic parenteral nutrition in malnourished hemodialysis patients. Mineral and Electrolyte Metabolism,1999;25:324-332.
17.Thorme S, Rosciano AE. Practical aspects of intradialytic parenteral nutritional support. Curr Opin Clin Nutr Metab Care 2002;5(3):293-296.
18.Hiroshige K, Iwamoto M, Kabashima N, Mutoh Y, Yuu K, Ohtani A. Prolonged use ofintradialysis parenteral nutrition in elderly malnourished chronic hemodialysis patients. Nephrol Dial Transplant 1998;13(8):2081-7.
19.Bilbrey GL, Cohen TL. Identification and treatment of protein calorie malnutrition in chronic hemodialysis patients. Dialysis & Transplantation1989;18(12):669-700.