Son Dönem Böbrek Yetmezliğinde Nutrisyon Desteği

Kronik böbrek yetmezliği (KBY), glomerül filtrasyon hızının (GFR) böbrek işlevlerinde saptanabilir düzeyde değişikliklere neden olacak kadar, kalıcı bir şekilde azaldığı durum olarak tanımlanabilir. Bu durum genellikle GFR 25 mL/dk/1.73 m2nın altına indiğinde ortaya çıkar. Son dönem böbrek yetmezliği (SDBY), endojen renal fonksiyonunun irreversibl kaybı ile karakterize ve hayatı tehdit eden üremiden korunmak için hastaya devamlı olarak diyaliz veya transplantasyon gibi renal replasman tedavilerinin uygulandığı klinik tabloyu oluşturur. SDBY insidansı ve prevalansı tüm dünyada artmaktadır. Türk Nefroloji Derneği verilerine göre son 10 yılda ülkemizde SDBY insidansında iki kat, prevalansında beş kat artış gözlenmiştir. Kronik böbrek yetmezliğine eşlik eden üremik sendrom iştah kaybıyla, azalmış oral besin alımıyla sonuçlanan gastrointestinal yan etkilerle, metabolik asidoz, endokrin etmenler, üremik toksisite, protein katabolizmasının başlamasıyla vb. ilişkilidir. Malnütrisyon SDBY olan hastalarda önemli bir sorundur. SDBY tanısı konmuş hastalarda protein enerji malnutrisyonunun (PEM) bulunma oranı hemodiyaliz (HD) hastalarında %18-75, sürekli ayaktan periton diyaliz (SAPD) hastalarında %10-50 arasındadır. Protein enerji malnütrisyon varlığı SDBYde artmış mortalite ve morbidite ile ilişkilidir. Malnütrisyon sık görüldüğü için, beslenme durumunun periyodik olarak değerlendirilmesi, erken tanı ve uygun tedavide diyaliz hastalarının rutin bakımının bir parçasıdır. Öncelikle tıbbi beslenme tedavisi bireysel olarak düzenlenmeli, oral yolla yeterli enerji ve besin ögesi alamayan hastalar ve beden kütle indeksi

Nutritional Support in End-Stage Renal Disease

Chronic kidney disease (CKF) is a state of permanent decrease in glomerular filtration rate (GFR) that will cause established changes in kidney functions. This status usually occurs when GFR decreases below 25mL/min/1.73m2. 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 dialysis and transplantation in order to be protected from harmful and life threatening effects of uremia. The incidence and prevalence of ESRD is increasing globally. According to the data of the Turkish Nephrology Society, ESRD incidence was increased two times and prevalence was increased five times in the last 10 years in Turkey. Uremia decreases appetite and causes reduced food intake that is related with its negative effects on the gastrointestinal system function, metabolic acidosis, endocrine factors, uremic toxicity, induction of protein catabolism, etc. Protein energy malnutrition (PEM) is an important problem in ESRD. PEM rates of the hemodialysis and peritoneal dialysis patients are 18-75% and 10-50 %, respectively. Protein energy malnutrition in ESRD is strongly related with increased morbidity and mortality. As a result of the frequency of malnutrition, 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 of the diet for each individual. Nutritional support is indicated 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. If the patients cant tolerate oral nutritional supplements, early enteral nutrition with tube feeding is recommended. If the patients cant tolerate enteral nutrition with tube feeding, then parenteral nutrition or intradialytic parenteral nutrition in hemodialysis patients is offered.

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