| Theme |
Points of dietary therapy for national registered dietitian to establish clinical guideline for nutrition in dialysis patients |
| Title |
Enteral nutritional therapy for critically illness in patients on chronic dialysis |
| Author |
Akihiko Kato |
Blood Purification Unit, Hamamatsu University School of Medicine |
| Author |
Eriko Saito |
Nutrition and Dietary Unit, Hamamatsu University School of Medicine |
| [ Summary ] |
To treat dialysis patients with complications due to a critical illnesses, it is recommended they not exceed 60 to 70 % of target energy requirements from enteral nutrition to prevent hyperglycemia, calling for prescribed underfeeding. In contrast, due to these patients' high catabolic states, appropriate protein/amino acid supplements of 1.5 to 2.0 g/kg/day are required to maintain neutral nitrogen balance. In overweight or obese dialysis patients, ideal body weight targets are applied to predict ideal energy intake levels. In patients with reduced lean body mass, an actual pre-illness body weight is preferable. Enteral nutrition is preferred for hemodynamically stable critically ill patients who have functioning gastrointestinal tracts. Because renal disease-specific liquid formulas obviously contain less protein, standard potassium and phosphrous formulas are adequate for the majority of critically ill patients. During the course of enteral feeding, it is necessary we carefully monitor electrolyte disorders such as hypokalemia and hypophosphatemia. |