| Theme |
Nutritional Management of Patients with Renal Failure -- Suitable for Ages and Clinical Conditions |
| Title |
Nutrition support for dialysis patients with complications |
| Author |
Ryohei Yamamoto |
Department of Nephrology, Osaka University School of Medicine |
| Author |
Takahito Ito |
Department of Nephrology, Osaka University School of Medicine |
| [ Summary ] |
Patients undergoing maintenance dialysis are often malnourished because of enhanced protein catabolism and loss of appetite secondary to uremia. Those who are unable to meet their protein and energy requirement with oral food intake should receive enteral or parenteral nutrition support. Enteral nutrition support should be considered first because of the lower complication rates of infection such as central venous catheter-related sepsis and also because of cost effectiveness. Individuals, who do not tolerate enteral nutrition for more than fourteen days, should be started on total or partial parenteral nutrition (intravenous hyperalimentation) without delay. The femoral, subclavian, or upper limb vein is not recommended as the insertion site for central venous catheters for parenteral nutrition. Femoral vein catheterization has a higher probability of sepsis and thrombosis. Subclavian and peripheral vein catheterization can lead to thrombotic stenosis of the subclavian vein which subsequently develops serious venous hypertension of the upper limb with arteriovenous fistula. |