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Treating malnutrition in patients on hemodialysis.

Article Excerpt
Malnutrition is common in patients on hemodialysis and is a powerful predictor of morbidity and mortality. Although much progress has been made in recent years in identifying the causes and pathogenesis of malnutrition in patients on hemodialysis, as well as recognizing the link between malnutrition and morbidity and mortality, no consensus has been reached concerning its management (Bossola et al., 2005).

There are many causes of inadequate nutritional intake in the population receiving dialysis. Taste abnormalities, such as dry mouth, acuity, metal flavors, and changes in taste, are often seen in patients with uremia. Anorectic factors, such as inflammation and/or infection, medications, psychological issues (including depression), poverty, and alcohol and drug addiction, all contribute to malnutrition in this population. Other factors associated with the dialysis process, including post-dialysis fatigue, poor dialysis adequacy (inadequate Kt/V), and cardiovascular instability, all have an adverse effect on nutritional status as well. Anorexia is present in approximately one-third of patients receiving hemodialysis and is the consequence of multiple complex and only partially defined disturbances involving inflammation and altered hormonal and amino acid patterns (Bossola et al., 2005).

Nutrition screening, dietary counseling, and dialytic adequacy have a critical role in malnutrition prevention. Pharmacological interventions have been used, and this article reviews approaches to increase appetite and weight gain in the hemodialysis population.

Appetite Stimulants

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