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Present Status and Perspectives in the Treatment of Malnutrition in Haemodialysis
Besides nutritional support, several therapeutic perspectives for the protein accretion of essential amino acid
that have been
treatment of malnutrition in dialysis have emerged during the past 10 reported in elderly people need to be studied in a controlled fashion in
years. These perspectives include various treatments aiming to improve dialysis patients. Hence, the modulation of protein and amino acid
appetite, decrease protein breakdown and/or promote protein supply may be a way to counteract altered protein synthesis in
synthesis. Daily dialysis – known to induce a liberalisation of maintenance haemodialysis patients. Exercise and anabolic hormones
alimentation and an improvement of nutritional status – should be also appeared to be efficient ways of improving protein status. Pupim
assessed as a therapy for malnutrition in selected patients.
and co-workers showed that exercise combined with IDPN compared
Pentoxifylline, a tumour necrosis factor (TNF)-alpha antagonist, was with IDPN alone induced a two-fold increase in forearm muscle
reported to acutely decrease whole-body proteolysis in chronically essential amino acid uptake and net muscle protein accretion.
controlled, randomised, double-blind study, the administration of
nandrolone decanoate was associated with an increase in muscle mass,
as assessed by pre-dialysis creatinine and dual energy X-ray
Data from FINES demonstrated
absorptiometry (DEXA), and an improvement of muscle performance.
Anabolic effects have been obtained in pilot studies with recombinant
that an increase in survival and an
growth hormone and insulin-like growth factor-1 in adult dialysis
improvement in morbidity can be patients.
Prolonged nutritional studies are required to establish the
expected when an amelioration
beneficial effect and the tolerance of these therapies.
of nutritional status is obtained
Therefore, present data demonstrate that in malnourished
during nutritional support.
haemodialysis patients nutritional support is able to improve
nutritional status. Moreover, data from FINES demonstrated that
an increase in survival and an improvement in morbidity can
be expected when an amelioration of nutritional status is obtained
Because of the implication of inflammation in during nutritional support. Besides nutritional supplementation,
protein catabolism, such an anti-inflammatory approach to protein numerous therapeutic perspectives need to be investigated during
depletion may be an interesting subject of clinical research on malnutrition in dialysis. Among them, the combination of nutritional
malnourished dialysis patients. Protein synthesis was reported to be support, exercise and anabolic agents has been reported to improve
improved by modulations of protein delivery in terms of either timing nutritional status and survival in other chronic diseases, such as
or composition of protein supply.
In elderly patients on haemodialysis, chronic obstructive pulmonary disease.
Such a multidisciplinary
branched-chain amino acid supplements have been shown to improve approach to the treatment of malnutrition should be evaluated in
both nutrient intakes and nutritional status.
Similarly, the effects on haemodialysis patients. ■
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