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EBPG Guideline on Nutrition
1Département de Néphrologie, JE 2411- Université Claude Bernard Lyon1, Lyon, France, 2Department of Nephrology, Nutrition and Dietetics, Guy's and St Thomas’ NHS Foundation Trust, London, UK (retired), 3Department of Nephrology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands, 4Department of Medicine, Division of Nephrology, University Hospital, Würzburg, Germany, 5Department of Medicine, Division of Nephrology, Ege University Medical Faculty, Izmir, Turkey, 6Nephrology, Dialysis and Intensive Care Unit, Lapeyronie University Hospital, Montpellier, France, 7Department of Diagnostic and Interventional Radiology, Helios Klinikum Wuppertal, University Hospital Witten/Herdecke, Germany, 8Medical Faculty University of Cologne, Medicine Clinic I, Hospital Merheim, Germany (retired), 9Department of Internal Medicine, Division of Nephrology, University Hospital Maastricht, The Netherlands, 10Nephrology Department, Reina Sofia University Hospital, Cordoba, Spain, 11Division of Nephrology and Dialysis, Bolognini Hospital, Seriate, Italy, 12Nephrology Unit, SM Annunziata Hospital, Florence, Italy, 13Department of Renal Medicine, St. James's University Hospital, Leeds, UK, 14Department of Surgery, University Hospital Maastricht, The Netherlands and 15Nephrology Section, Department of Internal Medicine, University Hospital, Ghent, Belgium
Correspondence and offprint requests to: Denis Fouque, MD, PhD, Department of Nephrology, Hôpital Edouard Herriot, 69437 Lyon cedex 03, France. E-mail: denis.fouque@chu-lyon.fr
Outline
Appendices
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Guideline 1. Prevalence of malnutrition and outcome |
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Rationale
Malnutrition is considered to be one of the late complications of chronic renal failure. A sub-analysis of the Modification of Diet in Renal Disease (MDRD) study, however, demonstrated that progressive renal insufficiency was associated with a spontaneous decline in protein intake. Predialysis patients appeared to have a spontaneous protein intake of <0.7 g/kg/day [1], which is below the minimal recommended daily intake. Thus, malnutrition in haemodialysis patients may already originate during stage IV of chronic renal failure.
It has been
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References |
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Guideline 2. Diagnosis and monitoring of malnutrition |
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Guideline 2.1. Diagnosis of malnutrition |
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Rationale
Dietary records
Appetite assessment
Rationale
Rationale
Rationale
Rationale
Rationale
Rationale and commentary
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(H) Technical investigations |
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Rationale
Suggestion for future research
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Guideline 2.2. Monitoring and follow-up of nutritional status |
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Rationale
Rationale
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Recommendation for future research |
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Rationale
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Technical investigations are not recommended for routine follow up |
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Rationale
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References |
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Guideline 3. Recommendations for protein and energy intake |
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Rationale
Protein requirements
Protein requirements in the normal population chronic haemodialysis
Protein intake and nutritional status in epidemiological studies in maintenance dialysis
Is a protein intake greater than 1.2 g/kg/day harmful in chronic haemodialysis?
Protein intake and CKD mineral and bone disease
Protein intake and frequency of haemodialysis
Protein intake and inflammation
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Recommendation for further research |
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Rationale
Energy metabolism in chronic kidney disease
How to estimate daily energy expenditure?
How to estimate daily energy intake?
Is energy intake sufficient in MHD patients?
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References |
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4. Recommendations for vitamins, minerals and trace elements administration in MHD patients |
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4.1. Vitamins |
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4.1.1 Water-soluble vitamins
Thiamine (B1)
Rationale
Riboflavin (B2)
Rationale
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Pyridoxine (B6) |
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Rationale
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Ascorbic Acid (vitamin C) |
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Rationale
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Folic Acid (Folate, vitamin B9) |
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Rationale
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B12 (cobalamin) |
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Rationale
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Niacin (vitamin B3, nicotinamide, nicotinic acid, vitamin PP) |
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Rationale
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Biotin (vitamin B8) |
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Rationale
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Pantothenic acid (vitamin B5) |
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Rationale
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4.1.2 Fat-soluble vitamins |
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Vitamin A (retinol)
Rationale
Vitamin E (alpha-tocopherol)
Rationale
Vitamin K
Rationale
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4.2. Minerals |
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Phosphate (phosphorus)
Rationale
Calcium
Rationale
Sodium and fluid
Rationale
Potassium
Rationale
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4.3. Trace elements |
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Iron (Fe)
Rationale
Zinc (Zn)
Rationale
Selenium (Se)
Rationale
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References |
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Guideline 5. Treatment of malnutrition |
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Rationale and commentary
Rationale
Clinical benefits of oral nutritional supplements
Clinical benefits of enteral tube feeding
Recommendations for further research
Rationale and commentary
Rationale
Recommendation for further research
Rationale
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References |
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Rationale
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References |
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Appendices |
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Formulas (body weight, nPNA, dialysis dose, residual renal function)
Body weight: definitions
Height
Estimating height in elderly and physically disabled patients [2]
Alternative height measurements
Length forearm (ulna), knee height and arm demispan
Length of forearm (ulna) (Fig. 1)
Knee height (Fig. 2)
Demispan (Fig. 3)
Ideal body weight estimation (Tables 4 and 5)
Body mass index (BMI)
Classification of BMI
Calculating BMI in amputees [3]
Body surface
Body water
Normalized protein equivalent of total nitrogen appearance nPNA
Residual renal function: glomerular filtration rate (GFR)
Dialysis dose
Standard conditions for blood sampling
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LABORATORY METHODS |
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Serum Albumin
Bicarbonate
C-reactive protein
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TECHNICAL ASSESSMENT |
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Subjective global assessment (SGA)
Anthropometry
Handgrip strength
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References |
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