[Nutritional problems related to acute renal insufficiency]

Abstract

The catabolic stress induced by acute renal failure is multifactorial in origin. Uremia is associated with increased protein degradation presumably due to toxic effects of increased metabolic products and to hormonal alterations. Moreover, anorexia and loss of nutrients during dialysis further contribute to protein-energy malnutrition. The goals of nutritional support are to reduce uremia, preserve nutritional status and accelerate renal function recovery. In fact, the indications for enteral or parenteral nutritional support in acute renal failure are primarily founded on clinical criteria rather than on a controlled demonstration of efficacy. The specific metabolic conditions imposed by renal failure on protein, carbohydrate, lipid and micronutrient homeostasis must be addressed. Total parenteral nutrition can be administered safely in acute renal failure, provided strict control of prescription and follow-up is achieved in order to avoid potentially serious complications.