Methods and Nutritional Interventions to Improve the Nutritional Status of Dialysis Patients in JAPAN-A Narrative Review

Abstract

Patients receiving dialysis therapy often have frailty, protein energy wasting, and sarcopenia. However, medical staff in Japan, except for registered dietitians, do not receive training in nutritional management at school or on the job. Moreover, registered dietitians work separately from patients and medical staff even inside a hospital, and there are many medical institutions that do not have registered dietitians. In such institutions, medical staff are required to manage patients' nutritional disorders without assistance from a specialist. Recent studies have shown that salt intake should not be restricted under conditions of low nutrition in frail subjects or those undergoing dialysis, and protein consumption should be targeted at 0.9 to 1.2 g/kg/day. The Japanese Society of Dialysis Therapy suggests that the Nutritional Risk Index-Japanese Hemodialysis (NRI-JH) is a useful tool to screen for older patients with malnutrition.

Keywords: frailty; hypercatabolism; protein energy wasting; sarcopenia.

Figure 1

Nutritional status in Japanese HD patients in 2015. (Masakane, I. et al. [10]). (a) Serum albumin level (b) Normalized protein catabolic rate, of Japanese HD patients. Data are expressed as Mean ± SD. Blue column expresses patients below 60 years old, green column 60–74 years old, and red column over 75 years old.