Ernährung bei chronischen Nierenerkrankungen: wann, was, wie

Abstract

Chronic kidney disease is associated with metabolic disorders. The nutrient requirement varies considerably and often it is not covered. This is why many patients experience severe deficiencies („kidney disease wasting“), which limits their quality of life and prognosis. On the other hand sodium, potassium and phosphate must be limited. Nutritional therapy is a relevant part of the therapy.

Chronische Nierenerkrankungen gehen mit metabolischen Störungen einher. Der Nährstoffbedarf variiert erheblich und wird vielfach nicht gedeckt. Folge davon sind oft schwere Mangelzustände, andererseits aber müssen Natrium, Kalium und Phosphat beschränkt werden. Die Ernährung bei chronisch Nierenkranken ist relevanter Teil der Therapie. Dieser Beitrag erläutert das praktische Vorgehen.

Schlüsselwörter

chronische Nierenerkrankung - Ernährungstherapie - Dialyse - Trinknahrung - parenterale Ernährung

Key words

chronic kidney disease - nutrition therapy - dialysis - oral nutritional supplement - parenteral nutrition

• Literatur

• 1 Fouque D, Kalantar-Zadeh K, Kopple J. et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 2008; 73: 391-398
• 2 Carrero JJ, Stenvinkel P, Cuppari L. et al. Etiology of the protein-energy wasting syndrome in chronic kidney disease: a consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). J Ren Nutr 2013; 23: 77-90
• 3 Druml W, Contzen B, Joannidis M. et al. S1 Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM), AKE, GESKES und DGfN: Enterale und Parenterale Ernährung von Patienten mit Niereninsuffizienz. Aktuel Ernaehrungsmed 2015; 40: 21-37
• 4 Cano N, Fiaccadori E, Tesinsky P. et al. ESPEN Guidelines on Enteral Nutrition: Adult renal failure. Clin Nutr 2006; 25: 295-310
• 5 Cano NJ, Aparicio M, Brunori G. et al. ESPEN Guidelines on Parenteral Nutrition: adult renal failure. Clin Nutr 2009; 28: 401-414
• 6 Friedrich B, Kuhlmann MK. Nierenerkrankungen. In Biesalski HK, Bischoff SC, Pirlich M. et al. Hrsg Ernährungsmedizin. 5.. Aufl. Stuttgart: Thieme; 2017: 917-936
• 7 Fiaccadori E, Cremaschi E, Regolisti G. Nutritional assessment and delivery in renal replacement therapy patients. Semin Dial 2011; 24: 169-175
• 8 Li Y, Tang X, Zhang J. et al. Nutritional support for acute kidney injury. Cochrane Database Syst Rev 2012; 8: CD005426
• 9 Druml W. Nutrition and renal insufficiency. Med Klin Intensivmed Notfmed 2013; 108: 384-390
• 10 Chou HH, Chiou YY, Hung PH. et al. Omega-3 fatty acids ameliorate proteinuria but not renal function in IgA nephropathy: a meta-analysis of randomized controlled trials. Nephron Clin Pract 2012; 121: c30-c35
• 11 Kalantar-Zadeh K, Cano NJ, Budde K. et al. Diets and enteral supplements for improving outcomes in chronic kidney disease. Nat Rev Nephrol 2011; 7: 369-384
• 12 Ikizler TA, Cano NJ, Franch H. et al. Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney Int 2013; 84: 1096-1107
• 13 Stratton RJ, Bircher G, Fouque D. et al. Multinutrient oral supplements and tube feeding in maintenance dialysis: a systematic review and meta-analysis. Am J Kidney Dis 2005; 46: 387-405
• 14 Boudville N, Rangan A, Moody H. Oral nutritional supplementation increases caloric and protein intake in peritoneal dialysis patients. Am J Kidney Dis 2003; 41: 658-663
• 15 Smolle KH, Kaufmann P, Holzer H. et al. Intradialytic parenteral nutrition in malnourished patients on chronic haemodialysis therapy. Nephrol Dial Transplant 1995; 10: 1411-1416
• 16 Pupim LB, Majchrzak KM, Flakoll PJ. et al. Intradialytic oral nutrition improves protein homeostasis in chronic hemodialysis patients with deranged nutritional status. J Am Soc Nephrol 2006; 17: 3149-3157
• 17 Dukkipati R, Kalantar-Zadeh K, Kopple JD. Is there a role for intradialytic parenteral nutrition? A review of the evidence. Am J Kidney Dis 2010; 55: 352-364
• 18 Cano NJ, Fouque D, Roth H. et al. Intradialytic parenteral nutrition does not improve survival in malnourished hemodialysis patients: a 2-year multicenter, prospective, randomized study. J Am Soc Nephrol 2007; 18: 2583-2591
• 19 Kuhlmann MK, Landthaler I, Höchst S. et al. PEP – Das Phosphat-Einheiten-Programm. Ein neues Konzept in der Behandlung der Hyperphosphatämie bei Dialysepatienten. Ernaehrungs-Umschau 2005; 52: 152-154