The Renal Failure Patient

Renal failure patients comprise a heterogenous group of subjects with widely differing metabolic patterns and nutritional requirements. These disease states include acute kidney injury (AKI), acute-on-chronic renal failure, chronic kidney disease, and regular hemodialysis therapy. Renal failure per se is associated with a broad spectrum of specific metabolic alterations; presents a panmetabolic disease process; and, especially in the case of AKI, induces a proinflammatory, pro-oxidative, and hypercatabolic state which exerts a profound impact on metabolism and morbidity/mortality. Besides the metabolic alterations induced by renal dysfunction and the often underrated/forgotten profound impact of renal replacement therapy, metabolism is also affected by the underlying disease process requiring intensive care unit therapy, other organ failures, and complications – especially infections. Certainly, nutrition support is not fundamentally different from other disease processes, but these variations in metabolism and nutrient requirements have to be considered when designing a nutrition regimen. Nutrition needs can differ widely between patients, as well as in the same patient during the course of disease. Thus, even more than in other subjects, the patient with renal failure requires an individualized approach in nutrition support, and because of the altered metabolism of many nutrients and intolerances for electrolytes and volume, the nutrition support in patients with renal failure requires much closer monitoring than in other disease states.