Nutrition in renal failure.

The present review will consider nutritional support problems in acute renal failure (ARF) and chronic renal failure (CRF) patients, chronic ambulatory peritoneal dialysis (CAPD) and those receiving regular haemodialysis (HD) treatment. For many years little advance had been made in the nutritional management of ARF until it was understood that such patients should receive protein and adequate energy input. Nevertheless, there is still a very high mortality rate in hypercatabolic ARF patients and this is partly related to their poor nutritional support. Studies have shown (Lee & Talbot, 1989) that relying on oral or enteral nutrition for such patients is bound to lead to inadequate intake, and there is a growing move afoot to suggest that all ARF patients, irrespective of gut function, should have their complete nutrition given intravenously. With respect to CRF the pendulum has swung from considering low-protein diets simply as palliative treatment in advanced CRF to the now more cautious approach suggesting that low-protein diets given early in progressive renal failure, i.e. serum creatinine between I50 and 200 prnolll, might considerably delay end-stage renal failure. Many problems remain in this area with respect to (a) the mechanisms by which low-protein diets work, (b) the patients who can best benefit from this treatment, (c) the effects of treatment of other intercurrent problems and (d) ensuring that diets are palatable and patients are given adequate dietary instruction. By and large, with respect to haemodialysis patients, there are few nutritional problems compared with earlier years, though nutritional problems are a continuing source of concern in CAPD patients, particularly in the elderly.