Patient Malnutrition
According to WHO, malnutrition is generally classified into three categories: protein-energy malnutrition, micronutrient deficiencies, and obesity (as cited in Edelman, Mandle, & Kudzma, p.622, 2013). Out of the three categories, protein-energy malnutrition has been identified by the World Hunger Education Services as the most lethal form of malnutrition (Edelman, Mandle, & Kudzma).
Chronic kidney disease (CKD) is one of the diseases in which serious complications emerge as a result of protein energy wasting (PEW) (Kopple, Massry, & Kalantar-Zadeh, 2013). Both, kidney and liver play an important role in the metabolism of proteins. Ambuhl et al. state that the protein breakdown and excretion is jointly handled by an intricate interaction between the two organs (as cited in Acton, p.43, 2013). Ferri (2015) describes CKD as a progressive decline in the renal function which leads to accumulation of waste products in the blood, electrolyte imbalance, and anemia. The pathophysiology of CKD causes numerous clinical manifestations in the patients with the disorder. Some of them include acidosis, sodium retention and wasting, urinary concentrating defect, renal osteodystrophy, growth retardation, hypertension, hyperlipidemia, and glucose intolerance (Ferri).
Kopple, Massry, & Kalantar-Zadeh (2013) acknowledge that the PEW in patients with CKD results as a result of multiple factors that directly or indirectly bring about alterations in the protein metabolism and energy balance. The causes of PEW comprise of anorexia, decreased nutrient intake, inflammation, oxidative and carbonyl stress, metabolic acidosis, volume overload, and co-morbid conditions such as diabetes and cardiac failure (Kopple, Massry, & Kalantar-Zadeh). Ambuhl et al contend that the clients with CKD have increased protein demand as they undergo renal replacement therapy by hemodialysis or peritoneal dialysis (as cited in Acton, p. 43, 2013). On the other hand, the protein intake, especially from animal sources has to be restricted as it may slow the progression of the disorder (Acton). The vicious circle of insufficient protein supply and increased protein demand depletes the protein reserves in the patient making him or her vulnerable to protein-energy malnutrition. Study by Jadeja & Kher (2012) evidence that other than increased morbidity and impaired quality of life, cachexia and mortality are the consequences of such kind of malnutrition in patients with CKD.
The clinical diagnosis of PEW in a patient with CKD could be established using criteria based on serum chemistry, body mass, muscle mass, and dietary intake (Jadeja & Kher, 2012). Serum chemistry tests encompass serum albumin, serum prealbumin (transthyretin), and serum cholesterol (Jadeja & Kher). Interventions for management of the malnutrition in such patient involves enhancement of oral intake. Strategies which could help in the increment of the process include avoidance of diet restrictions in clients with poor intake, correction of electrolyte abnormalities, and achieving glycemic control. CKD patients with PEW should be offered oral liquid supplements and snacks, treated for gastrointestinal conditions, and evaluated for depression, and subsequently the condition be managed (Jadeja & Kher).
Conclusion
Protein-energy malnutrition is one of the severest form of malnutrition which considerably affects the morbidity …
