Malnutrition in CKD: The Hidden Threat

Do you know that a Tsunami is persistently engulfing millions of lives worldwide? Any guess? I am talking about Chronic Kidney disease, a silent tsunami that is now the 5^th leading cause of death in the world. We often hear about the importance of managing kidney function and preventing further deterioration, but there’s an insidious aspect that’s frequently overlooked – malnutrition.

Yes, malnutrition – a term that might evoke images of starvation-stricken regions in far-off lands. Yet, this silent saboteur lurks closer than you think, entwined with the ominous shadow of CKD. Nearly 43% of CKD suffers from Malnutrition. In CKD malnutrition increases mortality risk by 5 fold. It’s a concern that deserves our attention, for it has the power to exacerbate the disease’s progression, heighten the risk of complications, and cast a dark cloud over the quality of life of those afflicted.

In this blog, we embark on an eye-opening journey to explore the deeply interwoven link between CKD and malnutrition.

What is Malnutrition?

Malnutrition happens when our bodies don’t get the right amount of nutrients over a long period of time. This can occur due to various reasons, such as having a poor diet that lacks specific nutrients, experiencing digestive issues, or having a disease that prevents the proper absorption of nutrients.

What is PEW?

PEW stands for Protein Energy Wasting. PEW is depletion of protein and other stores of the body. It is associated with diminished functional capacity, impaired quality of life, lack of some specific nutrients, increased morbidity or mortality in patients with CKD.

What causes PEW in CKD patients?

1. Anorexia– What is Anorexia? It is the medical term for decreased appetite. In CKD not on dialysis patients and patients on maintenance hemodialysis, anorexia is very common due to accumulation of anorexic agents, uremic load, amino acid imbalance, poor appetite regulation. Anorexia leads to less calorie and protein intake and malnutrition.
2. Acidosis– Acidosis is the medical term for increased acidic substance in blood. One of the main functions of kidney includes Acid base balance regulation in the body. In CKD patients, due to acid base imbalance, metabolic acidosis is most common phenomena, leading to poor outcome, demineralization of bones, muscle mass loss etc. These can cause PEW in the patients.
3. Increased energy expenditure– Increased energy expenditure due to increased morbidity or mortality, increased inflammation rate in patients can lead to muscle wasting and PEW.
4. Inflammation-CKD is a inflammatory disease that dysregulates hunger hormones in the body reducing appetite in such patients

How to Identify Protein Energy Wasting (PEW) in CKD Patients?

To identify if a CKD patient is experiencing PEW, healthcare professionals use specific scoring methods like SGA (Subjective Global Assessment), MIS (Malnutrition Inflammation Score), and PEW scores. These tools help nephrologists and clinical dietitians measure protein energy wasting, inflammation, comorbidity, and assess the patient’s condition.

PEW may be suspected if the patient shows any of the following symptoms:

1. Decreased BMI (Body Mass Index)
2. More than 5% weight loss in 3 months, or 10% weight loss in 6 months
3. Reduced levels of Albumin (a protein) in the blood
4. Reduced TIBC (Total Iron-Binding Capacity) level
5. Loss of Appetite (eating less than 0.8 grams of food per kilogram of body weight)
6. Presence of any inflammatory changes in the body
7. Weakness and fatigue
8. Loss of muscle mass, noticeable in areas like the periorbital region, biceps, and triceps.

Consequences of Malnutrition in CKD:

Malnutrition in CKD can have serious effects on a patient’s health and well-being:

1. Muscle Wasting: Malnutrition can lead to muscle loss, causing weakness and reduced physical function.
2. Compromised Immune System: Proper nutrition is essential for a strong immune system. Malnourished CKD patients are more prone to infections and recover more slowly.
3. Bone Health Complications: Inadequate intake of calcium and vitamin D can weaken bones, increasing the risk of fractures and osteoporosis.
4. Fatigue and Weakness: Malnutrition can lead to ongoing fatigue, impacting the ability to perform daily activities.
5. Cardiovascular Risks: Malnourished CKD patients have a higher risk of developing cardiovascular issues like heart disease and hypertension.

Why Nutritional Therapy is Important to Combat PEW?

Medical and Nutritional Therapy (MNT) is crucial for managing CKD and its complications. MNT provides the following benefits:

1. Preventing CKD-related symptoms.
2. Maintaining appropriate creatinine (Cr) levels.
3. Balancing electrolytes.
4. Preventing the accumulation of waste products in the body.
5. Maintaining acid-base balance.
6. Preventing muscle mass loss and PEW.
7. Slowing down the progression of the disease.

Managing malnutrition in CKD requires a team effort:

1. Nutritional Counseling: Registered dietitians create personalized diet plans that meet the patient’s nutritional needs while considering dietary restrictions.
2. Nutritional Supplements: Oral supplements may be recommended to fill nutritional gaps in some cases.
3. Medication Review: Healthcare providers assess the patient’s medications for potential contributions to malnutrition or interactions with nutrition.
4. Addressing Psychological Factors: Addressing mental health concerns can improve appetite and food intake.
5. Regular Monitoring: Regular follow-ups and nutritional assessments are crucial to track progress and make necessary adjustments.

Conclusion:

In the realm of Chronic Kidney Disease, malnutrition emerges as a formidable adversary that demands our attention. Its repercussions can undermine health, diminish the quality of life, and hasten disease progression. With screening, proper nutritional counselling and proactive measures, we can overcome this challenge.

A registered renal nutritionist plays a crucial role, whose expertise can craft personalized diet plans to suit individual needs. Their guidance and support can optimise the nutritional demand and eliminate malnutrition.

Malnutrition is an underrated problem that need special attention in CKD patients. Every CKD must visit a renal nutritionist and get a personalized dietary plan for them