Chronic Kidney Disease

The advanced chronic kidney disease is defined as a severe decrease in glomerular filtration rate (GFR) below 30 ml/min/1.73 m2, and includes stages 3B, 4 and 5.², e incluye los estadios 3B, 4 y 5.

The concept of malnutrition in CKD goes beyond a decrease in intake and weight loss, it encompasses a process of chronic inflammation, protein catabolism, metabolic changes and an accumulation of uremic toxins. Hence its specific definition as “Protein Energy Wasting” or its acronym PEW.

PEW predisposes to a worse prognosis and can lead to increased morbidity and mortality if intervention is not done in time. Its prevalence reaches up to 65% of patients on dialysis and in pre-dialysis stages, up to 28%.

When a risk of malnutrition or a diagnosis of PEW occurs, the 2020 KDOQI guidelines recommend the use of oral nutritional supplements for a minimum of 3 months.

The KDOQI 2020 guides recommend:

A caloric intake of 25-35 kcal/kg of weight/day depending on age, sex, level of physical activity, body composition, weight goal, ACKD stage, the presence of intercurrent diseases and the presence of inflammation that affect nutritional status.
A protein contribution:
- In stage 3-5 pre-dialysis
  - metabolically stable, a dose of 0.6 g/kg body weight/day is recommended.
  - Diabetics, a contribution of 0.8 g/kg of weight/day is recommended.
- On dialysis (HD and PD)
  - A contribution of 1.0-1.2 g/kg of weight/day is recommended
Electrolyte control: sodium, potassium and phosphorus.

When a person with diabetes is malnourished and needs oral supplementation to improve your nutritional statusIt is crucial that supplements do not worsen glycemic control. Depending on the nutritional needs of the patient, a hypercaloric and hyperprotein supplement with fiber (Bi1 diacare hp / hc) or normocaloric and normoprotein with fiber (Bi1 diacare) will be prescribed. If the patient requires enteral nutrition by feeding tube, the use of a specific formula for diabetes (Bi1 Via Diacare) is recommended.