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Ernährung bei Niereninsuffizienz

Spagat zwischen Nephroprotektion und Vermeidung einer Malnutrition

Nutrition for renal failure patients

Cleft between renal protection and avoidance of malnutrition

  • Leitthema
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Der Nephrologe Aims and scope

Zusammenfassung

Bei Patienten mit chronischer Niereninsuffizienz (CNI) kann die richtige Ernährung nicht nur die Lebensqualität, sondern auch die Prognose entscheidend verbessern. Während die diätetischen Empfehlungen in der Frühphase der chronischen Niereninsuffizienz vor allem auf eine Progressionshemmung abzielen, sollte in fortgeschrittenem Stadium der Niereninsuffizienz in erster Linie auf eine kalorisch ausreichende Ernährung geachtet werden. Die Malnutrition ist eine tückische Komplikation, da sie meist erst im fortgeschrittenen Stadium diagnostiziert wird, aber bereits bei milder Ausprägung die Überlebensrate signifikant verschlechtert. CNI-Patienten haben einen erhöhten Energiebedarf, führen aber in der Regel zu wenig Energie zu. Dies begünstigt eine Protein-Energie-Malnutrition, die bei Prädialyse-Patienten bereits in 20–50% und bei Dialysepatienten in bis zu 70% der Fälle vorliegen kann. Das gleichzeitige Auftreten von Malnutrition, Inflammation und Atherosklerose (MIA-Syndrom) wird bei bis zu 70% der Dialysepatienten beschrieben und ist mit einer besonders hohen Mortalität behaftet.

Abstract

For patients with chronic renal failure (CRF), correct nutrition can not only improve the quality of life but also the prognosis. Whereas the diet recommendations in the early phases of chronic renal insufficiency aim to inhibit progression of the disease, in advanced stages of renal failure the main concern is a sufficient caloric nutrition. Malnutrition is an insidious complication, because it is mostly initally diagnosed in advanced stages of CRF but even when mildly present can significantly affect survival. CRF patients have an increased energy requirement but normally supply too little energy. This favors a protein energy malnutrition, which can already be present in 20-25% of predialysis patients and up to 70% of dialysis patients. The simultaneous presence of malnutrition, inflammation and atherosclerosis (MIA syndrome) has been recorded in up to 70% of dialysis patients and is correlated to a particularly high mortality rate.

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Interessenkonflikt

Unterstützung der MIA-Studie durch Forschungsmittel der Firmen AMGEN und Fresenius Kabi.

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Authors and Affiliations

  1. Klinik für Innere Medizin und KfH-Nierenzentrum, Ev. Krankenhaus der Paul-Gerhardt-Stiftung, Postfach 10 02 52, 06872, Lutherstadt Wittenberg, Deutschland

    P.M. Jehle, K. Rehm & M. Jentzsch

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  1. P.M. Jehle
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  2. K. Rehm
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  3. M. Jentzsch
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Correspondence to P.M. Jehle.

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Jehle, P., Rehm, K. & Jentzsch, M. Ernährung bei Niereninsuffizienz. Nephrologe 3, 108–117 (2008). https://doi.org/10.1007/s11560-007-0132-9

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  • DOI: https://doi.org/10.1007/s11560-007-0132-9

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