Nutritional support in renal failure.

Abstract

The emergence of our ability to intervene nutritionally in the stressed patient has allowed a dramatic alteration in the clinical course of many disorders. Such support should not be denied or restricted to individuals with renal failure. Should acute oliguric renal failure develop, dialysis should be instituted and the patient should be supported to the fullest extent possible. It is most important to remember that support for patients with marginal degrees of renal failure is most common in the hospital setting. The challenge to meet nutrient requirements in the face of a failure in renal regulatory function is great indeed. Should the regulatory function of the kidney be so impaired that the delivery of nutrients is restricted, dialysis should be instituted as a secondary form of support so that nutritional intervention can be accomplished. There is little rationale for severely restricting protein and nutrient intake in any individual in an attempt to maintain low blood urea levels without dialysis. Once dialysis is instituted, near normal nutritional delivery should be maintained. Although many of the foregoing concepts are rational, they have not been tested in a manner to allow critical review by the scientific community. Initial studies using only essential amino acids were compared to glucose alone. More recent retrospective comparisons still have not resolved the controversy. Prospective, randomized controlled trials are needed to compare solutions containing only those amino acids believed to be essential with solutions delivering a more complete array.