Acute Kidney failure is a very serious complication in many critically ill patients and is linked with very high mortality. Severe form of acute kidney failure requires continuous renal replacement therapy. This is the reason why continuous replacement therapy is commonly used in most hospitals.
This therapy includes hemofiltration, which involves the transfer of different solutes and fluids through a semipermeable membrane, and dialysis, which basically involves the transfer of solutes and substances through a very low permeability membrane. The overall nutritional status of these patients is not good due to combination of increased protein metabolism and poor response to nutritional support.
Although there are many reasons for malnutrition in acute and chronic kidney failure, the main mechanisms by which renal replacement therapy effects nutrition are below :
1-Loss of minerals and nutrients through dialysis and filtration
2-Induction of substrates and other substances along with replacement fluids
Depending on the net composition, the replacement fluids may form a source of different carbohydrates such as lactase and glucose. Additionally, many key amino acids and glucose are also lost during replacement therapy. Many vital trace elements and minerals are also lost from body during this process.These trace elements are key components of many essential enzymes in the body and thus boost the immune system through their immunologic and anti-oxidant properties.
Copper, Selenium and Zinc metabolism have been shown to be mainly altered in acute and chronic kidney failure.The efficacy of Glutathione peroxidase, one of the potent antioxidants of the body, which requires selenium to work properly has been shown to be significantly decreased during continuous renal replacement therapy. The mechanism behind this is probably due to deficiency of selenium and decreased syntheses by parenchyma of renal cells. Similarly, continuous renal replacement therapy is also linked with copper deficiency and copper loss. This copper deficiency results in alteration of lipids and fatty acid metabolism with hypertriglyceridemia and severe life-threatening bradycardia.
Continuous renal replacement therapy results in deficiencies of many vital trace elements such as selenium and copper. Therefore, if you’re on dialysis, you need to be taking an assortment of natural supplements, including a multivitamin. It’s also important to maintain a diet that helps to balance these deficiencies by providing rich amounts of minerals and nutrients you could be losing.