Ernährungszustand bei Dialysepatienten

ZUSAMMENFASSUNG

Die Erkennung und Behandlung der Mangelernährung gehört zum klinischen Standard, wie es sich auch an einer verbesserten Ernährungssituation von Dialysepatienten in rezenten Untersuchungen widerspiegelt. Noch relativ neu ist der etwas unhandliche Begriff „chronic disease related malnutrition“ (C-DRM), der den immer noch gebräuchlicheren Begriff des „protein-energy wasting“ (PEW) ablösen sollte, da er die bei Dialysepatienten auch zur Mangelernährung beitragenden Ursachen besser widerspiegelt. In diesem Artikel wird gezeigt, wie eine C-DRM diagnostiziert werden kann. Es wird auf die wesentlichen Stellparameter für eine gute Ernährung beim Dialysepatienten eingegangen. Neben dem allgemeinen Kalorienbedarf findet dabei als Makronährstoff ausschließlich das Eiweiß (und das darin immer auch vorhandene Phosphat) Erwähnung. An Mineralien wird außerdem auf Natrium und Kalium eingegangen. Beim Vitaminbedarf werden nicht nur die wasserlöslichen – und damit während einer Dialyse herausgewaschenen – Vitamine behandelt, sondern auch die fettlöslichen. Auch an Vitamin D und K mangelt es nämlich häufig. Abschließend wird auf die therapeutischen Möglichkeiten wie die Diätberatung bzgl. einer verbesserten natürlichen Kost, Nahrungsergänzungsmittel, enterale Ernährung via perkutane endoskopische Gastrostomie (PEG) und den Nutzen der parenteralen Ernährung eingegangen.

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