Nutritional Treatment of Chronic Renal Failure

Enormous progress has been made in the treatment of chronic renal failure over the last decades. Until the 1950s, chronic renal failure was considered to be an inexorably lethal condition. This is no longer the case. In addition, the disease, severe uremic syndrome, is now extremely rare, if existent at all, in industrialized countries. Physicians of my generation who saw patients hospitalized with hemor­ raghes, pericarditis, severe anemia, cardiac failure, "malignant hypertension," pruritus, vomiting, generalized edema, and convulsions are particularly grate­ ful for this progress. I well remember seeing such patients hospitalized in the last days or weeks of their lives and also remember the sense of impotence I suffered for the com­ plete lack of efficient measures I had at my disposal to manage their condition. Nowadays, hemodialysis, peritoneal dialysis, and kidney transplantation allow patients with chronic renal failure to survive for very long periods of time in a satisfactory condition. Why then is there still a sense of dissatisfaction and why should we study dietary management? The drawbacks of dialysis and transplantation are the main reasons, but the certainty that dietary therapy is complementary to dialysis and even better than dialysis in certain conditions, is also very important.

Inhalt

1. A historical review of low-protein diets.- 2. Chronic renal failure: Definition, causes, and assessment.- 3. Adaptations of remnant nephrons.- 4. Causes of progression of renal disease.- 5. The uremic syndrome: Definition, diagnosis, causes of signs and symptoms, and complications.- 6. Uremic Toxins.- 7. Abnormalities of amino acid metabolism.- 8. Abnormalities of lipid metabolism.- 9. Abnormalities of carbohydrate metabolism.- 10. Sodium, potassium, and hydrogen ions in chronic renal failure.- 11. Abnormalities of calcium, phosphate, and magnesium metabolism.- 12. Neurological complications of the uremic syndrome.- 13. Hormonal derangements in chronic renal failure.- 14. The uremic syndrome as modified by replacement of renal function.- 15. Iatrogenic factors contributing to cause uremic manifestations.- 16. The assessment of nutritional state.- 17. Nutritional management in animals with chronic renal failure.- 18. The purposes and rationale of nutritional treatment of chronic renal failure.- 19. Indications and contraindications for nutritional therapy in chronic renal failure.- 20. Low-protein diets for chronic renal failure.- 21. Amino acid and keto acid supplements.- 22. Minerals, trace element, and vitamin supplements in patients on conservative treatment.- 23. Compliance with dietary recommendations.- 24. Influence of dietary treatment on the rate of progression of chronic renal failure.- 25. The effect of nutritional therapy on blood chemical abnormalities of chronic renal failure.- 26. Effects of dietary therapy on uremic symptoms and complications.- 27. Effects of nutritional treatment on hormonal and metabolic derangements of the uremic syndrome.- 28. Effects of nutritional treatment on the course of uremic neuropathy.- 29. Influence of nutritional management on renal bone disease.- 30. Unwanted side effects of nutritional therapy for patients with chronic renal failure.- 31. The economic implications of nutritional treatment of chronic renal failure.- 32. Nutritional treatment for patients on standard kidney function replacement.- 33. Nutritional treatment and infrequent hemodialysis.- 34. Nutrition and growth in children with chronic renal failure.- 35. Manipulation of alimentary lipids for the treatment of chronic renal failure.- 36. Tube feeding in patients suffering from renal failure.- 37. Therapeutic measures other than dietary treatment for chronic uremic patients.