A 66-year-old man with chronic renal failure secondary to urological interstitial nephropathy was on hemodialysis for 10 years.
He had suffered a left nephrectomy 14 years before and right for 8 years.
She was admitted from the emergency department with diarrhea and malnutrition.
At that time, he has edemas and is unable to walk.
She has symptoms and an EEG compatible with metabolic encephalopathy in the absence of electrolyte disturbances, aluminum intoxication or hyperemia.
The family says that she has been living alone for 6 months and eats in a restaurant where she often did not test the food served.
Dry weight (postdialysis) had progressively decreased from 46 kg with body mass index (BMI) of 22.8 kg/m2 7 years ago to 35 kg with BMI of 17.3 kg/m2 at admission.
He had anorexia and muscle weakness.
Analytical parameters indicated malnutrition.
During these years the dialysis dose was adequate (KTVurea Dagirdas according to the bicommental model of Maduell persistently > 1.5).
However, nPCR (normalized protein catabolic rate) was persistently low, with frequent figures around 0.45-0.55 g/Kg/d and maximum values of 0.71 g/Kg/d.
ed iron supplementation, non-specific dialyses, was prescribed initially for patients on dialysis foam: tolerance was bad because it did not taste the flavour increased, and the
It was found that the patient took 2-3 cans a day.
In addition, a protein compound (Renapro, Renacare) 3 sprinkled daily spoonfuls in food and intradialytic parenteral nutrition (NPID) was indicated three times a week providing oligochaete gCT,
Table III shows the theoretical nutritional contribution of the therapeutic measures taken.
The oral diet was also maintained.
With this treatment, nPCR increased to 1.35 g/Kg/d.
The following vitamins were added: vitamin B12 1,000 μg/d 3 days, B1 300 mg and B6 300 mg parenteral, and Beco 1 tablet daily, added to the supplements of PNID.
1.
During evolution, hypophosphoremia was observed, although phosphorus binders were suspended, so two ampoules of parenteral monosodium phosphate were administered post-dialysis for 6 weeks.
Figure 1 shows the evolution of nutritional analytical parameters from baseline and recovery associated with treatment.
Prealbumin increased from 12 to 31 mg/dL in 45 days and binding protein (RBP) from 6.2 to 13 mg/dL.
Weight on day 80 had increased to 37.5 kg.
