Hypertension and nephrology

[Nephrology]

DOLGOS Szilveszter1, TÁRNOKI Ádám Domonkos2, TÁRNOKI Dávid László2

JUNE 20, 2019

Hypertension and nephrology - 2019;23(03)

AFFILIATIONS

  1. Szent Margit Kórház, Nefrológiai Osztály, Budapest
  2. Semmelweis Egyetem, Radiológiai Klinika, Budapest

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[The authors show the data of Hungarian dialysis statistics from 2010 to 2015. The questionnaire - based data collection was made by Dialysis Registry Committee of the Hungarian Society of Nephrology. The number of all patients entered in the dialysis program increased by 8.4% over six years (an average of 1.4/ per year) and the number of new ones increased by 10.5% (1.75% per year). Between 2003 and 2009 the mean annual increasing of new patients was 7.5%! The incidence of new dialyzed patients was 440/1 million population in 2010 and 486/1 million) in 2015. The population point prevalence at the end of the year was 621/1 million in 2010 and 643/1 million in 2015. The penetrance of peritoneal dialysis was 13.5% in 2010, and 13.6% in 2015. The proportion of incident patients with diabetic or hypertensive nephropathies (conditions which lead to end stage renal disease) was about the same in 2010 (27 and 21%) than in 2016 (27 and 22%). The mean age of incident patients entered into dialysis program decreased from 66.9 years (2010) to 62.8 years (2015), surprisingly. The rate of patients on waiting list for renal transplantation was 10.7% in 2009 and increased to 15,8% in 2015. There is also a significant increase in the number of the annual renal transplantations (268 in 2010 and 356 in 2015). The mortality rate of chronically dialyzed patients shows little decrease (14.4-13.1%).]

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[Low protein diet is an important component of the non-pharmacological treatment of patients with chronic kidney disease (CKD). Along with the diet it is important to maintain appropriate energy intake to avoid malnutrition. It is recommended to supplement low protein diet (0.6-0.7 g protein/kg body weight/day) with essential amino acids and their ketoanalogues (ketoacids) in a dose of 1 tablet/8-10 kg body weight if there is a threat of protein malnutrition (eg. vegan diet). Very low protein diet (0.3-0.4 g protein/kg body weight/day) should be supplemented with ketoacids in a dose of 1 tablet/5 kg body weight. Low protein diet is recommended for patients with CKD stage 3 and progressively declining renal function, or nephrotic syndrome; in diabetic nephropathy; in CKD stage 4 and non-dialyzed CKD stage 5. Nephroprotective effect of very low protein diet is primarily expected is patients with an eGFR below 20-25 ml/min/1.73 m2 and good compliance. Dietary protein restriction may diminish acidosis and proteinuria, slow the progression of CKD and delay initiation of dialysis. Diets reduced in protein supplemented with appropriate energy intake and ketoacids are nutritionally safe. Dietary education and guidance of patients by qualified dietitians are of great importance in nephrology clinics. We illustrate the main points of our review with case reports.]