Oral and enteral supplements in kidney disease and kidney failure

Abstract: Guidelines for the use of oral nutritional supplements (ONS) and enteral nutrition (EN, tube feeding) in patients with kidney disease have been published. In patients with advanced chronic kidney disease (Stages G3B-G5 nondialysis) and nephrotic syndrome, ONS and EN have been poorly investigated. These nutrition interventions are indicated during treatment of established protein-energy wasting (PEW) and acute associated illnesses. In patients with end-stage kidney disease (Stage G5) receiving maintenance hemodialysis (MHD) and chronic peritoneal dialysis, the adverse impact of PEW on survival is a major concern. Studies have shown that ONS improve nutritional status in patients receiving MHD. However, studies are needed to determine whether morbidity and mortality can be reduced when nutritional status is improved with nutrition support, since PEW is responsible for the high mortality rates observed in these patients. EN via tube feeding is a component in the management of chronic dialysis patients, although studies examining the effectiveness of EN in these patients are also lacking. Keywords: Oral nutritional supplements; enteral nutrition; tube feeding; protein-energy wasting; advanced chronic kidney disease; end-stage kidney disease; maintenance hemodialysis; chronic peritoneal dialysis; nephrotic syndrome