Disorders of protein and lipid metabolism associated with chronic renal failure and chronic dialysis

Patients with chronic renal failure treated with maintenance dialysis demonstrate many abnormalities of protein, carbohydrate, and lipid metabolism. Losses into dialysate of amino acids and glucose during the course of hemodialysis and protein losses during peritoneal dialysis, associated with inadequate dietary intake and/or increased endogenous catabolism, may result in chronically negative nitrogen balance and a state resembling clinical malnutrition. Hypertriglyceridemia and low levels of high density lipoprotein cholesterol are also characteristic of the chronic dialysis patient. Patients receiving peritoneal and chronic ambulatory peritoneal dialysis may be at particular risk for hypertriglyceridemia because of high obligate glucose loads. Literature relating to these areas is reviewed, and specific recommendations outlined for dietary protein, amino acid, carbohydrate, and lipid content and composition in the chronic renal failure and chronic dialysis patient.