ESRD Patients with HIV Infection

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      50 Renal & Urology News               SEPTEMBER 2009                                                                                            www.renalandurologynews.com




                                                       RENAL NUTRITION UPDATE




           ESRD Patients with HIV Infection
           Few studies have looked at this population, but these patients may have high energy needs
           BY ALISON STEIBER, PhD, RD, LD                                                                                                         tients with both diseases has been
           HIGHLY-ACTIVE antiretroviral                                                                                                           conducted, but it is reasonable to
           therapy (HAART) has increased                                                                                                          assume that these patients will have
           survival rates in patients with HIV,                                                                                                   increased energy, protein, and pos-
           and an increased prevalence of kid-                                                                                                    sibly micronutrient needs because
           ney disease in this population has                                                                                                     of their increased energy expendi-
           accompanied the improved survi-                                                                                                        ture. Currently, the energy and pro-
           val. In a study of African-Americans                                                                                                   tein recommendations are 35 kcal/
           in Baltimore, Lucas et al reported                                                                                                     kg/day for ESRD patients who
           that the number of HIV-infected                                                                                                        are younger than 60 years and 30-
           individuals who reached end-stage                                                                                                      35 kcal/kg/day for ESRD patients
           renal disease (ESRD) and received                                                                                                      who are older than 60. An addi-
           renal replacement therapy in the                                                                                                       tional 10%-15% of energy needs
           pre-HAART era was 5.8 per 1,000                                                                                                        should be initially provided to ac-
           person-years compared with 9.7 per                                                                                                     count for the potential synergistic
           1,000 person-years in the current                                                                                                      effect of both HIV and ESRD. How-
           HAART era (AIDS. 2007;21:2435-                                                                                                         ever, because there are currently no
           2443).The ESRD and HIV-infected                                                                                                        well-powered studies to verify this,
           populations show some similar epi-                                                                                                     careful assessment is warranted.
           demiologic trends. Both populations                                                                                                      Weight change, BMI, subjective
           have a high proportion of patients                                                                                                     global assessment, and serum albu-
                                                                                                                                  JUPITERIMAGES



           with malnutrition that includes sig-                                                                                                   min and pre-albumin levels are key
           nificant energy and protein wast-                                                                                                      outcome measures to assess on a
           ing. In addition, data show that in                                                                                                    monthly basis in individuals with
           both populations, heavier indivi-       Patients with HIV who have end-stage renal disease have high-energy require-                   both HIV and ESRD. These param-
                                                   ments, so they may need increased
				
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