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Nutrition_0909 8/26/09 2:37 PM Page 1 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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