Kronik Böbrek Hastalığında Beslenme

Year 2023, , 219 - 225, 25.12.2023

Derya Özmen , Betül Pehlivan Zorlu , Nida Dinçel

https://doi.org/10.57221/izmirtip.1198911

Abstract

AMAÇ: Kronik böbrek hastalığı (KBH) yapısal veya fonksiyonel böbrek hasarının en az 3 ay boyunca devam etmesi olarak tanımlanır. KBH’da çocuklar büyüme geriliği açısından belirgin risk altındadır. Bu nedenle beslenmenin yakın izlemi önemlidir.

GEREÇ VE YÖNTEMLER: KDIGO ve konu ile ilgili makaleler taranarak KBH' da beslenme önerileri derlenmiştir.

BULGULAR: KDIGO başlıklar altında önerilerde bulunmuştur. Periyodik aralıklarla evre 2-5 KBH’lı tüm çocuklar beslenme durumu ve büyüme çizelgeleri ile takip edilmelidir. Beslenme durumu 3 günlük diyet listesi ya da 3 defa 24 saatlik diyet listesi ile değerlendirilmelidir. Büyüme değerlendirmesinde ağırlık ve boy, yaşa göre percentil çizelgeleri ya da SDS ile takip edilmelidir. Tahmini kuru ağırlık ve yaşa göre ağırlık percentilleri değerlendirilmelidir. Yine vücut kitle indeksi ve 3 yaş altında baş çevresi takibi yapılmalıdır. KBH Evre 5 hemodiyaliz hastalarında normalize edilmiş protein katabolizma hızı hesaplanmalıdır. Takip sıklığı hastanın yaşına ve hastalığın evresine, beslenme ve büyüme duruma göre planlanmalıdır. Fakat genel olarak belirlenen, sağlıklı yaşıtlarına göre 2 kat sıklıkta izlenmeleridir. Poliüri, büyüme gelişme geriliği, gerileyen veya düşük BMI, besin alımında yetersizlik ve sık hastalanan çocuk ve infantlarda izlem sıklığı artırılmalıdır. Kişiselleştirilmiş bir beslenme planı çocuk ve bakım veren için planlanmalıdır. Beslenme yönetiminde asıl olarak önerilen planlamanın pediatrik nefroloji ekibi, diyetisten ve çocuğun bakıcısı ile eş zamanlı olarak multidisipliner şekilde yürütülmesidir.
KBH’da risk faktörleri modifiye edilebilir ve edilemez olarak ayrılabilir. Modifiye edilemeyen risk faktörleri; düşük doğum ağırlığı, prematürite, azalan böbrek kütlesi ile somatik büyüme, daha önceki akut böbrek hasarı, düşük GFR iken; modifiye edilebilir risk faktörleri; hipertansiyon, proteinüri, obezite, asidoz, anemi, vasküler disfonksiyon, sigaradır. Bunun dışında bir de ilerlemeyi artıracak faktörler göz önünde bulundurulmalıdır. Bunlar ise; artmış ürik asit düzeyi, metabolik sendrom, glomerüler hiperfiltrasyon, hiperfosfatemi, artmış plazma FGF23 düzeyidir.

SONUÇ: Çocuklarda kronik böbrek hastalığı (KBH) ilerledikçe iştah ve besin alımı azalır. Bu nedenle iştahsızlık, besinlerin bağırsaklardan emiliminde azalma, fiziksel ve nörobilişsel gelişimi etkileyen metabolik asidoz nedeniyle malnutrisyon sık görülür. Kilo kaybı özelikle GFR <35 mL/dk/1,73m2’ye düştüğünde meydana gelir ve bu da SDBY için yüksek risk teşkil eder. Belirli büyüme parametrelerine bağlı beslenme tedavisi KBH olan çocuklar için geliştirilmiş olup pediatristler ve beslenme uzmanları ile koordine bir şekilde takip edilmelidir.

Keywords

beslenme, kronik böbrek, kalori, calorie

NUTRITION IN CHRONIC KIDNEY DISEASE

Abstract

AİM: Chronic kidney disease (CKD) is defined as the persistence of structural or functional kidney damage for at least 3 months. Children in CKD are at significant risk for growth retardation. Therefore, monitoring of nutrition is important.

MATERİALS AND METHODS: Nutrition recommendations in CKD were compiled by scanning KDIGO and related articles.

RESULTS: KDIGO made recommendations. All children with CKD stages 2-5 should be followed periodically with nutritional status and growth charts. Nutritional status should be evaluated with a 3-day diet list or a 3-time 24-hour diet list. In growth assessment, weight and height should be followed with percentile charts for age or SDS. Estimated dry weight and weight percentiles for age should be evaluated. Body mass index and head circumference under 3 years of age should be monitored. Normalized protein catabolism rate should be calculated in CKD Stage 5 hemodialysis patients. The frequency of follow-up should be planned according to the age of the patient and the stage of the disease, nutrition and growth status. However, what is generally determined is that they are observed twice as often as their healthy agemates. The frequency of follow-up should be increased in children and infants with polyuria, growth retardation, regressing or low BMI, inadequate food intake, and frequently sick children. A personalized nutrition plan should be planned for the child and caregiver. In nutritional management, the recommended planning is to be carried out in a multidisciplinary manner simultaneously with the pediatric nephrology team, dietitian and child's caregiver.

Risk factors in CKD can be divided into modifiable and non-modifiable. Unmodifiable risk factors; low birth weight, prematurity, somatic growth with decreased kidney mass, previous acute kidney injury, low GFR. Modifiable risk factors; hypertension, proteinuria, obesity, acidosis, anemia, vascular dysfunction, smoking. In addition, factors that will increase progress are increased uric acid level, metabolic syndrome, glomerular hyperfiltration, hyperphosphatemia, increased plasma FGF23 level.

CONCLUSION: As CKD progresses in children, appetite and food intake decrease. Therefore, malnutrition is common due to loss of appetite, decreased absorption of nutrients from the intestines, and metabolic acidosis that affects physical and neurocognitive development. Weight loss occurs especially when GFR falls to <35 mL/min/1.73m2, which poses a high risk for ESRD. Nutritional therapy based on specific growth parameters has been developed for children with CKD and should be followed in coordination with pediatricians and nutritionists.

Keywords

nutrition, chronic kidney, calorie

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