Kidney disease, chronic malnutrition

LDL, Low-density lipoprotein HDL, high-density lipoprotein CKD, chronic kidney disease MIA, malnutrition inflammation atherosclerosis. 

Chronic kidney disease (CKD), as evidenced by the inability of the kidneys to excrete nitrogenous and other waste products, usually develops over months to years (see Chap. 43). Malnutrition secondary to reduced oral nutrient intake frequently is evident when the glomerular filtration rate (GFR) drops below 20 to 25 mL/min. Patients with CKD are considered to have ESKD when the GER falls below 15 mL/min (see Chap. 44). Malnutrition is also a common occurrence in ESKD, not only because of decreased oral intake, but also due to increased nutrient losses via the various renal replacement therapies. Because of its chronicity, malnutrition in these patients is treated most frequently in the ambulatory setting with EN. 

The deficiency of potassium develops chronic diseases with malnutrition, gastro intestinal losses and alkalosis. In most of these cases intracellular potassium is transferred to extra cellular fluids which is quickly removed by kidneys. Symptoms of hyperkalemia include muscular weeikness, paralysis and dilation of heart. 

There is an increased risk of malnutrition associated with chronic diseases, especially disease of the intestinal tract, kidneys, and liver. Patients with chronic diseases like cancer, AIDS, and intestinal disorders may lose weight rapidly and become susceptible to undernourishment because they cannot absorb valuable vitamins, calories, and iron. 

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