Comments for:

Malnutrition: a frequent misdiagnosis for hemodialysis patients

William E. Mitch

William E. Mitch

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Commentary

Malnutrition in Hemodialysis Patients

Submitter: Mackenzie Walser | mwalser@bs.jhmi.edu

Johms Hopkin School of Medicine

Published September 5, 2002

Malnutrition: a frequent occurrence in hemodialysis patients.
Mackenzie Walser
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
To quote Mitch in a recent Commentary (1), "Precison in the use of words is necessary in any discipline, and this holds true for physicians and investigatorrs dealing with patients who have chronic kidney disease". He goes on to allege that diagnosing the abnormalities often seen in hemodialysis patients, such as fatigue, loss of weight with muscle mass being replaced by fatty tissue, and declining serum proteins, as "malnutrition" is "deeply misleading". The basis for this startling statement is that these abnormalities, according to Mitch, cannot be overcome by nutritional treatment. He states "To date, this approach has not proven to be successful".
On the contrary, it has been shown that nutritional treatment, namely oral supplementation with essential amino acids for 3-4 months, can significantly ameliorate hypoalbuminemia in hemodialysis patients (2,3). Other nutritional parameters also improved.
Malnutrition is exactly what these patients have.
1.Mitch, W.E. 2002. Malnutrition: a frequent misdiagnosis for hemodialysis patients. J. Clin. Invest. 110:437-439.
2.Eustace, J.A., Coresh, J., Kutchey, C., Te, P.L., Gimenez, L.F., Scheel, P.J. Jr, Walser, M. 2000. Randomized double-blind trial of oral essential amino acids for dialysis-associated hypoalbuminemia. Kidney Internat. 57:2527-2538.
3.Bronich, L., Te, T., Shetye, K., Eustace, J.A. 2001. Successful treatment of hypoalbuminemic hemodialysis patients with a modified regimen of oral essential amino acids. J. Ren. Nutr. 11:194-201.