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As a result of the continual growth in numbers of ESRD
patients, the need for assessment of the nutritional status and body
composition in this group has become of paramount importance. It
has been found that ESRD patients on maintance
dialysis often have an
electrolyte & fluid inbalance. These patients have shown evidence of
Malnutrition.
These alternations may suggest in patients on
maintance dialysis, the necessity to investigate for the presence of
co morbid
conditions to access the food intake or to change dialysis
strategy and dose. The increase in body water appears to primarily
accumulate in the extracellular space, particularly within the
intersitium of superficial tissues. Partial to total failure of Kidney
function also unpairs excretion of Metabolic toxins (e.g. urea,
creatinine and other middle molecules) and causes a inablity to
regulate normal electrolyte balance.
Haemodialysis is used to reduce uremic toxins, adjust electrolytes in the
blood and remove excess body water. Clinical studies
suggests that when fluid is withdrawn from the intravascular compartment,
plasma volume falls refilling the vascular system
depending on fluid shift from the interstitium.
Thus at the end of dialysis, a new equilibrium is established in which
plasma volume is partially, restored and fluid is lost from
peripheral
tissue interstitium. The peritoneal abdominal cavity is used as the
diffusion membrane.
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