Nephrology

Managing nutritional deficiencies is a crucial aspect in the treatment of patients with kidney disease. Both acute and chronic nephropathies are complex clinical conditions in which multiple factors contribute to the deterioration of the patient's nutritional status. The progressive loss of renal function, along with the dietary restrictions often required and, in some cases, dialysis therapy, can lead to significant imbalances in the intake, absorption, and metabolism of macro- and micronutrients.   

Targeted supplementation of these nutrients can significantly improve patients' quality of life by addressing anaemia and related nutritional deficiencies. 

Iron deficiency and anaemia in chronic kidney disease

Anaemia is a common complication in CKD patients and its prevalence increases as the disease progresses. It affects around 50% of individuals with chronic kidney disease, primarily due to reduced erythropoietin production and impaired red blood cell turnover. Additionally, systemic inflammation present in CKD further impairs iron absorption and utilisation, making conventional oral iron therapy less effective. 

Factors contributing to iron deficiency in kidney patients: 

  • Chronic inflammation, which inhibits the release of iron from stores and reduces the effectiveness of oral supplementation.
  • Intestinal malabsorption, particularly common in elderly patients or those undergoing drug treatments (e.g., proton pump inhibitors, metformin, teduglutide). 
  • Occult bleeding caused by dialysis or other associated conditions.
  • Low-protein or aproteic diet, which limits the intake of essential nutrients like vitamin B12 and folic acid, both essential for haemoglobin synthesis. 

Importance of magnesium in kidney and metabolic function

Magnesium is crucial for the proper regulation of muscles, nerves and cardiovascular functions. In nephropathic patients, gastric malabsorption and reduced renal reabsorption capacity can compromise magnesium levels, increasing the risk of complications. 

Factors contributing to magnesium deficiency in CKD patients: 

  • Alterations in intestinal absorption due to age, chronic inflammation and the use of medications that interfere with mineral absorption.
  • Reduced renal reabsorption due to the impaired nephron function preventing the recovery of filtered magnesium.
  • Controlled diet, often low in magnesium-rich foods to limit renal load. 

 

Nutritional supplementation in nephrology: clinical evidence and benefits

Targeted supplementation of essential nutrients such as iron, magnesium, vitamin B12 and folic acid is vital in supporting nephropathic patients, improving the management of anaemia and reducing malnutrition-related complications. 

An integrated nutritional approach, combined with drug therapy and a balanced diet, can significantly enhance the quality of life and clinical management of patients with chronic kidney disease. 

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