Specialty Enteral Feedings for Kidney Disease
Patients with renal failure often suffer from malnutrition or become critically ill and
require enteral feeding. Is it best to prescribe specialty renal feedings, such as Nepro® or
Suplena®, or are standard tube-feeding formulas adequate?
A summary of nutrition guidelines for chronic renal failure, developed by the National
Kidney Foundation Kidney Disease Outcome Quality Initiative (NKF KDOQI™), is
found at http://www.kidney.org/professionals/KDOQI/guidelines_updates/doqi_nut.html.
Medical nutrition therapy for kidney disease is sometimes complex. Enteral nutrition is a
safe and effective route to deliver nutrition support to patients with acute and chronic
renal failure, assuming standard protocol for tube placement and complications are in
place and that the gastrointestinal tract is functioning correctly.
As a rule, specialty tube feedings for renal patients are lower in sodium, potassium, and
phosphorus and higher in calories than standard feedings. Feedings that are designed for
stage 5 kidney disease (patients who receive dialysis) are high in protein.
Nepro and similar tube-feeding formulas contain 19 grams of protein/8 fluid ounces to
help meet the higher protein needs of a dialyzed patient. This type of feeding also is
usually lower in free water to minimize fluid load. Suplena and other products geared
toward individuals with stages 1–4 chronic kidney disease are lower in protein, because
of the reduced protein needs of those with chronic kidney disease who do not require
dialysis.
This unique balance of electrolytes, protein, and fluids is often beneficial for patients
with renal disease. However, if additional protein is indicated, nonspecialty formulas that
are protein- and calorie-dense and modular protein supplements also are available.
Careful attention to electrolyte balance is more critical in acute renal failure than chronic
renal failure. Provision of specialty formulas may provide the correct balance of nutrients
and a smaller water load than standard formulas.
Implications for dietetics practitioners
Base the selection of enteral feedings for patients with chronic kidney disease on the
stage of kidney disease, with low-protein feedings indicated for individuals with Stages
1–4 chronic kidney disease and high-protein feedings needed for those undergoing
dialysis.
Dietitians should conduct a complete nutrition assessment of renal patients who require
tube feeding to determine fluid and electrolyte needs. Careful evaluation of laboratory
values and outcomes of dialysis can help determine if fluid or electrolyte restrictions are
required. Standard high-calorie, high-protein feeding (1.5–2.0 kilocalories /milliliter) is
sometimes adequate for patients with chronic kidney disease who are undergoing
dialysis.
Dietitians should consider potential risks vs benefits of changing enteral feedings to meet
the sodium, potassium, and phosphorus needs of any renal patient who is on tube feeding.
If patients show intolerance to their enteral feeding prescription, a change in volume, rate,
or type of feeding is needed in an attempt to improve tolerance and maximize nutritional
status.
Some payer sources may not cover specialty enteral feedings, which are typically more
expensive than standard feedings. The cost/benefit of renal enteral feedings is an issue to
consider for some patients. The best way to minimize reimbursement issues is to have
complete and timely documentation clearly stating why a specialty formula was selected.
References and recommended readings
Abbott Nutrition. Improving Patient Outcomes With Nutritional Therapy: 2013 Abbott
Nutrition Product Reference. Columbus, OH: Abbott Nutrition; 2013.
Academy of Nutrition and Dietetics. Nutrition Care Manual®. Available to subscribers
at: www.nutritioncaremanual.org. Accessed January 3, 2013.
ASPEN Board of Directors and the Clinical Guidelines Task Force. Guidelines for the
use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter
Enteral Nutr. 2002;26(1 suppl):1SA-138SA.
National Kidney Foundation™. NKF K/DOQI Guidelines 2000: Adult Guidelines.
Maintenance dialysis: nutritional counseling and follow-up. Available at:
http://www.kidney.org/professionals/kdoqi/guidelines_updates/nut_a19.html. Accessed
January 3, 2013.
Review Date 1/13
R-0524