As we enter nutrition awareness month, I can’t help but think of the dialysis patient community, whose members often go unrecognized and many times suffer from malnutrition. This patient population may benefit from nutritional advice, oral supplements and finally, non-invasive precision medicine during their hemodialysis and peritoneal dialysis sessions, in general.
Yet adequate nutrition becomes even more important when a patient has a wound or wounds that won’t heal. Thus a brief review of the interplay between would healing and nutrition is valuable during nutrition awareness month.
Wound healing is a process that follows three different phases (inflammatory, proliferative, and maturation) characterized by specific events that require individual components (vitamins, nutrients, and water). This process is not always linear and can progress forward and backward. When wounds move backward in this process, it can result in delayed wound healing leading to chronic wounds. These can take months or years to heal.
So what constitutes adequate nutrition in malnourished patients (which equals to approximately 20%-60% dialysis patients) with wounds that require healing? Without appropriate nutritional support, malnourished patients will not progress through the stages that allow wounds to heal even though blood flow and perfusion are adequate. Malnutrition may also lead to decreased tensile strength, making tissue weak and wounds easy to open and thus increase infection rates.
Nutritional Needs
Carbohyrates: the process requiring the most energy in wound healing is making collagen. Without adequate carbohydrates to provide energy, the body
will break down and use the protein it has stored as fuel. Carbohydrates are important as they let your body spare protein for tissue growth.
Protein is a key building block for new tissue, is essential in virtually every cell of our body and is vitally important in malnourished dialysis patients. Protein is important for wound healing as it helps cells multiply, skin and tissue grow, prevent infection, control fluid balance and move nutrients
and oxygen around your body and to your wound. A protein deficit may relate to a loss of lean body mass, delayed wound healing and, in some cases, increased morbidity and mortality.
Micronutrients (Vitamins A, C, Zinc and Iron) play key roles in the prevention of tissue damage that can lead to wound infection. They are also important
as they help get oxygen to your wound and grow strong tissue to keep your healed wound from opening.
Water is a vital nutrient and is important in wound healing as it helps hydrate the wound bed, removes waste and controls the temperature of the wound. Water also carries other nutrients and oxygen to the wound site, enabling it to progress through an orderly wound healing process.
Nutritional Solutions
For malnourished dialysis patients struggling to meet their protein and nutritional needs, Intradialytic Parenteral Nutrition (IDPN) and Intraperitoneal Nutrition (IPN) therapy may be an option. IDPN/IPN has been shown to increase albumin levels, providing essential protein that supports wound healing.
By improving nutritional status, these therapies can help patients progress through the stages of healing more effectively, reducing the risk of chronic wounds and associated complications.
Proper nutrition is one of the most critical, yet often overlooked, factors in wound healing, especially for malnourished dialysis patients. By ensuring adequate intake of protein, carbohydrates, key vitamins, and hydration, we can help promote better wound healing outcomes and improve overall patient health.
We thank our guest blogger, Andy Araujo, BA, RN, Clinical Support Nurse, for sharing his knowledge and insights in this important blog post!
