Therapeutic Areas
Renal Insufficiency
The main function of the kidneys is the excretion of metabolic waste mainly from protein metabolism. Further functions include the maintenance of fluid balance, regulation of electrolyte status and other processes in the body. Renal failure involves the breakdown of one or all of these functions and causes profound abnormalities in overall nutrient metabolism.
The predominating symptom of renal insufficiency is the accumulation of urea in the blood. Urea is the waste product of protein breakdown and must be eliminated via the kidneys. This reflects the importance of adequate protein or amino acid intake in patients with renal insufficiency.
Both in acute and chronic kidney disease, an impairment in renal functions results in the accumulation of waste products in the body and inability to regulate electrolyte and water balance. In acute kidney disease, these disturbances are typically reversible, whereas they are most often not in chronic renal failure.
Chronic kidney disease can be characterized as progressive loss of kidney function. Symptoms of end-stage renal disease become apparent and kidney transplantation or maintenance dialysis is essential for survival.
In general, patients with renal insufficiency require special nutrition support. Adequate protein or amino acid intake is necessary to rule out protein malnutrition while not overburdening renal capacity with waste products.
Fresenius Kabi offers ketoanalogues of essential amino acids and essential amino acids to reduce nitrogen load in patients with chronic kidney disease and delay time to dialysis. Fresenius Kabi is the innovator of Ketosteril.
Fresenius Kabi also offers specific products for enteral and parenteral nutrition to ensure optimal nutritional management in this patient group.
Critical Illness
Critical illness refers to a wide spectrum of life-threatening medical or surgical conditions usually requiring intensive care, including special nutrition support like amino acids and calories and, if indicated, immune-modulatory agents. Critical illness may be prolonged if nutritional requirements are not met. Additionally, patients suffering from critical illness typically suffer from impaired immunological functions, possibly impacting on outcome. Consequently, patients should receive special nutrition support when indicated.
Specific nutrients like glutamine and omega-3 fatty acids from fish oil are important nutritional substrates for improving immunological functions in critical illness.
Fresenius Kabi offers parenteral and enteral products particularly suited to nutritional support in critical illness.
Oncology
Cancer represents a group of diseases characterized by uncontrolled growth and spread of abnormal cells. Cancer may be caused by external factors such as chemicals, radiations and viruses, or by internal factors such as hormones, aberrations of immune function.
Fresenius Kabi is specialized in the field of oncology products supported by integrated manufacturing, regulatory, sales, marketing and distribution set up.
Fresenius Kabi has expertise for development and manufacturing of Active Pharmaceutical Ingredients (API), intermediates and dosage forms. From the development of process technology to filing of Drug Master Files (DMFs), we have full range of capabilities that would suffice various needs of our patients. All our activities are carried out in-house supported by stringent analytical and testing capabilities.
The broad range of products span over injectables (liquid, dry, lyophilized), tablets and capsules. Our novel drug delivery system is dedicated to develop some high end products for substantially reducing the side effects and allergic reactions of the presently available formulations.
Blood Volume Substitution
The human body contains 50-60% water mainly in tissues and cells (e.g. a 70 kg adult carries 35-40 l water). The blood volume of an adult amounts approximately to 1/12 of the total body weight (e.g. 70 kg adult: 5-6 l blood).
Major losses of blood volume and body fluid (e.g. due to surgery or traumatic injuries) should be corrected immediately by administrating infusion solutions, e.g. blood volume substitutes (hydroxyethyl starch) and/or electrolytes to avoid organ malperfusion secondary to hypovolemia.
Fresenius Kabi offer a comprehensive range of products in infusion bags and bottles. For blood volume substitution, we offer artificial colloids, which are used mainly in surgery and emergency cases, and can be infused regardless of blood group. They can compensate for blood loss by binding water in the vascular system. Our products contain hydroxyethyl starch (HES), which is derived from waxy maize starch.
Anaesthesia
Anaesthesia creates a reversible state of unconsciousness and enables painless procedures. Anaesthesia typically consists of hypnotic agents such as propofol or volatile anaesthetics, as well as analgesics and, if indicated, muscle relaxants.
If indicated, the anaesthesiologist will decide which type of anaesthesia (general, local or regional) to be used and which dosage.
Diabetes Mellitus
Diabetes mellitus is a chronic metabolic disease characterized by a disturbance in glucose metabolism. Insulin, a hormone which is necessary for glucose metabolism (transport of glucose from the bloodstream into the cells), is either not produced at all by the body or is not produced in sufficient quantities. Moreover, the effective use of insulin can be reduced in diabetics. Consequently, the availability of a very important energy source for the cells -glucose- is reduced.
This disturbance in glucose metabolism leads to unfavorably increased or decreased glucose concentrations in the blood. Furthermore, alterations in the metabolism of fat and protein occur. The primary goal in nutrition therapy is to achieve a well-balanced glucose concentration in the blood in order to prevent acute (e.g. so-called coma diabeticum) and long-term complications (e.g. microvascular complications in the retina, kidneys, and peripheral nerves). In addition, the achievement of optimal blood lipid levels is important to avoid adverse cardiovascular effects.
Fresenius Kabi offers tube and sip feedings designed according to current scientific knowledge to meet the specific requirement of diabetics and to prevent acute and long-term complications.
Fluid Management
If body fluids are lacking due to losses and/or increased demand, they should be restored with (balanced) electrolyte solutions.
Electrolyte solutions are given to cover basal fluid demands or compensate for fluid losses. In addition, balanced electrolyte solutions provide diverse electrolytes targeting to maintain/restore a physiologic acid-base-status.
Furthermore, electrolyte solutions are used as a carrier for several drugs (e.g. i.v. antibiotics). Glucose solutions are part of a sufficient parenteral nutrition therapy.
Remember: 50-60% of our total body weight is water and electrolytes.
Liver Insufficiency
The liver is the largest organ in the body with several important functions, e.g. synthesis and metabolism of carbohydrates, proteins and fat. Furthermore, the liver is playing an important role in the detoxifying of potentially lethal substances, which are produced in the body (e.g. ammonia) or delivered with food (e.g. drugs and alcohol). The organ also serves as a storage center for essential nutrients such as glycogen (storage form of glucose), iron, and the fat soluble vitamins (A, D, E, K).
Patients who suffer from liver disease are often nutritionally compromised because of reduced food intake and disorders in the metabolism of ingested nutrients.
A severe and often deadly complication in patients with liver insufficiency is the so-called hepatic encephalopathy that is usually associated with altered concentrations of certain amino acids in the body. The hepatic encephalopathy is characterized by different severities including impaired abilities of writing, up to deep coma.
It is well known that the detrimental disturbance of the amino acid pattern is one of the influencing factors of hepatic encephalopathy. It is therefore advantageous to use diets with a specific pattern of certain amino acids for the dietary management in patients with severe hepatic encephalopathy to react this disturbance.
Fresenius Kabi offers parenteral and enteral solutions particularly suited to nutritional support in patients with liver insufficiency.
Maldigestion / Malabsorption
Maldigestion and malabsorption of nutrients typically results in malnutrition. It commonly occurs in a wide range of diseases like short-bowel syndrome, inflammatory bowel disease and pancreatic insufficiency.
The so-called short-bowel syndrome occurs when a combination of loss of bowel due to resection and/or dysfunction of the remaining bowel reduces intestinal absorption such that requirements of fluid, electrolytes, macronutrients, minerals, and vitamins are difficult to meet with normal nutrition. Symptoms of short-bowel syndrome include large volume diarrhea, thirst, and weight loss.
Patients suffering from pancreatic insufficiency have a decreased production of digestive enzymes resulting in maldigestion and malabsorption. The pancreas produces most of digestive enzymes, which are substances being essential for the digestion of nutrients and are, therefore, important for nutrient utilisation. Particularly patients with chronic pancreatitis are at increased risk of becoming malnourished.
Inflammatory bowel diseases include Crohn's disease and ulcerative colitis. Crohn's disease can involve any part of the alimentary tract from the mouth to the anus, whereas ulcerative colitis is a mucosal disease restricted to the colon. Mechanisms contributing to malnutrition in inflammatory bowel diseases include decreased food intake due to discomfort, diarrhea and dietary restrictions. Additionally, malabsorption of nutrients, increased nutrient requirements, resulting from fever and inflammation as well as drug nutrient interactions contribute to malnutrition.
Due to the impaired digestion and absorption of nutrients in these disease entities, the tolerance of so-called pre-digested enteral diets (oligopeptide diets) are considered to be good therapeutic options. In the case of non-tolerance of enteral nutrition, parenteral nutrition has to be considered.
Fresenius Kabi offers parenteral and enteral products particularly suited to dietary management in patients with maldigestion and malabsorption.
