Latest consensus and update on protein-energy wasting in chronic kidney disease

Yoshitsugu Obi, Hemn Qader, Csaba Kovesdy, Kamyar Kalantar-Zadeh

Research output: Contribution to journalReview article

64 Citations (Scopus)

Abstract

Purpose of review Protein-energy wasting (PEW) is a state of metabolic and nutritional derangements in chronic disease states including chronic kidney disease (CKD). Cumulative evidence suggests that PEW, muscle wasting and cachexia are common and strongly associated with mortality in CKD, which is reviewed here. Recent findings The malnutrition-inflammation score (KALANTAR Score) is among the comprehensive and outcome-predicting nutritional scoring tools. The association of obesity with poor outcomes is attenuated across more advanced CKD stages and eventually reverses in the form of obesity paradox. Frailty is closely associated with PEW, muscle wasting and cachexia. Muscle loss shows stronger associations with unfavorable outcomes than fat loss. Adequate energy supplementation combined with low-protein diet for the management of CKD may prevent the development of PEW and can improve adherence to low-protein diet, but dietary protein requirement may increase with aging and is higher under dialysis therapy. Phosphorus burden may lead to poor outcomes. The target serum bicarbonate concentration is normal range and at least 23mEq/l for nondialysis-dependent and dialysis-dependent CKD patients, respectively. A benefit of exercise is suggested but not yet conclusively proven. Summary Prevention and treatment of PEW should involve individualized and integrated approaches to modulate identified risk factors and contributing comorbidities.

Original languageEnglish (US)
Pages (from-to)254-262
Number of pages9
JournalCurrent Opinion in Clinical Nutrition and Metabolic Care
Volume18
Issue number3
DOIs
StatePublished - May 27 2015

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Chronic Renal Insufficiency
Protein-Restricted Diet
Cachexia
Proteins
Muscles
Dialysis
Obesity
Nutritional Requirements
Dietary Proteins
Bicarbonates
Malnutrition
Phosphorus
Comorbidity
Reference Values
Chronic Disease
Fats
Exercise
Inflammation
Mortality
Therapeutics

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Latest consensus and update on protein-energy wasting in chronic kidney disease. / Obi, Yoshitsugu; Qader, Hemn; Kovesdy, Csaba; Kalantar-Zadeh, Kamyar.

In: Current Opinion in Clinical Nutrition and Metabolic Care, Vol. 18, No. 3, 27.05.2015, p. 254-262.

Research output: Contribution to journalReview article

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