Wasting in chronic kidney disease

Robert H. Mak, Alp T. Ikizler, Csaba Kovesdy, Dominic S. Raj, Peter Stenvinkel, Kamyar Kalantar-Zadeh

Research output: Contribution to journalReview article

111 Citations (Scopus)

Abstract

Wasting/cachexia is prevalent among patients with chronic kidney disease (CKD). It is to be distinguished from malnutrition, which is defined as the consequence of insufficient food intake or an improper diet. Malnutrition is characterized by hunger, which is an adaptive response, whereas anorexia is prevalent in patients with wasting/cachexia. Energy expenditure decreases as a protective mechanism in malnutrition whereas it remains inappropriately high in cachexia/wasting. In malnutrition, fat mass is preferentially lost and lean body mass and muscle mass is preserved. In cachexia/wasting, muscle is wasted and fat is relatively underutilized. Restoring adequate food intake or altering the composition of the diet reverses malnutrition. Nutrition supplementation does not totally reverse cachexia/wasting. The diagnostic criteria of cachexia/protein-energy wasting in CKD are considered. The association of wasting surrogates, such as serum albumin and prealbumin, with mortality is strong making them robust outcome predictors. At the patient level, longevity has consistently been observed in patients with CKD who have more muscle and/or fat, who report better appetite and who eat more. Although inadequate nutritional intake may contribute to wasting or cachexia, recent evidence indicates that other factors, including systemic inflammation, perturbations of appetite-controlling hormones from reduced renal clearance, aberrant neuropeptide signaling, insulin and insulin-like growth factor resistance, and metabolic acidosis, may be important in the pathogenesis of CKD-associated wasting. A number of novel therapeutic approaches, such as ghrelin agonists and melanocortin receptor antagonists are currently at the experimental level and await confirmation by randomized controlled clinical trials in patients with CKD-associated cachexia/wasting syndrome.

Original languageEnglish (US)
Pages (from-to)9-25
Number of pages17
JournalJournal of Cachexia, Sarcopenia and Muscle
Volume2
Issue number1
DOIs
StatePublished - Jan 1 2011

Fingerprint

Cachexia
Chronic Renal Insufficiency
Malnutrition
Fats
Appetite
Muscles
Eating
Melanocortin Receptors
Ghrelin Receptor
Wasting Syndrome
Diet
Prealbumin
Hunger
Anorexia
Somatomedins
Acidosis
Neuropeptides
Serum Albumin
Energy Metabolism
Randomized Controlled Trials

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Physiology (medical)

Cite this

Mak, R. H., Ikizler, A. T., Kovesdy, C., Raj, D. S., Stenvinkel, P., & Kalantar-Zadeh, K. (2011). Wasting in chronic kidney disease. Journal of Cachexia, Sarcopenia and Muscle, 2(1), 9-25. https://doi.org/10.1007/s13539-011-0019-5

Wasting in chronic kidney disease. / Mak, Robert H.; Ikizler, Alp T.; Kovesdy, Csaba; Raj, Dominic S.; Stenvinkel, Peter; Kalantar-Zadeh, Kamyar.

In: Journal of Cachexia, Sarcopenia and Muscle, Vol. 2, No. 1, 01.01.2011, p. 9-25.

Research output: Contribution to journalReview article

Mak, RH, Ikizler, AT, Kovesdy, C, Raj, DS, Stenvinkel, P & Kalantar-Zadeh, K 2011, 'Wasting in chronic kidney disease', Journal of Cachexia, Sarcopenia and Muscle, vol. 2, no. 1, pp. 9-25. https://doi.org/10.1007/s13539-011-0019-5
Mak RH, Ikizler AT, Kovesdy C, Raj DS, Stenvinkel P, Kalantar-Zadeh K. Wasting in chronic kidney disease. Journal of Cachexia, Sarcopenia and Muscle. 2011 Jan 1;2(1):9-25. https://doi.org/10.1007/s13539-011-0019-5
Mak, Robert H. ; Ikizler, Alp T. ; Kovesdy, Csaba ; Raj, Dominic S. ; Stenvinkel, Peter ; Kalantar-Zadeh, Kamyar. / Wasting in chronic kidney disease. In: Journal of Cachexia, Sarcopenia and Muscle. 2011 ; Vol. 2, No. 1. pp. 9-25.
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