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Hypercatabolism in dialysis patients.
Curr Opin Nephrol Hypertens 2008; 17(6):589-94CO

Abstract

PURPOSE OF REVIEW

This article will provide a comprehensive review and update on recent advances in the field of protein-energy wasting and protein kinetics in patients with end-stage renal disease.

RECENT FINDINGS

Hypercatabolism in dialysis patients is related to intradialytic loss of amino acids as well as cytokine activation. Interleukin-6 pays a central role in regulating whole-body, muscle and hepatic protein turnover during hemodialysis. Amino acids released from the muscle protein catabolism are taken up by the liver for de-novo protein synthesis during hemodialysis. Intradialytic nutrient supplementation increases protein synthesis, but does not attenuate muscle protein catabolism.

SUMMARY

Protein-energy wasting observed in end-stage renal disease is a maladaptive metabolic state, which often coexists with inflammation. Cytokine-adipokine signaling plays an important role in protein-energy wasting. Peripheral blood mononuclear cells and skeletal muscle are important sources of interleukin-6 during hemodialysis. In addition to contributing to intradialytic protein catabolism, interleukin-6 impairs effective utilization of amino acids for protein synthesis. Although muscle protein breakdown increases during hemodialysis, whole-body proteolysis is not increased. The dissociation between regional and whole-body protein kinetics in end-stage renal disease is due to somatic-hepatic recycling of amino acids. Net anabolism during hemodialysis may be achieved only by providing nutrients as well as inhibiting overt inflammatory signals.

Authors+Show Affiliations

Division of Nephrology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131-5271, USA. draj@salud.unm.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

18941351

Citation

Raj, Dominic S C., et al. "Hypercatabolism in Dialysis Patients." Current Opinion in Nephrology and Hypertension, vol. 17, no. 6, 2008, pp. 589-94.
Raj DS, Sun Y, Tzamaloukas AH. Hypercatabolism in dialysis patients. Curr Opin Nephrol Hypertens. 2008;17(6):589-94.
Raj, D. S., Sun, Y., & Tzamaloukas, A. H. (2008). Hypercatabolism in dialysis patients. Current Opinion in Nephrology and Hypertension, 17(6), pp. 589-94. doi:10.1097/MNH.0b013e32830d5bfa.
Raj DS, Sun Y, Tzamaloukas AH. Hypercatabolism in Dialysis Patients. Curr Opin Nephrol Hypertens. 2008;17(6):589-94. PubMed PMID: 18941351.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hypercatabolism in dialysis patients. AU - Raj,Dominic S C, AU - Sun,Yijuan, AU - Tzamaloukas,Antonios H, PY - 2008/10/23/pubmed PY - 2008/12/20/medline PY - 2008/10/23/entrez SP - 589 EP - 94 JF - Current opinion in nephrology and hypertension JO - Curr. Opin. Nephrol. Hypertens. VL - 17 IS - 6 N2 - PURPOSE OF REVIEW: This article will provide a comprehensive review and update on recent advances in the field of protein-energy wasting and protein kinetics in patients with end-stage renal disease. RECENT FINDINGS: Hypercatabolism in dialysis patients is related to intradialytic loss of amino acids as well as cytokine activation. Interleukin-6 pays a central role in regulating whole-body, muscle and hepatic protein turnover during hemodialysis. Amino acids released from the muscle protein catabolism are taken up by the liver for de-novo protein synthesis during hemodialysis. Intradialytic nutrient supplementation increases protein synthesis, but does not attenuate muscle protein catabolism. SUMMARY: Protein-energy wasting observed in end-stage renal disease is a maladaptive metabolic state, which often coexists with inflammation. Cytokine-adipokine signaling plays an important role in protein-energy wasting. Peripheral blood mononuclear cells and skeletal muscle are important sources of interleukin-6 during hemodialysis. In addition to contributing to intradialytic protein catabolism, interleukin-6 impairs effective utilization of amino acids for protein synthesis. Although muscle protein breakdown increases during hemodialysis, whole-body proteolysis is not increased. The dissociation between regional and whole-body protein kinetics in end-stage renal disease is due to somatic-hepatic recycling of amino acids. Net anabolism during hemodialysis may be achieved only by providing nutrients as well as inhibiting overt inflammatory signals. SN - 1062-4821 UR - https://www.unboundmedicine.com/medline/citation/18941351/Hypercatabolism_in_dialysis_patients_ L2 - http://dx.doi.org/10.1097/MNH.0b013e32830d5bfa DB - PRIME DP - Unbound Medicine ER -