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New insights into the role of anabolic interventions in dialysis patients with protein energy wasting.
Curr Opin Nephrol Hypertens 2009; 18(6):469-75CO

Abstract

PURPOSE OF REVIEW

Patients on maintenance dialysis commonly develop protein-energy wasting (PEW), which is associated with poor survival. There have been several advances in anabolic interventions aimed at improving PEW in these patients in recent years.

RECENT FINDINGS

Oral or parenteral nutritional supplementation, especially if administered during dialysis, improves net protein anabolism in chronic hemodialysis patients. These beneficial effects have been extended to long-term benefits in recent clinical trials. Resistance exercise, alone or combined with intradialytic oral nutrition supplementation, also improves net protein balance in the acute setting although recent studies indicated a limited beneficial effect of long-term exercise alone on muscle protein accretion in chronic hemodialysis patients. Anabolic agents such as growth hormone and androgens have been shown to exert significant benefits on visceral protein stores, muscle mass and strength. Ghrelin, a hormone with combined orexigenic and anti-inflammatory effects, is a potential new nutritional intervention in maintenance dialysis patients.

SUMMARY

Existing anabolic therapeutic strategies have proven to be effective in improving PEW in maintenance dialysis patients. Combined anabolic interventions and several new and established anabolic hormones represent further promising nutritional interventions. Large-scale randomized controlled trials examining the effects of anabolic interventions on mortality and morbidity are still lacking.

Authors+Show Affiliations

Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2372, USA.No affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Review

Language

eng

PubMed ID

19713839

Citation

Dong, Jie, and T Alp Ikizler. "New Insights Into the Role of Anabolic Interventions in Dialysis Patients With Protein Energy Wasting." Current Opinion in Nephrology and Hypertension, vol. 18, no. 6, 2009, pp. 469-75.
Dong J, Ikizler TA. New insights into the role of anabolic interventions in dialysis patients with protein energy wasting. Curr Opin Nephrol Hypertens. 2009;18(6):469-75.
Dong, J., & Ikizler, T. A. (2009). New insights into the role of anabolic interventions in dialysis patients with protein energy wasting. Current Opinion in Nephrology and Hypertension, 18(6), pp. 469-75. doi:10.1097/MNH.0b013e328331489d.
Dong J, Ikizler TA. New Insights Into the Role of Anabolic Interventions in Dialysis Patients With Protein Energy Wasting. Curr Opin Nephrol Hypertens. 2009;18(6):469-75. PubMed PMID: 19713839.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - New insights into the role of anabolic interventions in dialysis patients with protein energy wasting. AU - Dong,Jie, AU - Ikizler,T Alp, PY - 2009/8/29/entrez PY - 2009/8/29/pubmed PY - 2009/12/25/medline SP - 469 EP - 75 JF - Current opinion in nephrology and hypertension JO - Curr. Opin. Nephrol. Hypertens. VL - 18 IS - 6 N2 - PURPOSE OF REVIEW: Patients on maintenance dialysis commonly develop protein-energy wasting (PEW), which is associated with poor survival. There have been several advances in anabolic interventions aimed at improving PEW in these patients in recent years. RECENT FINDINGS: Oral or parenteral nutritional supplementation, especially if administered during dialysis, improves net protein anabolism in chronic hemodialysis patients. These beneficial effects have been extended to long-term benefits in recent clinical trials. Resistance exercise, alone or combined with intradialytic oral nutrition supplementation, also improves net protein balance in the acute setting although recent studies indicated a limited beneficial effect of long-term exercise alone on muscle protein accretion in chronic hemodialysis patients. Anabolic agents such as growth hormone and androgens have been shown to exert significant benefits on visceral protein stores, muscle mass and strength. Ghrelin, a hormone with combined orexigenic and anti-inflammatory effects, is a potential new nutritional intervention in maintenance dialysis patients. SUMMARY: Existing anabolic therapeutic strategies have proven to be effective in improving PEW in maintenance dialysis patients. Combined anabolic interventions and several new and established anabolic hormones represent further promising nutritional interventions. Large-scale randomized controlled trials examining the effects of anabolic interventions on mortality and morbidity are still lacking. SN - 1473-6543 UR - https://www.unboundmedicine.com/medline/citation/19713839/New_insights_into_the_role_of_anabolic_interventions_in_dialysis_patients_with_protein_energy_wasting_ L2 - http://Insights.ovid.com/pubmed?pmid=19713839 DB - PRIME DP - Unbound Medicine ER -