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Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism.
Kidney Int 2013; 84(6):1096-107KI

Abstract

Protein energy wasting (PEW) is common in patients with chronic kidney disease (CKD) and is associated with adverse clinical outcomes, especially in individuals receiving maintenance dialysis therapy. A multitude of factors can affect the nutritional and metabolic status of CKD patients requiring a combination of therapeutic maneuvers to prevent or reverse protein and energy depletion. These include optimizing dietary nutrient intake, appropriate treatment of metabolic disturbances such as metabolic acidosis, systemic inflammation, and hormonal deficiencies, and prescribing optimized dialytic regimens. In patients where oral dietary intake from regular meals cannot maintain adequate nutritional status, nutritional supplementation, administered orally, enterally, or parenterally, is shown to be effective in replenishing protein and energy stores. In clinical practice, the advantages of oral nutritional supplements include proven efficacy, safety, and compliance. Anabolic strategies such as anabolic steroids, growth hormone, and exercise, in combination with nutritional supplementation or alone, have been shown to improve protein stores and represent potential additional approaches for the treatment of PEW. Appetite stimulants, anti-inflammatory interventions, and newer anabolic agents are emerging as novel therapies. While numerous epidemiological data suggest that an improvement in biomarkers of nutritional status is associated with improved survival, there are no large randomized clinical trials that have tested the effectiveness of nutritional interventions on mortality and morbidity.

Authors+Show Affiliations

Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Practice Guideline
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

23698226

Citation

Ikizler, T Alp, et al. "Prevention and Treatment of Protein Energy Wasting in Chronic Kidney Disease Patients: a Consensus Statement By the International Society of Renal Nutrition and Metabolism." Kidney International, vol. 84, no. 6, 2013, pp. 1096-107.
Ikizler TA, Cano NJ, Franch H, et al. Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney Int. 2013;84(6):1096-107.
Ikizler, T. A., Cano, N. J., Franch, H., Fouque, D., Himmelfarb, J., Kalantar-Zadeh, K., ... Wanner, C. (2013). Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney International, 84(6), pp. 1096-107. doi:10.1038/ki.2013.147.
Ikizler TA, et al. Prevention and Treatment of Protein Energy Wasting in Chronic Kidney Disease Patients: a Consensus Statement By the International Society of Renal Nutrition and Metabolism. Kidney Int. 2013;84(6):1096-107. PubMed PMID: 23698226.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. AU - Ikizler,T Alp, AU - Cano,Noel J, AU - Franch,Harold, AU - Fouque,Denis, AU - Himmelfarb,Jonathan, AU - Kalantar-Zadeh,Kamyar, AU - Kuhlmann,Martin K, AU - Stenvinkel,Peter, AU - TerWee,Pieter, AU - Teta,Daniel, AU - Wang,Angela Yee-Moon, AU - Wanner,Christoph, AU - ,, Y1 - 2013/05/22/ PY - 2013/02/14/received PY - 2013/02/28/revised PY - 2013/03/07/accepted PY - 2013/5/24/entrez PY - 2013/5/24/pubmed PY - 2014/7/22/medline SP - 1096 EP - 107 JF - Kidney international JO - Kidney Int. VL - 84 IS - 6 N2 - Protein energy wasting (PEW) is common in patients with chronic kidney disease (CKD) and is associated with adverse clinical outcomes, especially in individuals receiving maintenance dialysis therapy. A multitude of factors can affect the nutritional and metabolic status of CKD patients requiring a combination of therapeutic maneuvers to prevent or reverse protein and energy depletion. These include optimizing dietary nutrient intake, appropriate treatment of metabolic disturbances such as metabolic acidosis, systemic inflammation, and hormonal deficiencies, and prescribing optimized dialytic regimens. In patients where oral dietary intake from regular meals cannot maintain adequate nutritional status, nutritional supplementation, administered orally, enterally, or parenterally, is shown to be effective in replenishing protein and energy stores. In clinical practice, the advantages of oral nutritional supplements include proven efficacy, safety, and compliance. Anabolic strategies such as anabolic steroids, growth hormone, and exercise, in combination with nutritional supplementation or alone, have been shown to improve protein stores and represent potential additional approaches for the treatment of PEW. Appetite stimulants, anti-inflammatory interventions, and newer anabolic agents are emerging as novel therapies. While numerous epidemiological data suggest that an improvement in biomarkers of nutritional status is associated with improved survival, there are no large randomized clinical trials that have tested the effectiveness of nutritional interventions on mortality and morbidity. SN - 1523-1755 UR - https://www.unboundmedicine.com/medline/citation/23698226/Prevention_and_treatment_of_protein_energy_wasting_in_chronic_kidney_disease_patients:_a_consensus_statement_by_the_International_Society_of_Renal_Nutrition_and_Metabolism_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0085-2538(15)56097-3 DB - PRIME DP - Unbound Medicine ER -