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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.

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.

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  • Authors+Show Affiliations

    ,

    Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.

    , , , , , , , , , , ,

    Source

    Kidney international 84:6 2013 Dec pg 1096-107

    MeSH

    Anabolic Agents
    Appetite Stimulants
    Combined Modality Therapy
    Comorbidity
    Dietary Supplements
    Energy Metabolism
    Exercise
    Humans
    Nutritional Status
    Nutritional Support
    Protein-Energy Malnutrition
    Renal Dialysis
    Renal Insufficiency, Chronic
    Risk Factors
    Treatment Outcome

    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/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0085-2538(15)56097-3 DB - PRIME DP - Unbound Medicine ER -