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Latest consensus and update on protein-energy wasting in chronic kidney disease.
Curr Opin Clin Nutr Metab Care. 2015 May; 18(3):254-62.CO

Abstract

PURPOSE OF REVIEW

Protein-energy wasting (PEW) is a state of metabolic and nutritional derangements in chronic disease states including chronic kidney disease (CKD). Cumulative evidence suggests that PEW, muscle wasting and cachexia are common and strongly associated with mortality in CKD, which is reviewed here.

RECENT FINDINGS

The malnutrition-inflammation score (KALANTAR Score) is among the comprehensive and outcome-predicting nutritional scoring tools. The association of obesity with poor outcomes is attenuated across more advanced CKD stages and eventually reverses in the form of obesity paradox. Frailty is closely associated with PEW, muscle wasting and cachexia. Muscle loss shows stronger associations with unfavorable outcomes than fat loss. Adequate energy supplementation combined with low-protein diet for the management of CKD may prevent the development of PEW and can improve adherence to low-protein diet, but dietary protein requirement may increase with aging and is higher under dialysis therapy. Phosphorus burden may lead to poor outcomes. The target serum bicarbonate concentration is normal range and at least 23 mEq/l for nondialysis-dependent and dialysis-dependent CKD patients, respectively. A benefit of exercise is suggested but not yet conclusively proven.

SUMMARY

Prevention and treatment of PEW should involve individualized and integrated approaches to modulate identified risk factors and contributing comorbidities.

Authors+Show Affiliations

aDivision of Nephrology and Hypertension bHarold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California cUniversity of Tennessee Health Science Center, Memphis, Tennessee, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

25807354

Citation

Obi, Yoshitsugu, et al. "Latest Consensus and Update On Protein-energy Wasting in Chronic Kidney Disease." Current Opinion in Clinical Nutrition and Metabolic Care, vol. 18, no. 3, 2015, pp. 254-62.
Obi Y, Qader H, Kovesdy CP, et al. Latest consensus and update on protein-energy wasting in chronic kidney disease. Curr Opin Clin Nutr Metab Care. 2015;18(3):254-62.
Obi, Y., Qader, H., Kovesdy, C. P., & Kalantar-Zadeh, K. (2015). Latest consensus and update on protein-energy wasting in chronic kidney disease. Current Opinion in Clinical Nutrition and Metabolic Care, 18(3), 254-62. https://doi.org/10.1097/MCO.0000000000000171
Obi Y, et al. Latest Consensus and Update On Protein-energy Wasting in Chronic Kidney Disease. Curr Opin Clin Nutr Metab Care. 2015;18(3):254-62. PubMed PMID: 25807354.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Latest consensus and update on protein-energy wasting in chronic kidney disease. AU - Obi,Yoshitsugu, AU - Qader,Hemn, AU - Kovesdy,Csaba P, AU - Kalantar-Zadeh,Kamyar, PY - 2015/3/26/entrez PY - 2015/3/26/pubmed PY - 2015/12/19/medline SP - 254 EP - 62 JF - Current opinion in clinical nutrition and metabolic care JO - Curr Opin Clin Nutr Metab Care VL - 18 IS - 3 N2 - PURPOSE OF REVIEW: Protein-energy wasting (PEW) is a state of metabolic and nutritional derangements in chronic disease states including chronic kidney disease (CKD). Cumulative evidence suggests that PEW, muscle wasting and cachexia are common and strongly associated with mortality in CKD, which is reviewed here. RECENT FINDINGS: The malnutrition-inflammation score (KALANTAR Score) is among the comprehensive and outcome-predicting nutritional scoring tools. The association of obesity with poor outcomes is attenuated across more advanced CKD stages and eventually reverses in the form of obesity paradox. Frailty is closely associated with PEW, muscle wasting and cachexia. Muscle loss shows stronger associations with unfavorable outcomes than fat loss. Adequate energy supplementation combined with low-protein diet for the management of CKD may prevent the development of PEW and can improve adherence to low-protein diet, but dietary protein requirement may increase with aging and is higher under dialysis therapy. Phosphorus burden may lead to poor outcomes. The target serum bicarbonate concentration is normal range and at least 23 mEq/l for nondialysis-dependent and dialysis-dependent CKD patients, respectively. A benefit of exercise is suggested but not yet conclusively proven. SUMMARY: Prevention and treatment of PEW should involve individualized and integrated approaches to modulate identified risk factors and contributing comorbidities. SN - 1473-6519 UR - https://www.unboundmedicine.com/medline/citation/25807354/Latest_consensus_and_update_on_protein_energy_wasting_in_chronic_kidney_disease_ DB - PRIME DP - Unbound Medicine ER -