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Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis.
Clin Nutr. 2017 06; 36(3):663-671.CN

Abstract

BACKGROUND & AIMS

Protein-Energy Wasting (PEW) is the depletion of protein/energy stores observed in the most advanced stages of Chronic Kidney Disease (CKD). PEW is highly prevalent among patients on chronic dialysis, and is associated with adverse clinical outcomes, high morbidity/mortality rates and increased healthcare costs. This narrative review was aimed at exploring the pathophysiology of PEW in end-stage renal disease (ESRD) on hemodialysis. The main aspects of nutritional status evaluation, intervention and monitoring in this clinical setting were described, as well as the current approaches for the prevention and treatment of ESRD-related PEW.

METHODS

An exhaustive literature search was performed, in order to identify the relevant studies describing the epidemiology, pathogenesis, nutritional intervention and outcome of PEW in ESRD on hemodialysis.

RESULTS AND CONCLUSION

The pathogenesis of PEW is multifactorial. Loss of appetite, reduced intake of nutrients and altered lean body mass anabolism/catabolism play a key role. Nutritional approach to PEW should be based on a careful and periodic assessment of nutritional status and on timely dietary counseling. When protein and energy intakes are reduced, nutritional supplementation by means of specific oral formulations administered during the hemodialysis session may be the first-step intervention, and represents a valid nutritional approach to PEW prevention and treatment since it is easy, effective and safe. Omega-3 fatty acids and fibers, now included in commercially available preparations for renal patients, could lend relevant added value to macronutrient supplementation. When oral supplementation fails, intradialytic parenteral nutrition can be implemented in selected patients.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Sabatino A
Acute and Chronic Renal Failure Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
Regolisti G
Acute and Chronic Renal Failure Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
Karupaiah T
Dietetics Program, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia.
Sahathevan S
Dietetics Program, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia.
Sadu Singh BK
Dietetics Program, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia.
Khor BH
Dietetics Program, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia.
Salhab N
Department of Nutrition and Translational Research in Metabolism, Maastricht University, Netherlands.
Karavetian M
Department of Natural Sciences in Public Health, Zayed University, Dubai, United Arab Emirates.
Cupisti A
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Fiaccadori E
Acute and Chronic Renal Failure Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy. Electronic address: enrico.fiaccadori@unipr.it.

MeSH

Body CompositionBody Mass IndexComorbidityDatabases, FactualDietary FiberDietary SupplementsExerciseFatty Acids, Omega-3HumansKidney Failure, ChronicLife StyleNutrition AssessmentNutritional StatusNutritional SupportPractice Guidelines as TopicProtein-Energy MalnutritionRenal DialysisWasting Syndrome

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

27371993

Clinical Trial Links

Effect of Oral Nutritional Supplementation Combined With Impedance Vectors

Citation

Sabatino, A, et al. "Protein-energy Wasting and Nutritional Supplementation in Patients With End-stage Renal Disease On Hemodialysis." Clinical Nutrition (Edinburgh, Scotland), vol. 36, no. 3, 2017, pp. 663-671.
Sabatino A, Regolisti G, Karupaiah T, et al. Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis. Clin Nutr. 2017;36(3):663-671.
Sabatino, A., Regolisti, G., Karupaiah, T., Sahathevan, S., Sadu Singh, B. K., Khor, B. H., Salhab, N., Karavetian, M., Cupisti, A., & Fiaccadori, E. (2017). Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis. Clinical Nutrition (Edinburgh, Scotland), 36(3), 663-671. https://doi.org/10.1016/j.clnu.2016.06.007
Sabatino A, et al. Protein-energy Wasting and Nutritional Supplementation in Patients With End-stage Renal Disease On Hemodialysis. Clin Nutr. 2017;36(3):663-671. PubMed PMID: 27371993.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis. AU - Sabatino,A, AU - Regolisti,G, AU - Karupaiah,T, AU - Sahathevan,S, AU - Sadu Singh,B K, AU - Khor,B H, AU - Salhab,N, AU - Karavetian,M, AU - Cupisti,A, AU - Fiaccadori,E, Y1 - 2016/06/18/ PY - 2016/04/17/received PY - 2016/05/24/revised PY - 2016/06/11/accepted PY - 2016/7/4/pubmed PY - 2018/3/24/medline PY - 2016/7/4/entrez KW - Chronic kidney disease KW - Hemodialysis KW - Nutrients KW - Nutritional status KW - Protein-energy wasting SP - 663 EP - 671 JF - Clinical nutrition (Edinburgh, Scotland) JO - Clin Nutr VL - 36 IS - 3 N2 - BACKGROUND & AIMS: Protein-Energy Wasting (PEW) is the depletion of protein/energy stores observed in the most advanced stages of Chronic Kidney Disease (CKD). PEW is highly prevalent among patients on chronic dialysis, and is associated with adverse clinical outcomes, high morbidity/mortality rates and increased healthcare costs. This narrative review was aimed at exploring the pathophysiology of PEW in end-stage renal disease (ESRD) on hemodialysis. The main aspects of nutritional status evaluation, intervention and monitoring in this clinical setting were described, as well as the current approaches for the prevention and treatment of ESRD-related PEW. METHODS: An exhaustive literature search was performed, in order to identify the relevant studies describing the epidemiology, pathogenesis, nutritional intervention and outcome of PEW in ESRD on hemodialysis. RESULTS AND CONCLUSION: The pathogenesis of PEW is multifactorial. Loss of appetite, reduced intake of nutrients and altered lean body mass anabolism/catabolism play a key role. Nutritional approach to PEW should be based on a careful and periodic assessment of nutritional status and on timely dietary counseling. When protein and energy intakes are reduced, nutritional supplementation by means of specific oral formulations administered during the hemodialysis session may be the first-step intervention, and represents a valid nutritional approach to PEW prevention and treatment since it is easy, effective and safe. Omega-3 fatty acids and fibers, now included in commercially available preparations for renal patients, could lend relevant added value to macronutrient supplementation. When oral supplementation fails, intradialytic parenteral nutrition can be implemented in selected patients. SN - 1532-1983 UR - https://www.unboundmedicine.com/medline/citation/27371993/Protein_energy_wasting_and_nutritional_supplementation_in_patients_with_end_stage_renal_disease_on_hemodialysis_ DB - PRIME DP - Unbound Medicine ER -