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Cachexia/Protein energy wasting syndrome in CKD: Causation and treatment.
Semin Dial. 2019 11; 32(6):493-499.SD

Abstract

Cachexia is a multifactorial syndrome defined by significant body weight loss, fat and muscle mass reduction, and increased protein catabolism. Protein energy wasting (PEW) is characterized as a syndrome of adverse changes in nutrition and body composition being highly prevalent in patients with CKD, especially in those undergoing dialysis, and it is associated with high morbidity and mortality in this population. Multiple mechanisms are involved in the genesis of these adverse nutritional changes in CKD patients. There is no obvious distinction between PEW and cachexia from a pathophysiologic standpoint and should be considered as part of the spectrum of the same nutritional disorder in CKD with similar management approaches for prevention and treatment based on current understanding. A plethora of factors can affect the nutritional status of CKD patients requiring a combination of therapeutic approaches to prevent or reverse protein and energy depletion. At present, there is no effective pharmacologic intervention that prevents or attenuates muscle atrophy in catabolic conditions like CKD. Prevention and treatment of uremic muscle wasting involve optimal nutritional support, correction of acidosis, and physical exercise. There has been emerging consistent evidence that active treatment, perhaps by combining nutritional interventions and resistance exercise, may be able to improve but not totally reverse or prevent the supervening muscle wasting and weakness. Active research into more direct pharmacological treatment based on basic mechanistic research is much needed for this unmet medical need in patients with CKD.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Oliveira EA
Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California San Diego, California. Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil.
Zheng R
Department of Pediatric Nephrology, Rheumatology and Immunology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Carter CE
Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California San Diego, California.
Mak RH
Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California San Diego, California.

MeSH

CachexiaCombined Modality TherapyDietary SupplementsExerciseFemaleHumansKidney Failure, ChronicMaleMuscle WeaknessNutritional RequirementsNutritional SupportPrognosisProtein-Energy MalnutritionRenal Dialysis

Pub Type(s)

Editorial
Research Support, N.I.H., Extramural
Review

Language

eng

PubMed ID

31286575

Citation

Oliveira, Eduardo A., et al. "Cachexia/Protein Energy Wasting Syndrome in CKD: Causation and Treatment." Seminars in Dialysis, vol. 32, no. 6, 2019, pp. 493-499.
Oliveira EA, Zheng R, Carter CE, et al. Cachexia/Protein energy wasting syndrome in CKD: Causation and treatment. Semin Dial. 2019;32(6):493-499.
Oliveira, E. A., Zheng, R., Carter, C. E., & Mak, R. H. (2019). Cachexia/Protein energy wasting syndrome in CKD: Causation and treatment. Seminars in Dialysis, 32(6), 493-499. https://doi.org/10.1111/sdi.12832
Oliveira EA, et al. Cachexia/Protein Energy Wasting Syndrome in CKD: Causation and Treatment. Semin Dial. 2019;32(6):493-499. PubMed PMID: 31286575.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cachexia/Protein energy wasting syndrome in CKD: Causation and treatment. AU - Oliveira,Eduardo A, AU - Zheng,Ronghao, AU - Carter,Caitlin E, AU - Mak,Robert H, Y1 - 2019/07/08/ PY - 2019/7/10/pubmed PY - 2020/7/31/medline PY - 2019/7/10/entrez SP - 493 EP - 499 JF - Seminars in dialysis JO - Semin Dial VL - 32 IS - 6 N2 - Cachexia is a multifactorial syndrome defined by significant body weight loss, fat and muscle mass reduction, and increased protein catabolism. Protein energy wasting (PEW) is characterized as a syndrome of adverse changes in nutrition and body composition being highly prevalent in patients with CKD, especially in those undergoing dialysis, and it is associated with high morbidity and mortality in this population. Multiple mechanisms are involved in the genesis of these adverse nutritional changes in CKD patients. There is no obvious distinction between PEW and cachexia from a pathophysiologic standpoint and should be considered as part of the spectrum of the same nutritional disorder in CKD with similar management approaches for prevention and treatment based on current understanding. A plethora of factors can affect the nutritional status of CKD patients requiring a combination of therapeutic approaches to prevent or reverse protein and energy depletion. At present, there is no effective pharmacologic intervention that prevents or attenuates muscle atrophy in catabolic conditions like CKD. Prevention and treatment of uremic muscle wasting involve optimal nutritional support, correction of acidosis, and physical exercise. There has been emerging consistent evidence that active treatment, perhaps by combining nutritional interventions and resistance exercise, may be able to improve but not totally reverse or prevent the supervening muscle wasting and weakness. Active research into more direct pharmacological treatment based on basic mechanistic research is much needed for this unmet medical need in patients with CKD. SN - 1525-139X UR - https://www.unboundmedicine.com/medline/citation/31286575/Cachexia/Protein_energy_wasting_syndrome_in_CKD:_Causation_and_treatment_ DB - PRIME DP - Unbound Medicine ER -