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A Practical Approach to Nutrition, Protein-Energy Wasting, Sarcopenia, and Cachexia in Patients with Chronic Kidney Disease.
Blood Purif. 2020; 49(1-2):202-211.BP

Abstract

Objectives of Review: Protein-energy wasting (PEW) is a state of disordered catabolism resulting from metabolic and nutritional derangements in chronic disease states. Patients with chronic kidney disease (CKD), and end-stage renal disease (ESRD) in particular, have muscle wasting, sarcopenia, and cachexia that contribute to frailty and morbidity. Moreover, reverse epidemiology findings have strongly linked PEW with mortality in CKD and ESRD. Updated Findings: The malnutrition-inflammation score (KALANTAR Score) provides a useful tool to predict nutritional risk. A stronger focus on renal nutrition in renal patients is needed to attenuate cachexia and muscle loss. Malnutrition is a far greater threat in patients with renal disease than obesity, which means dietary counseling needs to be tailored to reflect this observation. The need to achieve optimal caloric intake is compounded by the need to limit excess protein intake in CKD, resulting in the need for energy supplementation to avoid PEW. Preventing PEW is the most pressing clinical concern in CKD/ESRD. Other nutritional issues to reckon in renal disease include the need to normalize serum bicarbonate to manage acidosis, uric acid control, and phosphorous control in CKD and ESRD. Exercise maybe beneficial, but further work is needed to prove a conclusive benefit via a randomized trial. Summary: PEW prevention is an integral part of renal nutrition and is of paramount importance given the obesity paradox. Integrative approaches by physicians and dieticians are needed to take a holistic view of a patient's diet beyond just control of particular laboratory parameters.

Authors+Show Affiliations

Division of Nephrology and Hypertension and Kidney Transplantation, Orange, California, USA. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA.Department of Medicine, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA.Division of Nephrology, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA.Division of Nephrology and Hypertension and Kidney Transplantation, Orange, California, USA. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA. Division of Nephrology, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA.Division of Nephrology and Hypertension and Kidney Transplantation, Orange, California, USA, kkz@uci.edu. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA, kkz@uci.edu. Division of Nephrology, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA, kkz@uci.edu.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31851983

Citation

Hanna, Ramy M., et al. "A Practical Approach to Nutrition, Protein-Energy Wasting, Sarcopenia, and Cachexia in Patients With Chronic Kidney Disease." Blood Purification, vol. 49, no. 1-2, 2020, pp. 202-211.
Hanna RM, Ghobry L, Wassef O, et al. A Practical Approach to Nutrition, Protein-Energy Wasting, Sarcopenia, and Cachexia in Patients with Chronic Kidney Disease. Blood Purif. 2020;49(1-2):202-211.
Hanna, R. M., Ghobry, L., Wassef, O., Rhee, C. M., & Kalantar-Zadeh, K. (2020). A Practical Approach to Nutrition, Protein-Energy Wasting, Sarcopenia, and Cachexia in Patients with Chronic Kidney Disease. Blood Purification, 49(1-2), 202-211. https://doi.org/10.1159/000504240
Hanna RM, et al. A Practical Approach to Nutrition, Protein-Energy Wasting, Sarcopenia, and Cachexia in Patients With Chronic Kidney Disease. Blood Purif. 2020;49(1-2):202-211. PubMed PMID: 31851983.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Practical Approach to Nutrition, Protein-Energy Wasting, Sarcopenia, and Cachexia in Patients with Chronic Kidney Disease. AU - Hanna,Ramy M, AU - Ghobry,Lena, AU - Wassef,Olivia, AU - Rhee,Connie M, AU - Kalantar-Zadeh,Kamyar, Y1 - 2019/12/18/ PY - 2019/10/15/received PY - 2019/10/18/accepted PY - 2019/12/19/pubmed PY - 2020/12/2/medline PY - 2019/12/19/entrez KW - Cachexia KW - Chronic kidney disease KW - End-stage renal disease KW - KALANTAR score KW - Protein-energy wasting KW - Sarcopenia SP - 202 EP - 211 JF - Blood purification JO - Blood Purif VL - 49 IS - 1-2 N2 - Objectives of Review: Protein-energy wasting (PEW) is a state of disordered catabolism resulting from metabolic and nutritional derangements in chronic disease states. Patients with chronic kidney disease (CKD), and end-stage renal disease (ESRD) in particular, have muscle wasting, sarcopenia, and cachexia that contribute to frailty and morbidity. Moreover, reverse epidemiology findings have strongly linked PEW with mortality in CKD and ESRD. Updated Findings: The malnutrition-inflammation score (KALANTAR Score) provides a useful tool to predict nutritional risk. A stronger focus on renal nutrition in renal patients is needed to attenuate cachexia and muscle loss. Malnutrition is a far greater threat in patients with renal disease than obesity, which means dietary counseling needs to be tailored to reflect this observation. The need to achieve optimal caloric intake is compounded by the need to limit excess protein intake in CKD, resulting in the need for energy supplementation to avoid PEW. Preventing PEW is the most pressing clinical concern in CKD/ESRD. Other nutritional issues to reckon in renal disease include the need to normalize serum bicarbonate to manage acidosis, uric acid control, and phosphorous control in CKD and ESRD. Exercise maybe beneficial, but further work is needed to prove a conclusive benefit via a randomized trial. Summary: PEW prevention is an integral part of renal nutrition and is of paramount importance given the obesity paradox. Integrative approaches by physicians and dieticians are needed to take a holistic view of a patient's diet beyond just control of particular laboratory parameters. SN - 1421-9735 UR - https://www.unboundmedicine.com/medline/citation/31851983/A_Practical_Approach_to_Nutrition_Protein_Energy_Wasting_Sarcopenia_and_Cachexia_in_Patients_with_Chronic_Kidney_Disease_ DB - PRIME DP - Unbound Medicine ER -