Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism
2013
Ikizler, T. Alp | Cano, Noël | Franch, Harold | Fouque, Denis | Himmelfarb, Jonathan | Kalantar-Zadeh, Kamyar | Kuhlmann, M. K. | Stenvinkel, Peter | Terwee, Pieter | Teta, Daniel | Wang, Angela Yee-Moon | Wanner, Christoph | Division of Nephrology, Department of Medicine ; Vanderbilt University School of Medicine [Nashville] | Unité de Nutrition Humaine (UNH) ; Institut National de la Recherche Agronomique (INRA)-Université d'Auvergne - Clermont-Ferrand I (UdA)-Clermont Université | Department of Nephrology ; Hôpital Edouard Herriot [CHU - HCL] ; Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL) | Department of Renal Medicine ; Karolinska Institute, Huddinge University Hospital | epartment of Nephrology ; Vrije Universiteit Medical Centre (VUMC) ; Vrije Universiteit Amsterdam [Amsterdam] (VU)-Vrije Universiteit Amsterdam [Amsterdam] (VU) | Department of Medicine, Service of Nephrology ; Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital [Lausanne] (CHUV) | Department of Medicine ; The University of Hong Kong (HKU) | Department of Medicine, Division of Nephrology ; Julius-Maximilians-Universität Würzburg = University of Würzburg [Würsburg, Germany] (JMU)
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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