Nutrition, inflammation and chronic kidney disease.
OBJECTIVE
Protein-energy wasting and chronic inflammation are important comorbid conditions that predict poor clinical outcome in patients with advanced chronic kidney disease. The current article aims to provide a brief overview of the etiology and nutritional consequences of chronic inflammation with an outline of potential treatment options.


RESULTS
The exact mechanisms leading to these unfavorable conditions are not fully elucidated and are most likely multifactorial. Irrespective of the specific etiologic mechanisms, it appears that the common pathway for all the metabolic derangements is related to exaggerated protein degradation relative to protein synthesis. Several studies suggest that chronic inflammation can predispose advanced chronic kidney disease patients to a catabolic state leading to worsening of protein-energy wasting by both increasing protein breakdown and decreasing protein synthesis. Chronic administration of nutritional supplementation, both parenterally and orally, improves nutritional status even in inflamed hemodialysis patients. Several pilot studies indicate that antiinflammatory intervention can also improve the metabolic and nutritional profiles.


CONCLUSIONS
While a single common etiology has not been identified in this complex process, nutritional and antiinflammatory interventions can provide potential treatment options to improve the high mortality and morbidity in patients with advanced chronic kidney disease.
Ikizler
T Alp
TA
Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2372, USA.
D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D004734:Energy Metabolism; D004750:Enteral Nutrition; D006801:Humans; D007249:Inflammation / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D009747:Nutritional Physiological Phenomena; D009752:Nutritional Status; D010288:Parenteral Nutrition; D011502:Protein-Energy Malnutrition / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors
D000893:Anti-Inflammatory Agents