New insights into the role of anabolic interventions in dialysis patients with protein energy wasting.
OBJECTIVE
Patients on maintenance dialysis commonly develop protein-energy wasting (PEW), which is associated with poor survival. There have been several advances in anabolic interventions aimed at improving PEW in these patients in recent years.


RESULTS
Oral or parenteral nutritional supplementation, especially if administered during dialysis, improves net protein anabolism in chronic hemodialysis patients. These beneficial effects have been extended to long-term benefits in recent clinical trials. Resistance exercise, alone or combined with intradialytic oral nutrition supplementation, also improves net protein balance in the acute setting although recent studies indicated a limited beneficial effect of long-term exercise alone on muscle protein accretion in chronic hemodialysis patients. Anabolic agents such as growth hormone and androgens have been shown to exert significant benefits on visceral protein stores, muscle mass and strength. Ghrelin, a hormone with combined orexigenic and anti-inflammatory effects, is a potential new nutritional intervention in maintenance dialysis patients.


CONCLUSIONS
Existing anabolic therapeutic strategies have proven to be effective in improving PEW in maintenance dialysis patients. Combined anabolic interventions and several new and established anabolic hormones represent further promising nutritional interventions. Large-scale randomized controlled trials examining the effects of anabolic interventions on mortality and morbidity are still lacking.
Dong
Jie
J
Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2372, USA.
Ikizler
T Alp
TA
D045930:Anabolic Agents / Q000191:economics / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004750:Enteral Nutrition / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D010288:Parenteral Nutrition / Q000191:economics; D011502:Protein-Energy Malnutrition / Q000191:economics / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006435:Renal Dialysis / Q000009:adverse effects* / Q000191:economics / Q000401:mortality; D055070:Resistance Training / Q000191:economics; D016896:Treatment Outcome
D045930:Anabolic Agents