title: Nutrition and chronic kidney disease.
abstract: The incidence of malnutrition disorders in chronic kidney disease (CKD) appears unchanged over time, whereas patient-care and dialysis techniques continue to progress. Despite some evidence for cost-effective treatments, there are numerous caveats to applying these research findings on a daily care basis. There is a sustained generation of data confirming metabolic improvement when patients control their protein intake, even at early stages of CKD. A recent protein-energy wasting nomenclature allows a simpler approach to the diagnosis and causes of malnutrition. During maintenance dialysis, optimal protein and energy intakes have been recently challenged, and there is no longer an indication to control hyperphosphatemia through diet restriction. Recent measurements of energy expenditure in dialysis patients confirm very low physical activity, which affects energy requirements. Finally, inflammation, a common state during CKD, acts on both nutrient intake and catabolism, but is not a contraindication to a nutritional intervention, as patients do respond and improve their survival as well as do noninflamed patients.
authors.affiliation: Department of Nephrology, Hôpital Edouard Herriot, Lyon, France. denis.fouque@chu-lyon.fr
authors.forename: Denis
authors.initials: D
authors.lastname: Fouque
authors.forename: Solenne
authors.initials: S
authors.lastname: Pelletier
authors.forename: Denise
authors.initials: D
authors.lastname: Mafra
authors.forename: Philippe
authors.initials: P
authors.lastname: Chauveau
mesh_terms: D000818:Animals; D002908:Chronic Disease; D004044:Dietary Proteins / Q000008:administration & dosage / Q000378:metabolism; D004734:Energy Metabolism; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D007674:Kidney Diseases / Q000150:complications / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D044342:Malnutrition / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology / Q000517:prevention & control; D009752:Nutritional Status; D011502:Protein-Energy Malnutrition / Q000209:etiology / Q000503:physiopathology; D006435:Renal Dialysis / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D004044:Dietary Proteins