title: Diets and enteral supplements for improving outcomes in chronic kidney disease.
abstract: Protein-energy wasting (PEW), which is manifested by low serum levels of albumin or prealbumin, sarcopenia and weight loss, is one of the strongest predictors of mortality in patients with chronic kidney disease (CKD). Although PEW might be engendered by non-nutritional conditions, such as inflammation or other comorbidities, the question of causality does not refute the effectiveness of dietary interventions and nutritional support in improving outcomes in patients with CKD. The literature indicates that PEW can be mitigated or corrected with an appropriate diet and enteral nutritional support that targets dietary protein intake. In-center meals or oral supplements provided during dialysis therapy are feasible and inexpensive interventions that might improve survival and quality of life in patients with CKD. Dietary requirements and enteral nutritional support must also be considered in patients with CKD and diabetes mellitus, in patients undergoing peritoneal dialysis, renal transplant recipients, and in children with CKD. Adjunctive pharmacological therapies, such as appetite stimulants, anabolic hormones, and antioxidative or anti-inflammatory agents, might augment dietary interventions. Intraperitoneal or intradialytic parenteral nutrition should be considered for patients with PEW whenever enteral interventions are not possible or are ineffective. Controlled trials are needed to better assess the effectiveness of in-center meals and oral supplements.
authors.affiliation: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA. kamkal@ucla.edu
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
authors.forename: Noël J
authors.initials: NJ
authors.lastname: Cano
authors.forename: Klemens
authors.initials: K
authors.lastname: Budde
authors.forename: Charles
authors.initials: C
authors.lastname: Chazot
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
authors.forename: Robert H
authors.initials: RH
authors.lastname: Mak
authors.forename: Rajnish
authors.initials: R
authors.lastname: Mehrotra
authors.forename: Dominic S
authors.initials: DS
authors.lastname: Raj
authors.forename: Ashwini R
authors.initials: AR
authors.lastname: Sehgal
authors.forename: Peter
authors.initials: P
authors.lastname: Stenvinkel
authors.forename: T Alp
authors.initials: TA
authors.lastname: Ikizler
mesh_terms: D002908:Chronic Disease; D019587:Dietary Supplements; D004750:Enteral Nutrition / Q000379:methods*; D005526:Food, Formulated; D006801:Humans; D007674:Kidney Diseases / Q000178:diet therapy*; D016896:Treatment Outcome