title: Effect of kidney failure and hemodialysis on protein and amino acid metabolism.
abstract: OBJECTIVE
  Despite technological innovations in renal replacement therapy, mortality is still high in patients with end-stage renal disease. This increase in mortality is not only limited to dialysis patients, but also includes all stages of chronic kidney disease (CKD) and is mainly because of cardiovascular disease. Protein-energy wasting becomes clinically manifest at an advanced CKD stage, early before or during the dialytic stage, and increases the morbidity and mortality in this patients' population. The purpose of this article is to review the recent observations on alterations of amino acid and protein metabolism which cause wasting and increase cardiovascular risk.
  
  
  RESULTS
  Recent studies have consistently increased our understanding of mechanisms causing wasting and vascular disease in CKD patients. These include changes in amino acid and lipoprotein metabolism potentially leading to alterations of biology and function of the vascular wall, anorexia and endocrine dysfunction, altered muscle intracellular signaling through the insulin receptor substrate/phosphatidylinositol 3-kinase/Akt pathway, and defective myocyte regeneration. These mechanisms may trigger wasting through an increase in protein degradation and/or acceleration of apoptotic processes in skeletal muscle and may be accelerated by hemodialysis, leading to progression of vascular disease and wasting.
  
  
  CONCLUSIONS
  The new understanding holds promise for new treatments which can prevent/treat vascular diseases and wasting in CKD patients.
authors: Department of Internal Medicine, University of Genoa, Azienda Ospedaliera Universitaria San Martino, Genoa, Italy. gari@unige.it
authors: Giacomo
authors: G
authors: Garibotto
authors: Alice
authors: A
authors: Bonanni
authors: Daniela
authors: D
authors: Verzola
mesh_terms: D000596:Amino Acids / Q000378:metabolism*; D017209:Apoptosis; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000378:metabolism / Q000401:mortality; D008074:Lipoproteins / Q000378:metabolism; D009124:Muscle Proteins / Q000378:metabolism; D018482:Muscle, Skeletal / Q000378:metabolism; D011502:Protein-Energy Malnutrition / Q000209:etiology* / Q000378:metabolism; D011506:Proteins / Q000378:metabolism*; D006435:Renal Dialysis / Q000009:adverse effects*; D019282:Wasting Syndrome / Q000209:etiology* / Q000378:metabolism
chemical_list: D000596:Amino Acids; D008074:Lipoproteins; D009124:Muscle Proteins; D011506:Proteins