title: Optimal nutrition in hemodialysis patients.
abstract: Protein-energy wasting (PEW) is highly prevalent in patients undergoing maintenance hemodialysis (MHD). It is important to note that there is a robust association between the extent of PEW and the risk of hospitalization and death in these patients, regardless of the nutritional marker used. The multiple etiologies of PEW in advanced kidney disease are still being elucidated. Apart from the multiple mechanisms that might lead to PEW, it appears that the common pathway for all of the derangements is related to exaggerated protein degradation along with decreased protein synthesis. The hemodialysis procedure per se is an important contributor to this process. Metabolic and hormonal derangements such as acidosis, inflammation, and resistance to anabolic properties of insulin resistance and growth hormone are all implicated for the development of PEW in MHD patients. Appropriate management of MHD patients at risk for PEW requires a comprehensive combination of strategies to diminish protein and energy depletion and to institute therapies that will avoid further losses. The mainstay of nutritional treatment in MHD patients is provision of an adequate amount of protein and energy, using oral supplementation as needed. Intradialytic parenteral nutrition should be attempted in patients who cannot efficiently use the gastrointestinal tract. Other anabolic strategies such as exercise, anabolic hormones, anti-inflammatory therapies, and appetite stimulants can be considered as complementary therapies in suitable patients.
authors: Department of Medicine, Division of Nephrology, Vanderbilt University School of Medicine, Nashville, TN 37232-2372, USA. alp.ikizler@vanderbilt.edu
authors: T Alp
authors: TA
authors: Ikizler
mesh_terms: D019167:Appetite Stimulants / Q000627:therapeutic use; D019587:Dietary Supplements; D005081:Exercise Therapy; D013006:Growth Hormone / Q000627:therapeutic use; D006801:Humans; D007249:Inflammation / Q000150:complications; D007333:Insulin Resistance; D009752:Nutritional Status; D010288:Parenteral Nutrition; D011502:Protein-Energy Malnutrition / Q000453:epidemiology* / Q000209:etiology; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000378:metabolism / Q000628:therapy*; D019282:Wasting Syndrome / Q000453:epidemiology* / Q000209:etiology
chemical_list: D019167:Appetite Stimulants; D013006:Growth Hormone