title: Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism.
abstract: Protein energy wasting (PEW) is common in patients with chronic kidney disease (CKD) and is associated with adverse clinical outcomes, especially in individuals receiving maintenance dialysis therapy. A multitude of factors can affect the nutritional and metabolic status of CKD patients requiring a combination of therapeutic maneuvers to prevent or reverse protein and energy depletion. These include optimizing dietary nutrient intake, appropriate treatment of metabolic disturbances such as metabolic acidosis, systemic inflammation, and hormonal deficiencies, and prescribing optimized dialytic regimens. In patients where oral dietary intake from regular meals cannot maintain adequate nutritional status, nutritional supplementation, administered orally, enterally, or parenterally, is shown to be effective in replenishing protein and energy stores. In clinical practice, the advantages of oral nutritional supplements include proven efficacy, safety, and compliance. Anabolic strategies such as anabolic steroids, growth hormone, and exercise, in combination with nutritional supplementation or alone, have been shown to improve protein stores and represent potential additional approaches for the treatment of PEW. Appetite stimulants, anti-inflammatory interventions, and newer anabolic agents are emerging as novel therapies. While numerous epidemiological data suggest that an improvement in biomarkers of nutritional status is associated with improved survival, there are no large randomized clinical trials that have tested the effectiveness of nutritional interventions on mortality and morbidity.
authors.affiliation: Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: T Alp
authors.initials: TA
authors.lastname: Ikizler
authors.forename: Noel J
authors.initials: NJ
authors.lastname: Cano
authors.forename: Harold
authors.initials: H
authors.lastname: Franch
authors.forename: Denis
authors.initials: D
authors.lastname: Fouque
authors.forename: Jonathan
authors.initials: J
authors.lastname: Himmelfarb
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
authors.forename: Martin K
authors.initials: MK
authors.lastname: Kuhlmann
authors.forename: Peter
authors.initials: P
authors.lastname: Stenvinkel
authors.forename: Pieter
authors.initials: P
authors.lastname: TerWee
authors.forename: Daniel
authors.initials: D
authors.lastname: Teta
authors.forename: Angela Yee-Moon
authors.initials: AY
authors.lastname: Wang
authors.forename: Christoph
authors.initials: C
authors.lastname: Wanner
mesh_terms: D045930:Anabolic Agents / Q000627:therapeutic use; D019167:Appetite Stimulants / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015897:Comorbidity; D019587:Dietary Supplements; D004734:Energy Metabolism / Q000187:drug effects; D015444:Exercise; D006801:Humans; D009752:Nutritional Status; D018529:Nutritional Support; D011502:Protein-Energy Malnutrition / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy*; D006435:Renal Dialysis / Q000009:adverse effects; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D045930:Anabolic Agents; D019167:Appetite Stimulants