title: Latest consensus and update on protein-energy wasting in chronic kidney disease.
abstract: OBJECTIVE
  Protein-energy wasting (PEW) is a state of metabolic and nutritional derangements in chronic disease states including chronic kidney disease (CKD). Cumulative evidence suggests that PEW, muscle wasting and cachexia are common and strongly associated with mortality in CKD, which is reviewed here.
  
  
  RESULTS
  The malnutrition-inflammation score (KALANTAR Score) is among the comprehensive and outcome-predicting nutritional scoring tools. The association of obesity with poor outcomes is attenuated across more advanced CKD stages and eventually reverses in the form of obesity paradox. Frailty is closely associated with PEW, muscle wasting and cachexia. Muscle loss shows stronger associations with unfavorable outcomes than fat loss. Adequate energy supplementation combined with low-protein diet for the management of CKD may prevent the development of PEW and can improve adherence to low-protein diet, but dietary protein requirement may increase with aging and is higher under dialysis therapy. Phosphorus burden may lead to poor outcomes. The target serum bicarbonate concentration is normal range and at least 23 mEq/l for nondialysis-dependent and dialysis-dependent CKD patients, respectively. A benefit of exercise is suggested but not yet conclusively proven.
  
  
  CONCLUSIONS
  Prevention and treatment of PEW should involve individualized and integrated approaches to modulate identified risk factors and contributing comorbidities.
authors: aDivision of Nephrology and Hypertension bHarold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California cUniversity of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors: Yoshitsugu
authors: Y
authors: Obi
authors: Hemn
authors: H
authors: Qader
authors: Csaba P
authors: CP
authors: Kovesdy
authors: Kamyar
authors: K
authors: Kalantar-Zadeh
mesh_terms: D000375:Aging; D002100:Cachexia / Q000209:etiology / Q000517:prevention & control*; D032921:Consensus; D004032:Diet; D004044:Dietary Proteins / Q000008:administration & dosage; D006801:Humans; D018482:Muscle, Skeletal / Q000473:pathology*; D009133:Muscular Atrophy / Q000209:etiology / Q000517:prevention & control*; D009751:Nutritional Requirements; D011502:Protein-Energy Malnutrition / Q000209:etiology / Q000517:prevention & control*; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D019282:Wasting Syndrome / Q000209:etiology / Q000517:prevention & control*
chemical_list: D004044:Dietary Proteins