title: [Croatian guidelines for screening, prevention and treatment of protein-energy wasting in chronic kidney disease patients].
abstract: There is a high incidence of cardiovascular morbidity and mortality among patients with chronic kidney disease (CKD) and malnutrition is a powerful predictor of cardiovascular morbidity and mortality in this population of patients. A multitude of factors related to CKD and renal replacement therapy can affect the nutritional status of CKD patients and lead to the development of malnutrition. In patients with CKD, protein energy wasting (PEW) is a condition that is distinct from undernutrition and is associated with inflammation, increased resting energy expenditure, low serum levels of albumin and prealbumin, sarcopenia, weight loss and poor clinical outcomes. Nutritional and metabolic derangements are implicated for the development of PEW in CKD and leading to the development of chronic catabolic state with muscle and fat loss. Prevention is the best way in treating PEW. Appropriate management of CKD 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 nutritional counselling and provision of an adequate amount of protein and energy, using oral supplementation as needed. Intradialytic parenteral nutrition and total enteral nutrition should be attempted in CKD patients who cannot use the gastrointestinal tract efficiently. Other strategies such as anemia correction, treatment of secondary hyperparathyroidism and acidosis, delivering adequate dialysis dose can be considered as complementary therapies in CKD patients. Multidisciplinary work of nephrologists, gastroenterologist and dietician is needed to achieve best therapeutic goals in treating CKD patients with PEW.
authors.forename: Nikolina
authors.initials: N
authors.lastname: Bašić-Jukić
authors.forename: Josipa
authors.initials: J
authors.lastname: Radić
authors.forename: Dragan
authors.initials: D
authors.lastname: Klarić
authors.forename: Marko
authors.initials: M
authors.lastname: Jakić
authors.forename: Božidar
authors.initials: B
authors.lastname: Vujičić
authors.forename: Marijana
authors.initials: M
authors.lastname: Gulin
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Krznarić
authors.forename: Eva
authors.initials: E
authors.lastname: Pavić
authors.forename: Petar
authors.initials: P
authors.lastname: Kes
authors.forename: Bojan
authors.initials: B
authors.lastname: Jelaković
authors.forename: Sanjin
authors.initials: S
authors.lastname: Rački
mesh_terms: D017523:Croatia; D004750:Enteral Nutrition; D006801:Humans; D009752:Nutritional Status; D010288:Parenteral Nutrition; D011502:Protein-Energy Malnutrition / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000628:therapy