title: [How to prevent protein-energy wasting in patients with chronic kidney disease--position statement of the Croatian Society of Nephrology, Dialysis and Transplantation].
abstract: Protein-energy wasting (PEW) is a frequent problem in patients with end-stage renal disease, which is associated with adverse outcome. Risk factors for development of PEW in dialysis patients include anorexia, limitations in food intake due to problems with mineral metabolism (hyperphosphatemia, hyperkalemia). Prevention of PEW in dialysis population demands different therapeutic measures to correct abnormalities and to prevent loss of energy and proteins. Therapeutic approach should be individualized based on the specific problems of each patient in order to correct metabolic problems and to optimize food intake. In patients with inability to maintain nutritional status with standard oral feeding, other measures which include oral nutrition supplements and intradialytic parenteral feeding should be applied. Anabolic steroids, growth hormone and adequate oral nutritional supplements, together with physical activity may prevent further catabolism and correct abnormalities. Appetite stimulators, antiinflammatory interventions and anabolic drugs seem promising; however, their efficacy should be investigated in future clinical trials.
authors.forename: Nikolina
authors.initials: N
authors.lastname: Bašić-Jukić
authors.forename: Sanjin
authors.initials: S
authors.lastname: Rački
authors.forename: Petar
authors.initials: P
authors.lastname: Kes
authors.forename: Dragan
authors.initials: D
authors.lastname: Ljutić
authors.forename: Bozidar
authors.initials: B
authors.lastname: Vujičić
authors.forename: Vesna
authors.initials: V
authors.lastname: Lovčić
authors.forename: Lidija
authors.initials: L
authors.lastname: Orlić
authors.forename: Ingrid
authors.initials: I
authors.lastname: Prkačin
authors.forename: Josipa
authors.initials: J
authors.lastname: Radić
authors.forename: Marko
authors.initials: M
authors.lastname: Jakić
authors.forename: Dragan
authors.initials: D
authors.lastname: Klarić
authors.forename: Marijana
authors.initials: M
authors.lastname: Gulin
mesh_terms: D045930:Anabolic Agents / Q000627:therapeutic use*; D019167:Appetite Stimulants / Q000627:therapeutic use*; D017523:Croatia; D019587:Dietary Supplements; D004734:Energy Metabolism / Q000187:drug effects; D019317:Evidence-Based Medicine; D006801:Humans; D009398:Nephrology / Q000592:standards*; D009752:Nutritional Status; D018529:Nutritional Support / Q000592:standards*; D011502:Protein-Energy Malnutrition / Q000209:etiology / Q000517:prevention & control*; D011785:Quality Assurance, Health Care / Q000592:standards; D006435:Renal Dialysis / Q000009:adverse effects; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy*
chemical_list: D045930:Anabolic Agents; D019167:Appetite Stimulants