title: [Protein-energy wasting and nutritional supplementation in chronic hemodialysis].
abstract: Protein Energy Wasting (PEW) is a pathological condition characterized by a progressive reduction of protein and energy stores. PEW has a high prevalence among patients with CKD/ESRD (Chronic Kidney Disease/End Stage Renal Disease) and is closely associated with adverse clinical outcomes and increased rate of hospitalization, complications and mortality. The multifactorial pathogenesis of PEW is complex. A key role is played both by the reduced intake of nutrients and the condition of hypercatabolism/reduced anabolism typical of renal patients. The approach to prevent or treat PEW has several milestones such as reduction of potential risk factors, improvement in lifestyle and correction of any factor related to dialysis. It also needs a periodic assessment of nutritional status by using biochemical markers, body and muscle mass variables, nutritional scores and instrumental methods, aiming for an early diagnosis. In case of reduced protein and energy intake, the administration of nutrients during dialysis, or the use of oral supplements specific for renal patients are the first nutritional interventions recommended. In fact, oral nutritional supplementation represents the most effective nutritional approach to PEW prevention and treatment. It is simple and safe and it has a positive impact on quality of life and survival of haemodialysis patients. In the case of failure of oral supplementation, nutritional support should be enhanced by using intradialytic parenteral nutrition (IDPN). If the patient has difficulty in swallowing or IDPN is insufficient, total enteral nutrition should be considered.
authors.forename: Laura
authors.initials: L
authors.lastname: Bozzoli
authors.forename: Alice
authors.initials: A
authors.lastname: Sabatino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Regolisti
authors.forename: Santo
authors.initials: S
authors.lastname: Morabito
authors.forename: Carlo
authors.initials: C
authors.lastname: Donadio
authors.forename: Adamasco
authors.initials: A
authors.lastname: Cupisti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Piotti
authors.forename: Enrico
authors.initials: E
authors.lastname: Fiaccadori
mesh_terms: D019587:Dietary Supplements; D041981:Gastrointestinal Tract / Q000503:physiopathology; D006801:Humans; D009752:Nutritional Status; D017410:Practice Guidelines as Topic; D011502:Protein-Energy Malnutrition / Q000175:diagnosis / Q000178:diet therapy* / Q000209:etiology / Q000517:prevention & control; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology / Q000628:therapy