title: Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis.
abstract: Protein-Energy Wasting (PEW) is the depletion of protein/energy stores observed in the most advanced stages of Chronic Kidney Disease (CKD). PEW is highly prevalent among patients on chronic dialysis, and is associated with adverse clinical outcomes, high morbidity/mortality rates and increased healthcare costs. This narrative review was aimed at exploring the pathophysiology of PEW in end-stage renal disease (ESRD) on hemodialysis. The main aspects of nutritional status evaluation, intervention and monitoring in this clinical setting were described, as well as the current approaches for the prevention and treatment of ESRD-related PEW.
  
  
  
  An exhaustive literature search was performed, in order to identify the relevant studies describing the epidemiology, pathogenesis, nutritional intervention and outcome of PEW in ESRD on hemodialysis.
  
  
  
  The pathogenesis of PEW is multifactorial. Loss of appetite, reduced intake of nutrients and altered lean body mass anabolism/catabolism play a key role. Nutritional approach to PEW should be based on a careful and periodic assessment of nutritional status and on timely dietary counseling. When protein and energy intakes are reduced, nutritional supplementation by means of specific oral formulations administered during the hemodialysis session may be the first-step intervention, and represents a valid nutritional approach to PEW prevention and treatment since it is easy, effective and safe. Omega-3 fatty acids and fibers, now included in commercially available preparations for renal patients, could lend relevant added value to macronutrient supplementation. When oral supplementation fails, intradialytic parenteral nutrition can be implemented in selected patients.
authors.affiliation: Acute and Chronic Renal Failure Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Sabatino
authors.affiliation: Acute and Chronic Renal Failure Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Regolisti
authors.affiliation: Dietetics Program, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia.
authors.forename: T
authors.initials: T
authors.lastname: Karupaiah
authors.affiliation: Dietetics Program, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia.
authors.forename: S
authors.initials: S
authors.lastname: Sahathevan
authors.affiliation: Dietetics Program, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia.
authors.forename: B K
authors.initials: BK
authors.lastname: Sadu Singh
authors.affiliation: Dietetics Program, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia.
authors.forename: B H
authors.initials: BH
authors.lastname: Khor
authors.affiliation: Department of Nutrition and Translational Research in Metabolism, Maastricht University, Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Salhab
authors.affiliation: Department of Natural Sciences in Public Health, Zayed University, Dubai, United Arab Emirates.
authors.forename: M
authors.initials: M
authors.lastname: Karavetian
authors.affiliation: Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Cupisti
authors.affiliation: Acute and Chronic Renal Failure Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy. Electronic address: enrico.fiaccadori@unipr.it.
authors.forename: E
authors.initials: E
authors.lastname: Fiaccadori
mesh_terms: D001823:Body Composition; D015992:Body Mass Index; D015897:Comorbidity; D016208:Databases, Factual; D004043:Dietary Fiber / Q000008:administration & dosage; D019587:Dietary Supplements; D015444:Exercise; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy*; D008019:Life Style; D015596:Nutrition Assessment; D009752:Nutritional Status; D018529:Nutritional Support; D017410:Practice Guidelines as Topic; D011502:Protein-Energy Malnutrition / Q000453:epidemiology* / Q000628:therapy*; D006435:Renal Dialysis / Q000009:adverse effects; D019282:Wasting Syndrome / Q000453:epidemiology* / Q000628:therapy*
chemical_list: D004043:Dietary Fiber; D015525:Fatty Acids, Omega-3
keywords: Chronic kidney disease; Hemodialysis; Nutrients; Nutritional status; Protein-energy wasting