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ESRD AND protein energy wasting

Magdalena Jankowska, Gabriela Cobo, Bengt Lindholm, Peter Stenvinkel
Inflammation is normally a protective and physiological response to harmful stimuli, but typically becomes an uncontrolled, maladaptive, and persistent process in patients with end-stage renal disease (ESRD). Through a deleterious cascade of poorly controlled reactions mediated by biologically active molecules (also called middle molecular weight uremia retention solutes), inflammation associates with a range of complications including cardiovascular disease and protein-energy wasting (PEW). Persistent inflammation, which is central to the conceptual etiological models of PEW and the malnutrition, inflammation, and atherosclerosis syndrome, induces and reignites processes leading to PEW in a number of ways including stimulation of both direct and indirect mechanisms of muscle proteolysis...
2017: Contributions to Nephrology
Lu Dai, Edyta Golembiewska, Bengt Lindholm, Peter Stenvinkel
Despite marked improvements in renal replacement therapy during the last 30 years, the age-adjusted mortality rate in end-stage renal disease (ESRD) patients is still unacceptably high and comparable to that of many malignancies. Cardiovascular disease (CVD) remains the major cause of morbidity and mortality in ESRD patients. However, traditional risk factors can only partially explain the high premature cardiovascular burden in this population. Nontraditional risk factors, including persistent low-grade inflammation, are critical in the pathogenesis of atherosclerosis, vascular calcification, and other causes of CVD and may also contribute to protein-energy wasting and other complications in chronic kidney disease (CKD) patients...
2017: Contributions to Nephrology
Jung-Ho Shin, Chae Rim Kim, Ki Hyun Park, Jin Ho Hwang, Su Hyun Kim
OBJECTIVE: Protein-energy wasting is common in patients on hemodialysis and is an independent risk factor for adverse events. The aim of this study was to retrospectively investigate whether phase angle (PA), known as a nutritional marker, can predict various clinical outcomes in patients with end-stage renal disease (ESRD) who are receiving hemodialysis. METHODS: Using bioelectrical impedance analysis (BIA), PA was obtained every 6 mo, and patients were divided into two groups according to baseline PA: group A included patients with PA ≥4...
September 2017: Nutrition
Shin Sook Kang, Jai Won Chang, Yongsoon Park
Protein-energy wasting (PEW) is associated with mortality in patients with end-stage renal disease (ESRD) on maintenance hemodialysis. The correct diagnosis of PEW is extremely important in order to predict clinical outcomes. However, it is unclear which parameters should be used to diagnose PEW. Therefore, this retrospective observational study investigated the relationship between mortality and nutritional parameters in ESRD patients on maintenance hemodialysis. A total of 144 patients were enrolled. Nutritional parameters, including body mass index, serum albumin, dietary intake, normalized protein catabolic rate (nPCR), and malnutrition inflammation score (MIS), were measured at baseline...
April 18, 2017: Nutrients
Garland A Campbell, James T Patrie, Bruce D Gaylinn, Michael O Thorner, Warren K Bolton
Background: . Protein-energy wasting (PEW) in end-stage renal disease (ESRD) patients is associated with increased morbidity and mortality, but options for treatment are limited. Growth hormone (GH) increases insulin-like growth factor 1 (IGF-1), with improved nutritional parameters, but must be given subcutaneously and does not provide normal GH secretion patterns. MK-0677, an oral ghrelin receptor agonist (GRA), maintains normal GH secretion and increases lean body mass in normal subjects; it has not been studied in dialysis patients, an essential step in assessing efficacy and safety prior to clinical trials...
March 3, 2017: Nephrology, Dialysis, Transplantation
Zhimin Chen, Abdul Rashid Qureshi, Paolo Parini, Eva Hurt-Camejo, Jonaz Ripsweden, Torkel B Brismar, Peter Barany, Armand M Jaminon, Leon J Schurgers, Olof Heimbürger, Bengt Lindholm, Peter Stenvinkel
BACKGROUND: In end-stage renal disease (ESRD), coronary artery calcification (CAC) and inflammation contribute to cardiovascular disease (CVD). Statins do not improve survival in patients with ESRD, and their effect on vascular calcification is unclear. We explored associations between CAC, inflammatory biomarkers, statins and mortality in ESRD. MATERIALS AND METHODS: In 240 patients with ESRD (63% males; median age 56 years) from cohorts including 86 recipients of living donor kidney transplant (LD-Rtx), 96 incident dialysis patients and 58 prevalent peritoneal dialysis patients, associations of CAC score (Agatston Units, AUs), interleukin-6 (IL-6) with high-sensitivity C-reactive protein (hsCRP), tumour necrosis factor (TNF), use of statins and all-cause mortality were analysed...
February 2017: European Journal of Clinical Investigation
A Sabatino, G Regolisti, T Karupaiah, S Sahathevan, B K Sadu Singh, B H Khor, N Salhab, M Karavetian, A Cupisti, E Fiaccadori
BACKGROUND & AIMS: 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...
June 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Erik Nilsson, Juan Jesus Carrero, Olof Heimbürger, Olof Hellberg, Bengt Lindholm, Peter Stenvinkel
BACKGROUND: Protein-energy wasting (PEW) is highly prevalent in haemodialysis (HD) patients and associated with increased mortality and cardiovascular disease (CVD). Insulin-like growth factor 1 (IGF-1) correlates to markers of PEW and CVD. Disturbances in the growth hormone axis in end-stage renal disease (ESRD) could have an impact on survival through increased PEW and CVD. METHODS: A cohort of 265 incident HD patients (median age 68 years, 59% males) was followed for 3 years...
February 2016: Clinical Kidney Journal
Paulo Roberto Santos, Diego Levi Silveira Monteiro, Paulo Henrique Alexandre de Paula, Vicente Lopes Monte Neto, Maria Leilah Ponte Monte Coelho, Cecília Costa Arcanjo, Fernando Lopes Ponte Neto, Marcela Lopes Lima, Natacha Campos Arriaga, Lília Mendes Vieira Coêlho, Wallena Cavalcante Brito
BACKGROUND: Dyspepsia is highly prevalent and easily assessed in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) and is not a traditional predictor of malnutrition. We sought to establish an association between dyspeptic symptoms and nutritional status in ESRD patients undergoing maintenance HD. METHODS: We studied 106 ESRD patients on HD. Dyspepsia was assessed through the Porto Alegre Dyspeptic Symptoms Questionnaire (PADYQ). Scores equal to or greater than 6 classified patients as dyspeptic...
2015: International Journal for Vitamin and Nutrition Research. Journal International de Vitaminologie et de Nutrition
Laura Bozzoli, Alice Sabatino, Giuseppe Regolisti, Santo Morabito, Carlo Donadio, Adamasco Cupisti, Giovanni Piotti, Enrico Fiaccadori
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...
September 2015: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Bulent Yardimci, Abdullah Sumnu, Ibrahim Kaya, Meltem Gursu, Zeki Aydin, Serhat Karadag, Sami Uzun, Emel Tatli, Savas Ozturk, Ercan Cetinus, Rumeyza Kazancioglu
BACKGROUNDS & OBJECTIVE: End-stage renal disease (ESRD) frequently causes Protein Energy Wasting (PEW), which is an important morbidity and mortality factor. Although it is difficult to assess PEW with a reliable method, there are various methods such as Handgrip strength test (HST), serum albumin, cholesterol, etc. HST is a simple and reliable antropometric method which is used for nutritional status and body muscle strength. This study aims to assess the relationship between HST and biochemical markers in evolution of nutritional status of ESRD patients...
July 2015: Pakistan Journal of Medical Sciences Quarterly
Charles Chazot, Ken Farrington, Ionut Nistor, Wim Van Biesen, Hanneke Joosten, Daniel Teta, Dimitrie Siriopol, Adrian Covic
In the last decade, an increasing number of patients over 75 years of age are starting renal replacement therapy. Frailty is highly prevalent in elderly patients with end-stage renal disease (ESRD) in the context of the increased prevalence of some ESRD-associated conditions: protein-energy wasting, inflammation, anaemia, acidosis or hormonal disturbances. There are currently no hard data to support guidance on the optimal duration of dialysis for frail/elderly ESRD patients. The current debate is not about starting dialysis or managing conservatory frail ESRD patients, but whether a more intensive regimen once dialysis is initiated (for whatever reasons and circumstances) would improve patients' outcome...
November 2015: International Urology and Nephrology
Samar Abd ElHafeez, Giovanni Tripepi, Francesca Mallamaci, Carmine Zoccali
BACKGROUND: Plasma aldosterone is markedly increased in end stage renal disease (ESRD). The relationship between aldosterone, all-cause and cardiovascular (CV) mortality in observational studies performed so far is controversial. DESIGN: We investigated the relationship between aldosterone, mortality and CV events in multivariate analyses including nutrition status, inflammation, LV function and fluids volume biomarkers in 278 ESRD patients without heart failure at baseline...
October 2015: European Journal of Clinical Investigation
Paolo Fanti, Daniela Giustarini, Ranieri Rossi, Sue E D Cunningham, Franco Folli, Khaled Khazim, John Cornell, Elena Matteucci, Shweta Bansal
OBJECTIVES: Oxidative stress contributes to the pathogenesis of protein-energy wasting in maintenance hemodialysis (MHD) patients, but knowledge of specific effectors and mechanisms remains fragmented. Aim of the study was to define whether and how food intake is involved in the causal relationship between oxidative stress and protein-energy wasting. METHODS: Seventy-one adult MHD patients and 24 healthy subjects (control) were studied cross-sectionally with analyses of diet record and of oxidative stress, as measured by a battery of plasma thiols including the protein sulfhydryl (-SH) group (PSH) levels (a marker of total protein-SH reducing capacity), the protein thiolation index (PTI, the ratio between disulfide, i...
November 2015: Journal of Renal Nutrition
Csaba P Kovesdy
We are in the midst of an epidemic of overnutrition which has resulted in a widespread increase in obesity rates in modern societies. Yet for patients suffering from serious chronic illnesses such as end stage renal disease (ESRD), malnutrition (encompassing both inadequate quantity and quality of nutrient intake) represents a far more significant danger. Protein-energy wasting has been identified as one of the strongest risk factor for adverse outcomes in ESRD patients, and modeling studies have suggested that improving nutrition could result in substantial lowering of mortality rates and other benefits...
January 2016: Seminars in Dialysis
Oleh M Akchurin, Frederick Kaskel
BACKGROUND: Despite recent advances in chronic kidney disease (CKD) and end-stage renal disease (ESRD) management, morbidity and mortality in this population remain exceptionally high. Persistent, low-grade inflammation has been recognized as an important component of CKD, playing a unique role in its pathophysiology and being accountable in part for cardiovascular and all-cause mortality, as well as contributing to the development of protein-energy wasting. SUMMARY: The variety of factors contribute to chronic inflammatory status in CKD, including increased production and decreased clearance of pro-inflammatory cytokines, oxidative stress and acidosis, chronic and recurrent infections, including those related to dialysis access, altered metabolism of adipose tissue, and intestinal dysbiosis...
2015: Blood Purification
Tetsuo Shoji, Masanori Emoto, Yoshiki Nishizawa, Masaaki Inaba
Protein-energy wasting plays an important role in the increased risk of mortality from cardiovascular disease in people with end-stage renal disease. Because protein-energy wasting is a condition of imbalance between anabolism and catabolism, endocrine and metabolic alterations that regulate such balance should be the possible target of intervention. Subjects with end-stage renal disease exhibit various changes in thyroid function, gonadal hormones, adrenal androgen, glucose metabolism, dyslipidemia, fatty acid composition, cholesterol absorption, and vitamin D...
March 2015: Journal of Renal Nutrition
Somchai Yongsiri, Jiranuch Thammakumpee, Suriya Prongnamchai, Pakaphan Dinchuthai, Rachaneeporn Chueansuwan, Siriporn Tangjaturonrasme, Pechngam Chaivanit
BACKGROUND: Protein-energy wasting is a significant problem in End stage renal disease (ESRD) patients. Furthermore, it compromises the patient's Quality of life (QOL). Multifrequency Bioimpedance Spectroscopy (BIS) is a validated method to assess body composition in dialysis patients. There has been no data on the relationship between body composition and QOL in ESRD patients who were treated with different modalities. OBJECTIVE: To explore the association between body composition as assessed by BIS and QOL in ESRD patients who received different treatment modalities...
March 2014: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Adamasco Cupisti, Claudia D'Alessandro, Giordano Fumagalli, Valentina Vigo, Mario Meola, Caterina Cianchi, Maria F Egidi
Chronic kidney disease (CKD) patients are at risk for protein-energy wasting, abnormal body composition and impaired physical capacity. These complications lead to increased risk of hospitalization, morbidity and mortality.In CKD patient as well as in healthy people, there is a close association between nutrition and physical activity. Namely, inadequate nutrient (energy) intake impairs physical performance thus favoring a sedentary lifestyle: this further contributes to loss of muscle strength and mass, which limit the quality of life and rehabilitation of CKD patients...
2014: Kidney & Blood Pressure Research
Caroline C Pelletier, Laetitia Koppe, Pascaline M Alix, Emilie Kalbacher, Marine L Croze, Aoumeur Hadj-Aissa, Denis Fouque, Fitsum Guebre-Egziabher, Christophe O Soulage
Zinc-α2-glycoprotein (ZAG), a potent cachectic factor, is increased in patients undergoing maintenance dialysis. However, there is no data for patients before initiation of renal replacement therapy. The purpose of the present study was to assess the relationship between plasma ZAG concentration and renal function in patients with a large range of glomerular filtration rate (GFR). Plasma ZAG concentration and its relationship to GFR were investigated in 71 patients with a chronic kidney disease (CKD) stage 1 to 5, 17 chronic hemodialysis (HD), 8 peritoneal dialysis (PD) and 18 non-CKD patients...
2014: PloS One
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