Abstract
Multi-factors, such as anorexia, activation of renin-angiotensin system, inflammation, and metabolic acidosis, contribute to malnutrition in chronic kidney disease (CKD) patients. Most of these factors, contributing to the progression of malnutrition, worsen as CKD progresses. Protein restriction, used as a treatment for CKD, can reduce the risk of CKD progression, but may worsen the sarcopenia, a syndrome characterized by a progressive and systemic loss of muscle mass and strength. The concomitant rate of sarcopenia is higher in CKD patients than in the general population. Sarcopenia is also associated with mortality risk in CKD patients. Thus, it is important to determine whether protein restriction should be continued or loosened in CKD patients with sarcopenia. We may prioritize protein restriction in CKD patients with a high risk of end-stage kidney disease (ESKD), classified to stage G4 to G5, but may loosen protein restriction in ESKD-low risk CKD stage G3 patients with proteinuria <0.5 g/day, and rate of eGFR decline <3.0 mL/min/1.73 m2/year. However, the effect of increasing protein intake alone without exercise therapy may be limited in CKD patients with sarcopenia. The combination of exercise therapy and increased protein intake is effective in improving muscle mass and strength in CKD patients with sarcopenia. In the case of loosening protein restriction, it is safe to avoid protein intake of more than 1.5 g/kgBW/day. In CKD patients with high risk in ESKD, 0.8 g/kgBW/day may be a critical point of protein intake.
Highlights
As the other section in this issue describes the pathogenesis of malnutrition in dialysis patients, this paper will focus on the optimal protein intake and exercise on pre-dialysis chronic kidney disease (CKD) patients with sarcopenia
The supplementation of vitamin D and leucine-enriched diet in elderly patients with sarcopenia for 13 weeks improved the chair-rise test and limb muscle mass compared with controls, but there was no difference in grip strength or short physical performance battery (SPPB) [49]
Reflecting the aging of CKD patients in recent years, malnutrition and sarcopenia have been the focus of much attention
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Dietary protein intake gradually decreases during the progression of kidney injury, even in the CKD patients with minimal dietary intervention [5] This trend was observed for urinary creatinine excretion, a marker of muscle mass [5]. D is associated with muscle intake and exercise on pre-dialysis CKD patients with sarcopenia. On the other hand, increased protein intake may accelerate the progression of CKD Considering these two opposing effects, it is important to consider the appropriate protein intake for CKD patients with sarcopenia. As the other section in this issue describes the pathogenesis of malnutrition in dialysis patients, this paper will focus on the optimal protein intake and exercise on pre-dialysis CKD patients with sarcopenia
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