Abstract
Elevated protein catabolism and protein malnutrition are common in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The underlying etiology includes, but is not limited to, metabolic acidosis intestinal dysbiosis; systemic inflammation with activation of complements, endothelin-1 and renin-angiotensin-aldosterone (RAAS) axis; anabolic hormone resistance; energy expenditure elevation; and uremic toxin accumulation. All of these derangements can further worsen kidney function, leading to poor patient outcomes. Many of these CKD-related derangements can be prevented and substantially reversed, representing an area of great potential to improve CKD and ESRD care. This review integrates known information and recent advances in the area of protein nutrition and malnutrition in CKD and ESRD. Management recommendations are summarized. Thorough understanding the pathogenesis and etiology of protein malnutrition in CKD and ESRD patients will undoubtedly facilitate the design and development of more effective strategies to optimize protein nutrition and improve outcomes.
Highlights
Chronic kidney disease (CKD) has become a worldwide epidemic with an occurrence rate in the population of approximately 5%–15% [1]
This review presents updated information, intergrading previous knowledge with a specific focus on the unique aspect of protein balance and nutrition in CKD and end-stage renal disease (ESRD)
Metabolic acidosis plays an important role in the accelerated protein catabolism, negative nitrogen balance and loss of lean body mass in CKD and ESRD [18,19]
Summary
Chronic kidney disease (CKD) has become a worldwide epidemic with an occurrence rate in the population of approximately 5%–15% [1]. Prevalence of end-stage renal disease (ESRD) population relying on dialysis is on the rise [2]. Suboptimal nutritional intake is common in the population of CKD and ESRD and poses a direct risk for protein malnutrition [3,4]. Suboptimal nutritional status has been related to multiple alterations including metabolic acidosis, bowel flora alteration and hormonal dysregulation, all of which could promote kidney disease progression and increase morbidity and mortality. This review presents updated information, intergrading previous knowledge with a specific focus on the unique aspect of protein balance and nutrition in CKD and ESRD.
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