Protein–Energy Wasting and Nutritional Interventions in Chronic Kidney Disease

Abstract

Protein–energy wasting (PEW) is a common comorbid condition in patients with chronic kidney disease (CKD), especially in ones with end-stage renal disease (ESRD) and on maintenance dialysis. PEW in CKD patients is associated with increased rates of hospitalization and death. The unique aspects of CKD confound reliable screening for PEW and assessment of nutritional status, complicating management of this comorbid condition. Several measures can be applied to prevent development of PEW in CKD by targeting the etiologic factors such as appropriate dietary nutrient intake, avoiding catabolic effects of renal replacement therapy, and treating systemic inflammation, metabolic acidosis, and hormonal derangements. In patients where preventive measures and oral dietary intake from regular meals cannot maintain adequate nutritional status, nutritional supplementation, administered orally, enterally, or parenterally, is shown to be effective in replenishing protein and energy stores. The advantages of oral nutritional supplements include proven efficacy, safety, and compliance. Anabolic steroids and exercise, in combination with nutritional supplementation or alone, have been shown to improve protein stores and represent potential additional approaches for the treatment of PEW. Appetite stimulants, anti-inflammatory interventions, and newer anabolic agents can be used as adjunctive therapies where indicated.