Ungewollter Gewichtsverlust bei chronischer Nierenkrankheit

Abstract

If the causes of unintended weight loss are already diverse in pre-dialysis patients, at the stage of dialysis requirement avariety of other causes are added. Both stages share atrend towards loss of appetite and nausea, whereby uremic toxins certainly do not represent the only cause. In addition, both stages involve increased catabolism and therefore ahigher calorie requirement. In the dialysis stage, protein loss (more in peritoneal dialysis than in hemodialysis) and the sometimes extensive dietary restrictions (low potassium, low phosphate, fluid restriction) are added. The problem of malnutrition, especially in dialysis patients, has been increasingly recognized in recent years, and there is atrend towards improvement. Initially, the causes of weight loss were subsumed under the terms protein energy wasting (PEW), which emphasized the protein loss in dialysis, and malnutrition-inflammation-atherosclerosis (MIA) syndrome, which highlighted chronic inflammation in dialysis patients; however, avariety of other factors contribute to weight loss, which are better described by the term chronic disease-related malnutrition (C-DRM). Weight loss is the most significant factor in recognizing malnutrition, as pre-existing obesity (especially typeII diabetes mellitus) often makes the recognition more difficult. In the future, the increasing use of glucagon-like peptide 1 (GLP-1) agonists for weight loss could also lead to weight loss being perceived as intentional rather than distinguishing between intentional fat loss and unintentional loss of muscle mass.