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Protein-Energy Wasting

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Nutrition in Kidney Disease

Part of the book series: Nutrition and Health ((NH))

Abstract

Among individuals with CKD stage 5D, who undergo maintenance dialysis treatment to survive, currently one out of every five people dies each year in the USA. This unacceptably high mortality rate has not changed substantially in recent years despite many advances in dialysis techniques and patient care [1]. Maintenance dialysis patients also have a high hospitalization rate and a low health-related quality of life. Cardiovascular diseases comprise the bulk of morbidity and mortality in dialysis patients. The dialysis-dependent CKD-5D population grows constantly and fast, almost surpassing over half a million in the USA, and continues to consume a disproportionately large component of the Medicare budget; hence, identifying factors that lead to poor dialysis outcome and their successful management is of outmost importance [1]. It was once believed that the traditional cardiovascular risk factors and/or conditions related to dialysis treatment and technique are the main causes of poor clinical outcome; however, randomized controlled trials have failed to show an improvement of mortality by lowering serum cholesterol [2] or increasing dialysis dose [3, 4]. Whereas frequent (such as daily in-center or nocturnal) hemodialysis may have better outcome, it is highly unlikely that this modality ever be offered to more than a small fraction of patients, whereas infrequent (e.g., twice weekly) hemodialysis is practiced more frequently in developing countries [5]. Evidence suggests that conditions other than the traditional cardiovascular risk factors be related to the enormous cardiovascular epidemic and high death rates in this population. Among the potential candidates for the poor clinical outcomes in maintenance dialysis patients, the protein-energy wasting (PEW) continues to be at the top of the list [6]. Observational studies have repeatedly and consistently shown a strong association between measures of nutritional status and survival in maintenance dialysis patients [7–9].

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Acknowledgment

Supported by grants from the National Institute of Diabetes Digestive and Kidney Diseases of the National Institutes of Health (K24-DK091419 and R01-DK078106).

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Authors and Affiliations

  1. Division of Nephrology and Hypertension, University of California Irvine Medical Center, 101 The City Drive South, City Tower, Suite 400-ZOT: 4088, Orange, CA, 92868-3217, USA

    Kamyar Kalantar-Zadeh M.D., M.P.H., Ph.D.

  2. School of Medicine, University of California Irvine, Irvine, CA, USA

    Kamyar Kalantar-Zadeh M.D., M.P.H., Ph.D.

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  1. Kamyar Kalantar-Zadeh M.D., M.P.H., Ph.D.
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Correspondence to Kamyar Kalantar-Zadeh M.D., M.P.H., Ph.D. .

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Editors and Affiliations

  1. Dept. Primary Care, University of Medicine & Dentistry, New Jersey, Stratford, New Jersey, USA

    Laura D. Byham-Gray

  2. Dept. Nutrition, Long Island University C.W. Post Campus, Brookville, New York, USA

    Jerrilynn D. Burrowes

  3. Div. Nephrology, Stanford University School of Medicine, Stanford, California, USA

    Glenn M. Chertow

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Kalantar-Zadeh, K. (2014). Protein-Energy Wasting. In: Byham-Gray, L., Burrowes, J., Chertow, G. (eds) Nutrition in Kidney Disease. Nutrition and Health. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-685-6_13

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  • DOI: https://doi.org/10.1007/978-1-62703-685-6_13

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  • Publisher Name: Humana Press, Totowa, NJ

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