Protein-energy malnutrition in chronic kidney disease

DOI: https://doi.org/10.29296/25877305-2021-01-06
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1
Year: 
2021

T. Zueva, Candidate of Medical Sciences; S. Urazlina; Professor T. Zhdanova, MD Ural State
Medical University, Yekaterinburg

Chronic kidney disease (CKD) creates a pathological environment with metabolic disorders that affect nutrient intake, metabolism, and energy expenditure, leading to malnutrition and increasing the risk of morbidity and mortality. Successful management of protein-energy malnutrition (PEM) in patients with CKD requires a comprehensive approach to assessment and therapeutic intervention. This needs a deep understanding of the complex mechanisms involved in the development of protein energy depletion and malnutrition in CKD. This literature review deals with the topical issues of malnutrition in CKD: epidemiology, pathophysiology, diagnostic methods, outcomes, and treatment principles.
Keywords: 
nephrology
protein-energy malnutrition
chronic kidney disease
malnutrition
dialysis

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References: 
  1. Amreeva Z.K. Narushenie nutritsionnogo statusa u patsientov s hronicheskoj bolezn'ju pochek. Vestnik Kazahskogo Natsional'nogo meditsinskogo universiteta. 2018; 1: 208–11 [Amreyeva Z.K. Nutritional status disorders in patients with chronic kidney disease. Vestnik KazNMU. 2018; 1: 208–11 (in Russ.)].
  2. Stenvinkel P., Heimburger O., Lindholm B. et al. Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrol Dial Transplant. 2000; 15 (7): 953–60. DOI: 10.1093/ndt/15.7.953
  3. Mihajlova L.V., Gorenshtejn T.A., Vil'ms A.L. i dr. Pokazateli kachestva zhizni u bol'nyh s terminal'noj stadiej hronicheskoj bolezni pochek na gemodialize. Vestnik Baltijskogo federal'nogo universiteta im. I. Kanta. Serija: Estestvennye i meditsinskie nauki. 2019; 2: 88–97 [Mikhailova L.V., Gorenshteyn T.A. Vilms A.L. et al. The indicators of the quality of life in patients with a terminal stage of chronic kidney disease on hemodialysis. Vestnik Baltijskogo federal’nogo universiteta im. I. Kanta. Serija: Estestvennye i medicinskie nauki. 2019; 2: 88–97 (in Russ)].
  4. Sabatino A., Regolisti G., Karupaiah T. et al. Protein-energy Wasting and Nutritional Supplementation in Patients With End-Stage Renal Disease on Hemodialysis. Clin Nutr. 2017; 36 (3): 663–71. DOI: 10.1016/j.clnu.2016.06.007
  5. Carrero J.J., Stenvinkel P., Cuppari L. et al. Etiology of the protein-energy wasting syndrome in chronic kidney disease: a consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). J Ren Nutr. 2013; 23 (2): 77–90. DOI: 10.1053/j.jrn.2013.01.001
  6. Aggarwal H.K., Jain D., Chauda R. et al. Assessment of Malnutrition Inflammation Score in Different Stages of Chronic Kidney Disease. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2018; 39 (2–3): 51–61. DOI: 10.2478/prilozi-2018-0042
  7. Iorember F.M. Malnutrition in Chronic Kidney Disease. Front Pediatr. 2018; 6: 161. DOI: 10.3389/fped.2018.00161
  8. Oluseyi A., Enajite O. Malnutrition in pre-dialysis chronic kidney disease patients in a teaching hospital in Southern Nigeria. Afr Health Sci. 2016; 16 (1): 234–41. DOI: 10.4314/ahs.v16i1.31
  9. Agafonova O.V., Gritsenko T.A., Bogdanova Ju.V. i dr. Poliklinicheskaja terapija: Uchebnik. Pod red. D.I. Davydkina, Ju.V. Schukina. 2-e izd., pererab. i dop. M.: GEOTAR-Media, 2020; 840 s. [Agafonova O.V., Gritsenko T.A., Bogdanova Yu.V. et al. Poliklinicheskaya terapiya: Uchebnik. Pod red. D.I. Davydkina, Yu.V. Shchukina. 2-e izd., pererab. i dop. M.: GEOTAR-Media, 2020; 840 s. (in Russ.)] DOI: 10.33029/9704-5545-6-PLT-2020-1-840
  10. Hill J.O. Can a Small-Changes Approach Help Address the Obesity Epidemic? A Report of the Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council. Am J Clin Nutr. 2009; 89 (2): 477–84. DOI: 10.3945/ajcn.2008.26566
  11. Windahl K., Faxen Irving G., Almquist T. et al. Prevalence and Risk of Protein-Energy Wasting Assessed by Subjective Global Assessment in Older Adults With Advanced Chronic Kidney Disease: Results From the EQUAL Study. J Ren Nutr. 2018; 28 (3): 165–74. DOI: 10.1053/j.jrn.2017.11.002
  12. Dai L., Mukai H., Lindholm B. et al. Clinical global assessment of nutritional status as predictor of mortality in chronic kidney disease patients. PLoS One. 2017; 12: e0186659. DOI:10.1371/journal.pone.0186659
  13. Vetchinnikova O.N., Pichugina I.S. Belkovo-energeticheskaja nedostatochnost' u patsientov s hronicheskoj bolezn'ju pochek na dializnoj terapii. Uchebnoe posobie. M., 2015; 55 [Vetchinnikova O.N., Pichugina I.S. Belkovo-energeticheskaya nedostatochnost’ u patsientov s khronicheskoi bolezn’yu pochek na dializnoi terapii. Uchebnoe posobie. M., 2015; 55 (in Russ.)].
  14. Kuzjarova A.S., Gasanov M.Z., Batjushin M.M. i dr. Molekuljarnye osnovy myshechnogo istoschenija: rol' miostatina i proteinkinazy v β-progressirovanii belkovoenergeticheskoj nedostatochnosti u patsientov na gemodialize. Arhiv' vnutrennej meditsiny. 2019; 9 (2): 126–32 [Kuzyarova A.S., Gasanov M.Z., Batyushin M.M. et al. Molecular bases of muscular definition: the role of myostatin and proteinkinase p in progression of protein-energy waste in patients on hemodialysis. The Russian Archives of Internal Medicine. 2019; 9 (2): 126–32 (in Russ.)]. DOI: 10.20514/2226-6704-2019-9-2-126-132
  15. Kistler B.M., Benner D., Burrowes J.D. et al. Eating During Hemodialysis Treatment: A Consensus Statement From the International Society of Renal Nutrition and Metabolism. J Ren Nutr. 2018; 28 (1): 4–12. DOI: 10.1053/j.jrn.2017.10.003
  16. Zha Y., Qian Q. Protein Nutrition and Malnutrition in CKD and ESRD. Nutrients. 2017; 9 (3): 208. DOI: 10.3390/nu9030208
  17. Jagadeswaran D., Indhumathi E., Hemamalini A.J. et al. Inflammation and nutritional status assessment by malnutrition inflammation score and its outcome in pre-dialysis chronic kidney disease patients. Clin Nutr. 2019; 38 (1): 341–7. DOI: 10.1016/j.clnu.2018.01.001
  18. Monzani A., Perrone M., Prodam F. et al. Unacylated ghrelin and obestatin: promising biomarkers of protein energy wasting in children with chronic kidney disease. Pediatr Nephrol. 2018; 33 (4): 661–72. DOI: 10.1007/s00467-017-3840-z
  19. Kovesdy C.P., Kopple J.D., Kalantar-Zadeh K. Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: reconciling low protein intake with nutritional therapy. Am J Clin Nutr. 2013; 97 (6): 1163–77. DOI: org/10.3945/ajcn.112.036418
  20. Tereschenko I.V., Kajushev P.E. Sistema grelin – obestatin v norme i pri patologii. Ter arh. 2014; 86 (12): 116–20 [Tereshchenko I.V., Kayushev P.E. The ghrelin-obestatin system in health and disease. Ter arkh. 2014; 86 (12): 116–20 (in Russ.)]. DOI: 10.17116/terarkh20148612116-120
  21. Mak R.H., Cheung W., Cone R.D. et al. Leptin and inflammation-associated cachexia in chronic kidney disease. Kidney Int. 2006; 69 (5): 794–7. DOI: 10.1038/sj.ki.5000182
  22. Kaynar K., Kural B.V., Ulusoy S. et al. Is there any interaction of resistin and adiponectin levels with protein-energy wasting among patients with chronic kidney disease. Hemodial Int. 2014; 18(1): 153–62. DOI: 10.1111/hdi.12072
  23. Maraj M., Kuśnierz-Cabala B., Dumnicka P. et al. Malnutrition, Inflammation, Atherosclerosis Syndrome (MIA) and Diet Recommendations among End-Stage Renal Disease Patients Treated with Maintenance Hemodialysis. Nutrients. 2018; 10 (1): 69. DOI: 10.3390/nu10010069
  24. Siew E.D., Ikizler T.A. Insulin resistance and protein energy metabolism in patients with advanced chronic kidney disease. Semin Dial. 2010; 23 (4): 378–82. DOI: 10.1111/j.1525-139X.2010.00763.x
  25. Spoto B., Pisano A., Zoccali C. Insulin resistance in chronic kidney disease: a systematic review. Am J Physiol Renal Physiol. 2016; 311 (6): F1087–F1108. DOI: 10.1152/ajprenal.00340.2016
  26. Cigarran S., Pousa M., Castro M.J. et al. Endogenous testosterone, muscle strength, and fat-free mass in men with chronic kidney disease. J Ren Nutr. 2013; 23 (5): e89–95. DOI: 10.1053/j.jrn.2012.08.007
  27. Campbell G.A., Patrie J.T., Gaylinn B.D. et al. Oral ghrelin receptor agonist MK-0677 increases serum insulin-like growth factor 1 in hemodialysis patients: a randomized blinded study. Nephrol Dial Transplant. 2018; 33 (3): 523–30. DOI: 10.1093/ndt/gfw474
  28. Zha Y., Qian Q. Protein Nutrition and Malnutrition in CKD and ESRD. Nutrients. 2017; 9 (3): 208. DOI: 10.3390/nu9030208
  29. Zhdanova T.V., Nazarov A.V., Shalaev V.A. i dr. Sindrom vospalenija u bol'nyh hronicheskoj pochechnoj nedostatochnost'ju (HPN) Vserossijskaja nauchno-prakticheskaja konferentsija «Bolezni pochek: epidemiologija, diagnostika i lechenie» 27–28 sentjabrja 2004g. g. Kyzyl. Nefrologija (Pril. 2). 2004: 190–1 [Zhdanova T.V., Nazarov A.V., Shalaev V.A. i dr. Sindrom vospaleniya u bol’nykh khronicheskoi pochechnoi nedostatochnost’yu (KhPN) Vserossiiskaya nauchno-prakticheskaya konferentsiya «Bolezni pochek: epidemiologiya, diagnostika i lechenie» 27–28 sentyabrya 2004g. g. Kyzyl. Nefrologiya (Pril. 2). 2004: 190–1 (in Russ)].
  30. Zueva T.V., Shalaev V.A., Nazarov A.V. i dr. Diagnostika sindroma endogennoj intoksikatsii pri hronicheskoj pochechnoj nedostatochnosti. Nizhegorodskij meditsinskij zhurnal. 2005; 3: 104–9 [Zueva T.V., Shalaev V.A., Nazarov A.V. et al. Diagnostika sindroma endogennoi intoksikatsii pri khronicheskoi pochechnoi nedostatochnosti. Nizhegorodskii meditsinskii zhurnal. 2005; 3: 104–9 (in Russ.)].
  31. Zueva T.V., Zhdanova T.V., Urazlina S.E. i dr. Hronicheskaja bolezn' pochek kak provospalitel'nyj sindrom. Vrach. 2020; 31 (6): 27–34 [Zueva T.V., Zhdanova T.V., Uraslina S.E. et al. Chronic kidney disease as a proinflammatory syndrome. Vrach. 2020; 31 (6): 27–34 (in Russ)]. DOI: 10.29296/25877305-2020-06-05
  32. Zhang K., Gao J., Chen J. et al. MICS, an easily ignored contributor to arterial calcification in CKD patients. Am J Physiol Renal Physiol. 2016; 311 (4): F663–F670. DOI: 10.1152/ajprenal.00189.2016
  33. Zyga S., Christopoulou G., Malliarou M. Malnutrition-inflammation-atherosclerosis syndrome in patients with end-stage renal disease. J Ren Care. 2011; 37 (1): 12–5. DOI: 10.1111/j.1755-6686.2011.00201.x
  34. Mutluay R., Konca Degertekin C., Isiktas Sayilar E. et al. Serum fetuin-A is associated with the components of MIAC (malnutrition, inflammation, atherosclerosis, calcification) syndrome in different stages of chronic kidney disease. Turk J Med Sci. 2019; 49 (1): 327–35. DOI: 10.3906/sag-1809-43
  35. Ramezani A., Massy Z.A., Meijers B. et al. Role of the Gut Microbiome in Uremia: A Potential Therapeutic Target. Am J Kidney Dis. 2016; 67 (3): 483–98. DOI: 10.1053/j.ajkd.2015.09.027
  36. Guenzani D., Buoli M., Caldiroli L. et al. Malnutrition and inflammation are associated with severity of depressive and cognitive symptoms of old patients affected by chronic kidney disease. J Psychosom Res. 2019; 124: 109783. DOI: 10.1016/j.jpsychores.2019.109783
  37. Jhee J.H., Kim H., Park S. et al. Vitamin D deficiency is significantly associated with depression in patients with chronic kidney disease. PLoS One. 2017; 12 (2): e0171009. DOI: 10.1371/journal.pone.0171009
  38. Lee P.S., Bhan I., Thadhani R. The potential role of plasma gelsolin in dialysis-related protein-energy wasting. Blood Purif. 2010; 29 (2): 99–101. DOI: 10.1159/000245632
  39. Zhang H., Tao Y., Wang Z., et al. Evaluation of nutritional status and prognostic impact assessed by the prognostic nutritional index in children with chronic kidney disease. Medicine (Baltimore). 2019; 98 (34): e16713. DOI: 10.1097/MD.0000000000016713
  40. Olivares-Gandy H.J., Dominguez-Isidro S., López-Dominguez E. et al. A telemonitoring system for nutritional intake in patients with chronic kidney disease receiving peritoneal dialysis therapy. Comput Biol Med. 2019; 109: 1–13. DOI: 10.1016/j.compbiomed.2019.04.012
  41. Lu L., Huang Y.F., Wang M.Q. et al. Dietary fiber intake is associated with chronic kidney disease (CKD) progression and cardiovascular risk, but not protein nutritional status, in adults with CKD. Asia Pac J Clin Nutr. 2017; 26 (4): 598–605. DOI: 10.6133/apjcn.072016.08