A Practical Approach to Nutrition, Protein-Energy Wasting, Sarcopenia, and Cachexia in Patients with Chronic Kidney Disease
A Practical Approach to Nutrition, Protein-Energy Wasting, Sarcopenia, and Cachexia in Patients with Chronic Kidney Disease
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DOI：
10.1159/000504240
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发表时间：
2020-02-01
影响因子：
3
通讯作者：
Kalantar-Zadeh, Kamyar
中科院分区：
文献类型：
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作者：
Hanna, Ramy M.;Ghobry, Lena;Kalantar-Zadeh, Kamyar
综述目的：蛋白质能量浪费(PEW)是慢性疾病状态下代谢和营养紊乱引起的一种无序分解代谢状态。慢性肾脏疾病(CKD)患者，尤其是终末期肾脏疾病(ESRD)患者，肌肉萎缩、骨质疏松症和恶病质是导致虚弱和发病率的原因。此外，反向流行病学发现将PEW与慢性肾脏病和终末期肾病的死亡率密切相关。最新发现：营养不良-炎症评分(Kalantar评分)为预测营养风险提供了一个有用的工具。需要更多地关注肾脏患者的肾脏营养，以减少恶病质和肌肉损失。营养不良对肾病患者的威胁比肥胖大得多，这意味着饮食咨询需要量身定做，以反映这一观察结果。达到最佳卡路里摄入量的需要与限制慢性肾脏病过量蛋白质摄入量的需要相结合，导致需要补充能量以避免出现PEW。预防PEW是CKD/ESRD最紧迫的临床问题。其他需要考虑的营养问题包括需要使血清碳酸氢盐正常化以控制酸中毒，控制尿酸，以及控制慢性肾脏病和终末期肾病的磷。锻炼可能是有益的，但还需要进一步的工作，才能通过随机试验证明确实有益。摘要：PEW预防是肾脏营养不可或缺的一部分，考虑到肥胖悖论，预防PEW至关重要。医生和营养师需要采取综合的方法，从整体上看待患者的饮食，而不仅仅是控制特定的实验室参数。
Objectives of Review: Protein-energy wasting (PEW) is a state of disordered catabolism resulting from metabolic and nutritional derangements in chronic disease states. Patients with chronic kidney disease (CKD), and end-stage renal disease (ESRD) in particular, have muscle wasting, sarcopenia, and cachexia that contribute to frailty and morbidity. Moreover, reverse epidemiology findings have strongly linked PEW with mortality in CKD and ESRD. Updated Findings: The malnutrition-inflammation score (KALANTAR Score) provides a useful tool to predict nutritional risk. A stronger focus on renal nutrition in renal patients is needed to attenuate cachexia and muscle loss. Malnutrition is a far greater threat in patients with renal disease than obesity, which means dietary counseling needs to be tailored to reflect this observation. The need to achieve optimal caloric intake is compounded by the need to limit excess protein intake in CKD, resulting in the need for energy supplementation to avoid PEW. Preventing PEW is the most pressing clinical concern in CKD/ESRD. Other nutritional issues to reckon in renal disease include the need to normalize serum bicarbonate to manage acidosis, uric acid control, and phosphorous control in CKD and ESRD. Exercise maybe beneficial, but further work is needed to prove a conclusive benefit via a randomized trial. Summary: PEW prevention is an integral part of renal nutrition and is of paramount importance given the obesity paradox. Integrative approaches by physicians and dieticians are needed to take a holistic view of a patients diet beyond just control of particular laboratory parameters.