Protein Nutrition and Malnutrition in CKD and ESRD.
Protein Nutrition and Malnutrition in CKD and ESRD.
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DOI：
10.3390/nu9030208
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发表时间：
2017-02-27
期刊：
影响因子：
5.9
通讯作者：
Qian Q
中科院分区：
文献类型：
--
作者：
Zha Y;Qian Q
蛋白质分解代谢升高和蛋白质营养不良在慢性肾病（CKD）和终末期肾病（ESRD）患者中很常见。潜在的病因包括但不限于：代谢性酸中毒、肠道生态失调；补体、内皮素-1和肾素-血管紧张素-醛固酮（RAAS）轴激活的全体性炎症；合成代谢激素抵抗；能量消耗增加；和尿毒症毒素积累。所有这些紊乱会进一步恶化肾功能，导致患者预后不良。许多这些CKD相关的紊乱是可以预防和基本上逆转的，这代表了改善CKD和ESRD护理的巨大潜力。本文综述了CKD和ESRD中蛋白质营养和营养不良领域的已知信息和最新进展。总结了管理建议。深入了解CKD和ESRD患者蛋白质营养不良的发病机制和病因无疑将有助于设计和开发更有效的策略来优化蛋白质营养和改善预后。
Elevated protein catabolism and protein malnutrition are common in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The underlying etiology includes, but is not limited to, metabolic acidosis intestinal dysbiosis; systemic inflammation with activation of complements, endothelin-1 and renin-angiotensin-aldosterone (RAAS) axis; anabolic hormone resistance; energy expenditure elevation; and uremic toxin accumulation. All of these derangements can further worsen kidney function, leading to poor patient outcomes. Many of these CKD-related derangements can be prevented and substantially reversed, representing an area of great potential to improve CKD and ESRD care. This review integrates known information and recent advances in the area of protein nutrition and malnutrition in CKD and ESRD. Management recommendations are summarized. Thorough understanding the pathogenesis and etiology of protein malnutrition in CKD and ESRD patients will undoubtedly facilitate the design and development of more effective strategies to optimize protein nutrition and improve outcomes.