Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis

A. Sabatino, G. Regolisti, Tilakavati Karupaiah, S. Sahathevan, B. K. Sadu Singh, B. H. Khor, N. Salhab, M. Karavetian, A. Cupisti, E. Fiaccadori

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background & aims: Protein-Energy Wasting (PEW) is the depletion of protein/energy stores observed in the most advanced stages of Chronic Kidney Disease (CKD). PEW is highly prevalent among patients on chronic dialysis, and is associated with adverse clinical outcomes, high morbidity/mortality rates and increased healthcare costs. This narrative review was aimed at exploring the pathophysiology of PEW in end-stage renal disease (ESRD) on hemodialysis. The main aspects of nutritional status evaluation, intervention and monitoring in this clinical setting were described, as well as the current approaches for the prevention and treatment of ESRD-related PEW. Methods: An exhaustive literature search was performed, in order to identify the relevant studies describing the epidemiology, pathogenesis, nutritional intervention and outcome of PEW in ESRD on hemodialysis. Results and conclusion: The pathogenesis of PEW is multifactorial. Loss of appetite, reduced intake of nutrients and altered lean body mass anabolism/catabolism play a key role. Nutritional approach to PEW should be based on a careful and periodic assessment of nutritional status and on timely dietary counseling. When protein and energy intakes are reduced, nutritional supplementation by means of specific oral formulations administered during the hemodialysis session may be the first-step intervention, and represents a valid nutritional approach to PEW prevention and treatment since it is easy, effective and safe. Omega-3 fatty acids and fibers, now included in commercially available preparations for renal patients, could lend relevant added value to macronutrient supplementation. When oral supplementation fails, intradialytic parenteral nutrition can be implemented in selected patients.

Original languageEnglish
JournalClinical Nutrition
DOIs
Publication statusAccepted/In press - 17 Apr 2016

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Chronic Kidney Failure
Renal Dialysis
Proteins
Nutritional Status
Parenteral Nutrition
Omega-3 Fatty Acids
Appetite
Energy Intake
Chronic Renal Insufficiency
Health Care Costs
Counseling
Dialysis
Epidemiology
Morbidity
Kidney
Food
Mortality
Therapeutics

Keywords

  • Chronic kidney disease
  • Hemodialysis
  • Nutrients
  • Nutritional status
  • Protein-energy wasting

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Nutrition and Dietetics

Cite this

Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis. / Sabatino, A.; Regolisti, G.; Karupaiah, Tilakavati; Sahathevan, S.; Sadu Singh, B. K.; Khor, B. H.; Salhab, N.; Karavetian, M.; Cupisti, A.; Fiaccadori, E.

In: Clinical Nutrition, 17.04.2016.

Research output: Contribution to journalArticle

Sabatino, A, Regolisti, G, Karupaiah, T, Sahathevan, S, Sadu Singh, BK, Khor, BH, Salhab, N, Karavetian, M, Cupisti, A & Fiaccadori, E 2016, 'Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis', Clinical Nutrition. https://doi.org/10.1016/j.clnu.2016.06.007
Sabatino, A. ; Regolisti, G. ; Karupaiah, Tilakavati ; Sahathevan, S. ; Sadu Singh, B. K. ; Khor, B. H. ; Salhab, N. ; Karavetian, M. ; Cupisti, A. ; Fiaccadori, E. / Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis. In: Clinical Nutrition. 2016.
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