Protein Energy Wasting and Sarcopenia in Dialysis Patients

Abstract

As the aging of the population progresses in Japan, the nutritional problems in dialysis patients are being highlighted. Frailty is a clinical concept including body weight loss, muscle weakness, fatigability, decreased walking speed, and decreased physical activity, which means an intermediate concept between healthy subjects and disability subjects, indicating that their activities of daily living are not decreased but they cannot smoothly perform housework or exercise. Morbidity of dialysis patients is known to be high, and mortality of dialysis patients with frailty is 3 times higher. Sarcopenia is one of the principal reasons for or triggers of frailty. It is a disease setting showing decreased muscle volume and quality associated with decreased physical function or quality of life. Recent mean age at dialysis therapy induction is getting near to 70 years old in Japan. Japanese dialysis patients who are elderly and present organ failure would have a double risk for sarcopenia. Patients with advanced stages of CKD are generally given protein diet, and it has been reported that a low protein intake in dialysis patients would be a significant risk for developing sarcopenia and increasing mortality. Recently, the focus has been on protein energy wasting (PEW) - an underlying disease condition in sarcopenia or frailty. PEW is an energy wasting condition occurring in dialysis patients, and the cause of PEW is principally decreased food intake and increased catabolism. It has recently been revealed that decreased protein intake would be a risk factor for increased mortality in dialysis patients. The incidence of PEW in dialysis patients is reported to be 14%. To avoid sarcopenia and PEW leading to frailty, we should pay much more attention to an appropriate protein and calorie intake rather than restriction in dialysis patients.

Low serum adiponectin level is associated with better physical health-related quality of life in chronic kidney disease

“…A large percentage of CKD patients are in a ‘malnutrition-inflammation’ status caused by reduced caloric intake due to symptoms of uremia, reduced absorption of nutrients, cachexia, and persistent inflammatory status. In CKD, protein-energy wasting is caused by a complex interaction of persistent inflammation, malnutrition, acidosis status, and increased catabolism, resulting in sarcopenia 32 . It is assumed that serum adiponectin levels are increased to counteract this ‘malnutrition-inflammation’ status 33 .…”

Prediction of premature all-cause mortality in patients receiving peritoneal dialysis using modified artificial neural networks

“…Lowering LDL-c levels can significantly improve the prognosis of patients with chronic kidney disease (CKD) stage 1-4, but researchers have not clearly determined whether it can improve the prognosis of patients with CKD5 or CKD5d [ 42 – 44 ]. Strict lipid control may also cause malnutrition in patients receiving dialysis, which is an important factor contributing to the death of patients receiving dialysis [ 45 , 46 ]. LDL-c levels were closely related to the premature mortality of patients treated with PD in our study.…”

Comparison of dialysis dose through real-time Kt/V by ultraviolet absorbance of spent dialysate, single-pool Daugirdas II, and Kt/BSA according to sex and age

“…The Brazilian population on dialysis, as well as around the world, is aging 15,16,17 . A better understanding of the physiological differences and consequent needs in dialysis of this sub-population is necessary.…”