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Protein-Energy Wasting and Mortality in Chronic Kidney Disease
Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, Azienda Ospedale Università San Martino, Genoa University, Viale Benedetto XV 6, Genoa, Italy
Department of Surgery, Azienda Ospedale Università San Martino, Genoa University, Largo R. Benzi, Genoa, Italy
* Author to whom correspondence should be addressed.
Received: 25 February 2011; in revised form: 29 April 2011 / Accepted: 3 May 2011 / Published: 19 May 2011
Abstract: Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD) and is associated with an increased death risk from cardiovascular diseases. However, while even minor renal dysfunction is an independent predictor of adverse cardiovascular prognosis, PEW becomes clinically manifest at an advanced stage, early before or during the dialytic stage. Mechanisms causing loss of muscle protein and fat are complex and not always associated with anorexia, but are linked to several abnormalities that stimulate protein degradation and/or decrease protein synthesis. In addition, data from experimental CKD indicate that uremia specifically blunts the regenerative potential in skeletal muscle, by acting on muscle stem cells. In this discussion recent findings regarding the mechanisms responsible for malnutrition and the increase in cardiovascular risk in CKD patients are discussed. During the course of CKD, the loss of kidney excretory and metabolic functions proceed together with the activation of pathways of endothelial damage, inflammation, acidosis, alterations in insulin signaling and anorexia which are likely to orchestrate net protein catabolism and the PEW syndrome.
Keywords: protein-energy wasting; malnutrition; chronic kidney disease; cardiovascular risk; skeletal muscle
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Bonanni, A.; Mannucci, I.; Verzola, D.; Sofia, A.; Saffioti, S.; Gianetta, E.; Garibotto, G. Protein-Energy Wasting and Mortality in Chronic Kidney Disease. Int. J. Environ. Res. Public Health 2011, 8, 1631-1654.
Bonanni A, Mannucci I, Verzola D, Sofia A, Saffioti S, Gianetta E, Garibotto G. Protein-Energy Wasting and Mortality in Chronic Kidney Disease. International Journal of Environmental Research and Public Health. 2011; 8(5):1631-1654.
Bonanni, Alice; Mannucci, Irene; Verzola, Daniela; Sofia, Antonella; Saffioti, Stefano; Gianetta, Ezio; Garibotto, Giacomo. 2011. "Protein-Energy Wasting and Mortality in Chronic Kidney Disease." Int. J. Environ. Res. Public Health 8, no. 5: 1631-1654.