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Protein Nutrition and Malnutrition in CKD and ESRD

1 and 2,*
Department of Nephrology, Guizhou Provincial People’s Hospital, Guizhou 550002, China
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
Author to whom correspondence should be addressed.
Nutrients 2017, 9(3), 208;
Received: 14 December 2016 / Accepted: 23 February 2017 / Published: 27 February 2017
(This article belongs to the Special Issue Nutrition and Chronic Kidney Disease)
PDF [1155 KB, uploaded 1 March 2017]


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. View Full-Text
Keywords: protein  nutrition;  protein  catabolism;  chronic  kidney  disease;  dialysis;  acidosis;  inflammation; hormonal derangements; uremic toxins protein  nutrition;  protein  catabolism;  chronic  kidney  disease;  dialysis;  acidosis;  inflammation; hormonal derangements; uremic toxins

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Zha, Y.; Qian, Q. Protein Nutrition and Malnutrition in CKD and ESRD. Nutrients 2017, 9, 208.

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