nutrients-logo

Journal Browser

Journal Browser

Prevention and Treatment of Malnutrition and Its Complications in Chronic Kidney Disease

A Special Issue of Nutrients (ISSN 2072-6643) belonging to the section "Clinical Nutrition".

Deadline for manuscript submissions: 25 January 2027 | Viewed by 7716

Editors


E-Mail Website1 Website2
Guest Editor
Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy
Interests: chronic renal disease progression; malnutriotion and sarcopenia in CKD
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, 16142 Genova, Italy
Interests: diet in nephology; glomerulonephritis; immunity and inflammatory processes in renal diseases; hemodialysis; kidney transplantation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In CKD patients, malnutrition and sarcopenia prevalence increases with disease progression, driven by shared pathophysiological mechanisms, and recent research highlights systemic inflammation and nutritional deficiencies as key contributors. Intrdyalitic protein losses as well as uremic toxins and increased system inflammation promote muscle protein degradation and inhibit synthesis, intensifying muscle wasting. Concurrent malnutrition, especially protein–energy wasting and inadequate calories and amino acid intake, further accelerates muscle loss. Personalized interventions, including amino acids supplementation and omega-3 fatty acids, show promise in reducing inflammation and preserving muscle mass.

Futhermore, emerging evidence underscores the importance of the gut–muscle axis; alterations in gut microbiota in CKD are linked to systemic inflammation and muscular deterioration. Probiotics and prebiotics are being explored as potential strategies to restore gut homeostasis and mitigate muscle wasting.

Additionally, the interconnection of malnutrition, inflammation, and mineral bone disorders suggests a broader entity called “osteosarcopenia.”

This Special Issue of Nutrients aims to examine epidemiological relationships and therapeutic strategies, including dietary approaches (low-protein, vegetarian, and ketogenic diets), nutritional supplements, and nutritional approaches combined with lifestyle changes or pharmacological or dialytic interventions, to better manage malnutrition and/or sarcopenia in CKD patients.

Dr. Simone Vettoretti
Dr. Pasquale Esposito
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • chronic kidney disease
  • malnutrition
  • sarcopenia
  • osteosarcopenia
  • inflammation and malnutrition
  • dietary interventions in CKD

Benefits of Publishing in a Special Issue

  • Ease of navigation: Grouping papers by topic helps scholars navigate broad scope journals more efficiently.
  • Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
  • Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
  • External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.
  • Reprint: MDPI Books provides the opportunity to republish successful Special Issues in book format, both online and in print.

Further information on MDPI's Special Issue policies can be found here.

Published Papers (4 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Jump to: Review

23 pages, 3812 KB  
Article
Low Time-Weighted Parathyroid Hormone Is Associated with Malnutrition-Inflammation and Functional Dependence in Maintenance Hemodialysis
by Nomy Levin Iaina, Alexandra Petkutsa, Nayaf Habashi and Evgenia Gurevich
Nutrients 2026, 18(16), 2742; https://doi.org/10.3390/nu18162742 - 21 Aug 2026
Viewed by 274
Abstract
Background/Objectives: Low parathyroid hormone (PTH) levels in maintenance hemodialysis may reflect malnutrition, inflammation, reduced functional reserve, or low bone turnover rather than optimal CKD-MBD control. We evaluated associations of longitudinal PTH burden with nutritional-inflammatory and functional-dependence profiles, hospitalization, and mortality. Methods: [...] Read more.
Background/Objectives: Low parathyroid hormone (PTH) levels in maintenance hemodialysis may reflect malnutrition, inflammation, reduced functional reserve, or low bone turnover rather than optimal CKD-MBD control. We evaluated associations of longitudinal PTH burden with nutritional-inflammatory and functional-dependence profiles, hospitalization, and mortality. Methods: This retrospective cohort included 188 adults receiving maintenance hemodialysis. Serial PTH measurements were summarized using time-weighted mean PTH. Associations with nutritional-inflammatory biomarkers, functional-dependence measures, and hospitalization were assessed using regression models. Mortality was primarily evaluated using a joint longitudinal–survival model linking repeated log2-transformed PTH measurements with time to death and adjusting for age, sex, dialysis vintage, and dialysis access. A 6-month landmark analysis was performed as a complementary sensitivity analysis. Results: Median time-weighted mean PTH was 292 pg/mL. Lower longitudinal PTH burden was associated with lower albumin, cholesterol, and transferrin and higher C-reactive protein and ferritin. Higher PTH was associated with lower odds of worse mobility and dependence in dressing, bathing, toileting, and continence after adjustment. Hospitalization was not significantly associated with PTH. During follow-up, 62 patients died. In the joint model, each twofold higher estimated current PTH level was associated with a lower observed mortality hazard (adjusted hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.46–0.73; p < 0.001). The 6-month landmark analysis included 159 patients and 44 subsequent deaths. Each twofold higher PTH level was associated with lower subsequent mortality hazard (HR 0.69, 95% CI 0.51–0.95; p = 0.021), while PTH < 150 pg/mL was associated with higher mortality than PTH 300–600 pg/mL (HR 2.84, 95% CI 1.22–6.63). Conclusions: Low time-weighted PTH was associated with adverse nutritional-inflammatory and functional profiles, and lower estimated current PTH with higher mortality. Findings were consistent in the 6-month landmark analysis, do not establish causality, and support interpreting PTH in the broader clinical context. Full article
Show Figures

Figure 1

15 pages, 5436 KB  
Article
Impact of Calcium–Magnesium Ratio in Purified Water Remineralization on Calcium Oxalate Crystal Formation and Renal Injury
by Yingbin Zhang, Jiaohua Luo, Yao Tan, Zhiqiang Wang, Kun Qian, Weiyan Chen, Ke Cui, Ji-An Chen and Yujing Huang
Nutrients 2026, 18(5), 792; https://doi.org/10.3390/nu18050792 - 27 Feb 2026
Viewed by 1766
Abstract
Despite the known association between calcium and magnesium in drinking water and stone risk, the difference in stone prevention of purified water remineralized with varying calcium-to-magnesium ratios (Ca:Mg) remains unclear. Objectives: This study investigates the impact of different Ca:Mg in the remineralization [...] Read more.
Despite the known association between calcium and magnesium in drinking water and stone risk, the difference in stone prevention of purified water remineralized with varying calcium-to-magnesium ratios (Ca:Mg) remains unclear. Objectives: This study investigates the impact of different Ca:Mg in the remineralization of purified water on calcium oxalate crystallization and renal injury. Methods: Sixty male Sprague-Dawley rats were induced calcium oxalate crystals by a sodium oxalate diet and divided into six groups, where they drank purified water with or without remineralized varying Ca:Mg (0.5, 3.4, 10, 20, 100). Serum and urine biomarkers of renal function, renal injury, mineral metabolism, bone metabolism, and urine calcium oxalate crystals were detected. Kidneys were isolated for pathological examination. Results: Findings showed that remineralization by 0.5 and 3.4 Ca:Mg significantly reduced urinary calcium oxalate crystallization, renal injury, and improved renal function, while extreme ratios (Ca:Mg over 10) showed no benefits. Conclusions: These results elucidate the pathophysiological effects of Ca:Mg in drinking water on renal health, particularly emphasizing the protective role of the 0.5 and 3.4 in inhibiting calcium oxalate crystallization and mitigating renal injury. It provides a quantifiable reference for purified water remineralization aimed at stone prevention. Full article
Show Figures

Figure 1

Review

Jump to: Research

17 pages, 2131 KB  
Review
Sarcopenia in Kidney Transplantation: Bridging Pathophysiology to Patient-Centered Care
by Anna Pisacreta, Paolo Molinari, Lara Caldiroli, Margherita Di Naro, Francesco Pesce, Anna De Amici, Anna Regalia, Simona Verdesca, Silvia Malvica, Giuseppe Grandaliano, Giuseppe Castellano and Carlo Alfieri
Nutrients 2026, 18(9), 1352; https://doi.org/10.3390/nu18091352 - 24 Apr 2026
Cited by 1 | Viewed by 1102
Abstract
Sarcopenia, defined as the progressive loss of skeletal muscle mass and strength, is increasingly recognized as a significant concern in patients with chronic kidney disease (CKD) and particularly in kidney transplant recipients (KTx-ps). This review explores the complex interplay of pathophysiological mechanisms, prevalence, [...] Read more.
Sarcopenia, defined as the progressive loss of skeletal muscle mass and strength, is increasingly recognized as a significant concern in patients with chronic kidney disease (CKD) and particularly in kidney transplant recipients (KTx-ps). This review explores the complex interplay of pathophysiological mechanisms, prevalence, and management strategies of sarcopenia in the context of kidney transplantation. CKD contributes to sarcopenia through systemic inflammation, malnutrition, uremic toxin accumulation, and metabolic imbalances, all of which persist or are exacerbated after transplantation due to immunosuppressive therapies especially corticosteroids. Notably, the post-transplant period may introduce additional risks, such as altered body composition and reduced physical activity, further aggravating muscle wasting. Sarcopenia affects approximately 26% of KTx-ps, leading to adverse outcomes including decreased quality of life, increased risk of infection, frailty, delayed recovery, and graft loss. The diagnosis remains challenging due to variability in assessment tools and a lack of standardized criteria. Management strategies must be multifactorial, including personalized nutritional support, targeted physical activity, and, where appropriate, pharmacological interventions. Early identification through imaging and functional testing is critical, especially in older patients and those with prolonged dialysis vintage. Emerging therapies, such as myostatin inhibitors, offer promise but require further validation. Additionally, early steroid withdrawal may mitigate muscle loss without compromising graft survival in selected patients. This review underscores the need for heightened awareness and standardized protocols to identify and manage sarcopenia in kidney transplantation, ultimately improving long-term outcomes and patient-centered care. Full article
Show Figures

Figure 1

18 pages, 1766 KB  
Review
Nutritional and Metabolic Interventions to Prevent and Treat Protein–Energy Wasting in Nondialysis CKD—Narrative Review
by Patrícia Kleinová, Blichová Tímea, Vnučák Matej, Karol Graňák, Kollár Andrej, Ševčíková Katarína and Ivana Dedinská
Nutrients 2026, 18(3), 390; https://doi.org/10.3390/nu18030390 - 24 Jan 2026
Cited by 3 | Viewed by 3831
Abstract
Background: Protein–energy wasting (PEW) is a major predictor of morbidity and mortality in patients with chronic kidney disease (CKD), even before the initiation of dialysis. Its multifactorial pathogenesis includes reduced dietary intake, chronic inflammation, metabolic acidosis, hormonal disturbances, and dysbiosis of the gut [...] Read more.
Background: Protein–energy wasting (PEW) is a major predictor of morbidity and mortality in patients with chronic kidney disease (CKD), even before the initiation of dialysis. Its multifactorial pathogenesis includes reduced dietary intake, chronic inflammation, metabolic acidosis, hormonal disturbances, and dysbiosis of the gut microbiota. Early recognition and targeted management are crucial for preventing muscle loss, functional decline, and adverse outcomes. Methods: This narrative review summarises and integrates current evidence from the literature on nutritional and metabolic interventions to prevent and treat protein–energy wasting in patients with nondialysis chronic kidney disease. Relevant clinical trials, meta-analyses, and experimental studies published up to date were evaluated, focusing on dietary strategies, metabolic modulation, physical exercise, and gut microbiome-targeted therapies. Results: Adequate energy and protein intake remain the cornerstone of PEW management, based on available clinical and observational evidence. Individualised diets emphasising high-quality and plant-based proteins, oral nutritional supplements, and ketoanalogues can attenuate muscle wasting. Correction of metabolic acidosis and inflammation enhances protein anabolism and nitrogen balance. Physical exercise acts synergistically with dietary interventions to preserve muscle mass and function. Novel approaches—such as modulating the gut–kidney axis with pre-, pro-, and postbiotics or supplementing with short-chain fatty acids—show promise in improving metabolic and inflammatory profiles. Conclusions: The management of PEW in nondialysis CKD requires a personalised approach that integrates nutrition, physical activity, metabolic correction and microbiome modulation. Early, coordinated intervention may help to slow the progression of CKD and improve patient survival and quality of life. Full article
Show Figures

Figure 1

Back to TopTop