Protein-Energy Wasting, Sarcopenia, Cachexia and Muscle Wasting in Patients Living with Chronic Kidney Disease

Dear Colleagues,

Chronic kidney disease (CKD) is characterized by reduced function, or altered structure, of the kidneys. CKD is very common with a global prevalence of 13%. Thankfully, advances in renal replacement therapy have successfully increased longevity of life and reduced the impact of many comorbidities, such as anemia.

Nevertheless, CKD places a considerable burden on health systems, risk of death remains high in patients living with CKD, and quality of life remains unacceptably poor. A particularly challenging complication of CKD is altered body composition. Obesity is common, and whilst the identification of obese patients is relatively straightforward, treatment is challenging (as in all populations). In patients living with CKD, nutrition management is further complicated by the ‘obesity paradox’, where the outcome of patients with higher BMI is paradoxically improved compared to normal BMI

One possible explanation for better outcomes in patients with higher BMI is that protein-energy wasting may be reduced. Protein-energy wasting is common in patients living with CKD, and patients living with CKD who have protein-energy wasting have higher mortality, whilst poor muscle function prevents patients from completing activities of daily living, reducing the quality of life. Thus, prevention, identification, and treatment of protein-energy wasting remain an important topic requiring further research.

What nutritional strategies might attenuate protein-energy wasting in patients living with CKD? An added complication in patients living with CKD is that excessive protein intake may increase disease progression. Indeed, guidelines suggest lowering protein intake to preserve kidney function, but this practice is not without risk. For example, low protein diets may reduce the quality of life, and thus this practice is not universally implemented.

The present Special Issue of Nutrients aims to tackle this challenging topic head-on. The issue’s objectives are to provide updates on the impact of protein-energy wasting on morbidity, mortality, and patient-reported outcomes; offer accurate methods for defining, assessing, and identifying protein-energy wasting; and inform readers on state-of-the-art interventions from a lifestyle (nutritional or exercise) perspective, in patients living with chronic kidney disease. Authors are invited to submit relevant original contributions, review articles, systematic reviews, and meta-analyses on human or experimental animal models, for consideration and inclusion in this Special Issue.

Dr. Jamie Hugo Macdonald
Guest Editor

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