Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis.

BACKGROUND & AIMS: Protein-Energy Wasting (PEW) is the depletion of protein/energy stores observed in the most advanced stages of Chronic Kidney Disease (CKD). PEW is highly prevalent among patients on chronic dialysis, and is associated with adverse clinical outcomes, high morbidity/mortality rates and increased healthcare costs. This narrative review was aimed at exploring the pathophysiology of PEW in end-stage renal disease (ESRD) on hemodialysis. The main aspects of nutritional status evaluation, intervention and monitoring in this clinical setting were described, as well as the current approaches for the prevention and treatment of ESRD-related PEW. METHODS: An exhaustive literature search was performed, in order to identify the relevant studies describing the epidemiology, pathogenesis, nutritional intervention and outcome of PEW in ESRD on hemodialysis. RESULTS AND CONCLUSION: The pathogenesis of PEW is multifactorial. Loss of appetite, reduced intake of nutrients and altered lean body mass anabolism/catabolism play a key role. Nutritional approach to PEW should be based on a careful and periodic assessment of nutritional status and on timely dietary counseling. When protein and energy intakes are reduced, nutritional supplementation by means of specific oral formulations administered during the hemodialysis session may be the first-step intervention, and represents a valid nutritional approach to PEW prevention and treatment since it is easy, effective and safe. Omega-3 fatty acids and fibers, now included in commercially available preparations for renal patients, could lend relevant added value to macronutrient supplementation. When oral supplementation fails, intradialytic parenteral nutrition can be implemented in selected patients.

Comparison of Malnutrition Prevalence Between Haemodialysis and Continuous Ambulatory Peritoneal Dialysis Patients: A Cross-sectional Study

Introduction: Introduction: Malnutrition is a serious unresolved nutritional problem amongst dialysis patients associated with increased mortality and morbidity and prevalence differs according to dialysis modalities. This study compared protein- energy malnutrition (PEM) prevalence in haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: A total of 155 HD and 90 CAPD patients were enrolled. PEM prevalence was determined using body mass mdex (BMI), serum albumin, Dialysis Malnutrition Score (DM5) and dietary intake. Results: CAPD patients had significantly higher BMI (24.1 � 4.8 kg/m2 vs. 22.7 � 4.8 kg/m2 p=O.024) and mid-arm muscle area (32.1 � 12.4 cm2 vs. 29.5 � 15.9 cm2 p=O.044) than HD patients. They also had significantly lower serum albumin (31 � 5 g/L vs. 35 � 6 g/L; p5 years were independent risk factors of PEM hi dialysis patients. Conclusion: Periodic nutritional assessments, education and dietary counseling should be emphasised in these patients as a preventive measure of PEM.