The Experts below are selected from a list of 3054 Experts worldwide ranked by ideXlab platform
Denis Fouque - One of the best experts on this subject based on the ideXlab platform.
-
Distinguishing between cachexia, sarcopenia and Protein Energy Wasting in end-stage renal disease patients on dialysis
Palliative Medicine and Hospice Care - Open Journal, 2016Co-Authors: Joanne Reid, Denis Fouque, Kamyar Kalantar-zadeh, Helen Noble, Adrian Slee, Andrew Davenport, Ken Farrington, Samuel Porter, David S. Seres, Miles D. WithamAbstract:Patients with end-stage renal disease (ESRD) receiving dialysis can have altered nutritional status and body composition due to dietary restrictions, level of physical activity, co-morbidities, metabolic alterations and inflammation.1 As such, weight loss or Wasting is common among this population with up to 75% of adults with ESRD undergoing maintenance dialysis displaying some evidence of Wasting.2 There are several forms of loss of lean muscle mass or Wasting in ESRD, including ‘Protein Energy Wasting’, ‘cachexia’, and ‘age-related sarcopenia’ and these terms are often used interchangeably alongside ‘malnutrition’ in current care. Limited understanding of the differences between such terms is arguably a barrier to accurate recognition and management of these disorders in patients with ESRD. For instance, a recent European study of over 700 dietetic participants concluded that only 13% of health care professionals who could differentiate between malnutrition, starvation, cachexia and sarcopenia.3 Such knowledge is pertinent as for example, loss of muscle mass is a key feature in both sarcopenia and cachexia, but most patients with sarcopenia are not cachectic,4 as muscle Wasting occurs with aging
-
A simple Protein-Energy Wasting score predicts survival in maintenance hemodialysis patients
Journal of Renal Nutrition, 2014Co-Authors: Xavier Moreau-gaudry, Guillaume Jean, Leslie Genet, Dominique Lataillade, Eric Legrand, François Kuentz, Denis FouqueAbstract:OBJECTIVE: Nutritional status is a powerful predictor of survival in maintenance hemodialysis patients but remains challenging to assess. We defined a new Protein Energy Wasting (PEW) score based on the nomenclature proposed by the International Society of Renal Nutrition and Metabolism in 2008. DESIGN AND METHODS: This score, graded from 0 (worse) to 4 (best) was derived from 4 body nutrition compartments: serum albumin, body mass index, a normalized serum creatinine value, and Protein intake as assessed by nPNA. SUBJECTS: We applied this score to 1443 patients from the ARNOS prospective dialysis cohort and provide survival data from 2005 until 2008. MAIN OUTCOME MEASURE: Patients survival at 3.5 year. RESULTS: Survival ranged from 84%-69% according to the Protein-Energy Wasting score. There was a clear-cut reduction in survival (5%-7%; P \textless 0.01) for each unit decrement in the score grade. There was a 99% survival at 1 year for patients with the score of 4. In addition, the 6-month variation of this PEW score also strongly predicted patients' survival (P \textless 0.01). CONCLUSION: A new simple and easy-to-get PEW score predicts survival in maintenance hemodialysis patients. Furthermore, increase of this nutritional score over time also indicates survival improvement, and may help to better identify subgroups of patients with a high mortality rate, in which nutrition support should be enforced.
-
a simple Protein Energy Wasting score predicts survival in maintenance hemodialysis patients
Journal of Renal Nutrition, 2014Co-Authors: Xavier Moreaugaudry, Guillaume Jean, Leslie Genet, Dominique Lataillade, Eric Legrand, François Kuentz, Denis FouqueAbstract:Objective: Nutritional status is a powerful predictor of survival in maintenance hemodialysis patients but remains challenging to assess. We defined a new Protein Energy Wasting (PEW) score based on the nomenclature proposed by the International Society of Renal Nutrition and Metabolism in 2008. Design and Methods: This score, graded from 0 (worse) to 4 (best) was derived from 4 body nutrition compartments: serum albumin, body mass index, a normalized serum creatinine value, and Protein intake as assessed by nPNA. Subjects: We applied this score to 1443 patients from the ARNOS prospective dialysis cohort and provide survival data from 2005 until 2008. Main Outcome Measure: Patients survival at 3.5 year. Results: Survival ranged from 84%-69% according to the Protein-Energy Wasting score. There was a clear-cut reduction in survival (5%-7%; P , 0.01) for each unit decrement in the score grade. There was a 99% survival at 1 year for patients with the score of 4. In addition, the 6-month variation of this PEW score also strongly predicted patients’ survival (P , 0.01). Conclusion: A new simple and easy-to-get PEW score predicts survival in maintenance hemodialysis patients. Furthermore, increase of this nutritional score over time also indicates survival improvement, and may help to better identify subgroups of patients with a high mortality rate, in which nutrition support should be enforced.
-
A Simple Protein–Energy Wasting Score Predicts Survival in Maintenance Hemodialysis Patients
Journal of Renal Nutrition, 2014Co-Authors: Xavier Moreau-gaudry, Guillaume Jean, Leslie Genet, Dominique Lataillade, Eric Legrand, François Kuentz, Denis FouqueAbstract:Objective: Nutritional status is a powerful predictor of survival in maintenance hemodialysis patients but remains challenging to assess. We defined a new Protein Energy Wasting (PEW) score based on the nomenclature proposed by the International Society of Renal Nutrition and Metabolism in 2008. Design and Methods: This score, graded from 0 (worse) to 4 (best) was derived from 4 body nutrition compartments: serum albumin, body mass index, a normalized serum creatinine value, and Protein intake as assessed by nPNA. Subjects: We applied this score to 1443 patients from the ARNOS prospective dialysis cohort and provide survival data from 2005 until 2008. Main Outcome Measure: Patients survival at 3.5 year. Results: Survival ranged from 84%-69% according to the Protein-Energy Wasting score. There was a clear-cut reduction in survival (5%-7%; P , 0.01) for each unit decrement in the score grade. There was a 99% survival at 1 year for patients with the score of 4. In addition, the 6-month variation of this PEW score also strongly predicted patients’ survival (P , 0.01). Conclusion: A new simple and easy-to-get PEW score predicts survival in maintenance hemodialysis patients. Furthermore, increase of this nutritional score over time also indicates survival improvement, and may help to better identify subgroups of patients with a high mortality rate, in which nutrition support should be enforced.
-
a proposed nomenclature and diagnostic criteria for Protein Energy Wasting in acute and chronic kidney disease
Kidney International, 2008Co-Authors: Denis Fouque, Joel D. Kopple, Noël Cano, Philippe Chauveau, Lilian Cuppari, Harold A. Franch, Gabriele Guarnieri, Talat Alp Ikizler, Kamyar Kalantarzadeh, George A. KaysenAbstract:The recent research findings concerning syndromes of muscle Wasting, malnutrition, and inflammation in individuals with chronic kidney disease (CKD) or acute kidney injury (AKI) have led to a need for new terminology. To address this need, the International Society of Renal Nutrition and Metabolism (ISRNM) convened an expert panel to review and develop standard terminologies and definitions related to Wasting, cachexia, malnutrition, and inflammation in CKD and AKI. The ISRNM expert panel recommends the term 'Protein-Energy Wasting' for loss of body Protein mass and fuel reserves. 'Kidney disease Wasting' refers to the occurrence of Protein-Energy Wasting in CKD or AKI regardless of the cause. Cachexia is a severe form of Protein-Energy Wasting that occurs infrequently in kidney disease. Protein-Energy Wasting is diagnosed if three characteristics are present (low serum levels of albumin, transthyretin, or cholesterol), reduced body mass (low or reduced body or fat mass or weight loss with reduced intake of Protein and Energy), and reduced muscle mass (muscle Wasting or sarcopenia, reduced mid-arm muscle circumference). The kidney disease Wasting is divided into two main categories of CKD- and AKI-associated Protein-Energy Wasting. Measures of chronic inflammation or other developing tests can be useful clues for the existence of Protein-Energy Wasting but do not define Protein-Energy Wasting. Clinical staging and potential treatment strategies for Protein-Energy Wasting are to be developed in the future.
Kamyar Kalantar-zadeh - One of the best experts on this subject based on the ideXlab platform.
-
Distinguishing between cachexia, sarcopenia and Protein Energy Wasting in end-stage renal disease patients on dialysis
Palliative Medicine and Hospice Care - Open Journal, 2016Co-Authors: Joanne Reid, Denis Fouque, Kamyar Kalantar-zadeh, Helen Noble, Adrian Slee, Andrew Davenport, Ken Farrington, Samuel Porter, David S. Seres, Miles D. WithamAbstract:Patients with end-stage renal disease (ESRD) receiving dialysis can have altered nutritional status and body composition due to dietary restrictions, level of physical activity, co-morbidities, metabolic alterations and inflammation.1 As such, weight loss or Wasting is common among this population with up to 75% of adults with ESRD undergoing maintenance dialysis displaying some evidence of Wasting.2 There are several forms of loss of lean muscle mass or Wasting in ESRD, including ‘Protein Energy Wasting’, ‘cachexia’, and ‘age-related sarcopenia’ and these terms are often used interchangeably alongside ‘malnutrition’ in current care. Limited understanding of the differences between such terms is arguably a barrier to accurate recognition and management of these disorders in patients with ESRD. For instance, a recent European study of over 700 dietetic participants concluded that only 13% of health care professionals who could differentiate between malnutrition, starvation, cachexia and sarcopenia.3 Such knowledge is pertinent as for example, loss of muscle mass is a key feature in both sarcopenia and cachexia, but most patients with sarcopenia are not cachectic,4 as muscle Wasting occurs with aging
-
Latest consensus and update on Protein-Energy Wasting in chronic kidney disease.
Current Opinion in Clinical Nutrition and Metabolic Care, 2015Co-Authors: Yoshitsugu Obi, Csaba P. Kovesdy, Hemn Qader, Kamyar Kalantar-zadehAbstract:Purpose of review Protein-Energy Wasting (PEW) is a state of metabolic and nutritional derangements in chronic disease states including chronic kidney disease (CKD). Cumulative evidence suggests that PEW, muscle Wasting and cachexia are common and strongly associated with mortality in CKD, which is reviewed here.
-
Protein-Energy Wasting and uremic failure to thrive in children with chronic kidney disease: They are not small adults
Pediatric Nephrology, 2014Co-Authors: Noureddin Nourbakhsh, Connie M. Rhee, Kamyar Kalantar-zadehAbstract:Protein-Energy Wasting (PEW), a condition of decreased body Protein and fat mass, is highly prevalent in patients with chronic kidney disease (CKD) and a potent predictor of mortality in this population. In adults with CKD, PEW has typically been defined on the basis of (1) deranged biochemical parameters, (2) reduced body mass, (3) reduced muscle mass, and (4) decreased dietary Protein intake. Emerging data suggest that PEW may also commonly afflict children with CKD and have a negative impact on growth and development (“uremic failure to thrive”), yet it remains comparatively understudied and less well characterized in these patients. Given the challenges of applying adult-defined PEW criteria to the pediatric population, the authors of a recent study entitled “Protein Energy Wasting in children with chronic kidney disease” [Abraham et al. (2014) Pediatr Nephrol 29:1231–1238] have sought to develop a scoring system and three alterative definitions for this condition using a combination of biochemical markers, clinical measurements, and subjective reporting in children in the CKiD cohort: (1) minimal PEW definition (≥2 adult-defined PEW criteria); (2) standard PEW definition (≥3 adult-defined PEW criteria); (3) modified PEW definition (≥3 adult-defined PEW criteria, plus short stature or poor growth). These authors observed that meeting the modified PEW definition was associated with a significantly increased risk of hospitalization in unadjusted analyses, i.e., a 2.2-fold higher risk, and trended towards increased risk in multivariable adjusted analyses, i.e., 2.0-fold higher risk. At the present time, future studies validating these findings and developing further refined definitions and/or scoring systems for the detection and management of PEW in children and uremic failure to thrive are urgently needed.
-
Protein-Energy Wasting
Nutrition in Kidney Disease, 2013Co-Authors: Kamyar Kalantar-zadehAbstract:Among individuals with CKD stage 5D, who undergo maintenance dialysis treatment to survive, currently one out of every five people dies each year in the USA. This unacceptably high mortality rate has not changed substantially in recent years despite many advances in dialysis techniques and patient care [1]. Maintenance dialysis patients also have a high hospitalization rate and a low health-related quality of life. Cardiovascular diseases comprise the bulk of morbidity and mortality in dialysis patients. The dialysis-dependent CKD-5D population grows constantly and fast, almost surpassing over half a million in the USA, and continues to consume a disproportionately large component of the Medicare budget; hence, identifying factors that lead to poor dialysis outcome and their successful management is of outmost importance [1]. It was once believed that the traditional cardiovascular risk factors and/or conditions related to dialysis treatment and technique are the main causes of poor clinical outcome; however, randomized controlled trials have failed to show an improvement of mortality by lowering serum cholesterol [2] or increasing dialysis dose [3, 4]. Whereas frequent (such as daily in-center or nocturnal) hemodialysis may have better outcome, it is highly unlikely that this modality ever be offered to more than a small fraction of patients, whereas infrequent (e.g., twice weekly) hemodialysis is practiced more frequently in developing countries [5]. Evidence suggests that conditions other than the traditional cardiovascular risk factors be related to the enormous cardiovascular epidemic and high death rates in this population. Among the potential candidates for the poor clinical outcomes in maintenance dialysis patients, the Protein-Energy Wasting (PEW) continues to be at the top of the list [6]. Observational studies have repeatedly and consistently shown a strong association between measures of nutritional status and survival in maintenance dialysis patients [7–9].
-
Protein-Energy Wasting as a Risk Factor of Morbidity and Mortality in Chronic Kidney Disease
Nutritional Management of Renal Disease, 2013Co-Authors: Csaba P. Kovesdy, Kamyar Kalantar-zadehAbstract:Mortality remains extremely high in patients with dialysis-requiring end-stage renal disease and nondialysis dependent CKD. Whereas traditional cardiovascular disease risk factors are unable to account for this high mortality risk, abnormal nutrition and inflammation have been shown to be some of the strongest risk factors associated with adverse outcomes in these groups. Due to their complex interplay, condition characterized by the presence of malnutrition and/or inflammation are now grouped under the term Protein-Energy Wasting. Indicators of Protein-Energy Wasting such as low serum albumin, low blood cholesterol, low Protein intake or low BMI have been associated with an array of adverse outcomes in CKD and ESRD, such as increased mortality, morbidity, and hospitalization rates. Some of these indicators are also traditional cardiovascular risk factors, and the presence of Protein-Energy Wasting may be one of the main reasons why such traditional risk factors have shown inverse associations with outcomes in CKD and ESRD compared to the general population. This chapter provides an in-depth discussion of the epidemiology of Protein-Energy Wasting in CKD and ESRD, including its associations with various adverse outcomes, and discusses the possible pathophysiologic underpinnings of such associations. The strong associations of virtually all aspects of Protein-Energy Wasting with adverse outcomes in CKD and ESRD suggests that treatments directed against these conditions may be beneficial toward improving outcomes in these patients. While there are currently no large clinical trials proving such a benefit, we discuss epidemiologic evidence supporting the efficacy of nutritional interventions in achieving better clinical outcomes in CKD and ESRD.
Joel D. Kopple - One of the best experts on this subject based on the ideXlab platform.
-
Is it Important to Prevent and Treat Protein-Energy Wasting in Chronic Kidney Disease and Chronic Dialysis Patients?
Journal of Renal Nutrition, 2018Co-Authors: Bereket Tessema Lodebo, Anuja Shah, Joel D. KoppleAbstract:Protein-Energy Wasting (PEW), which essentially refers to decreased body Protein mass and fuel (Energy) reserves, is common in advanced chronic kidney disease (CKD) patients and end-stage kidney disease patients undergoing chronic dialysis. The term PEW is used rather than Protein-Energy malnutrition because many causes of PEW in CKD and end-stage kidney disease patients does not involve reduced nutrient intake (e.g., catabolic illness, oxidants, biologicals lost in urine and dialysate, acidemia). The prevalence of PEW in CKD increases as glomerular filtration rate declines and is highest in chronic dialysis patients. PEW in CKD is important because it is associated with substantially increased morbidity and mortality and reduced quality of life. Many signs of PEW can be improved with nutritional therapy. It is not known whether amelioration or eradication of PEW by treatment of underlying illnesses, nutritional therapy, and/or other measures will reduce morbidity and mortality or improve quality of life. Clinical trials are indicated to answer these questions.
-
Frailty and Protein-Energy Wasting in Elderly Patients with End Stage Kidney Disease
Journal of The American Society of Nephrology, 2012Co-Authors: Jun Chul Kim, Kamyar Kalantar-zadeh, Joel D. KoppleAbstract:Older people constitute an increasingly greater proportion of patients with advanced CKD, including those patients undergoing maintenance dialysis treatment. Frailty is a biologic syndrome of decreased reserve and resistance to stressors that results from cumulative declines across multiple physiologic systems and causes vulnerability to adverse outcomes. Frailty is common in elderly CKD patients, and it may be associated with Protein-Energy Wasting (PEW), sarcopenia, dynapenia, and other complications of CKD. Causes of frailty with or without PEW in the elderly with CKD can be classified into three categories: causes primarily caused by aging per se, advanced CKD per se, or a combination of both conditions. Frailty and PEW in elderly CKD patients are associated with impaired physical performance, disability, poorer quality of life, and reduced survival. Prevention and treatment of these conditions in the elderly CKD patients often require a multifaceted approach. Here, we examine the causes and consequences of these conditions and examine the interplay between frailty and PEW in elderly CKD patients.
-
Effect of diabetes mellitus on Protein-Energy Wasting and Protein Wasting in end-stage renal disease.
Seminars in Dialysis, 2010Co-Authors: Nazanin Noori, Joel D. KoppleAbstract:Protein Wasting (PW) or Protein-Energy Wasting (PEW) occurs commonly in patients with diabetes mellitus who have end-stage renal disease (ESRD) and are undergoing maintenance dialysis (MD) therapy. Some but not all studies indicate that PW or PEW is more prevalent in diabetic when compared with nondiabetic MD patients and that diabetic patients commencing maintenance hemodialysis (MHD) are more likely to lose fat-free, edema-free weight than are incident nondiabetic MHD patients. The causes of PW and PEW in diabetic MD patients are probably largely similar to those of nondiabetic MD patients. These causes include anorexia, reduced food intake, concurrent illnesses particularly when associated with inflammatory processes, physical or mental debility, removal of nutrients by dialysis procedure, acidemia, possibly physical deconditioning, and oxidant and carbonyl stress. However, diabetic MD patients are also at greater risk for PW or PEW from comorbidities related to diabetes per se. These disorders include ischemic vascular disease, hypertension, gastrointestinal dysfunction, and neuropathy. Metabolic disorders such as insulin deficiency or resistance to the actions of insulin, and elevated levels of counterregulatory hormones may also contribute to PW or PEW in diabetic MD patients. Mechanisms by which these metabolic disorders in diabetic ESRD patients may cause PW or PEW are discussed.
-
causes and prevention of Protein Energy Wasting in chronic kidney failure
Seminars in Nephrology, 2009Co-Authors: Ramnath Dukkipati, Joel D. KoppleAbstract:Protein-Energy Wasting (PEW), defined as reduced somatic and/or circulating body Protein mass, decreased fat mass, and usually reduced Protein and Energy intake, has a prevalence that is variously estimated to be 18% to 75% in maintenance hemodialysis and chronic peritoneal dialysis patients. PEW is associated with increased morbidity and mortality and often is preventable or treatable. Thus, it has been argued that maintenance hemodialysis and chronic peritoneal dialysis patients should be monitored routinely for PEW and treated for this condition, when it occurs. A trend toward PEW can emerge in early stage 3 chronic kidney disease with an increasing risk toward the development and worsening of PEW as chronic kidney disease progresses. A main cause of PEW is inflammation, which may occur with or without clinically evident illness and can be associated with the most severe forms of PEW. Another major cause of PEW is decreased nutrient intake relative to the patient's nutritional needs, and may be caused by anorexia, which may be engendered by uremic toxicity, emotional depression, medications, or inflammatory disorders. Nonanorexic causes of reduced nutrient intake include inadequate finances to purchase or prepare foods; medical or surgical illnesses that impair the person's ability to ingest, digest, assimilate, or process the nutrients; impaired cognitive function; other mental or physical disabilities; and loss of dentures. Losses of nutrients during dialysis treatments or in urine (eg, the nephrotic syndrome), acidemia, and hormonal disorders can contribute to the development of PEW. Early initiation and adequate doses of renal replacement therapy, rapid treatment of reversible inflammatory processes, ensuring an adequate nutrient intake, and prevention of acidemia may be used to prevent and treat PEW.
-
a proposed nomenclature and diagnostic criteria for Protein Energy Wasting in acute and chronic kidney disease
Kidney International, 2008Co-Authors: Denis Fouque, Joel D. Kopple, Noël Cano, Philippe Chauveau, Lilian Cuppari, Harold A. Franch, Gabriele Guarnieri, Talat Alp Ikizler, Kamyar Kalantarzadeh, George A. KaysenAbstract:The recent research findings concerning syndromes of muscle Wasting, malnutrition, and inflammation in individuals with chronic kidney disease (CKD) or acute kidney injury (AKI) have led to a need for new terminology. To address this need, the International Society of Renal Nutrition and Metabolism (ISRNM) convened an expert panel to review and develop standard terminologies and definitions related to Wasting, cachexia, malnutrition, and inflammation in CKD and AKI. The ISRNM expert panel recommends the term 'Protein-Energy Wasting' for loss of body Protein mass and fuel reserves. 'Kidney disease Wasting' refers to the occurrence of Protein-Energy Wasting in CKD or AKI regardless of the cause. Cachexia is a severe form of Protein-Energy Wasting that occurs infrequently in kidney disease. Protein-Energy Wasting is diagnosed if three characteristics are present (low serum levels of albumin, transthyretin, or cholesterol), reduced body mass (low or reduced body or fat mass or weight loss with reduced intake of Protein and Energy), and reduced muscle mass (muscle Wasting or sarcopenia, reduced mid-arm muscle circumference). The kidney disease Wasting is divided into two main categories of CKD- and AKI-associated Protein-Energy Wasting. Measures of chronic inflammation or other developing tests can be useful clues for the existence of Protein-Energy Wasting but do not define Protein-Energy Wasting. Clinical staging and potential treatment strategies for Protein-Energy Wasting are to be developed in the future.
Giovanni Montini - One of the best experts on this subject based on the ideXlab platform.
-
unacylated ghrelin and obestatin promising biomarkers of Protein Energy Wasting in children with chronic kidney disease
Pediatric Nephrology, 2018Co-Authors: Alice Monzani, Michela Perrone, Flavia Prodam, Stefania Moia, Giulia Genoni, Sara Testa, Fabio Paglialonga, A Rapa, Gianni Bona, Giovanni MontiniAbstract:Background Impairment in orexigenic/anorexigenic hormone balance may be key in the pathogenesis of Protein Energy Wasting in children with chronic kidney disease (CKD). Measurement of ghrelin and obestatin concentrations in children with CKD would help assess the potential contribution of these hormones to uremic Protein Energy Wasting.
-
Unacylated ghrelin and obestatin: promising biomarkers of Protein Energy Wasting in children with chronic kidney disease
'Springer Science and Business Media LLC', 2018Co-Authors: Alice Monzani, Michela Perrone, Flavia Prodam, Stefania Moia, Giulia Genoni, Sara Testa, Fabio Paglialonga, A Rapa, Gianni Bona, Giovanni MontiniAbstract:Background: Impairment in orexigenic/anorexigenic hormone balance may be key in the pathogenesis of Protein Energy Wasting in children with chronic kidney disease (CKD). Measurement of ghrelin and obestatin concentrations in children with CKD would help assess the potential contribution of these hormones to uremic Protein Energy Wasting. Methods: This was a cross-sectional caseâ\u80\u93control study. Acylated and unacylated ghrelin and obestatin were measured in 42 children on conservative treatment (CT), 20 children on hemodialysis, 48 pediatric renal transplant (RTx) recipients and 43 controls (CTR) (mean age 11.9, range 5â\u80\u9320 years). Weight, height and bicipital, tricipital, subscapular and suprailiac folds were measured, and the body mass index-standard deviation score (BMI-SDS), percentage of fat mass and fat-free mass were calculated. Urea and creatinine were measured and the glomerular filtration rate (GFR) calculated. Results: Unacylated ghrelin level was higher in patients than controls (p = 0.0001), with the highest levels found in hemodialysis patients (p = 0.001 vs. CKD-CT, p = 0.0001 vs. RTx, p < 0.0001 vs. CTR). Obestatin level was significantly higher in patients on hemodialysis than those on conservative treatment, RTx recipients and controls (p < 0.0001 in each case). Unacylated ghrelin negatively correlated with weight-SDS (p < 0.0001), BMI-SDS (p = 0.0005) and percentage fat mass (p = 0.004) and positively correlated with percentage fat-free mass (p = 0.004). Obestatin concentration negatively correlated with weight-SDS (p = 0.007). Unacylated ghrelin and obestatin concentrations positively correlated with creatinine and urea and inversely with eGFR, even after adjustments for gender, age, puberty and BMI-SDS (p < 0.0001 for each model). Conclusions: Unacylated ghrelin and obestatin, negatively related to renal function, seem to be promising inverse indicators of nutritional status in children with CKD. Potential therapeutic implications in terms of optimization of their removal in patients on hemodialysis could be hypothesized
Peter Stenvinkel - One of the best experts on this subject based on the ideXlab platform.
-
Protein-Energy Wasting/Malnutrition and the Inflammatory Response
Nutrition in Kidney Disease, 2020Co-Authors: Carla Maria Avesani, Bengt Lindholm, Peter StenvinkelAbstract:The importance of enhanced inflammatory response as a leading cause of diminished reserves of Protein stores in chronic kidney disease (CKD) has been extensively described as part of the uremic phenotype in the last 20 years. The persistent low-grade inflammation observed in end-stage renal disease (ESRD) patients plays a crucial role in Protein Energy Wasting (PEW) by promoting increased Energy expenditure and Protein catabolism while decreasing Protein synthesis. This cycle can result in a negative nitrogen balance with loss of muscle mass and consequent Wasting. In addition, inflammation, which has a pivotal role in the atherogenic process, worsens cardiovascular mortality and can further aggravate the detrimental outcomes, especially if Wasting is present. The cardiovascular mortality of ESRD patients is further increased in those with inflammation (C-reactive Protein [CRP] ≥10 mg/L) and malnutrition (assessed by subjective global assessment (SGA)), as compared with those with only inflammation or malnutrition, or in the absence of both conditions. Since inflammation is believed to be a leading cause of PEW and cardiovascular disease (CVD) in ESRD, and inflammation therefore represents a potential target for therapeutic – pharmacological as well as nonpharmacological – interventions, this chapter aims to review the interrelation between inflammation and nutritional disorders, especially PEW, and to discuss potential strategies of treatment targeting inflammation, PEW, and sarcopenia.
-
Protein Energy Wasting malnutrition and the inflammatory response
2020Co-Authors: Carla Maria Avesani, Bengt Lindholm, Peter StenvinkelAbstract:The importance of enhanced inflammatory response as a leading cause of diminished reserves of Protein stores in chronic kidney disease (CKD) has been extensively described as part of the uremic phenotype in the last 20 years. The persistent low-grade inflammation observed in end-stage renal disease (ESRD) patients plays a crucial role in Protein Energy Wasting (PEW) by promoting increased Energy expenditure and Protein catabolism while decreasing Protein synthesis. This cycle can result in a negative nitrogen balance with loss of muscle mass and consequent Wasting. In addition, inflammation, which has a pivotal role in the atherogenic process, worsens cardiovascular mortality and can further aggravate the detrimental outcomes, especially if Wasting is present. The cardiovascular mortality of ESRD patients is further increased in those with inflammation (C-reactive Protein [CRP] ≥10 mg/L) and malnutrition (assessed by subjective global assessment (SGA)), as compared with those with only inflammation or malnutrition, or in the absence of both conditions. Since inflammation is believed to be a leading cause of PEW and cardiovascular disease (CVD) in ESRD, and inflammation therefore represents a potential target for therapeutic – pharmacological as well as nonpharmacological – interventions, this chapter aims to review the interrelation between inflammation and nutritional disorders, especially PEW, and to discuss potential strategies of treatment targeting inflammation, PEW, and sarcopenia.
-
Inflammation and Protein-Energy Wasting in the Uremic Milieu.
Contributions To Nephrology, 2017Co-Authors: Magdalena Jankowska, Bengt Lindholm, Gabriela Cobo, Peter StenvinkelAbstract:Inflammation is normally a protective and physiological response to harmful stimuli, but typically becomes an uncontrolled, maladaptive, and persistent process in patients with end-stage renal disease (ESRD). Through a deleterious cascade of poorly controlled reactions mediated by biologically active molecules (also called middle molecular weight uremia retention solutes), inflammation associates with a range of complications including cardiovascular disease and Protein-Energy Wasting (PEW). Persistent inflammation, which is central to the conceptual etiological models of PEW and the malnutrition, inflammation, and atherosclerosis syndrome, induces and reignites processes leading to PEW in a number of ways including stimulation of both direct and indirect mechanisms of muscle proteolysis. Similar to other chronic diseases, inflammation in the uremic milieu is the consequence of multiple factors including comorbidities, such as infections. In addition, inflammation is further aggravated in ESRD by uremic immune dysfunction, inadequate renal removal of cytokines, and inflammatory responses to dialysis. It is plausible that only by disrupting this vicious circle(s) by acting on several levels of the inflammatory cascade rather than targeting single causes of inflammation will it be possible to improve the prognosis in ESRD patients. Accordingly, treatment of uremic inflammation and PEW require an integrated approach. In addition to lifestyle modifications, nutritional supplements, and drugs with anti-inflammatory potential, improved dialysis therapy using high retention onset membranes has emerged recently. This novel dialysis technique, also called expanded hemodialysis (HDx), may provide a more efficient removal of middle molecules involved in the cascade of inflammatory mediators with selectivity against albumin losses. Plausibly, the implementation of HDx, integrated with strategies blocking an excessive secretion of inflammatory mediators, may offer a new therapeutic approach to chronic inflammation and PEW in ESRD.
-
Protein-Energy Wasting modifies the association of ghrelin with inflammation, leptin, and mortality in hemodialysis patients
Kidney International, 2010Co-Authors: Juan Jesus Carrero, Olof Heimbürger, Peter Bárány, Bengt Lindholm, Ayumu Nakashima, Abdul Rashid Qureshi, Peter StenvinkelAbstract:Ghrelin abnormalities contribute to anorexia, inflammation, and cardiovascular risk in hemodialysis patients, leading to worse outcome. However, ghrelin levels are influenced by the nutritional status of the individual. We hypothesized that the consequences of ghrelin alterations in hemodialysis patients are context sensitive and dependent on the presence of Protein-Energy Wasting (PEW). In this cross-sectional study of 217 prevalent hemodialysis patients followed for 31 months, we measured ghrelin, leptin, PEW (subjective global assessment), and C-reactive Protein (an index of inflammation). Compared to patients in the middle and upper tertile of ghrelin levels, those in the lowest tertile were older, had higher leptin levels and body mass index, and presented an increased mortality risk that persisted after adjustment for age, gender, and dialysis vintage. This risk was lost after correction for comorbidities. Patients with PEW and low ghrelin values had abnormally high C-reactive Protein and leptin by multivariate analysis of variance, and the highest mortality risk compared to non-PEW with high ghrelin from all-cause and cardiovascular-related mortality (adjusted hazard ratios of 3.34 and 3.54, respectively). Low ghrelin values in Protein-Energy wasted hemodialysis patients were linked to a markedly increased cardiovascular mortality risk. Thus, since these patients were more anorectic, our results provide a clinical scenario where ghrelin therapies may be particularly useful.
-
Plasma Pentraxin 3 in Patients with Chronic Kidney Disease: Associations with Renal Function, Protein-Energy Wasting, Cardiovascular Disease, and Mortality
Clinical Journal of The American Society of Nephrology, 2007Co-Authors: Mengli Tong, Juan Jesus Carrero, A. Rashid Qureshi, Björn Anderstam, Olof Heimbürger, Peter Bárány, Jonas Axelsson, Anders Alvestrand, Peter Stenvinkel, Bengt LindholmAbstract:Background and Objectives: Plasma Protein pentraxin 3 concentrations are elevated in a wide range of diseased states. However, no study has evaluated Protein pentraxin 3 in patients with chronic kidney disease. Design, Setting, Participants, & Measurements: Plasma Protein pentraxin 3 concentrations were analyzed in relation to GFR, inflammation, cardiovascular disease, and Protein-Energy Wasting in 71 patients with stages 3 to 4 chronic kidney disease, 276 patients with stage 5 chronic kidney disease, and 61 control subjects. Survival (5 yr) in patients with stage 5 chronic kidney disease was analyzed in relation to Protein pentraxin 3 levels. Results: Both patient groups with chronic kidney disease had higher Protein pentraxin 3 concentrations than control subjects, with the highest concentration in patients with stage 5 chronic kidney disease. In all patients with chronic kidney disease, Protein pentraxin 3 correlated negatively with GFR and positively with inflammatory markers. Patients with Protein-Energy Wasting, inflammation, and cardiovascular disease had higher concentrations of Protein pentraxin 3 than their counterparts. Patients with high Protein pentraxin 3 levels had higher all-cause and cardiovascular mortality. After adjustment for age, gender, C-reactive Protein, and cardiovascular disease, all-cause mortality was still significantly higher in patients with high Protein pentraxin 3. Finally, Protein pentraxin 3 showed a predictive value of mortality similar to that of IL-6 and better than C-reactive Protein. Conclusion: Plasma Protein pentraxin 3 increases as GFR declines and is associated with the presence of cardiovascular disease and Protein-Energy Wasting. Furthermore, in patients with chronic kidney disease, elevated Protein pentraxin 3 predicted all-cause mortality.
