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Protein-energy wasting and mortality in chronic kidney disease.

Bonanni A, Mannucci I, Verzola D, Sofia A, Saffioti S, Gianetta E, Garibotto G - Int J Environ Res Public Health (2011)

Bottom Line: Mechanisms causing loss of muscle protein and fat are complex and not always associated with anorexia, but are linked to several abnormalities that stimulate protein degradation and/or decrease protein synthesis.In addition, data from experimental CKD indicate that uremia specifically blunts the regenerative potential in skeletal muscle, by acting on muscle stem cells.During the course of CKD, the loss of kidney excretory and metabolic functions proceed together with the activation of pathways of endothelial damage, inflammation, acidosis, alterations in insulin signaling and anorexia which are likely to orchestrate net protein catabolism and the PEW syndrome.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, Azienda Ospedale Università San Martino, Genoa University, Viale Benedetto XV 6, Genoa, Italy. alice.bonanni@libero.it

ABSTRACT
Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD) and is associated with an increased death risk from cardiovascular diseases. However, while even minor renal dysfunction is an independent predictor of adverse cardiovascular prognosis, PEW becomes clinically manifest at an advanced stage, early before or during the dialytic stage. Mechanisms causing loss of muscle protein and fat are complex and not always associated with anorexia, but are linked to several abnormalities that stimulate protein degradation and/or decrease protein synthesis. In addition, data from experimental CKD indicate that uremia specifically blunts the regenerative potential in skeletal muscle, by acting on muscle stem cells. In this discussion recent findings regarding the mechanisms responsible for malnutrition and the increase in cardiovascular risk in CKD patients are discussed. During the course of CKD, the loss of kidney excretory and metabolic functions proceed together with the activation of pathways of endothelial damage, inflammation, acidosis, alterations in insulin signaling and anorexia which are likely to orchestrate net protein catabolism and the PEW syndrome.

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Related in: MedlinePlus

Major mechanisms promoting infections in patients with chronic kidney disease.
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Related In: Results  -  Collection

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f1-ijerph-08-01631: Major mechanisms promoting infections in patients with chronic kidney disease.

Mentions: Chronic uremia is considered a state of acquired immunodeficiency [126] and CKD patients are at high risk for infection [127]. Among participants in the HEMO Study [128] who died during follow-up, infection was the primary cause of death in 23%. The overall probability of death during an infection-related hospitalization was 15%. Numerous factors, including advanced age, diabetes, hypoalbuminemia, immunosuppressive therapy, dialysis catheters, the dialysis procedure and uremia per se potentially predispose CKD patients to infections (Figure 1). Malnutrition causes defective immune function because of enhanced susceptibility to infections and deficient damage healing [129]. There are nutrients such as arginine and glutamine which can improve the immune response [130–132]. CKD patients are predisposed to zinc [133,134], vitamin B6 (pyridoxine), vitamin C and folic acid deficiencies [135,136], which can lead to alterations in host defense.


Protein-energy wasting and mortality in chronic kidney disease.

Bonanni A, Mannucci I, Verzola D, Sofia A, Saffioti S, Gianetta E, Garibotto G - Int J Environ Res Public Health (2011)

Major mechanisms promoting infections in patients with chronic kidney disease.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3108132&req=5

f1-ijerph-08-01631: Major mechanisms promoting infections in patients with chronic kidney disease.
Mentions: Chronic uremia is considered a state of acquired immunodeficiency [126] and CKD patients are at high risk for infection [127]. Among participants in the HEMO Study [128] who died during follow-up, infection was the primary cause of death in 23%. The overall probability of death during an infection-related hospitalization was 15%. Numerous factors, including advanced age, diabetes, hypoalbuminemia, immunosuppressive therapy, dialysis catheters, the dialysis procedure and uremia per se potentially predispose CKD patients to infections (Figure 1). Malnutrition causes defective immune function because of enhanced susceptibility to infections and deficient damage healing [129]. There are nutrients such as arginine and glutamine which can improve the immune response [130–132]. CKD patients are predisposed to zinc [133,134], vitamin B6 (pyridoxine), vitamin C and folic acid deficiencies [135,136], which can lead to alterations in host defense.

Bottom Line: Mechanisms causing loss of muscle protein and fat are complex and not always associated with anorexia, but are linked to several abnormalities that stimulate protein degradation and/or decrease protein synthesis.In addition, data from experimental CKD indicate that uremia specifically blunts the regenerative potential in skeletal muscle, by acting on muscle stem cells.During the course of CKD, the loss of kidney excretory and metabolic functions proceed together with the activation of pathways of endothelial damage, inflammation, acidosis, alterations in insulin signaling and anorexia which are likely to orchestrate net protein catabolism and the PEW syndrome.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, Azienda Ospedale Università San Martino, Genoa University, Viale Benedetto XV 6, Genoa, Italy. alice.bonanni@libero.it

ABSTRACT
Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD) and is associated with an increased death risk from cardiovascular diseases. However, while even minor renal dysfunction is an independent predictor of adverse cardiovascular prognosis, PEW becomes clinically manifest at an advanced stage, early before or during the dialytic stage. Mechanisms causing loss of muscle protein and fat are complex and not always associated with anorexia, but are linked to several abnormalities that stimulate protein degradation and/or decrease protein synthesis. In addition, data from experimental CKD indicate that uremia specifically blunts the regenerative potential in skeletal muscle, by acting on muscle stem cells. In this discussion recent findings regarding the mechanisms responsible for malnutrition and the increase in cardiovascular risk in CKD patients are discussed. During the course of CKD, the loss of kidney excretory and metabolic functions proceed together with the activation of pathways of endothelial damage, inflammation, acidosis, alterations in insulin signaling and anorexia which are likely to orchestrate net protein catabolism and the PEW syndrome.

Show MeSH
Related in: MedlinePlus