Longitudinal Weight Change During CKD Progression and Its Association With Subsequent Mortality

Ku, Elaine; Kopple, Joel D.; Johansen, Kirsten L.; McCulloch, Charles E.; Go, Alan S.; Xie, Dawei; Lin, Feng; Hamm, L. Lee; He, Jiang; Kusek, John W.; Navaneethan, Sankar D.; Ricardo, Ana C.; Rincon-Choles, Hernan; Smogorzewski, Miroslaw; Hsu, Chi‐yuan; Appel, Lawrence J.; Feldman, Harold I.; Lash, James P.; Ojo, Akinlolu; Rahman, Mahboob; Townsend, Raymond R.

doi:10.1053/j.ajkd.2017.09.015

Cited by 65 publications

(61 citation statements)

References 38 publications

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“…Body weight loss remains a valid criterion; in a recent study including almost 5000 patients, a significant weight loss began relatively early during the course of CKD and was associated with a substantially higher risk for death after dialysis therapy initiation. 19 Overall, both classifications have identified a nonvoluntary weight loss as a phenotypical criterion based on a robust literature: greater than 5% within the past 6 months or >10% beyond 6 months as recently proposed by the Global Leadership Initiative on Malnutrition. 20 The presence of a critical weight loss (>5% in 6 months) should probably be considered as a major criterion to define cachexia/PEW.…”

Section: Body Weight and Body Compositionmentioning

confidence: 99%

Kidney cachexia or protein‐energy wasting in chronic kidney disease: facts and numbers

Koppe

Fouque

Kalantar-Zadeh

2019

J cachexia sarcopenia muscle

156

105

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Background Weight loss and homeostatic disturbances of both energy and protein balances are characteristics of several illnesses including cancer, heart failure, and chronic kidney disease (CKD). Different definitions have been used to describe this deleterious process. The term protein‐energy wasting (PEW) has been proposed for CKD patients by the International Society of Renal Nutrition and Metabolism . Methods We searched the publication in Medline from February 2008 to September 2018 using PEW or cachexia in their title. Results Since its inception, the term PEW has been exceptionally successful, highlighted by 327 original publications referenced in PubMed over 10 years. Using this classification, several studies have confirmed that PEW is among the strongest predictors of mortality in CKD patients [hazard ratio of 3.03; confidence interval of 1.69–5.26 in 1068 haemodialysis patients and 1.40 (1.04–1.89) in 1487 non‐dialysed patients across PEW stages 0 to 4]. Based on this classification, prevalence of PEW is 28% to 54% among 16 434 adults undergoing maintenance dialysis. PEW prevalence increases when renal function declines, that is, from <2% in CKD stages 1–2 to 11–54% in CKD stages 3–5. A more general definition of cachexia for all chronic diseases proposed by the Society on Sarcopenia, Cachexia and Wasting Disorders was also published concurrently. In the CKD area, we found 180 publications using ‘cachexia’ underlining that some confusion or overlap may exist. The definitions of PEW and cachexia are somewhat similar, and the main difference is that a loss of body weight >5% is a mandatory criterion for cachexia but supportive for PEW. Conclusions The recent understanding of cachexia physiopathology during CKD progression suggests that PEW and cachexia are closely related and that PEW corresponds the initial state of a continuous process that leads to cachexia, implicating the same metabolic pathways as in other chronic diseases. Despite the success of the definition of PEW, using a more uniform term such as ‘kidney disease cachexia’ could be more helpful to design future research through collaborative groups of researchers with focus on cachexia.

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Section: Body Weight and Body Compositionmentioning

confidence: 99%

Kidney cachexia or protein‐energy wasting in chronic kidney disease: facts and numbers

Koppe

Fouque

Kalantar-Zadeh

2019

J cachexia sarcopenia muscle

156

105

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“…The similarity of the GFR levels in these various studies 1,18,19,22,23 when evidence for PEW begins to become apparent, roughly around 30-40 mL/min/ 1.73 m 2 or slightly lower in the South Korean CKD patients, is rather striking and has clinical implications. For example, a 45-year-old Caucasian with an estimated glomerular filtration rate (eGFR), calculated from the Chronic Kidney Disease Epidemiology Collaboration equation, 24 The prevalence of PEW in maintenance hemodialysis (MHD) and chronic peritoneal dialysis (CPD) patients is more common than in nondialyzed CKD patients.…”

Section: Peritoneal Dialysis Patientsmentioning

confidence: 80%

“…19 Few, if any, of these latter patients had insulin requiring diabetes mellitus. Strikingly, two other more recent longitudinal studies from the Chronic Renal Insufficiency Cohort of nondialyzed CKD adults and the African American Study of Kidney Disease and Hypertension 22 and the CKD in Children Study 23 also indicate that the BMI of these individuals began to decrease when their GFR fell below 35 mL/minute/1.73 m 2 .…”

Section: Peritoneal Dialysis Patientsmentioning

confidence: 97%

Is it Important to Prevent and Treat Protein-Energy Wasting in Chronic Kidney Disease and Chronic Dialysis Patients?

Lodebo

Shah

Kopple

2018

Journal of Renal Nutrition

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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.

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“…The evaluation of body mass for the diagnosis of PEW based on the ISRNM recommendations is mostly related to BMI values and body weight changes. Body weight loss of more than 5% in the first 6 months of dialysis significantly increases mortality risk, while weight gain during the first year of dialysis is associated with better survival . The BMI quantifies changes in body mass adjusted for height (body weight in kg/height 2 [m 2 ]).…”

Section: Protein Energy Wasting and Nutritional Status Evaluation In mentioning

confidence: 99%

“…Body weight loss of more than 5% in the first 6 months of dialysis significantly increases mortality risk, while weight gain during the first year of dialysis is associated with better survival. 15,16 The BMI quantifies changes in body mass adjusted for height (body weight in kg/height 2 [m 2 ]). For this reason, BMI neither allows one to differentiate lean body mass and fat mass changes, nor accounts for the hydration status of patients.…”

Section: Nutritional Status Evaluation In Esrdmentioning

confidence: 99%

Dietary protein and nutritional supplements in conventional hemodialysis

Sabatino

Piotti

Cosola

et al. 2018

Seminars in Dialysis

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Protein energy wasting (PEW) is a condition commonly occurring among patients with ESRD on hemodialysis. PEW is characterized by depletion of protein and energy stores and is caused by multiple factors related to chronic kidney disease, acute and chronic comorbidities and by renal replacement therapy itself. Anorexia is central in the pathogenesis of PEW; it is frequently observed in these patients whose protein and energy intakes are typically lower than guidelines recommendations. If untreated, PEW invariably leads to major complications, and may activate a vicious circle with further worsening of nutritional status. Dietary counseling and nutritional status monitoring play a key role in the prevention and treatment of PEW, since they allow an early identification of high risk patients, as well as the assessment of the response to nutritional intervention. Different nutritional approaches can be implemented following thorough nutritional counseling. These are chosen on the basis of patients' spontaneous dietary intake, severity of PEW and acute comorbidities. Initially, regular encounters with the dietitian allow patients to clarify doubts and strengthen basic concepts on nutrition to improve dietary intake and prevent PEW. When PEW is present or the patient is at high risk, the clinician may opt for the administration of oral intradialytic or daily supplements, aiming at increasing energy and protein intake, while in selected cases intradialytic parenteral nutrition may be used. This review addresses the main issues of nutritional status in ESRD patients on hemodialysis-its evaluation and monitoring, as well as at describing the available nutritional interventions.

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Longitudinal Weight Change During CKD Progression and Its Association With Subsequent Mortality

Cited by 65 publications

References 38 publications

Kidney cachexia or protein‐energy wasting in chronic kidney disease: facts and numbers

Kidney cachexia or protein‐energy wasting in chronic kidney disease: facts and numbers

Is it Important to Prevent and Treat Protein-Energy Wasting in Chronic Kidney Disease and Chronic Dialysis Patients?

Dietary protein and nutritional supplements in conventional hemodialysis

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