A proposed nomenclature and diagnostic criteria for protein–energy wasting in acute and chronic kidney disease

Abstract

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.

Body fat mass is correlated with serum transthyretin levels in maintenance hemodialysis patients

“…Various terms, such as uremic malnutrition, protein!energy malnutrition, malnutrition!inflammation!atherosclerosis syndrome, and malnutrition !inflammation complex syndrome, have been used for malnutrition in patients with renal disease, resulting in some confusion (7). Therefore, the International Society of Renal Nutrition and Metabolism (ISRNM) proposed the term "protein!…”

“…Therefore, the International Society of Renal Nutrition and Metabolism (ISRNM) proposed the term "protein! energy wasting (PEW)", which refers to the multiple metabolic and nutritional alterations occurring in renal disease patients, and established diagnostic criteria for PEW (7,8).…”

Plasma Retinol Concentration Is Mainly Driven by Transthyretin in Hemodialysis Patients

“…Protein energy wasting syndrome affects 30 to 60% of hemodialysis patients (HD) and contributes to high morbidity and mortality rates in this specific population [1]. Yet, in daily practices, very little concern is made about micronutrients (i.e.…”

Unacylated ghrelin and obestatin in pediatric CKD: are they important in protein energy wasting?

“…BThe proposed criteria to establish the diagnosis of PEW includes four categories: (1) biochemical indexes; (2) body weight parameters, including reduced body fat and weight loss; (3) reduced muscle mass; (4) low protein/energy intake [ 2]. Anorexia is included as a criterion for cachexia [7], while poor protein/energy intake is a criterion for PEW [1]. Anorexia, defined as the loss of appetite and early satiety, is prevalent in adults and pediatric CKD patients [8].…”