Cachexia and protein-energy wasting in children with chronic kidney disease

Abstract

Children with chronic kidney disease (CKD) are at risk for “cachexia” or “protein-energy wasting” (PEW). These terms describe a pathophysiologic process resulting in the loss of muscle, with or without loss of fat, and involving maladaptive responses, including anorexia and elevated metabolic rate. PEW has been defined specifically in relation to CKD. We review the diagnostic criteria for cachexia and PEW in CKD and consider the limitations and applicability of these criteria to children with CKD. In addition, we present an overview of the manifestations and mechanisms of cachexia and PEW. A host of pathogenetic factors are considered, including systemic inflammation, endocrine perturbations, and abnormal neuropeptide signaling, as well as poor nutritional intake. Mortality risk, which is 100- to 200-fold higher in patients with end-stage renal disease than in the general population, is strongly correlated with the components of cachexia/PEW. Further research into the causes and consequences of wasting and growth retardation is needed in order to improve the survival and quality of life for children with CKD.

Association of genetic variants of ghrelin, leptin and UCP2 with malnutrition inflammation syndrome and survival in end-stage renal disease patients

“…It is found in acylated and des-acylated versions in the body. The acylated version attaches to growth hormone secretagogue receptor (GHS-R1a) and exerts biological function while des-acylated form is nonfunctional and may contribute to appetite loss in ESRD patients (Mak et al 2012). Increase in plasma levels of total ghrelin correlates with fat mass in ESRD patients .…”

Melanocortin antagonism ameliorates muscle wasting and inflammation in chronic kidney disease

“…CACHEXIA IS PREVALENT AMONG patients with chronic kidney disease (CKD) and is associated with anorexia and progressive loss of body fat and lean mass (26,27). Although calorie deficiency from anorexia is a common feature, cachexia is not prevented by increased caloric intake.…”

Optimizing Enteral Nutrition for Growth in Pediatric Chronic Kidney Disease (CKD)

“…Children with protein energy wasting have high energy needs with concurrent anorexia and poor intake as well as significant breakdown of protein and muscle stores while being unable to utilize fat stores. Overfeeding only increases fat mass without promoting muscle regain (14). Prevention is ideal, however, clinical expertise is critical in determination of adequate but not excessive feedings to replete the patient with PEW to promote optimal growth.…”