Effect of Diabetes Mellitus on Protein–Energy Wasting and Protein Wasting in End‐Stage Renal Disease

Abstract

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.

Comparison of Markers of Appetite and Inflammation Between Hemodialysis Patients With and Without Failed Renal Transplants

“…Gastrointestinal (GI) sensory-motor abnormalities are common in patients with diabetes mellitus and PEW can result only from these GI sensory motor abnormalities and not related to loss of appetite. 35 Diabetes also modifies the interaction between IGF-I and ghrelin, which are important hormones for the nutrition. Hyperglycemia suppresses ghrelin secretion and can also affect BMI.…”

“…In addition, diabetic patients were excluded from the study because of the effects of diabetes on nutritional status of the patients. 34,35 The transplants were performed between 1981 and 2008. Although new developments that occurred in HD and transplantation practice during this period may affect the clinical status of the study patients, the failed-transplant and HD patients who never underwent a transplant groups were pairmatched in demographic features and time on dialysis.…”

Comparison of Muscle Mass Indices Using Computed Tomography or Dual X-Ray Absorptiometry for Predicting Physical Performance in Hemodialysis Patients

“…In HD patients, various factors including inflammation lead to insulin resistance, which is associated with increased catabolism and decreased anabolism in the muscles [26, 27]. These lead to sarcopenia or protein-energy wasting.…”

“…However, the association between insulin resistance and change in fat mass is complex. Patients with insulin resistance or DM have decreased lipolysis and increased adipogenesis, but HD patients are prone to low energy intake and increased catabolism [26, 27, 29]. Although HD patients with adequate or high energy intake have increased fat mass, most HD patients have decreased or stable fat mass when on dialysis [30-32].…”

Análise da sobrevida do paciente e do enxerto de diabéticos submetidos a diferentes modalidades de transplante

“…A gastroparesia diabética, complicação frequente em pacientes diabéticos, associada à deficiência de insulina e resistência periférica à insulina podem comprometer o estado nutricional desses pacientes (Noori & Kopple, 2010). formulações (com relação aos picos de ação e cálculo de meia vida).…”