Etiology of the Protein-Energy Wasting Syndrome in Chronic Kidney Disease: A Consensus Statement From the International Society of Renal Nutrition and Metabolism (ISRNM)

Carrero, Juan Jesús; Stenvinkel, Peter; Cuppari, Lílian; İkizler, T. Alp; Kalantar-Zadeh, Kamyar; Kaysen, George A.; Mitch, William E.; Price, S. Russ; Wanner, Christoph; Wang, Angela Yee-Moon; Wee, Pieter ter; Franch, Harold A.

doi:10.1053/j.jrn.2013.01.001

Cited by 689 publications

(661 citation statements)

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“…These observations collectively imply an integrated role of vitamin D for bone and muscle health. Such a role may have substantial clinical implications, especially for CKD patients, in which musculoskeletal alterations and their complications, including muscle pain and weakness, sarcopenia, fatigability, reduced exercise tolerance, fractures, and falls, adversely affect quality of life and survival 12, 13, 14, 15, 16, 17…”

Section: Introductionmentioning

confidence: 99%

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Molina

Carrero

Bover

et al. 2017

J cachexia sarcopenia muscle

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The spectrum of activity of vitamin D goes beyond calcium and bone homeostasis, and growing evidence suggests that vitamin D contributes to maintain musculoskeletal health in healthy subjects as well as in patients with chronic kidney disease (CKD), who display the combination of bone metabolism disorder, muscle wasting, and weakness. Here, we review how vitamin D represents a pathway in which bone and muscle may interact. In vitro studies have confirmed that the vitamin D receptor is present on muscle, describing the mechanisms whereby vitamin D directly affects skeletal muscle. These include genomic and non‐genomic (rapid) effects, regulating cellular differentiation and proliferation. Observational studies have shown that circulating 25‐hydroxyvitamin D levels correlate with the clinical symptoms and muscle morphological changes observed in CKD patients. Vitamin D deficiency has been linked to low bone formation rate and bone mineral density, with an increased risk of skeletal fractures. The impact of low vitamin D status on skeletal muscle may also affect muscle metabolic pathways, including its sensitivity to insulin. Although some interventional studies have shown that vitamin D may improve physical performance and protect against the development of histological and radiological signs of hyperparathyroidism, evidence is still insufficient to draw definitive conclusions.

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Section: Introductionmentioning

confidence: 99%

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Molina

Carrero

Bover

et al. 2017

J cachexia sarcopenia muscle

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“…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).…”

Section: Introductionmentioning

confidence: 99%

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

Matsuura

Shirai²,

Kubo

et al. 2017

J. Med. Invest.

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: Serum transthyretin (TTR), also known as prealbumin, is a reliable nutritional indicator and an independent prognostic factor for maintenance hemodialysis patients. However, we recently reported that serum TTR levels did not affect protein−energy wasting (PEW). In this study, we investigated factors affecting serum TTR levels in 60 maintenance hemodialysis patients. The patients were divided into High-TTR and Low-TTR groups according to the median serum TTR level. Albumin levels were significantly higher and C-reactive protein (CRP) levels were significantly lower in the High-TTR group than in the Low-TTR group. Although body fat mass was significantly higher in the High-TTR group than in the Low-TTR group, no significant difference in body fat ratio were observed. These findings suggest that body fat mass is related to serum TTR levels, apart from factors such as albumin and CRP levels, which showed correlations with serum TTR levels. Because body fat mass is related to better survival in maintenance hemodialysis patients, it may contribute to the prognostic value of serum TTR levels. In addition, in such patients, it may be important to evaluate body fat mass rather than body fat ratio and to maintain the minimum necessary body fat mass.

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“…UCP2 is also related to energy metabolism and obesity in human and rodent models (Schrauwen and Hesselink 2002). Increase in energy expenditure in ESRD patients is identified as a factor associated with malnutrition inflammation syndrome; hence, UCP2 is a potential marker of interest in this regard (Carrero et al 2013).…”

Section: Introductionmentioning

confidence: 99%