Rehabilitation Nutrition in Patients with Chronic Kidney Disease and Cachexia

Abstract

Rehabilitation nutrition is a proposed intervention strategy to improve nutritional status and physical function. However, rehabilitation nutrition in patients with cachexia and protein-energy wasting (PEW), which are the main nutrition-related problems in patients with chronic kidney disease (CKD), has not been fully clarified. Therefore, this review aimed to summarize the current evidence and interventions related to rehabilitation nutrition for cachexia and PEW in patients with CKD. CKD is a serious condition worldwide, with a significant impact on patient prognosis. In addition, CKD is easily complicated by nutrition-related problems such as cachexia and PEW owing to disease background- and treatment-related factors, which can further worsen the prognosis. Although nutritional management and exercise therapy are reportedly effective for cachexia and PEW, the effectiveness of combined nutrition and exercise interventions is less clear. In the future, rehabilitation nutrition addressing the nutritional problems associated with CKD will become more widespread as more scientific evidence accumulates. In clinical practice, early intervention in patients with CKD involving both nutrition and exercise after appropriate assessment may be necessary to improve patient outcomes.

Relationships of Weight Change from 20 Years of Age with the Risks of All-Cause and Cardiovascular Mortality in Patients with Chronic Kidney Disease

“…Low energy intake results in greater catabolism 28) and worsening nutritional status. Furthermore, conditions such as sarcopenia, frailty, and protein energy wasting frequently occur in patients with CKD, and their effects are exacerbated by low nutrient intake 29,30) . Previous studies have reported that frailty and sarcopenia are associated with cardiovascular 31) and all-cause 32) mortalities.…”

An Overview of Chronic Kidney Disease Pathophysiology: The Impact of Gut Dysbiosis and Oral Disease

“…In the oral cavity, excess urea is converted into ammonia by the urease-positive oral microbiota, decreasing the salivary flow and leading to dry mouth, better known as xerostomia, that is usually observed in ESRD patients [223,224]. The CKD patient often perceives an unpleasant metallic taste following the ingestion of food, which consequently leads to decreased appetite and contributes to poor nutritional intake and protein-energy wasting syndrome [225][226][227].…”

Redox Signaling in Chronic Kidney Disease-Associated Cachexia

“…Recently, rehabilitation nutrition has emerged as a strategy to overcome nutritional alterations and physical dysfunction [ 61 ]. This strategy includes the evaluation of patients’ nutritional and physical states, the definition of aims, and the simultaneous initiation of the nutritional approach and rehabilitation [ 62 , 63 ]. nutritional management can be founded on the International Classification of Functioning, Disability, and Health (ICF).…”