Management of the nutritional aspects of Chronic Kidney Disease (CKD) presents a number of challenges. In patients with CKD, and especially in those undergoing maintenance dialysis Protein-Energy Wasting (PEW) is by far the strongest risk factor for adverse outcomes and death. Patients undergoing dialysis die of the short-term consequences of PEW. This suggests that in a patient with CKD whose risk of short-term mortality is high, interventions that improve nutritional status and prevent or correct wasting and loss of muscle mass have the potential to save lives, as compared to the conventional interventions, such as, treating high levels of cholesterol, hypertension or obesity. Furthermore, studies related to the nutritional status have shown that wasting is common in CKD, as approximately 18% to 75% of patients with CKD, undergoing dialysis therapy, show evidence of wasting.
One recently published study evaluated serum albumin. The results indicated that serum albumin concentration was far superior as a predictor of mortality. PEW seemed to be a strong predictor of mortality in patients with CKD, and improving nutritional status by dietary and non-dietary interventions could be an important step toward improving the outcomes in CKD.
Evidence indicates that surrogates of PEW, such as, low serum levels of albumin or inadequate protein intake, correlate with mortality. Measuring the serum levels of
albumin remains the simplest test that is readily available. A low serum albumin concentration is by far the strongest predictor of poor outcomes and mortality in patients on dialysis as compared with any other risk factor, including the traditional risk factors (hypertension, high levels of cholesterol, diabetes, and obesity); and the nonconventional risk factors (measures of anemia, mineral and bone surrogates, and dialysis treatment).
U.S. Renal Data System (USRDS) showed that for every 1 g /dl fall in the serum albumin level is associated with a 39% increase in the risk of cardiovascular death. Reports indicate that patients attending dialysis clinics that provide superior care and have a good performance, exhibit higher serum albumin levels and better survival rates, than patients who attend clinics with an inferior performance. Longevity has consistently been observed in those patients with CKD who have a better nutritional status, including larger muscle mass, fat mass, better appetite, and higher protein intake.
Protein Energy Wasting is a distinct condition in the Chronic Kidney Disease Community, and causes adverse health outcomes. Dietary and nutritional support appear to be the most effective way in combating PEW. KidneyBuzz.com strongly suggests that all who are suffering with CKD be assessed monthly or quarterly for the presence of PEW, and should discuss with their healthcare team oral nutritional support whenever necessary.
Reference: Jadeja, Yashpal P., and Vijay Kher. National Center for Biotechnology Information. U.S. National Library of Medicine