A Review Article on Wasting in CKD
Dr. Mak and colleagues article in The Journal of Cachexia, Sarcopenia and Muscle is worth a read! You will not have come across the journal unless you work in the field. It is well written, thoughtful, and has authors who are experts in the field. Plus, it's published in an open access journal
Mak RH, Ikizler AT, Kovesdy CP, Raj DS, Stenvinkel P, Kalantar-Zadeh K.Wasting in chronic kidney disease. JCachex Sarcopenia Muscle. 2011 Mar;2(1):9-25. Epub2011 Mar 16. The authors make 3 important points:1. "The wasting/cachexia syndrome in CKD patients consists of anorexia, increased energy expenditure, decreased protein stores characterized by a low serum albumin, and loss of body weight and loss of muscle mass. Importantly, the individual components of this syndrome all represent risk factors for mortality in patients with CKD, which is 100–200 times higher than the general population".
2. "Wasting/cachexia.....[should] be distinguished from malnutrition, which is defined as the consequence of insufficient food intake or an improper diet. Malnutrition is characterized by hunger, which is an adaptive response, whereas anorexia is prevalent in patients with wasting/cachexia. Energy expenditure decreases as a protective mechanism in malnutrition whereas it remains inappropriately high in cachexia/wasting. In malnutrition, fat mass is preferentially lost and lean body mass and muscle mass is preserved. In cachexia/wasting, muscle is wasted and fat is relatively underutilized."
3. "At the patient level, longevity has consistently been observed in patients with CKD who have more muscle and/or fat, who report better appetite and who eat more. Although inadequate nutritional intake may contribute to wasting or cachexia, recent evidence indicates that other factors, including systemic inflammation, perturbations of appetite-controlling hormones from reduced renal clearance, aberrant neuropeptide signaling, insulin and insulin-like growth factor resistance, and metabolic acidosis, may be important in the pathogenesis of CKD-associated wasting".
