Protein nutrition and malnutrition in CKD and ESRD

Zha, Yan; Qian, Qi

doi:10.3390/nu9030208

Cited by 292Dialysis and Renal Disease ManagementClinical Nutrition and GastroenterologyNutrition and Health in Aging

Protein nutrition and malnutrition in CKD and ESRD

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Zha, Yan, Qian, Qi·2017·Nutrients

DOI 10.3390/nu9030208PMC PMC5372871

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Abstract

Elevated protein catabolism and protein malnutrition are common in patients with chronic kidney disease (CKD) and end‐stage renal disease (ESRD). The underlying etiology includes, but is not limited to, metabolic acidosis intestinal dysbiosis; systemic inflammation with activation of complements, endothelin‐1 and renin‐angiotensin‐aldosterone (RAAS) axis; anabolic hormone resistance; energy expenditure elevation; and uremic toxin accumulation. All of these derangements can further worsen kidney function, leading to poor patient outcomes. Many of these CKD‐related derangements can be prevented and substantially reversed, representing an area of great potential to improve CKD and ESRD care. This review integrates known information and recent advances in the area of protein nutrition and malnutrition in CKD and ESRD. Management recommendations are summarized. Thorough understanding the pathogenesis and etiology of protein malnutrition in CKD and ESRD patients will undoubtedly facilitate the design and development of more effective strategies to optimize protein nutrition and improve outcomes.

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In patients receiving maintenance dialysis, protein requirements may be closer to 1.2 to 1.3 g/kg/d as a result of dialysis-related protein loss and systemic inflammation.
“In patients receiving maintenance dialysis, protein requirements may be closer to 1.2 to 1.3 g·kg−1·d−1129 as a result of dialysis-related protein loss and systemic inflammation.”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [129]

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Self-citation
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Chronic Kidney Disease as Oxidative Stress- and Inflammatory-Mediated Cardiovascular Disease
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Prognostic Nutritional Index as a Predictor of Diabetic Nephropathy Progression
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The Effects of Synbiotic Supplementation on Metabolic Status in Diabetic Patients Undergoing Hemodialysis: a Randomized, Double-Blinded, Placebo-Controlled Trial
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Emerging cross-talks between chronic kidney disease–mineral and bone disorder (CKD–MBD) and malnutrition–inflammation complex syndrome (MICS) in patients receiving dialysis
Yamada, S., Tsuruya, K., Kitazono, T., & Nakano, T. (2022) · Clinical and Experimental Nephrology · doi:10.1007/s10157-022-02216-x · Cited by 58 · see citing works
Challenges of reducing protein-bound uremic toxin levels in chronic kidney disease and end stage renal disease
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Blood-incompatibility in haemodialysis: alleviating inflammation and effects of coagulation
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A Low Geriatric Nutrition Risk Index Is Associated with Progression to Dialysis in Patients with Chronic Kidney Disease
Kuo, I., Huang, J., Wu, P.-Y., Chen, S., Chang, J., & Chen, H. (2017) · Nutrients · doi:10.3390/nu9111228 · Cited by 51 · see citing works
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Cardiovascular Consequences of Uremic Metabolites: an Overview of the Involved Signaling Pathways
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Alkaline Diet and Metabolic Acidosis: Practical Approaches to the Nutritional Management of Chronic Kidney Disease
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Metabolomics profiling distinctively identified end-stage renal disease patients from chronic kidney disease patients
Dahabiyeh, L. A., Nimer, R. M., Sumaily, K. M., Alabdaljabar, M. S., Jacob, M., Sabi, E. M., Hussein, M. H., & Rahman, A. M. A. (2023) · Scientific Reports · doi:10.1038/s41598-023-33377-8 · Cited by 41 · see citing works
Prevalence of hypothyroidism in Japanese chronic kidney disease patients
Yuasa, R., Ohashi, Y., Saito, A., Tsuboi, K., Shishido, S., & Sakai, K. (2020) · Renal Failure · doi:10.1080/0886022x.2020.1777162 · Cited by 40 · see citing works
Effect of essential amino acid кetoanalogues and protein restriction diet on morphogenetic proteins (FGF-23 and Кlotho) in 3b–4 stages chronic кidney disease patients: a randomized pilot study
Milovanova, L., Fomin, V. V., Moiseev, S. V., Taranova, M. V., Milovanov, Y., Lysenko, L. V., Козлов, В. В., Kozevnikova, E., Milovanova, S. Y., Lebedeva, M. V., et al. (2018) · Clinical and Experimental Nephrology · doi:10.1007/s10157-018-1591-1 · Cited by 38 · see citing works
The prevalence of malnutrition in hemodialysis patients
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Targeting Inflammatory Imbalance in Chronic Kidney Disease: Focus on Anti-Inflammatory and Resolution Mediators
Rispoli, R. M., Popolo, A., Fabrizio, V. D., Bianca, R. D. D. V., Autore, G., Dalli, J., & Marzocco, S. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26073072 · Cited by 34 · see citing works
Risk of end‐stage renal disease from chronic kidney disease defined by decreased glomerular filtration rate in type 1 diabetes: A comparison with type 2 diabetes and the effect of metabolic syndrome
Lee, Y., Han, K., Kim, B., Jun, J. E., Lee, S., Ahn, J., Kim, G., Jin, S., & Kim, J. H. (2019) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.3197 · Cited by 34 · see citing works
Prevalence of Taste Changes and Association with Other Nutrition-Related Symptoms in End-Stage Kidney Disease Patients
Dawson, J., Brennan, F. P., Hoffman, A. T., Josland, E. A., Li, K. C., Smyth, A., & Brown, M. A. (2020) · Journal of Renal Nutrition · doi:10.1053/j.jrn.2020.06.003 · Cited by 34 · see citing works
Influence of Plant and Animal Proteins on Inflammation Markers among Adults with Chronic Kidney Disease: A Systematic Review and Meta-Analysis
Aycart, D., Acevedo, S., Eguiguren-Jiménez, L., & Andrade, J. (2021) · Nutrients · doi:10.3390/nu13051660 · Cited by 33 · see citing works
Association of Dose and Frequency on the Survival of Patients on Maintenance of Hemodialysis in China: A Kaplan-Meier and Cox-Proportional Hazard Model Analysis
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Probiotics, Prebiotics, and Synbiotics for Patients on Dialysis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Chen, C., Wang, J., Li, J., Zhang, W., & Ou, S. (2022) · Journal of Renal Nutrition · doi:10.1053/j.jrn.2022.04.001 · Cited by 31 · see citing works
Prescribing Hemodialysis or Hemodiafiltration: When One Size Does Not Fit All the Proposal of a Personalized Approach Based on Comorbidity and Nutritional Status
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Analysis of malnutrition factors for inpatients with chronic kidney disease
Xi, W., Wu, C., Liang, Y.-L., Wang, L., & Cao, Y. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2022.1002498 · Cited by 30 · see citing works
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Chen, T., Wan, H., Luo, Y., & Chen, L. (2024) · Scientific Reports · doi:10.1038/s41598-024-71579-w · Cited by 30 · see citing works
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Prognostic impact of malnutrition on cardiovascular events in coronary artery disease patients with myocardial damage
Arikawa, R., Kanda, D., Ikeda, Y., Tokushige, A., Sonoda, T., Anzaki, K., & Ohishi, M. (2021) · BMC Cardiovascular Disorders · doi:10.1186/s12872-021-02296-9 · Cited by 30 · see citing works
Association between Cognitive Impairment and Malnutrition in Hemodialysis Patients: Two Sides of the Same Coin
Rotondi, S., Tartaglione, L., Pasquali, M., Ceravolo, M. J., Mitterhofer, A. P., Noce, A., Tavilla, M., Lai, S., Tinti, F., Muci, M. L., et al. (2023) · Nutrients · doi:10.3390/nu15040813 · Cited by 28 · see citing works
Protein-energy wasting significantly increases healthcare utilization and costs among patients with chronic kidney disease: a propensity-score matched cohort study
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Ambulatory Hemodialysis-Technology Landscape and Potential for Patient-Centered Treatment
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3-Carboxy-4-methyl-5-propyl-2-furanpropanoic acid (CMPF) induces cell death through ferroptosis and acts as a trigger of apoptosis in kidney cells
Park, J. S., Kim, D.-H., Choi, H., Kim, C. S., Bae, E. H., Kwon, S., & Kim, S. W. (2023) · Cell Death and Disease · doi:10.1038/s41419-023-05601-w · Cited by 25 · see citing works
Effect of Oat β-Glucan Supplementation on Chronic Kidney Disease: A Feasibility Study
Hill, E., Sapa, H., Negrea, L. A., Bame, K., Hostetter, T. H., Barkoukis, H. D., Dusso, A., & Dobre, M. A. (2019) · Journal of Renal Nutrition · doi:10.1053/j.jrn.2019.06.012 · Cited by 25 · see citing works
Predictors of Dietitian Referrals in Hospitals
Eglseer, D., & Bauer, S. (2020) · Nutrients · doi:10.3390/nu12092863 · Cited by 19 · see citing works
Pathogenic spectrum and risk factors of peritoneal dialysis-associated peritonitis: a single-center retrospective study
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Association of skeletal muscle mass, kidney disease and mortality in older men and women: the cardiovascular health study
Kruse, N. T., Bůžková, P., Barzilay, J. I., Valderrábano, R. J., Robbins, J. A., Fink, H. A., & Jalal, D. I. (2020) · Aging · doi:10.18632/aging.202135 · Cited by 22 · see citing works
A novel model of adenine-induced chronic kidney disease-associated gastrointestinal dysfunction in mice: The gut-kidney axis
Hayeeawaema, F., Muangnil, P., Jiangsakul, J., Tipbunjong, C., Huipao, N., & Khuituan, P. (2023) · Saudi Journal of Biological Sciences · doi:10.1016/j.sjbs.2023.103660 · Cited by 22 · see citing works
Prevalence and prognostic value of malnutrition in patients with acute coronary syndrome and chronic kidney disease
Ni, W., Guo, K., Shi, S., Cheng, L., Zhou, Y., Zhang, F., Xu, J., Lin, K., Chen, C., Gao, Z., et al. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1187672 · Cited by 22 · see citing works
Satellite cell function, intramuscular inflammation and exercise in chronic kidney disease
O’Sullivan, T. F., Smith, A. C., & Watson, E. L. (2018) · Clinical Kidney Journal · doi:10.1093/ckj/sfy052 · Cited by 22 · see citing works
Progress in the study of nutritional status and selenium in dialysis patients
Cao, M., Zheng, S., Zhang, W., & Hu, G. (2023) · Annals of Medicine · doi:10.1080/07853890.2023.2197296 · Cited by 20 · see citing works
Association between advanced lung cancer inflammation index and chronic kidney disease: a cross-sectional study
Li, X., Wang, Q., Wu, F., Ye, Z., & Li, Y. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1430471 · Cited by 19 · see citing works
Influence of protein intake on the changes in skeletal muscle mass after kidney transplantation
Kosoku, A., Iwai, T., Ishihara, T., Kabei, K., Nishide, S., Maeda, K., Hanayama, Y., Ishimura, E., & Uchida, J. (2022) · Clinical Nutrition · doi:10.1016/j.clnu.2022.07.028 · Cited by 18 · see citing works
Effects of Propolis Supplementation on Gut Microbiota and Uremic Toxin Profiles of Patients Undergoing Hemodialysis
Fonseca, L. D. S., Ribeiro, M. M., Schultz, J., Borges, N. A., Cardozo, L., Leal, V. D. O., Alves, M. R., Paiva, B. R., Leite, P. E. C., Sanz, C. L., et al. (2024) · Toxins · doi:10.3390/toxins16100416 · Cited by 18 · see citing works
Hemodialysis—Nutritional Flaws in Diagnosis and Prescriptions. Could Amino Acid Losses Be the Sharpest “Sword of Damocles”?
Bolasco, P. (2020) · Nutrients · doi:10.3390/nu12061773 · Cited by 20 · see citing works
Glycyrrhetinic Acid Protects Renal Tubular Cells against Oxidative Injury via Reciprocal Regulation of JNK-Connexin 43-Thioredoxin 1 Signaling
Zhou, Y., Gao, L., Xia, P., Zhao, J., Li, W., Zhou, Y., Wei, Q., Wu, Q., Wu, Q., Sun, D., et al. (2021) · Frontiers in Pharmacology · doi:10.3389/fphar.2021.619567 · Cited by 18 · see citing works
A high neutrophil to lymphocyte ratio is associated with poor nutritional status in chronic kidney disease patients
Han, Q., Lin, S., He, F., Zhang, R., Xie, X., Qing, F., Huang, R., Chen, C., & Yang, Q. (2022) · British Journal Of Nutrition · doi:10.1017/s000711452100516x · Cited by 17 · see citing works
Construction of a C-reactive protein-albumin-lymphocyte index-based prediction model for all-cause mortality in patients on maintenance hemodialysis
Huang, J., Hao, J., Luo, H., Chen, L., Luo, H., Liu, J., Xu, Y., & Wang, P. (2025) · Renal Failure · doi:10.1080/0886022x.2024.2444396 · Cited by 17 · see citing works
The relationship between the prognostic nutritional index and new-onset pneumonia in peritoneal dialysis patients
Shang, S.-J., Huang, Y., Zhan, X.-J., Peng, F.-F., Wang, X.-Y., Wen, Y.-Q., Feng, X.-R., Zhou, Q., Tang, L., Long, H., et al. (2022) · International Urology and Nephrology · doi:10.1007/s11255-022-03233-1 · Cited by 16 · see citing works
Polypharmacy Predicts Onset and Transition of Frailty, Malnutrition, and Adverse Outcomes in Peritoneal Dialysis Patients
Chan, G. C., Ng, J. K., Chow, K.-M., Cheng, P. M., Law, M.-C., Leung, C. B., Li, P. K.-T., & Szeto, C. (2022) · The journal of nutrition health & aging · doi:10.1007/s12603-022-1859-8 · Cited by 16 · see citing works
Phase Angle Association with Dietary Habits and Metabolic Syndrome in Diabetic Hypertensive Patients: A Cross-Sectional Study
Nenadić, D. B., Radić, J., Kolak, E., Vučković, M., Novak, I., Selak, M., & Radić, M. (2022) · Nutrients · doi:10.3390/nu14235058 · Cited by 16 · see citing works
Sodium Bicarbonate Treatment and Clinical Outcomes in Chronic Kidney Disease with Metabolic Acidosis
Yang, T.-Y., Lin, H.-M., Wang, H., Chuang, M., Hsieh, C.-C., Tsai, K., & Chen, J. (2024) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.0000000000000487 · Cited by 16 · see citing works
Associations of total protein, albumin, and globulin with insulin resistance: an NHANES study
Zeng, R., Xu, J., Zhang, Y.-Z., Tan, J.-W., Kong, Y.-J., Zhang, M., & Guo, L. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1393137 · Cited by 16 · see citing works
Relationship between gut microbiota and nutritional status in patients on peritoneal dialysis
Tian, N., Yan, Y., Chen, N., Xu, S., Chu, R., Wang, M., Duan, S., Ren, H., Song, S., Wang, L., et al. (2023) · Scientific Reports · doi:10.1038/s41598-023-27919-3 · Cited by 16 · see citing works
Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association
Vest, A. R., DiDomenico, R. J., Lichtenstein, L., Slater, T., Ekpo, E., Damluji, A. A., Bohula, E., Alviar, C. L., on behalf of the American Heart Association Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology, & Council on Cardiovascular and Stroke Nursing (2026) · Circulation · doi:10.1161/cir.0000000000001405 · Cited by 15 · see citing works
Patient and Health Care Professional Perspectives on Addressing Obesity in ESKD
Harhay, M. N., Klassen, A. C., Gunen, B., Hingorany, S. S., Sweeting, J. M., Lee, J., Haileselasse, J. R., & Milliron, B. (2023) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2023.02.005 · Cited by 15 · see citing works
Associated factors of cardiac valve calcification and its prognostic effects among patients with chronic kidney disease: a systematic review and meta-analysis
Zhang, J., Pang, Q., Wang, S., Wu, L., & Zhang, A. (2023) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2023.1120634 · Cited by 15 · see citing works
Geriatric Nutritional Risk Index as a Prognostic Factor for Renal Progression in Patients with Type 2 Diabetes Mellitus
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Authors: Zha, Y., & Qian, Q.
Affiliations: Guizhou Provincial People's Hospital (CN)
Mayo Clinic (US)
Corresponding author: Qian, Qi
ORCID: Zha, Yan
Qian, Qi
Venue: Nutrients
Publisher: MDPI AG
Published: 2017-02-27
Volume: 9
Issue: 3
Pages: 208
ISSN: 2072-6643 (ISSN-L)
DOI: 10.3390/nu9030208
PMC: PMC5372871
OpenAlex: W2592471438
Cited by: 292
References: 175
Citations by year: 2026: 30 · 2025: 35 · 2024: 35 · 2023: 39 · 2022: 43 · 2021: 33 · 2020: 31 · 2019: 23 · 2018: 18 · 2017: 4
FWCI: 2.78
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
Locations: Nutrients (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics: Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
Keywords: protein malnutrition, chronic kidney disease, end-stage renal disease, protein degradation, metabolic acidosis, gut dysbiosis, systemic inflammation, complement activation, endothelin-1, renin-angiotensin-aldosterone system, energy expenditure, uremic toxins, dietary management
MeSH terms: Adult, Dietary Proteins, Humans, Kidney Failure, Chronic, Metabolic Diseases, Nutritional Status, Protein-Energy Malnutrition, Randomized Controlled Trials as Topic, Renal Insufficiency, Chronic

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