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Protein Nutrition and Malnutrition in CKD and ESRD
Open accessAbstract
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−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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Metadata
- Authors
- Zha, Y., & Qian, Q.
- Affiliations
- Guizhou Provincial People's Hospital (CN)
- Mayo Clinic (US)
- Corresponding author
- Qian, Qi
- Venue
- Nutrients
- Publisher
- MDPI AG
- Published
- 2017-02-27
- Volume
- 9
- Issue
- 3
- Pages
- 208
- ISSN
- 2072-6643 (ISSN-L)
- 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
- 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 (medical) › 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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