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Nutrients
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Protein-Energy Wasting, Sarcopenia, Cachexia and Muscle Wasting in Patients Living...
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Protein-Energy Wasting, Sarcopenia, Cachexia and Muscle Wasting in Patients Living with Chronic Kidney Disease

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (10 March 2022) | Viewed by 10544

Special Issue Editor

Dr. Jamie Hugo Macdonald

E-Mail Website
Guest Editor
School of Sport, Health and Exercise Sciences, College of Health Sciences, Bangor University, George Building, Bangor, Gwynedd LL57 2PZ, UK
Interests: chronic kidney disease; lifestyle interventions to enhance quality of life (e.g. physical activity and structured exercise); methods of assessing body composition (e.g. DXA, bioelectrical impedance); applying physiological knowledge to improve outcomes (e.g. fluid overload, declining GFR, fatigue)

Special Issue Information

Dear Colleagues,

Chronic kidney disease (CKD) is characterized by reduced function, or altered structure, of the kidneys. CKD is very common with a global prevalence of 13%. Thankfully, advances in renal replacement therapy have successfully increased longevity of life and reduced the impact of many comorbidities, such as anemia.

Nevertheless, CKD places a considerable burden on health systems, risk of death remains high in patients living with CKD, and quality of life remains unacceptably poor. A particularly challenging complication of CKD is altered body composition. Obesity is common, and whilst the identification of obese patients is relatively straightforward, treatment is challenging (as in all populations). In patients living with CKD, nutrition management is further complicated by the ‘obesity paradox’, where the outcome of patients with higher BMI is paradoxically improved compared to normal BMI

One possible explanation for better outcomes in patients with higher BMI is that protein-energy wasting may be reduced. Protein-energy wasting is common in patients living with CKD, and patients living with CKD who have protein-energy wasting have higher mortality, whilst poor muscle function prevents patients from completing activities of daily living, reducing the quality of life. Thus, prevention, identification, and treatment of protein-energy wasting remain an important topic requiring further research.

What nutritional strategies might attenuate protein-energy wasting in patients living with CKD? An added complication in patients living with CKD is that excessive protein intake may increase disease progression. Indeed, guidelines suggest lowering protein intake to preserve kidney function, but this practice is not without risk. For example, low protein diets may reduce the quality of life, and thus this practice is not universally implemented.

The present Special Issue of Nutrients aims to tackle this challenging topic head-on. The issue’s objectives are to provide updates on the impact of protein-energy wasting on morbidity, mortality, and patient-reported outcomes; offer accurate methods for defining, assessing, and identifying protein-energy wasting; and inform readers on state-of-the-art interventions from a lifestyle (nutritional or exercise) perspective, in patients living with chronic kidney disease. Authors are invited to submit relevant original contributions, review articles, systematic reviews, and meta-analyses on human or experimental animal models, for consideration and inclusion in this Special Issue.

Dr. Jamie Hugo Macdonald
Guest Editor

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • body composition
  • diet
  • malnutrition
  • nutritional supplements
  • metabolism
  • frailty
  • obesity
  • lifestyle interventions
  • physical activity
  • protein intake

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Published Papers (3 papers)

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13 pages, 318 KiB  
Article
Protein Energy Wasting in a Cohort of Maintenance Hemodialysis Patients in Dhaka, Bangladesh
by Tanjina Rahman, Ban-Hock Khor, Sharmela Sahathevan, Deepinder Kaur, Eno Latifi, Mousume Afroz, Esrat Jahan Mitali, Bayan Tashkandi, Nura Afza Salma Begum, Tasnuva Sarah Kashem, Shakib Uz Zaman Arefin, Zulfitri Azuan Mat Daud, Tilakavati Karupaiah, Harun Ur Rashid and Pramod Khosla
Nutrients 2022, 14(7), 1469; https://doi.org/10.3390/nu14071469 - 1 Apr 2022
Cited by 3 | Viewed by 3087
Abstract
Malnutrition is associated with high rates of mortality among patients with end stage kidney disease (ESKD). There is a paucity of data from Bangladesh, where around 35,000–40,000 people reach ESKD annually. We assessed protein-energy wasting (PEW) amongst 133 patients at a single hemodialysis [...] Read more.
Malnutrition is associated with high rates of mortality among patients with end stage kidney disease (ESKD). There is a paucity of data from Bangladesh, where around 35,000–40,000 people reach ESKD annually. We assessed protein-energy wasting (PEW) amongst 133 patients at a single hemodialysis setting in Dhaka. Patients were 49% male, age 50 ± 13 years, 62% were on twice-weekly hemodialysis. Anthropometric, biochemical, and laboratory evaluations revealed: BMI 24.1 ± 5.2 kg/m2, mid-arm muscle circumference (MAMC) 21.6 ± 3.6 cm, and serum albumin 3.7 ± 0.6 g/dL. Based on published criteria, 18% patients had PEW and for these patients, BMI (19.8 ± 2.4 vs. 25.2 ± 5.2 kg/m2), MAMC (19.4 ± 2.4 vs. 22.2 ± 3.8 cm), serum albumin (3.5 ± 0.7 vs. 3.8 ± 0.5 g/dL), and total cholesterol (135 ± 34 vs. 159 ± 40 mg/dL), were significantly lower as compared to non-PEW patients, while hand grip strength was similar (19.5 ± 7.6 vs. 19.7 ± 7.3 kg). Inflammatory C-reactive protein levels tended to be higher in the PEW group (20.0 ± 34.8 vs. 10.0 ± 13.9 p = 0.065). Lipoprotein analyses revealed PEW patients had significantly lower low density lipoprotein cholesterol (71 ± 29 vs. 88 ± 31 mg/dL, p < 0.05) and plasma triglyceride (132 ± 51 vs. 189 ± 103 mg/dL, p < 0.05), while high density lipoprotein cholesterol was similar. Nutritional assessments using a single 24 h recall were possible from 115 of the patients, but only 66 of these were acceptable reporters. Amongst these, while no major differences were noted between PEW and non-PEW patients, the majority of patients did not meet dietary recommendations for energy, protein, fiber, and several micronutrients (in some cases intakes were 60–90% below recommendations). Malnutrition Inflammation Scores were significantly higher in PEW patients (7.6 ± 3.1 vs. 5.3 ± 2.7 p < 0.004). No discernible differences were apparent in measured parameters between patients on twice- vs. thrice-weekly dialysis. Data from a larger cohort are needed prior to establishing patient-management guidelines for PEW in this population. Full article
(This article belongs to the Special Issue Protein-Energy Wasting, Sarcopenia, Cachexia and Muscle Wasting in Patients Living with Chronic Kidney Disease)
12 pages, 4188 KiB  
Article
Association of Serum Phosphate with Low Handgrip Strength in Patients with Advanced Chronic Kidney Disease
by Ping-Huang Tsai, Hsiu-Chien Yang, Chin Lin, Chih-Chien Sung, Pauling Chu and Yu-Juei Hsu
Nutrients 2021, 13(10), 3605; https://doi.org/10.3390/nu13103605 - 14 Oct 2021
Cited by 6 | Viewed by 2233
Abstract
Muscle wasting and hyperphosphatemia are becoming increasingly prevalent in patients who exhibit a progressive decline in kidney function. However, the association between serum phosphate (Pi) level and sarcopenia in advanced chronic kidney disease (CKD) patients remains unclear. We compared the serum Pi levels [...] Read more.
Muscle wasting and hyperphosphatemia are becoming increasingly prevalent in patients who exhibit a progressive decline in kidney function. However, the association between serum phosphate (Pi) level and sarcopenia in advanced chronic kidney disease (CKD) patients remains unclear. We compared the serum Pi levels between advanced CKD patients with (n = 51) and those without sarcopenia indicators (n = 83). Low appendicular skeletal muscle mass index (ASMI), low handgrip strength, and low gait speed were defined per the standards of the Asian Working Group for Sarcopenia. Mean serum Pi level was significantly higher in advanced CKD patients with sarcopenia indicators than those without sarcopenia indicators (3.88 ± 0.86 vs. 3.54 ± 0.73 mg/dL; p = 0.016). Univariate analysis indicated that serum Pi was negatively correlated with ASMI, handgrip strength, and gait speed. Multivariable analysis revealed that serum Pi was significantly associated with handgrip strength (standardized β = −0.168; p = 0.022) and this association persisted even after adjustments for potential confounders. The optimal serum Pi cutoff for predicting low handgrip strength was 3.65 mg/dL, with a sensitivity of 82.1% and specificity of 56.6%. In summary, low handgrip strength is common in advanced CKD patients and serum Pi level is negatively associated with handgrip strength. Full article
(This article belongs to the Special Issue Protein-Energy Wasting, Sarcopenia, Cachexia and Muscle Wasting in Patients Living with Chronic Kidney Disease)
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41 pages, 3457 KiB  
Systematic Review
The Effect of Non-Pharmacological and Pharmacological Interventions on Measures Associated with Sarcopenia in End-Stage Kidney Disease: A Systematic Review and Meta-Analysis
by Daniel S. March, Thomas J. Wilkinson, Thomas Burnell, Roseanne E. Billany, Katherine Jackson, Luke A. Baker, Amal Thomas, Katherine A. Robinson, Emma L. Watson, Matthew P. M. Graham-Brown, Arwel W. Jones and James O. Burton
Nutrients 2022, 14(9), 1817; https://doi.org/10.3390/nu14091817 - 27 Apr 2022
Cited by 15 | Viewed by 4059
Abstract
This systematic review and meta-analysis provides a synthesis of the available evidence for the effects of interventions on outcome measures associated with sarcopenia in end-stage kidney disease (ESKD). Thirteen databases were searched, supplemented with internet and hand searching. Randomised controlled trials of non-pharmacological [...] Read more.
This systematic review and meta-analysis provides a synthesis of the available evidence for the effects of interventions on outcome measures associated with sarcopenia in end-stage kidney disease (ESKD). Thirteen databases were searched, supplemented with internet and hand searching. Randomised controlled trials of non-pharmacological or pharmacological interventions in adults with ESKD were eligible. Trials were restricted to those which had reported measures of sarcopenia. Primary outcome measures were hand grip strength and sit-to-stand tests. Sixty-four trials were eligible (with nineteen being included in meta-analyses). Synthesised data indicated that intradialytic exercise increased hand grip strength (standardised mean difference, 0.58; 0.24 to 0.91; p = 0.0007; I2 = 40%), and sit-to-stand (STS) 60 score (mean difference, 3.74 repetitions; 2.35 to 5.14; p < 0.001; I2 = 0%). Intradialytic exercise alone, and protein supplementation alone, resulted in no statistically significant change in STS5 (−0.78 s; −1.86 to 0.30; p = 0.16; I2 = 0%), and STS30 (MD, 0.97 repetitions; −0.16 to 2.10; p = 0.09; I2 = 0%) performance, respectively. For secondary outcomes, L-carnitine and nandrolone-decanoate resulted in significant increases in muscle quantity in the dialysis population. Intradialytic exercise modifies measures of sarcopenia in the haemodialysis population; however, the majority of trials were low in quality. There is limited evidence for efficacious interventions in the peritoneal dialysis and transplant recipient populations. Full article
(This article belongs to the Special Issue Protein-Energy Wasting, Sarcopenia, Cachexia and Muscle Wasting in Patients Living with Chronic Kidney Disease)
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