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Pathophysiological and clinical aspects of malnutrition in chronic renal failure

Published online by Cambridge University Press:  14 December 2007

G. Caimi ,
C. Carollo  and
R. Lo Presti
G. Caimi*
Affiliation:
Via Leonardo da Vinci 52, 90145 Palermo, Italy Department of Internal Medicine, Cardiovascular and Renal Diseases, Università di Palermo, Palermo, Italy
C. Carollo
Affiliation:
Department of Internal Medicine, Cardiovascular and Renal Diseases, Università di Palermo, Palermo, Italy
R. Lo Presti
Affiliation:
Department of Internal Medicine, Cardiovascular and Renal Diseases, Università di Palermo, Palermo, Italy
*
*Corresponding author: Professor Gregorio Caimi, fax +39 91 6554535, email [email protected]
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Abstract

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Kidney diseases are the ninth leading cause of death in the USA. In these patients cardiovascular mortality is greater than in the general population. This observation, not completely explained by the so-called ‘traditional’ cardiovascular risk factors, lead the authors to postulate other ‘emerging’ ones found in chronic renal failure patients. Among these new findings, nutritional status, considered as the balance existing between nutrient requirements and intakes, plays an important role for the development of cardiovascular diseases. In fact several nutritional parameters are widely known as pathophysiological determinants of cardiovascular disturbances, which are based on accelerated atherosclerosis, due especially to enhanced oxidative stress and endothelial dysfunction. Chronic renal failure is a clinical condition that from many points of view seems to be a chronic inflammatory state, and many studies confirm this observation. This influences nutritional status especially in dialysis patients. Malnutrition is related in turn to accelerated atherosclerosis thus leading to a postulated ‘malnutrition, inflammation, atherosclerosis’ (MIA) syndrome in which malnutrition, inflammation and atherosclerosis contribute to an elevated cardiovascular mortality rate. The present review explores this issue, first by describing epidemiological aspects of malnutrition in chronic renal failure patients and then by analysing the specific biochemical and metabolic features of these patients.

Keywords

Chronic renal failureKidney diseaseAtherosclerosisMalnutrition
Type
Research Articles
Information
Nutrition Research Reviews , Volume 18 , Issue 1 , June 2005 , pp. 89 - 97
Copyright
Copyright © The Authors 2005

References

Allen, KL, Miskulin, D, Yan, G, Dwyer, JT, Frydrych, A, Leung, J, Poole, D & the Hemodialysis (HEMO) Study Group (2002) Association of nutritional markers with physical and mental health status in prevalent hemodialysis patients from HEMO Study. Journal of Nutrition 12, 160–169.Google Scholar
Allison, SP (2000) Malnutrition, disease, and outcome. Nutrition 16, 590–593.CrossRefGoogle ScholarPubMed
Annuk, M, Zilmer, M & Fellstrom, B (2003) Endothelium-dependent vasodilation and oxidative stress in chronic renal failure: impact on cardiovascular disease. Kidney International 63, Suppl., S50–S53.CrossRefGoogle Scholar
Apeland, T, Mansoor, MA, Seljeflot, I, Bronstad, I, Goransson, L & Strandjord, RE (2002) Homocysteine, malondialdehyde and endothelial markers in dialysis patients during low-dose folinic acid therapy. Journal of Internal Medicine 252, 456–464.CrossRefGoogle ScholarPubMed
Arias, E, Anderson, RN, Kung, HC, Murphy, SL & Kochanek, KD (2003) Deaths: final data for 2001. National Vital Statistics Reports 52, 1–115.Google Scholar
Ates, K, Ates, A, Kutlay, S, Nergizoglu, G & Karatan, O (2004) Total lymphocyte count in peripheral blood of peritoneal dialysis patients: relationship to clinical parameters and outcome. Journal of Nephrology 17, 246–252.Google Scholar
Bergstrom, J (1999) Mechanisms of uremic suppression of appetite. Journal of Renal Nutrition 9, 129–132.Google Scholar
Cano, N (2000) Denutrition et insuffisance renale chronique (Malnutrition and chronic renal failure). Annales de Medecine Interne 151, 563–574.Google ScholarPubMed
Carvounis, CP, Manis, T, Coritsidis, G, Dubinsky, M & Serpente, P (2000) Total lymphocyte count: a promising prognostic index of mortality in patients on CAPD. Peritoneal Dialysis International 20, 33–38.Google Scholar
Ceballos-Picot, I, Witko-Sarsat, V, Merad-Boudia, M, Nguyen, AT, Thevenin, M, Jaudon, MC, Zingraff, J, Verger, C, Jungers, P & Descamps-Latscha, B (1996) Glutathione antioxidant system as a marker of oxidative stress in chronic renal failure. Free Radical Biology and Medicine 21, 845–853.CrossRefGoogle ScholarPubMed
Channon, KM & Guzik, TJ (2002) Mechanisms of superoxide production in human blood vessels: relationship to endothelial dysfunction, clinical and genetic risk factors. Journal of Physiology and Pharmacology 53, 515–524.Google ScholarPubMed
Chauveau, P, Fouque, D, Combe, C, Laville, M, Canaud, B, Azar, R, Cano, N, Aparicio, M & Leverve, X (2000) Acidosis and nutritional status in hemodialyzed patients. Seminars in Dialysis 13, 241–246.CrossRefGoogle ScholarPubMed
Chazot, C, Laurent, G, Charra, B, Blanc, C, VoVan, C, Jean, G, Vanel, T, Terrat, JC & Ruffet, M (2001) Malnutrition in long-term haemodialysis survivors. Nephrology Dialysis and Transplantation 16, 61–69.CrossRefGoogle ScholarPubMed
Chumlea, WC, Dwyer, J, Bergen, C, Burkart, J, Paranandi, L, Frydrych, A, Cockram, DB, Kusek, JW, McLeroy, S & Hemodialysis Study Group (2003) Nutritional status assessed from anthropometric measures in the HEMO study. Journal of Renal Nutrition 13, 31–38.CrossRefGoogle ScholarPubMed
Collins, AJ, Kasiske, B, Herzog, C, Chen, SC, Everson, S, Constantini, E, Grimm, R, McBean, M, Xue, J, Chavers, B, Matas, A, Manning, W, et al. (2003) Excerpts from the United States Renal Data System 2003 annual data report: atlas of end-stage renal disease in the United States. American Journal of Kidney Diseases 42, A5–A7.Google ScholarPubMed
Dalle-Donne, I, Giustarini, D, Colombo, R, Rossi, R & Milzani, A (2003) Protein carbonylation in human diseases. Trends in Molecular Medicine 9, 169–176.CrossRefGoogle ScholarPubMed
De Precigout, V, Chauveau, P, Delclaux, C, El Haggan, W, Baillet, L, Barthe, N, Gobinet, A, Combe, C & Aparicio, M (2000) No change of hyperleptinemia despite a decrease in insulin concentration in patients with chronic renal failure on a supplemented very low protein diet. Americal Journal of Kidney Diseases 36, 1201–1206.Google Scholar
Detsky, AS, Baker, JP, Mendelson, RA, Wolman, SL, Wesson, DE & Jeejeebhoy, KN (1984) Evaluating the accuracy of nutritional assessment techniques applied to hospitalized patients: methodology and comparisons. Journal of Parenteral and Enteral Nutrition 8, 153–159.Google Scholar
Feld, S & Hirschberg, R (1996) Growth hormone, the insulin-like growth factor system, and the kidney. Endocrine Reviews 17, 423–480.Google Scholar
Feneberg, R, Sparber, M, Veldhuis, JD, Mehls, O, Ritz, E & Schaefer, F (2002) Altered temporal organization of plasma insulin oscillations in chronic renal failure. The Journal of Clinical Endocrinology and Metabolism 87, 1965–1973.Google Scholar
Flanigan, MJ, Frankenfield, DL, Prowant, BF, Bailie, GR, Frederick, PR & Rocco, MV (2001) Nutritional markers during peritoneal dialysis: data from the 1998 Peritoneal Dialysis Core Indicators Study. Peritoneal Dialysis International 21, 345–354.CrossRefGoogle ScholarPubMed
Franceschini, R, Robaudo, C, Corsini, G, Cataldi, A, Bruno, E, Russo, R, Rolandi, E & Barreca, T (1998) Somatostatin release in response to glucose is impaired in chronic renal failure. Biomedicine and Pharmacotherapy 52, 208–213.CrossRefGoogle ScholarPubMed
Galle, J, Seibold, S & Wanner, C (2003) Inflammation in uraemic patients: what is the link? Kidney and Blood Pressure Research 26, 65–75.Google Scholar
Galle, J & Wanner, C (1997) Oxidative stress and vascular injury-relevant for atherogenesis in uraemic patients? Nephrology Dialysis Transplantation 12, 2480–2483.CrossRefGoogle ScholarPubMed
Galle, J & Wanner, C (1999) Modification of lipoproteins in uremia: oxidation, glycation and carbamoylation. Mineral and Electrolyte Metabolism 25, 263–268.Google Scholar
Garibotto, G (1999) Muscle amino acid metabolism and the control of muscle protein turnover in patients with chronic renal failure. Nutrition 15, 145–155.Google Scholar
Garibotto, G, Pastorino, N & Sofia, A (2001) Il controllo del metabolismo proteico nei pazienti in trattamento dialitico (The control of protein metabolism in dialysis treatment patients). Giornale Italiano di Nefrologia 18, 683–694.Google Scholar
Golden, MHN (1982) Transport proteins as indices of protein status. American Journal of Clinical Nutrition 35, Suppl., 1159–1165.Google Scholar
Goodship, THJ (1998) What is the relationship between metabolic acidosis and nutritional status in dialysis patients? American Journal of Kidney Diseases 31, 884–889.Google Scholar
Guarnieri, G, Antonione, R & Biolo, G (2003) Mechanisms of malnutrition in uremia. Journal of Renal Nutrition 13, 153–157.CrossRefGoogle ScholarPubMed
Guarnieri, G, Toigo, G, Situlin, R, Faccini, L, Coli, U, Landini, S, Bazzato, G, Dardi, F & Campanacci, L (1983) Muscle biopsy studies in chronically uremic patients: evidence for malnutrition. Kidney International 16, Suppl., S187–S193.Google ScholarPubMed
Haviv, YS, Sharkia, M & Safadi, R (2000) Hypoglycemia in patients with renal failure. Renal Failure 22, 219–223.CrossRefGoogle ScholarPubMed
Henle, T (2003) AGEs in foods: do they play a role in uremia? Kidney International 63, Suppl., S145–S147.Google Scholar
Himmelfarb, J, Stenvinkel, P, Ikizler, TA & Hakim, RM (2002) The elephant in uremia: oxidant stress as a unifying concept of cardiovascular disease in uremia. Kidney International 62, 1524–1538.CrossRefGoogle ScholarPubMed
Ishimura, E, Okuno, S, Kitatani, K, Kim, M, Shoji, T, Nakatani, T, Inaba, M & Nishizawa, Y (2002) Different risk factors for peripheral vascular calcification between diabetic and non-diabetic haemodialysis patients – importance of glycaemic control. Diabetologia 45, 1446–1448.Google Scholar
Johannsson, G & Ahlmen, J (2003) End-stage renal disease: endocrine aspects of treatment. Growth Hormone and IGF Research 13, Suppl. A, S94–S101.CrossRefGoogle ScholarPubMed
Kalantar-Zadeh, K, Supasyndh, O, Lehn, RS, McAllister, CJ & Kopple, JD (2003) Normalized protein nitrogen appearance is correlated with hospitalization and mortality in hemodialysis patients with Kt/V greater than 1.20. Journal of Renal Nutrition 13, 15–25.CrossRefGoogle Scholar
Kasper, M & Funk, RH (2001) Age-related changes in cells and tissues due to advanced glycation end products (AGEs). Archives of Gerontology and Geriatrics 32, 233–243.Google Scholar
Kaysen, GA, Dubin, JA, Muller, HG, Mitch, WE, Rosales, LM & Levin, NW (2002) Relationships among inflammation, nutrition and physiologic mechanisms establishing albumin levels in hemodialysis patients. Kidney International 61, 2240–2249.Google Scholar
Kaysen, GA & Kumar, V (2003) Inflammation in ESRD: causes and potential consequences. Journal of Renal Nutrition 13, 158–160.CrossRefGoogle ScholarPubMed
Kopple, JD (1999) Pathophysiology of protein-energy wasting in chronic renal failure. Journal of Nutrition 129, Suppl. 1S, 247S–251S.Google Scholar
Kovacic, V, Roguljic, L & Kovacic, V (2003) Metabolic acidosis of chronically hemodialyzed patients. Americal Journal of Nephrology 23, 158–164.CrossRefGoogle ScholarPubMed
Kraus, LM, Kraus, AP Jr (2001) Carbamoylation of amino acids and proteins in uremia. Kidney International 59, Suppl., S102–S107.Google Scholar
Leypoldt, JK, Cheung, AK, Carroll, CE, Stannard, DC, Pereira, BJ, Agodoa, LY & Port, FK (1999) Effect of dialysis membranes and middle molecules removal on chronic hemodialysis patient survival. American Journal of Kidney Diseases 33, 349–355.Google Scholar
Locatelli, F, Canaud, B, Eckardt, KU, Stenvinkel, P, Wanner, C & Zoccali, C (2003) Oxidative stress in end-stage renal disease: an emerging threat to patient outcome. Nephrology Dialysis and Transplantation 18, 1272–1280.Google Scholar
Lowrie, EG & Lew, NL (1990) Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. American Journal of Kidney Diseases 15, 458–482.Google Scholar
Mak, RHK (2000) Impact of end-stage renal disease and dialysis on glycaemic control. Seminars in Dialysis 13, 4–8.Google Scholar
Mancini, A, Grandaliano, G, Magarelli, P & Allegretti, A (2003) Nutritional status in hemodialysis patients and bioimpedance vector analysis. Journal of Renal Nutrition 13, 199–204.CrossRefGoogle ScholarPubMed
Manno, C, Gesualdo, LD'Altri, C, Rossini, M, Grandaliano, G & Schena, FP (2001) Valutazione e trattamento della malnutrizione in dialisi (Appraisal and treatment of malnutrition in dialysis patients). Giornale Italiano di Nefrologia 18, 542–551.Google Scholar
Massy, ZA & Nguyen-Khoa, T (2002) Oxidative stress and chronic renal failure: markers and management. Journal of Nephrology 15, 336–341.Google Scholar
Memoli, B, Guida, B, Saravo, MT, Nastasi, A, Trio, R, Liberti, R, D'Arcangelo, R, Romano, G, Esposito, A & Cianciaruso, B (2002) Fattori predittivi e diagnostici della malnutrizione nel paziente in trattamento emodialitico (Predictive and diagnostic factors of malnutrition in hemodialysis patients). Giornale Italiano di Nefrologia 19, 456–466.Google Scholar
Mitch, WE, Du, J, Bailey, JL & Price, SR (1999) Mechanisms causing muscle proteolysis in uremia: the influence of insulin and cytokines. Mineral and Electrolyte Metabolism 25, 216–219.CrossRefGoogle ScholarPubMed
Miyata, T, Wada, Y, Cai, Z, Iida, Y, Horie, K, Yasuda, Y, Maeda, K, Kurokawa, K, van Ypersele de Strihou, C (1997) Implication of an increased oxidative stress in the formation of advanced glycation end products in patients with end-stage renal failure. Kidney International 51, 1170–1181.CrossRefGoogle ScholarPubMed
Morena, M, Cristol, JP & Canaud, B (2000) Why hemodialysis patients are in a prooxidant state? What could be done to correct the pro/antioxidant imbalance. Blood Purification 18, 191–199.Google Scholar
National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. American Journal of Kidney Disease 39, Suppl. 1, S1–S266.Google Scholar
Nevalainen, P, Lahtela, JT, Mustonen, J & Pasternack, A (1997) The influence of peritoneal dialysis and the use of subcutaneous and intraperitoneal insulin on glucose metabolism and serum lipids in type 1 diabetic patients. Nephrology Dialysis and Transplantation 12, 145–150.Google Scholar
Nguyen-Khoa, T, Massy, ZA, De Bandt, JP, Kebede, M, Salama, L, Lambrey, G, Witko-Sarsat, V, Drueke, TB, Lacour, B & Thévenin, M (2001) Oxidative stress and haemodialysis: role of inflammation and duration of dialysis treatment. Nephrology Dialysis and Transplantation 16, 335–340.Google Scholar
Norton, PA (2002) Affect of serum leptin on nutritional status in renal disease. Journal of the American Dietetic Association 102, 1119–1125.Google Scholar
Peck, LW (1997) Essential fatty acid deficiency in renal failure: can supplements really help? Journal of the American Dietetic Association 97, Suppl., S150–S153.Google Scholar
Pecoits-Filho, R, Nordfors, L, Heimburger, O, Lindholm, B, Anderstam, B, Marchlewska, A & Stenvinkel, P (2002) Solubile leptin receptors and serum leptin in end-stage renal disease: relationship with inflammation and body composition. European Journal of Clinical Investigation 32, 811–817.Google Scholar
Querques, M, Strippoli, GF, Dell'Aquila, R, Gallucci, M, Di Iorio, B, Manno, C & Gruppo di Studio Apulo-Lucano sulla Nutrizione (2002) Prevalenza della malnutrizione negli uremici in trattamento emodialitico di Puglia e Lucania (Prevalence of malnutrition in uremic patients undergoing hemodialysis therapy in Puglia and Lucania). Giornale Italiano di Nefrologia 19, 160–167.Google Scholar
Qureshi, AR, Alvestrand, A, Danielsson, A, Divino-Filho, JC, Gutierrez, A, Lindholm, B & Bergstrom, J (1998) Factors predicting malnutrition in hemodialysis patients: a cross-sectional study. Kidney International 53, 773–782.Google Scholar
Qureshi, AR, Alvestrand, A, Divino-Filho, JC, Gutierrez, A, Heimburger, O, Lindholm, B & Bergstrom, J (2002) Inflammation, malnutrition and cardiac disease as predictors of mortality in hemodialysis patients. Journal of the American Society of Nephrology 13, S28–S36.Google Scholar
Salahudeen, AK, Dykes, P & May, W (2003) Risk factors for higher mortality at the highest levels of spKt/V in haemodialysis patients. Nephrology Dialysis and Transplantation 18, 1339–1344.CrossRefGoogle ScholarPubMed
Shamsuzzaman, ASM, Winnicki, M, Wolk, R, Svatikova, A, Phillips, BG, Davidson, DE, Berger, PB & Somers, VK (2004) Independent association between plasma leptin and c-reactive protein in healthy humans. Circulation 109, 2181–2185.Google Scholar
Shinohara, K, Shoji, T, Emoto, M, Tahara, H, Koyama, H, Ishimura, E, Miki, T, Tabata, T & Nishizawa, Y (2002) Insulin resistance as an independent predictor of cardiovascular mortality in patients with end-stage renal disease. Journal of the American Society of Nephrology 13, 1894–1900.Google Scholar
Sofia, A, Russo, R, Saffioti, S, Sacco, P, Dertenois, L, Pastorino, N, Verzola, D, Ravera, F, Deferrari, G & Garibotto, G (2002) Effetti acuti della dialisi peritoneale sul metabolismo proteico (Acute effects of peritoneal dialysis on muscle protein turnover). Giornale Italiano di Nefrologia 19, 37–43.Google ScholarPubMed
Stenvinkel, P (2003) Interactions between inflammation, oxidative stress, and endothelial dysfunction in end-stage renal disease. Journal of Renal Nutrition 13, 144–148.CrossRefGoogle ScholarPubMed
Stenvinkel, P & Alvestrand, A (2002) Inflammation in end-stage renal disease: sources, consequences and therapy. Seminars in Dialysis 15, 329–337.CrossRefGoogle ScholarPubMed
Stenvinkel, P, Heimburger, O, Lindholm, B, Kaysen, G & Bergstrom, J (2000) Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrology Dialysis and Transplantation 15, 953–960.Google Scholar
Stenvinkel, P, Heimburger, O & Lonnqvist, F (1997) Serum leptin concentrations correlate to plasma insulin concentrations independent of body fat content in chronic renal failure. Nephrology Dialysis and Transplantation 12, 1321–1325.Google Scholar
Stenvinkel, P, Heimburger, O, Tuck, CH & Berglund, L (1998) Apo(a)-isoform size, nutritional status and inflammatory markers in chronic renal failure. Kidney International 53, 1336–1342.CrossRefGoogle ScholarPubMed
Suliman, ME, Heimburger, O, Barany, P, Anderstam, B, Pecoits-Filho, R, Rodriguez Ayala, E, Qureshi, AR, Fehrman-Ekholm, I, Lindholm, B & Stenvinkel, P (2003) Plasma pentosidine is associated with inflammation and malnutrition in end-stage renal disease patients starting on dialysis therapy. Journal of the American Society of Nephrology 14, 1614–1622.CrossRefGoogle ScholarPubMed
Szeto, CC & Lai, KN (1998) Metabolic acidosis and nutritional status of patients receiving continuous ambulatory peritoneal dialysis. The International Journal of Artificial Organs 21, 192–195.CrossRefGoogle ScholarPubMed
Tonshoff, B, Blum, WF & Mehls, O (1995) Insulin-like growth factors (IGF) and IGF binding proteins in children with chronic renal failure. Progress in Growth Factor Research 6, 481–491.CrossRefGoogle ScholarPubMed
Tsumura, M, Kinouchi, T, Ono, S, Nakajima, T & Komoda, T (2001) Serum lipid metabolism abnormalities and change in lipoprotein contents in patients with advanced-stage renal disease. Clinica Chimica Acta 314, 27–37.Google Scholar
Uribarri, J, Peppa, M, Cai, W, Goldberg, T, Lu, M, He, C & Vlassara, H (2003) Restriction of dietary glycotoxins reduces excessive advanced glycation end products in renal failure patients. Journal of the American Society of Nephrology 14, 728–731.Google Scholar
Vallance, P, Leone, A, Calver, A, Collier, J & Moncada, S (1992) Accumulation of an endogenous inhibitor of NO synthesis in chronic renal failure. Lancet 339, 572–575.Google ScholarPubMed
Vanholder, R, De Smet, R, Glorieux, G, Argiles, A, Baurmeister, U, Brunet, P, Clark, W, Cohen, G, De Deyn, PP, Deppisch, R, Descamps-Latscha, B, Henle, T, et al. for the European Uremic Toxin Work Group (2003) Review on uremic toxins: classification, concentration and interindividual variability. Kidney International 63, 1934–1943.Google Scholar
Vazelov, E, Borissova, AM, Kirilov, G, Assenova, B, Tchetirska, M & Krivoshiev, S (2003) L -carnitine consecutively administered to patients on hemodialysis improves beta-cell response. The International Journal of Artificial Organs 26, 304–307.Google Scholar
Zoccali, C, Benedetto, FA, Maas, R, Mallamaci, F, Tripepi, G, Malatino, LS, Boger, R & CREED Investigators (2002) Asymmetric dimethylarginine, C-reactive protein, and carotid intima-media thickness in end-stage renal disease. Journal of the American Society of Nephrology 13, 490–496.Google Scholar
Zoccali, C, Mallamaci, F & Tripepi, G (2003) Adipose tissue as a source of inflammatory cytokines in health and disease: focus on end-stage renal disease. Kidney International 63, Suppl., S65–S68.CrossRefGoogle Scholar