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Review
. 2022 Nov 9;14(22):4722.
doi: 10.3390/nu14224722.

Rehabilitation Nutrition in Patients with Chronic Kidney Disease and Cachexia

Masatsugu Okamura  1   2   3 , Tatsuro Inoue  3   4 , Masato Ogawa  3   5 , Kengo Shirado  3   6 , Nobuyuki Shirai  3   7 , Takuma Yagi  3   8 , Ryo Momosaki  9 , Yoji Kokura  10
Affiliations
Review

Rehabilitation Nutrition in Patients with Chronic Kidney Disease and Cachexia

Masatsugu Okamura et al. Nutrients. .

Abstract

Rehabilitation nutrition is a proposed intervention strategy to improve nutritional status and physical function. However, rehabilitation nutrition in patients with cachexia and protein-energy wasting (PEW), which are the main nutrition-related problems in patients with chronic kidney disease (CKD), has not been fully clarified. Therefore, this review aimed to summarize the current evidence and interventions related to rehabilitation nutrition for cachexia and PEW in patients with CKD. CKD is a serious condition worldwide, with a significant impact on patient prognosis. In addition, CKD is easily complicated by nutrition-related problems such as cachexia and PEW owing to disease background- and treatment-related factors, which can further worsen the prognosis. Although nutritional management and exercise therapy are reportedly effective for cachexia and PEW, the effectiveness of combined nutrition and exercise interventions is less clear. In the future, rehabilitation nutrition addressing the nutritional problems associated with CKD will become more widespread as more scientific evidence accumulates. In clinical practice, early intervention in patients with CKD involving both nutrition and exercise after appropriate assessment may be necessary to improve patient outcomes.

Keywords: cachexia; chronic kidney disease; exercise therapy; nutritional disorders; protein-energy wasting; rehabilitation nutrition.

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Conflict of interest statement

The authors declare no conflict of interest. The corresponding author (Y.K.) is identical to the Special Issue editor. A different editor is responsible for this review, and Y.K. was not involved in any decisions and the selection of the reviewers. Therefore, the responsible author (Y.K.) also has no conflict of interest.

Figures

Figure 1
Figure 1
Conceptual diagram of cachexia and protein-energy wasting in patients with chronic kidney disease. CKD, chronic kidney disease; PEW, protein-energy wasting.
Figure 2
Figure 2
Flowchart of rehabilitation nutrition in patients with chronic kidney disease. AA/KA, amino acid/keto acid; BMI, body mass index; CKD, chronic kidney disease; DPI, dietary protein intake; EDW, estimated dry weight; GH, growth hormone; IBW, ideal body weight; IDPN, intradialytic parenteral nutrition; IL-1ra, interleukin-1 receptor antagonist; ONS, oral nutritional supplement; PEG, percutaneous endoscopic gastrostomy; PEW, protein-energy wasting; SGA, subjective global assessment; TPN, total parenteral nutrition, adapted from [5,47,83].
See this image and copyright information in PMC

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