NUTRITIONAL MANAGEMENT OF STAGE 5 CHRONIC
KIDNEY DISEASE
Protein-energy malnutrition (PEM), i.e. a loss in lean body mass,
which is partly dependent from increased protein catabolism, is
common in patients with CKD undergoing dialysis (Siew & Ikizler
2010). PEM is, however, just one aspect of a syndrome known as
the malnutrition–inflammation complex syndrome, which takes
into account the association between chronic inflammation and
nutritional status (Kalantar-Zadeh et al. 2003). On the other
hand, overweight and obesity are becoming increasingly com-
mon in dialysis patients. Although many observational studies
have shown that obesity might be associated with better out-
comes in dialysis patients, the lack of a clear pathophysiological
explanation and, most importantly, the absence of randomised
controlled trials testing whether nutritional interventions resulting
in weight gain can lead to greater survival, do not warrant mod-
ifications of current practice, but this may change in the future
(Kalantar-Zadeh 2007).