The incidence of malnutrition disorders in chronic kidney
disease (CKD) appears unchanged over time, whereas
patient-care and dialysis techniques continue to progress.
Despite some evidence for cost-effective treatments, there
are numerous caveats to applying these research findings on
a daily care basis. There is a sustained generation of data
confirming metabolic improvement when patients control
their protein intake, even at early stages of CKD. A recent
protein–energy wasting nomenclature allows a simpler
approach to the diagnosis and causes of malnutrition. During
maintenance dialysis, optimal protein and energy intakes
have been recently challenged, and there is no longer an
indication to control hyperphosphatemia through diet
restriction. Recent measurements of energy expenditure in
dialysis patients confirm very low physical activity, which
affects energy requirements. Finally, inflammation, a
common state during CKD, acts on both nutrient intake and
catabolism, but is not a contraindication to a nutritional
intervention, as patients do respond and improve their
survival as well as do noninflamed patients.