Abstract：The metabolic milieu in chronic kidney disease (CKD) is significantly altered due to renal functional decline (such as metabolic acidosis, dyslipidemia, insulin resistance), and metabolic acidosis is associated with increased protein catabolism in patients with CKD. Renal functional decline could also cause hormonal imbalance and it is implicated in the suppression of appetite in patients with CKD. In the end it leads to inadequate nutrient intake. The intestinal microbial flora is significantly altered in patients with CKD and plays a pathogenic role in the chronic inflammatory state seen in CKD. Chronic inflammatory state increases resting energy expenditure and catabolism. Protein-energy wasting, which essentially refers to decreased body protein mass and energy reserves, is common in advanced chronic kidney disease patients and end-stage kidney disease patients undergoing chronic dialysis. Increased protein catabolism, inadequate nutrient intake and increased resting energy expenditure and catabolism could lead to protein-energy wasting (PEW) in patients with CKD. Malnutrition can increase the risk of morbidity and mortality in children and adults with chronic kidney disease. Decreased appetite, reduced dietary intake, loss of nutrients in dialysis patients, hormone imbalance, inflammation, increased catabolism and other factors interact easily to cause malnutrition in patients with chronic kidney disease. A better understanding of pathophysiologic mechanisms of protein-energy wasting in patients with CKD might lead to the development of novel and effective therapies for malnutrition
2018, Vol. 5 
