Pathophysiological and clinical aspects of malnutrition in chronic renal failure

• Published in: Nutrition research reviews Vol. 18; no. 1; pp. 89 - 97
• Main Authors: Caimi, G., Carollo, C., Lo Presti, R.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.06.2005
• Subjects: amino acid metabolism; Atherosclerosis; Biological and medical sciences; Cardiovascular diseases; Dialysis; Epidemiology; Feeding. Feeding behavior; Fundamental and applied biological sciences. Psychology; glucose metabolism; Health risks; Hemodialysis; human health; human nutrition; inflammation; insulin; Kidney diseases; Malnutrition; Mortality; Nutrient balance; Nutrient requirements; Nutrient status; Nutrition research; Nutritional status; Oxidative stress; Peritoneal dialysis; Proteins; renal failure; Risk factors; Vertebrates: anatomy and physiology, studies on body, several organs or systems; United States > US; Italy; Kidney disease; Chronic renal failure; Malnutrition; Atherosclerosis; Urinary system disease; Nutrition disorder; Chronic renal failure: Kidney disease: Atherosclerosis: Malnutrition; Cardiovascular disease; Chronic kidney disease; Vascular disease; Vertebrata; Chronic; Mammalia; Renal failure
• DOI: 10.1079/NRR200599
• ISSN: 0954-4224

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.