Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, Franch H, Guarnieri G, Ikizler T A, Kaysen G, Lindholm B, Massy Z, Mitch W, Pineda E, Stenvinkel P, Treviño-Becerra A, Wanner C
Department of Nephrology, Hopital Edouard Herriot, Université Lyon 1, U870 INSERM, Lyon, France.
Kidney Int. 2008 Feb;73(4):391-8. doi: 10.1038/sj.ki.5002585. Epub 2007 Dec 19.
The recent research findings concerning syndromes of muscle wasting, malnutrition, and inflammation in individuals with chronic kidney disease (CKD) or acute kidney injury (AKI) have led to a need for new terminology. To address this need, the International Society of Renal Nutrition and Metabolism (ISRNM) convened an expert panel to review and develop standard terminologies and definitions related to wasting, cachexia, malnutrition, and inflammation in CKD and AKI. The ISRNM expert panel recommends the term 'protein-energy wasting' for loss of body protein mass and fuel reserves. 'Kidney disease wasting' refers to the occurrence of protein-energy wasting in CKD or AKI regardless of the cause. Cachexia is a severe form of protein-energy wasting that occurs infrequently in kidney disease. Protein-energy wasting is diagnosed if three characteristics are present (low serum levels of albumin, transthyretin, or cholesterol), reduced body mass (low or reduced body or fat mass or weight loss with reduced intake of protein and energy), and reduced muscle mass (muscle wasting or sarcopenia, reduced mid-arm muscle circumference). The kidney disease wasting is divided into two main categories of CKD- and AKI-associated protein-energy wasting. Measures of chronic inflammation or other developing tests can be useful clues for the existence of protein-energy wasting but do not define protein-energy wasting. Clinical staging and potential treatment strategies for protein-energy wasting are to be developed in the future.
近期关于慢性肾脏病（CKD）或急性肾损伤（AKI）患者肌肉消耗、营养不良和炎症综合征的研究结果，引发了对新术语的需求。为满足这一需求，国际肾脏营养与代谢学会（ISRNM）召集了一个专家小组，以审查和制定与CKD和AKI患者的消耗、恶病质、营养不良和炎症相关的标准术语及定义。ISRNM专家小组建议用“蛋白质-能量消耗”来表示身体蛋白质质量和能量储备的丢失。“肾脏病消耗”指的是CKD或AKI患者中发生的蛋白质-能量消耗，无论其病因如何。恶病质是蛋白质-能量消耗的一种严重形式，在肾脏病中很少发生。如果出现以下三个特征，则可诊断为蛋白质-能量消耗：（血清白蛋白、转甲状腺素蛋白或胆固醇水平低）、体重减轻（身体或脂肪量低或减少，或因蛋白质和能量摄入减少而体重减轻）以及肌肉量减少（肌肉消耗或肌肉减少症，上臂中部肌肉周长减小）。肾脏病消耗主要分为与CKD相关的蛋白质-能量消耗和与AKI相关的蛋白质-能量消耗两类。慢性炎症指标或其他正在开发的检测方法可能是蛋白质-能量消耗存在的有用线索，但不能定义蛋白质-能量消耗。蛋白质-能量消耗的临床分期和潜在治疗策略将在未来制定。
