Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, Azienda Ospedale Università San Martino, Genoa University, Viale Benedetto XV 6, Genoa, Italy.
Int J Environ Res Public Health. 2011 May;8(5):1631-54. doi: 10.3390/ijerph8051631. Epub 2011 May 19.
Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD) and is associated with an increased death risk from cardiovascular diseases. However, while even minor renal dysfunction is an independent predictor of adverse cardiovascular prognosis, PEW becomes clinically manifest at an advanced stage, early before or during the dialytic stage. Mechanisms causing loss of muscle protein and fat are complex and not always associated with anorexia, but are linked to several abnormalities that stimulate protein degradation and/or decrease protein synthesis. In addition, data from experimental CKD indicate that uremia specifically blunts the regenerative potential in skeletal muscle, by acting on muscle stem cells. In this discussion recent findings regarding the mechanisms responsible for malnutrition and the increase in cardiovascular risk in CKD patients are discussed. During the course of CKD, the loss of kidney excretory and metabolic functions proceed together with the activation of pathways of endothelial damage, inflammation, acidosis, alterations in insulin signaling and anorexia which are likely to orchestrate net protein catabolism and the PEW syndrome.
蛋白质能量消耗（PEW）在慢性肾脏病（CKD）患者中很常见，并且与心血管疾病死亡风险增加有关。然而，即使是轻微的肾功能障碍也是不良心血管预后的独立预测因素，但 PEW 在晚期才表现出临床症状，甚至在透析阶段之前或早期就出现了。导致肌肉蛋白和脂肪损失的机制很复杂，并不总是与厌食症有关，但与刺激蛋白质降解和/或减少蛋白质合成的几种异常有关。此外，来自 CKD 实验的数据表明，尿毒症通过作用于肌肉干细胞，特异性地削弱了骨骼肌的再生潜能。在本次讨论中，我们探讨了导致 CKD 患者营养不良和心血管风险增加的机制的最新发现。在 CKD 过程中，肾脏排泄和代谢功能的丧失与内皮损伤、炎症、酸中毒、胰岛素信号改变和厌食症途径的激活同时发生，这些途径可能协调净蛋白质分解和 PEW 综合征。
