Centre Hospitalier Lyon-Sud, Univ Lyon, CarMeN, Dept Nephrology, Pierre-Bénite, France.
Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, School of Medicine, Orange, Irvine, CA, USA.
J Cachexia Sarcopenia Muscle. 2019 Jun;10(3):479-484. doi: 10.1002/jcsm.12421. Epub 2019 Apr 12.
Weight loss and homeostatic disturbances of both energy and protein balances are characteristics of several illnesses including cancer, heart failure, and chronic kidney disease (CKD). Different definitions have been used to describe this deleterious process. The term protein-energy wasting (PEW) has been proposed for CKD patients by the International Society of Renal Nutrition and Metabolism.
We searched the publication in Medline from February 2008 to September 2018 using PEW or cachexia in their title.
Since its inception, the term PEW has been exceptionally successful, highlighted by 327 original publications referenced in PubMed over 10 years. Using this classification, several studies have confirmed that PEW is among the strongest predictors of mortality in CKD patients [hazard ratio of 3.03; confidence interval of 1.69-5.26 in 1068 haemodialysis patients and 1.40 (1.04-1.89) in 1487 non-dialysed patients across PEW stages 0 to 4]. Based on this classification, prevalence of PEW is 28% to 54% among 16 434 adults undergoing maintenance dialysis. PEW prevalence increases when renal function declines, that is, from <2% in CKD stages 1-2 to 11-54% in CKD stages 3-5. A more general definition of cachexia for all chronic diseases proposed by the Society on Sarcopenia, Cachexia and Wasting Disorders was also published concurrently. In the CKD area, we found 180 publications using 'cachexia' underlining that some confusion or overlap may exist. The definitions of PEW and cachexia are somewhat similar, and the main difference is that a loss of body weight >5% is a mandatory criterion for cachexia but supportive for PEW.
The recent understanding of cachexia physiopathology during CKD progression suggests that PEW and cachexia are closely related and that PEW corresponds the initial state of a continuous process that leads to cachexia, implicating the same metabolic pathways as in other chronic diseases. Despite the success of the definition of PEW, using a more uniform term such as 'kidney disease cachexia' could be more helpful to design future research through collaborative groups of researchers with focus on cachexia.
体重减轻和能量及蛋白质平衡的稳态紊乱是包括癌症、心力衰竭和慢性肾脏病（CKD）在内的几种疾病的特征。已经使用了不同的定义来描述这种有害过程。国际肾脏营养与代谢学会提出了用于 CKD 患者的术语“蛋白质能量消耗（PEW）”。
我们在 2008 年 2 月至 2018 年 9 月期间在 Medline 中使用 PEW 或厌食症作为标题进行了搜索。
自成立以来，PEW 一词非常成功，在过去 10 年中，PubMed 中引用了 327 篇原始出版物。使用这种分类，几项研究证实 PEW 是 CKD 患者死亡的最强预测因素之一[在 1068 名血液透析患者中风险比为 3.03；在 1487 名未接受透析的患者中风险比为 1.40（1.04-1.89），PEW 分期为 0 至 4]。基于这种分类，在接受维持性透析的 16434 名成年人中，PEW 的患病率为 28%至 54%。随着肾功能下降，PEW 的患病率增加，即从 CKD 1-2 期的<2%到 CKD 3-5 期的 11-54%。同时还提出了由肌肉减少症、恶病质和消耗障碍协会提出的用于所有慢性疾病的更一般的厌食症定义。在 CKD 领域，我们发现使用“厌食症”的 180 篇出版物，这表明可能存在一些混淆或重叠。PEW 和厌食症的定义有些相似，主要区别在于体重减轻>5%是厌食症的强制性标准，但对 PEW 有支持作用。
最近对 CKD 进展过程中恶病质生理学的理解表明，PEW 和恶病质密切相关，PEW 对应于导致恶病质的连续过程的初始状态，涉及与其他慢性疾病相同的代谢途径。尽管 PEW 的定义取得了成功，但使用更统一的术语，如“肾脏病恶病质”，可能更有助于通过专注于恶病质的研究人员合作小组设计未来的研究。
