Cachexia in Chronic Kidney Disease

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Many reports indicate that in patients with advanced chronic kidney disease (CKD) and those on dialysis there is a high prevalence of PEM, up to 40% or more, and a strong association between malnutrition and greater morbidity and mortality [25]. CKD patients not only have a high prevalence of malnutrition, but also a higher occurrence rate of inflammatory processes. Many conditions leading to malnutrition and wasting may also cause inflammation. Oxidative stress may be a major underlying cause for both conditions [26]. Since both malnutrition and inflammation are strongly associated with each other and can change many nutritional measures and clinical outcomes in the same direction, and because the relative contributions of measures of these two conditions to each other and to poor outcomes in CKD patients are not yet well defined, the term 'malnutrition-inflammation complex syndrome' (MICS) has been suggested to denote the important contribution of both of these conditions to end-stage renal disease outcome [25]. The MICS may also be defined as the 'malnutrition-inflam-mation-cachexia syndrome' to indicate better the presence of the wasting syndrome pointed out recently. However, unlike cancer cachexia, the wasting syndrome in CKD usually does not lead to immediate death from the direct consequences of malnutrition, but acts over time to promote atherosclerotic cardiovascular disease [27].

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