Why is malnutrition associated with mortality in CKD

Why is malnutrition associated with mortality in CKD?

Markers of PEW are some of the strongest independent predictors of adverse outcomes in patients with CKD and end-stage kidney disease.

The link between PEW and mortality has been established almost exclusively in epidemiologic and observational studies.

Thus only an association has been established. Causality needs to be verified in randomized controlled trials of nutritional interventions, even though the association is strong, robust, and consistent.

Multiple pathophysiologic mechanisms have been invoked to explain the link between poor nutritional status and mortality in CKD:

• Lower muscle and adipose mass decrease circulating lipoprotein that normally suppresses circulating endotoxin

• Gastrointestinal, hematopoietic, and immune dysfunctions leading to more infections

• Micronutrient deficiency leading to oxidative stress and endothelial dysfunction

• Inadequate circulating gelsolin to oppose deleterious effects of circulating actin, including platelet activation leading to increased thromboembolic events

• The maladaptive activation of the inflammatory and oxidative cascade can potentiate the effects of low nutrient intake by increasing catabolism

• Novel factors such as proinflammatory high-density lipoprotein (HDL), myeloperoxidase, and pentraxin may also play important roles

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