Malnutrition And CVD Complication In CKD: Clinical Study With 1239 Case Patients And Experimental Studies Of 5/6 Nephrectomy Rat Treated With Chinese Herb

Malnutrition is a common occurrence in end-stage renal disease(ESRD) patients before the start of dialysis, and it becomes even more common after patients start on peritoneal dialysis (PD) or hemodialysis (HD).It is now well established that protein-energy malnutrition is one of the most important predictors of survival in ESRD patients. And, PEM in renal patients also appears to be a risk factor for development of pulmonary edema and infectious complications.To date, however, no trials have established that there is effective treatment that either restores albumin level to normal or reduces and of the long-term risks of hypoalbuminemia in ESRD.Recent data suggest that hypoalbuminemia may be a reflection of chronic inflammatition rather than nutrion per se. clearly, better efforts are needed to assess the degree of malnutrition and the presence of chronic inflammation during both the CKD and ESRD periods so as to develop appropriate means of early intervention.The cause of PEM is multifactorial. CKD disrupts several components of protein metabolism, increasing nitrogen and essential amino acidrequirements. Concomitant disease also can congtribute to hypoalbuminemia.Factors associated with socioeconomic status and access to medical care havealso been implicated. It is also possible that the uremic milieu in ESRDpatients may itself promote protein catabolism and possibly increase dietary otein requirements. There are many disorders include resistance to insulin,growth hormone, and insulin-like growth f actor- 1 (IGF-1) and bothhyperglucagonemia and hyperparathyroidism, which may each promotegluconeogenesis. Vitamin D and it's metabolites may stimulate proteinsynthesis in skeletal muscle; hencem vitamin D deficiency theoretically couldlead to protein wasting in skeletal muscle.It is well established that the fradual decrease of nutritional intake of protein and energy, occurring simultaneously with impaired nutritional status.However, there are large interpatient variation in requirements with lowprotein and energy intake may exhibit neutral or positive nitrogen balance, whereas others may benefit from very high intake.Energy deficiency due to a low energy intake or increased energy expenditure (REE) is probably an important but often neglected cause of wasting in ESRD patients. A low energy intake reduces the utilization of protein, and energy intake therefore has a direct effect on nitrogen balance in ESRD patients: this effect may be even stronger than the effect of protein intake on nitrogen balance. Although REE may be increased in other patient groups with wasting disorders, normal or increased REEUremia also may be associated with increased concentrations of a number of inflammatory cytokines and other compounds that may promote a catabolic state. It's well know that low-grade chronic inflammation(the microinflammation state of uremia) with increased circulating levels ofC-reactive protein(CRP) and proinflammation cytokines such as TNF-a and interleukin-6(IL-6) has been recognized increasingly as one of the most important contributors to PEM in ESRD patients. Proinflammation cytokines may cause PEM by increasing REE and protein catabolism, and they may also affect appetite and eating behaviors. Assessment of inflammatory markers is of value to distinguish two types of -PEM in ESRD patients, pure PEM (type 1) OR "inflammatory" PEM (type 2). The latter form of PEM is associated with inflammation usually reflected by low serum albumin, comorbidity, elevated REE, increased oxidative stress, increasing protein catabolism and inability to reverse PEM by nutritional support. The prognosis of patients with only type 1 PEM and no inflammation, comordity and other complicating factors is usually more favorable. There are many causes of elevated proinflammatory cytokines in ESRD patients. First of all, deteriorating renal function is associated with an increase hi serum cytokines and then soluble receptors. Secondly, a number of conditions a...