Protein nutrition and malnutrition in CKD and ESRD

Yan Zha, Qi Qian

Research output: Contribution to journalReview articlepeer-review

67 Scopus citations


Elevated protein catabolism and protein malnutrition are common in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The underlying etiology includes, but is not limited to, metabolic acidosis intestinal dysbiosis; systemic inflammation with activation of complements, endothelin-1 and renin-angiotensin-aldosterone (RAAS) axis; anabolic hormone resistance; energy expenditure elevation; and uremic toxin accumulation. All of these derangements can further worsen kidney function, leading to poor patient outcomes. Many of these CKD-related derangements can be prevented and substantially reversed, representing an area of great potential to improve CKD and ESRD care. This review integrates known information and recent advances in the area of protein nutrition and malnutrition in CKD and ESRD. Management recommendations are summarized. Thorough understanding the pathogenesis and etiology of protein malnutrition in CKD and ESRD patients will undoubtedly facilitate the design and development of more effective strategies to optimize protein nutrition and improve outcomes.

Original languageEnglish (US)
Article number208
Issue number3
StatePublished - Mar 2017


  • Acidosis
  • Chronic kidney disease
  • Dialysis
  • Hormonal derangements
  • Inflammation
  • Protein catabolism
  • Protein nutrition
  • Uremic toxins

ASJC Scopus subject areas

  • Food Science
  • Nutrition and Dietetics


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