Exp Clin Transplant. 2026 Jul;24(Suppl 2):39-43. doi: 10.6002/ect.MESOT2025.P189.
ABSTRACT
Protein energy wasting is a highly prevalent and clinically significant complication in patients receiving maintenance hemodialysis, affecting approximately 30 % to 50 % of this population worldwide. Protein energy wasting is associated with substantially increased risk of all -cause and cardiovascular mortality, reduced functional capacity, impaired immune function, and poor quality of life. The pathogenesis of protein energy wasting is multifactorial and involves reduced dietary intake, chronic inflammation, metabolic acidosis, dialysis -related nutrient losses, hormonal and metabolic disturbances, and comorbid disease burden. This narrative literature review synthesized contemporary evidence (2020 -2025) on the epidemiology, pathophysiology, assessment, and nutritional management of protein energy wasting in patients receiving hemodialysis. We highlighted limitations of traditional biochemical markers such as serum albumin and emphasized the importance of multidimensional nutritional assessment using validated clinical tools, including the Subjective Global Assessment and Malnutrition-Inflammation Score, complemented by objective body composition techniques. We also discussed current guideline -recommended targets for protein and energy intake, as well as real -world barriers to achieving these targets. We reviewed and examined evidence supporting oral nutritional supplementation as first -line therapy, along with indications for intradialytic parenteral nutrition in selected patients with severe or refractory protein energy wasting, and the role of micronutrient management, vitamin D repletion, and targeted trace element supplementation. Emerging adjunctive strategies, including omega -3 fatty acids, gut microbiome modulation, and exercise -nutrition synergy, were also addressed. Overall, effective management of protein energy wasting requires early identification, individualized dietary strategies, and integration within multidisciplinary dialysis care models. Future research should prioritize pragmatic trials focused on hard clinical outcomes and personalized approaches to nutritional therapy in this high -risk population.
PMID:42538655 | DOI:10.6002/ect.MESOT2025.P189