Serum protein deficits arise from many etiologies in people with CKD (18,24). Simple malnutrition is caused by insufficient nutrient intake relative to requirements and responds to correction of deficient intake. In contrast, malnutrition or wasting caused by inflammation and secondary effects of other comorbidities results in hypermetabolism and inefficient utilization of nutrients. With this form of malnutrition, simple nutritional repletion without measures to correct the underlying comorbidities and inflammation is ineffective. Because there are interactions between inflammation, anorexia, and poor nutrient intake, a multifaceted intervention strategy that optimizes dialysis delivery, energy and protein intake, corrects concomitant conditions (e.g., acidosis, anemia, uremia, medication side effects, economic concerns, dental health, etc.), and addresses inflammation and elevated proinflammatory cytokines is needed. Biochemical assessment is an instrumental part in differentially diagnosing the etiology of protein deficits in people with CKD.
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