Juan J. Carrero, PhD Pharm, PhD Med

Journal of Renal Nutrition, Vol 21, No 1 (January), 2011: pp 7–11

Anorexia or loss of appetite is an important component of the protein-energy wasting (PEW) syndrome observed in advanced chronic kidney disease (CKD) that directly contributes to poor patient outcomes, higher hospitalization rates, and poor quality of life. Although previous studies on the prevalence of this condition during the early stages of CKD are not available, it has been reported to be present in 40% to 50% of the patients with CKD on maintenance dialysis.1 Traditionally, anorexia has been considered to be a sign of uremic intoxication, and the fact that these symptoms are at least temporarily and partially relieved after initiation of maintenance dialysis therapy suggests that the retention of uremic toxins may contribute to anorexia.2 However, anorexia cannot be just confined to effects of uremic toxins because it links to several other important complications in CKD. A proper understanding of the multifactorial causes of uremic anorexia is necessary to correctly tackle this problem because the best treatment might most likely be multifaceted. This review aims at providing an overview on the mechanisms involved in the development of uremic anorexia.

Conclusion

In this review article the author concluded that anorexia represents a complex and multifactorial disorder, which may have its origin in renal failure, but later involves metabolic abnormalities that are not fully corrected by dialysis therapy. In these derangements, systemic inflammation is likely to play an integrative role. In conclusion, the treatment of uremic anorexia and ultimately PEW should likely be multifaceted. Improving protein and energy intake is of outmost importance, but might not suffice. A combination of
approaches, with anti-inflammatory therapies for instance, would be of paramount interest.