FACTORS CONTRIBUTING TO CATABOLISM IN END-STAGE RENAL-DISEASE PATIENTS

End-stage renal disease (ESRD) patients, whether they are treated with hemodialysis or continuous ambulatory peritoneal dialysis, frequently suffer from protein-energy malnutrition, which is associated with inc reased morbidity and mortality. The protein requirements in dialysis p atients are increased compared to those of healthy individuals and non dialyzed patients with chronic renal failure. The intake of protein an d energy is frequently reduced because of the underlying disease, como rbidity, psychosocial factors, and uremic anorexia (underdialysis). Th ere are several factors in ESRD patients that may enhance protein cata bolism and increase protein requirements, such as low energy intake, a mino acid abnormalities, metabolic acidosis, endocrine abnormalities ( insulin resistance, hyperglucagonemia, hyperparathyroidism, insensitiv ity to growth hormone and insulin-like growth factor-1, cardiac failur e. infection and inflammation, anemia, and physical inactivity. The di alytic procedures per se may enhance protein catabolism due to dialyti c losses of protein and amino acids and, in hemodialysis, an inflammat ory response to blood-dialyzer interaction. The relative importance of the various factors which cause anorexia and stimulate protein catabo lism is still not well understood.