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Protein-Energy Wasting Dialysis — ESENeph MCQ

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ModerateHaemodialysisProtein-Energy Wasting DialysisESENeph

A 55-year-old man on haemodialysis has a consistently low pre-dialysis serum albumin (28 g/L) despite adequate protein intake. His CRP is 8 mg/L (mildly elevated). He has no nephrotic syndrome. What does this reflect?

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Correct answer: E — Protein-energy wasting (PEW) syndrome – characterised by hypoalbuminaemia, muscle wasting, and inflammation; it is associated with increased mortality in dialysis patients

Protein-energy wasting (PEW, previously called 'malnutrition-inflammation complex syndrome') affects 30-50% of dialysis patients. It is characterised by reduced serum albumin, low body weight/muscle mass, reduced dietary intake, and chronic inflammation. Low albumin in dialysis is primarily driven by inflammation (acute-phase response reprioritising hepatic protein synthesis) rather than inadequate nutrition. PEW is one of the strongest predictors of mortality in dialysis patients. Management includes optimising dialysis adequacy, dietary counselling, treating underlying inflammation, and potentially oral nutritional supplements.

Reference: KDOQI 2020 – Nutrition in CKD; Ikizler et al 2013 – PEW