Table 1 Phathogenesis of PEW in CKD patients

1. Decreased protein and energy intake

 a. Anorexia

 b. Dietary restrictions

 c. Alterations in organs involved in nutrient intake

 d. Depression

2. Hypermetabolism

 a. Increased energy expenditure

  (1) Inflammation

  (2) Increased circulating proinflammatory cytokines

 b. Hormonal disorders

  (1) Insulin resistance of CKD

  (2) Increased glucocorticoid activity

3. Metabolic acidosis

4. Decreased physical activity

5. Decreased anabolism

 a. Resistance to GH/IGF-1

 b. Low thyroid hormone levels

6. Comorbidities

 a. Diabetes mellitus

 b. Chronic heart failure

7. Dialysis procedure

 a. Nutrient losses into dialysate

 b. Dialysis-related inflammation

 c. Dialysis-related hypermetabolism