1. Extension of Healthy Life Span of Dialysis Patients in the Era of a 100-Year Life.
- Author
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Inaba, Masaaki, Inaba, Masaaki, and Mori, Katsuhiko
- Subjects
Medicine ,CKD ,CKD-MBD ,FGF23 ,aKlotho ,aging ,arterial spin labeling ,blood oxygenation level-dependent ,blood pressure ,body mass index ,body weight ,cardiovascular disease ,carnitine ,carnitine deficiency ,chronic kidney disease ,clinical malnutrition ,diabetes ,dialysis ,dialysis patients ,diffusion tensor imaging ,end-stage kidney disease ,exercise ,exercise tolerance ,fat mass ,frailty ,hemodialysis ,hypercatabolism ,hypertension ,magnetic resonance imaging ,malnutrition ,mortality ,muscle physiology ,n/a ,nutrition ,nutritional status ,nutritional support ,obesity paradox ,older individuals ,peritoneal dialysis ,phosphate-binder ,physical activity ,potassium ,potassium excretion ,protein energy wasting ,protein energy wasting (PEW) ,protein synthesis ,quality of life ,renal rehabilitation ,salt ,sarcopenia ,sarcopenia and frailty ,skeletal muscle ,sodium ,subcutaneous fat ,visceral fat ,zinc - Abstract
Summary: Malnutrition is becoming a more prominent health problem, with an increasing number of elderly CKD patients being put on dialysis. In addition, the presence of inflammation, sarcopenia/frailty, diabetes, and CVD is a definite and independent risk factor associated with higher mortality in this population. Although the restriction of protein intake has been recommended to protect eGFR decline, hyperphosphatemia, and hyperkalemia in CKD patients, it might accelerate the loss of skeletal muscle and adipose mass, leading to a poor prognosis. Therefore, flexible responses are considered regarding whether protein restriction should be continued or loosened in pre-dialysis CKD patients. In undernourished elderly patients undergoing hemodialysis, sufficient calorie/protein intake is necessary to counteract the development of sarcopenia/frailty. It is expected that the application of new drugs including phosphate binders and potassium chelators may achieve both a high enough intake and balanced levels of phosphate and potassium. Furthermore, the improvement of deficient micronutrients and poor appetite is also necessary. Comprehensive care is essential for the wellbeing of elderly patients undergoing hemodialysis. The topicof this Special Issue is "Extension of Healthy Life Span of Dialysis Patients in the Era of a 100-Year Life".