Anorexia in hemodialysis patients: an update

Area of Science:

• Nephrology
• Gastroenterology
• Metabolic Disorders

Background:

• Anorexia, or loss of appetite, is prevalent in hemodialysis (HD) patients, affecting one-third of this population.
• The exact causes of anorexia in HD patients remain unclear, but potential factors include uremic toxins, inflammation, and hormonal imbalances.
• This condition contributes significantly to malnutrition, cachexia, and diminished quality of life in hemodialysis patients.

Purpose of the Study:

• To explore the pathogenesis and clinical significance of anorexia in hemodialysis patients.
• To review current and potential therapeutic strategies for managing anorexia in this patient group.

Main Methods:

• Literature review of proposed pathogenetic mechanisms.
• Analysis of the impact of anorexia on nutritional status and quality of life.
• Evaluation of existing and experimental treatment options.

Main Results:

• Proposed factors involved in anorexia pathogenesis include middle molecules, inflammation, altered amino acids, leptin, ghrelin, and neuropeptide Y.
• Anorexia is linked to reduced energy and protein intake, malnutrition, and cachexia.
• The prognostic value of anorexia as an independent factor in HD patients is still under debate.

Conclusions:

• Treatment strategies may involve intensified dialysis, nutritional support, and branched-chain amino acid supplementation.
• Further randomized trials are needed to validate the efficacy of megestrol acetate.
• Ghrelin administration and melanocortin-receptor antagonists show promise for future therapeutic interventions.