Uremic acidosis and protein metabolism

Mechanisms causing loss of lean body mass in uremia include an inability to activate metabolic adaptations to a low-protein diet caused by anorexia, or other factors. The adaptations include decreased degradation of essential amino acids and protein. Metabolic acidosis activates specific pathways which increase catabolism by mechanisms that include stimulation of genes. The inability to adapt to dietary protein restriction causes loss of lean body mass.