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PERAN PROTEIN ENERGY WASTING DALAM PROGRESIVITAS PENYAKIT GINJAL KRONIS : A NARRATIVE LITERATURE REVIEW

RSUD Dr. Soegiri Lamongan, Lamongan, Jawa Timur, Indonesia

Received: 13 Mar 2024; Revised: 29 Nov 2025; Accepted: 2 Dec 2025; Available online: 30 Apr 2026; Published: 12 May 2026.

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Abstract

ABSTRACT

Background: Chronic kidney disease is a growing global health concern. A common complication in chronic kidney disease patients is Protein Energy Wasting, a malnutrition condition leading to muscle mass loss and a decline in nutritional status. Protein Energy Wasting accelerates chronic kidney disease progression, increases comorbidities, and reduces quality of life.

Objective: This study explores the role of Protein Energy Wasting in chronic kidney disease progression and evaluates nutritional strategies to mitigate its effects.

Methods: A narrative literature review was conducted using PubMed, Science Direct, and Google Scholar. Articles were selected based on inclusion and exclusion criteria, focusing on studies from the last five years (2021-2025) discussing Protein Energy Wasting and chronic kidney disease.

Results: Protein Energy Wasting in chronic kidney disease patients is driven by chronic inflammation, metabolic disorders, and hormonal imbalances, leading to faster kidney function decline and increased health risks. Effective management requires a multidisciplinary approach, including a low-protein diet with specialized renal nutrition, anti-inflammatory therapy, and adequate protein and energy intake to maintain muscle mass.

Conclusion: Protein Energy Wasting significantly contributes to chronic kidney disease progression and increases morbidity and mortality. Proper nutritional interventions, such as tailored diets and renal-specific supplements, help preserve nutritional status and slow disease progression. Further research is needed to refine strategies for managing Protein Energy Wasting and improving patient outcomes.

Keywords: Chronic kidney disease; protein energy wasting; malnutrition

 

ABSTRAK

Latar Belakang: Penyakit ginjal kronis merupakan masalah kesehatan global yang terus meningkat. Salah satu komplikasi umum pada pasien penyakit ginjal kronis adalah Protein Energy Wasting, yaitu kondisi malnutrisi yang menyebabkan kehilangan massa otot dan penurunan status gizi. Protein Energy Wasting mempercepat progresi penyakit ginjal kronis, meningkatkan risiko komorbiditas, dan menurunkan kualitas hidup pasien.

Tujuan: Studi ini mengeksplorasi peran Protein Energy Wasting dalam progresi penyakit ginjal kronis serta mengevaluasi strategi gizi untuk mengurangi dampaknya.

Metode: Kajian pustaka dengan pendekatan naratif dilakukan menggunakan database PubMed, Science Direct, dan Google Scholar. Artikel dipilih berdasarkan kriteria inklusi dan eksklusi, dengan fokus pada penelitian lima tahun terakhir (2021-2025) yang membahas hubungan antara Protein Energy Wasting dan penyakit ginjal kronis.

Hasil: Protein Energy Wasting pada pasien penyakit ginjal kronis disebabkan oleh inflamasi kronis, gangguan metabolik, dan ketidakseimbangan hormonal, yang mempercepat penurunan fungsi ginjal serta meningkatkan risiko komplikasi kesehatan. Penanganan Protein Energy Wasting memerlukan pendekatan multidisiplin, seperti diet rendah protein dengan gizi khusus penyakit ginjal, terapi antiinflamasi, serta asupan cukup protein dan energi untuk menjaga massa otot.

Kesimpulan: Protein Energy Wasting berperan penting dalam progresi penyakit ginjal kronis dan berhubungan erat dengan meningkatnya angka morbiditas dan mortalitas. Intervensi gizi yang tepat, seperti diet yang disesuaikan dan suplementasi khusus ginjal, dapat membantu mempertahankan status gizi serta memperlambat perkembangan penyakit. penelitian lebih lanjut diperlukan untuk mengembangkan strategi optimal dalam menangani Protein Energy Wasting pada pasien penyakit ginjal kronis guna meningkatkan kualitas hidup mereka.

Kata kunci: Penyakit ginjal kronis; protein energy wasting; malnutrisi


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Keywords: Penyakit ginjal kronis; protein energy wasting; malnutrisi

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  1. GBD 2019 Diseases and Injuries Collaborators. Global, regional, and national burden of chronic kidney disease, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;395(10225):709-33. doi: 10.1016/S0140-6736(20)30054-5
  2. Media Indonesia. Mencegah melesatnya jumlah penderita ginjal kronis. Media Indonesia. 2024 May 9. Available from: https://mediaindonesia.com/kolom-pakar/752745/mencegah-melesatnya-jumlah-penderita-ginjal-kronis
  3. Hidayat R, Suryani H, Adi T. Prevalensi penyakit ginjal kronis dan faktor risiko pada pasien gagal ginjal stadium akhir yang menjalani hemodialisis di Rumah Sakit Cipto Mangunkusumo. J Nefrol Indones. 2021;20(1):15-23. doi: 10.21776/jo.2021
  4. Zhang X, Zhang X, Li S. Protein-energy wasting and its relationship with inflammation in patients with chronic kidney disease. J Ren Nutr. 2021;31(4):312-20. doi: 10.1053/j.jrn.2020.09.010
  5. Rasouli M, Miri M, Fadaei R. Mechanisms of protein-energy wasting in chronic kidney disease. Nephrol Dial Transplant. 2020;35(5):850-8. doi: 10.1093/ndt/gfz220
  6. Yamada S, Nakano T, Tsuneyoshi S, Arase H, Shimamoto S, Taniguchi M, et al. Association between modified simple protein-energy wasting (PEW) score and all-cause mortality in patients receiving maintenance hemodialysis. Ren Replace Ther. 2020;6:39. doi: 10.1186/s41100-020-00289-6
  7. Rashid I, Sahu G, Tiwari P, Willis CV, Asche CV, Bagga TK, et al. Malnutrition as a potential predictor of mortality in chronic kidney disease patients on dialysis: a systematic review and meta-analysis. Clin Nutr. 2024;43(7):1760-9. doi: 10.1016/j.clnu.2024.05.037
  8. Ma M, Ding M, et al. The correlation between protein-energy wasting and the incidence of major adverse cardiovascular events in adult maintenance hemodialysis patients: a single-center retrospective cohort study. Ren Fail. 2025;47(1):e2441399. doi: 10.1080/0886022X.2024.2441399
  9. Fouque D, Laville M, Aparicio M. Nutritional therapy in advanced chronic kidney disease: the role of ketoanalogs. Nephrology. 2018;23(4):315-22
  10. Ikizler TA, Cano NJ, Franch H, Fouque D, Himmelfarb J, Kalantar-Zadeh K, et al. Prevention and treatment of protein-energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney Int. 2013;84(6):1096-107. doi: 10.1038/ki.2013.147
  11. Kalantar-Zadeh K, Karaboyas A, Robinson B. Protein-energy wasting in chronic kidney disease: new definitions and management strategies. Nat Rev Nephrol. 2021;17(8):497-508. doi: 10.1038/s41581-021-00424-9
  12. Dalrymple LS, Go AS. Epidemiology of infection in chronic kidney disease. Clin J Am Soc Nephrol. 2020;15(2):277-87. doi: 10.2215/CJN.04670419
  13. Kang Y, Kim H, Lee J. A new approach to addressing protein-energy wasting in patients with chronic kidney disease: clinical interventions and management. Nat Rev Nephrol. 2022;18(3):189-98. doi: 10.1038/s41581-022-00588-4
  14. Kelly OJ, Huang MC, Liao HY, et al. A low-protein diet with a renal-specific oral nutrition supplement helps maintain nutritional status in patients with advanced chronic kidney disease. J Pers Med. 2021;11(12):1360. doi: 10.3390/jpm11121360
  15. Mansouri F, et al. Association between pro-vegetarian dietary pattern and the risk of protein-energy wasting and sarcopenia in patients with chronic kidney disease. J Health Popul Nutr. 2024;43:606. doi: 10.1186/s41043-024-00606-3
  16. Han Q, Zhang R, Wu J, He F, Qing F, Li W, et al. Cross-sectional relationship between dietary protein intake, energy intake, and protein-energy wasting in chronic kidney disease patients. Br J Nutr. 2024;132(2):309-14. doi: 10.1017/S0007114524001041
  17. Osunbor OA, Unuigbe EI, Okaka EI, Adejumo OA. Protein-energy wasting in predialysis chronic kidney disease patients and associated factors: a comparative cross-sectional study. PLoS One. 2023;18(5):e0286075. doi: 10.1371/journal.pone.0286075
  18. Yogesh M, Nagda J, Kankhara F, Parmar PA, Mody M, Vyas SS, et al. Prevalence and predictors of sarcopenia, protein-energy wasting, and sarcopenic obesity in patients with chronic kidney disease. Indian J Nephrol. 2024. doi: 10.25259/IJN_241_2024
  19. Narasaki Y, et al. Why protein-energy wasting leads to faster progression of chronic kidney disease. Curr Opin Nephrol Hypertens. 2025. doi: 10.1097/MNH.0000000000001035
  20. Zhang Y, Li X, Wang Z, Liu H. Predictive value of circulating fibroblast growth factor-23 and Klotho on protein-energy wasting in patients undergoing hemodialysis. Front Nutr. 2024;11:1497869. doi: 10.3389/fnut.2024.1497869
  21. Kidney Disease Outcomes Quality Initiative (KDOQI). Clinical practice guidelines for nutrition in chronic kidney disease: 2020 update. Am J Kidney Dis. 2020;76(3 Suppl 1):S1-107
  22. Liu X, Wu J, He Y, et al. Energy intake and cardiovascular mortality in patients with chronic kidney disease: analysis of NHANES 2009–2018. Nutr J. 2024;23(1):12. doi: 10.1186/s12937-024-00980-y
  23. Sanches FM, Avesani CM, Ikizler TA, et al. Energy expenditure in chronic kidney disease patients: results from direct and indirect calorimetry. Front Nutr. 2021;8:654930. doi: 10.3389/fnut.2021.654930
  24. Ikizler TA, Burrowes JD, Byham-Gray LD, et al. KDOQI clinical practice guideline for nutrition in CKD: 2020 update—protein and energy. Am J Kidney Dis. 2021;77(2 Suppl 1):S1-107. doi: 10.1053/j.ajkd.2020.10.006
  25. Kalantar-Zadeh K, Fouque D. Nutritional management of chronic kidney disease. N Engl J Med. 2022;387(19):1779-91. doi: 10.1056/NEJMra2204236
  26. Choi H, Lee H, Lee K, et al. Nutritional management of protein-energy wasting in patients with chronic kidney disease: an updated review. Nutrients. 2023;15(9):2084. doi: 10.3390/nu15092084
  27. Rhee CM, Jing J, Kovesdy CP, et al. Dietary omega-3 polyunsaturated fatty acids and kidney health: insights from clinical and epidemiological studies. Nephrol Dial Transplant. 2023;38(6):892-904. doi: 10.1093/ndt/gfad063
  28. Martins D, Ribeiro E, Silva R, et al. Nutritional strategies in the management of protein-energy wasting in CKD: recent evidence and perspectives. Semin Dial. 2023;36(1):29-36. doi: 10.1111/sdi.13147
  29. Shah A, Kalantar-Zadeh K, Kopple JD. Vitamin D in chronic kidney disease: a clinical update. Nutrients. 2021;13(10):3396. doi: 10.3390/nu13103396
  30. Chmielewski M, Stenvinkel P, Carrero JJ. Micronutrient deficiencies and oxidative stress in CKD: nutritional perspectives. Clin Nutr. 2023;42(4):567-74. doi: 10.1016/j.clnu.2023.05.001
  31. Li SN, Wang Y, Chen L. Serum albumin and mortality risk in patients with chronic kidney disease: a prospective cohort study. Clin Kidney J. 2024;17(3):451-9
  32. Zhou X, Liu Y, Zhang T. Hypoalbuminemia, inflammation, and outcomes in chronic kidney disease: a multicenter analysis. BMC Nephrol. 2025;26(1):221
  33. Harlacher E, Wollenhaupt J, Baaten CCFMJ, Noels H. Impact of uremic toxins on endothelial dysfunction in chronic kidney disease: a systematic review. Int J Mol Sci. 2022;23(1):531. doi: 10.3390/ijms23010531
  34. Podkowińska A, Formanowicz D. Chronic kidney disease as oxidative stress- and inflammatory-mediated cardiovascular disease. Antioxidants. 2020;9(8):752. doi: 10.3390/antiox9080752
  35. Ochodnicky P, Henning RH, van Dokkum RPE, de Zeeuw D. Albumin as an active player in renal disease: its role in endothelial injury and tubulointerstitial inflammation. Kidney Int. 2022;101(5):850-65
  36. Kawakami H, et al. Personalized nutrition in chronic kidney disease. Nutrients. 2025;17(3):512. doi: 10.3390/nu17030512
  37. Garibotto G, Sofia A, Russo R. Role of amino acid and keto-analog supplementation in chronic kidney disease. J Nephrol. 2022;35:795-807. doi: 10.1007/s40620-022-01357-8
  38. Stenvinkel P, Ikizler TA, Carrero JJ. Nutrition and metabolic interventions in dialysis patients: focus on PEW. Semin Dial. 2023;36(1):34-45. doi: 10.1111/sdi.13111
  39. Wang Y, Li X, Chen J. Nutritional support strategies for patients with protein-energy wasting in chronic kidney disease. Front Nutr. 2024;11:1425987. doi: 10.3389/fnut.2024.1425987
  40. Khor BH, Sumida K, Scholes-Robertson N, Karupaiah T, Kovesdy CP, Kalantar-Zadeh K. Nutrition education models for patients with chronic kidney disease. Semin Nephrol. 2023;43(2):151404. doi: 10.1016/j.semnephrol.2023.151404
  41. British Journal of Nutrition. Diet therapy along with nutrition education can improve renal function in people with stages 3–4 chronic kidney disease who do not have diabetes: a randomised controlled trial. Br J Nutr. 2022;128(12):2327-37. doi: 10.1017/S000711452200172X
  42. Padial M, Taylor A, Sabatino A, Carrero JJ, Fouque D. From ultra-processed foods towards healthy eating for CKD patients: a proposal of educational infographics. J Nephrol. 2024;37:323-9. doi: 10.1007/s40620-023-01817-

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