Abstract:

ABSTRACT   The patients with chronic kidney disease usually have progressive protein-energy waste, which increases the morbidity and mortality. Most body stores of protein are in skeletal muscle, the protein depletion presents itself as loss of muscle mass, or muscle atrophy. The pathogenesis of muscle wasting is very complex, which is usually caused by multifactors. Previous studies showed that anorexia, activation of the ATP-dependent ubiquitin-proteasome system and defects in insulin/insulin-like growth factor 1 (IGF-1)/PI3K/Akt intracellular signaling processes accelerated muscle protein degradation, decreased protein synthesis, and caused the muscle atrophy. Recent studies found that elevated levels of cytokines, metabolic acidosis, increased levels of myostatin and glucocorticoid also play an important role in causing muscle wasting. Some of their mechanisms are not clear, and more studies are needed for finding effective treatment to improve the outcome of patients with CKD.