Etiology of the Protein-Energy Wasting Syndrome in Chronic Kidney Disease: A Consensus Statement From the International Society of Renal Nutrition andMetabolism (ISRNM)

Protein-energy wasting (PEW), a term proposed by the International Society of Renal Nutrition and Metabolism (ISRNM), refers to the multiple nutritional and catabolic alterations that occur in chronic kidney disease (CKD) and associate with morbidity and mortality. To increase awareness, identify research needs, and provide the basis for future work to understand therapies and consequences of PEW, ISRNM provides this consensus statement of current knowledge on the etiology of PEW syndrome in CKD. Although insufficient food intake (true undernutrition) due to poor appetite and dietary restrictions contribute, other highly prevalent factors are required for the full syndrome to develop. These include uremia-induced alterations such as increased energy expenditure, persistent inflammation, acidosis, and multiple endocrine disorders that render a state of hypermetabolism leading to excess catabolism of muscle and fat. in addition, comorbid conditions associated with CKD, poor physical activity, frailty, and the dialysis procedure per se further contribute to PEW. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc.Abbott NutritionShireAbbot Renal NutritionBaxter HealthcareKarolinska Inst, Div Renal Med, Dept Clin Sci Intervent & Technol, Solna, SwedenUniversidade Federal de São Paulo, Div Nephrol, Dept Med, São Paulo, BrazilVanderbilt Univ, Sch Med, Dept Med, Div Nephrol, Nashville, TN 37212 USAUniv Calif Irvine, Med Ctr, Harold Simmons Ctr, Div Nephrol & Hypertens, Orange, CA USAUniv Calif Davis, Dept Internal Med, Davis, CA 95616 USAUniv Calif Davis, Dept Biochem & Mol Med, Davis, CA 95616 USABaylor Coll Med, Dept Med, Div Nephrol, Houston, TX 77030 USAEmory Univ, Sch Med, Div Renal, Dept Med, Atlanta, GA 30306 USAAtlanta Dept Vet Affairs Med Ctr, Res Serv, Decatur, GA 30033 USAUniv Wurzburg, Div Nephrol, Dept Internal Med, D-97070 Wurzburg, GermanyUniv Hong Kong, Dept Med, Queen Mary Hosp, Hong Kong, Hong Kong, Peoples R ChinaVrije Univ Amsterdam Med Ctr, Dept Nephrol, Amsterdam, NetherlandsUniversidade Federal de São Paulo, Div Nephrol, Dept Med, São Paulo, BrazilWeb of Scienc

Acute Kidney Injury in a Patient on Tenofovir Alafenamide Fumarate After Initiation of Treatment for Hepatitis C Virus Infection

HIV treatment with tenofovir alafenamide fumarate (TAF) has decreased renal toxicity compared with tenofovir disoproxil fumarate in clinical trials. We report the case of a patient with HIV/HCV coinfection who was started on a TAF-based HIV regimen and developed acute kidney injury that worsened with the addition of sofosbuvir-ledipasvir