[Protein metabolism in renal failure]

Patients with chronic renal failure are often characterized by clinical and laboratory signs of protein and calories malnutrition, which is associated with a significant increase in the total morbidity and mortality risk. The loss of muscle mass is often multifactorial. If the patient is consuming a low protein diet the risk of protein calories malnutrition is increased. Among the various factors that can affect protein metabolism the role of calories and protein intake as well the influences of concomitant conditions as increased leptin levels and uncontrolled metabolic acidosis are evaluated. Hemodialysis treatment induces a transient increase in proteolysis which is associated with a significant loss of amino acid in the dialysis fluid. Subclinical inflammation contributes to malnutrition increasing both muscle proteolysis and anorexia. Albumin levels are often reduced in dialysis patients, this decline is associated with an increase in morbidity and mortality. Various factors as protein intake, acidosis and inflammation can affect albumin levels via a reduction in hepatic albumin synthesis.