How to Reverse PEW

You’re asking about Protein-Energy Wasting (PEW) in Chronic Kidney Disease (CKD), and how to reverse it.

This is a critical and complex issue in CKD management, as PEW is strongly associated with increased morbidity and mortality.

Reversing PEW in CKD is a multi-faceted approach that requires close collaboration between the patient, their nephrologist, a registered dietitian (preferably one specializing in kidney disease), and other healthcare professionals. There’s no single “magic bullet,” but rather a combination of strategies.
Here’s a breakdown of how to approach reversing PEW in CKD:

1. Comprehensive Nutritional Assessment and Monitoring:

• Initial Assessment: A thorough evaluation by a renal dietitian is crucial. This includes:
  • Dietary history (food intake, preferences, aversions, allergies).
  • Anthropometric measurements (weight, height, BMI, body composition if possible – e.g., skinfolds, bioelectrical impedance analysis).
  • Biochemical markers (albumin, prealbumin, transferrin, cholesterol, blood urea nitrogen (BUN), creatinine, electrolytes). While these are markers, they are not always direct measures of nutritional status.
  • Clinical signs (muscle wasting, loss of subcutaneous fat, edema).
  • Functional status (handgrip strength, gait speed, activities of daily living).
• Ongoing Monitoring: Regular follow-up with the dietitian and medical team to track progress, adjust the diet, and address any new challenges.

2. 2. Optimize Dietary Intake:
      This is the cornerstone of reversing PEW.