Protein Energy Wasting (PEW)

nephroplus | April 18, 2019

By Mary Selvaraj, Msc. Nutrition, Dietician, NephroPlus.

What is PEW?

PEW is defined as a “state of decreased body stores of protein and energy fuels (body protein and fat masses)”. This definition is given by the International Society of Renal Nutrition and Metabolism (ISRNM)’s expert panel.

What is the PEW Scenario?

PEW is present in 30-65% or more of Dialysis patients around the world.

What is the cause of PEW? 
The cause is multi-factorial. It includes both nutritional and non-nutritional factors. It can be said that the etiology is complex. But still, poor Nutrition and Catabolism plays the main role.

What are the Factors  contributing to PEW in Dialysis?


Nutritional factors:

-Decreased nutrient intake as compared to nutritional needs. Poor Nutrition aggravates PEW.

-Loss of appetite due to high urea levels.

-Losses of nutrients during dialysis treatments or in urine (as in Nephrotic Syndrome).

-Protein Energy Breakdown

-Other  factors like academia and hormonal disorders can contribute to the development of PEW.

Non nutritional factors:

-Emotional depression.

-Long term use of too many medications.

-Other causes may include reduced nutrient intake due to inadequate finances to purchase or prepare foods.

-Impaired intake due to medical or surgical illnesses

-Loss of dentures.

-Co -morbidities like Diabetes

What is the PEW Vicious Cycle?


Undernutrition /Malnutrition leads to weight loss and leads to poor outcomes in dialysis.  This, in turn, causes loss of nutrients which leads to low appetite and the cycle of malnutrition continues.

What should I do to correct PEW?

PEW in dialysis patients is associated with harmful/adverse outcomes.  PEW is a predictor of mortality in dialysis patients.

But don’t worry. It can be managed at an early stage itself. This is by correcting PEW with an appropriate Medical Nutrition Therapy. Studies show that high Protein and high Calorie diet or addition of Oral Nutritional Supplements will improve the nutritional status and outcomes in dialysis patients. This measure can improve blood serum albumin concentration – we already know that there are amino acid losses in the dialysate in dialysis. By improving albumin in blood we can in turn can improve longevity and QOL (Quality of Life).

So, if you are undernourished or in the high metabolic state, such as undergoing regular Dialysis procedure, do this:

1) Include foods which are high in Protein

2) Keep a watch on your Calorie intake.

3) Include Oral Nutritional Supplements

To elaborate:

Include foods which are high in Protein

1) Protein can vary from 1.2-1.5 g per kg IBW.

More than 50% of your protein intake should come from High Biological Value protein. Food sources can  include dairy, poultry, fish and egg whites.

Keep a check on Serum Albumin levels and make sure it stays above 3.5mEq/L. It is suggested to repeat testing of S. Albumin monthly or quarterly to ensure you are reaching your dietary goals.

2) Keep a watch on your Calorie intake.

Total Energy intake can be simply put as 30-35 Kcal/Kg Ideal Body Weight. Eg: Energy requirement of a 60 kg man with a normal BMI will be between 1800- 2100 kcal per day.

3) Include Oral Nutritional Supplements

For details on Oral Nutritional Supplements for Dialysis patients contact your Dietician.

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