الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Cachexia is defined as a state of undernutrition derived from both anorexia, i.e. insufficient food intake, and low serum protein levels and the loss of muscle mass as the result of a catabolic state. All of these factors occur in the ESRD patient, usually as the consequence of a number of interrelated mechanisms stimulated by renal insufficiency. Chronic inflammation is an important cause of cachexia in ESRD patients. Recent studies suggest that adipokines or adipocytokines such as leptin, adiponectin, resistin, tumor necrosis factor and interleukin-6, may play important roles in uremic cachexia. Leptin is a protein hormone, predominantly produced by adipocytes and presumed to be involved in the maintenance of stable body mass. Levels of leptin are significantly increased in dialysis patients. High levels of leptin inhibit food intake and increase energy expenditure through several complicated pathways. Recent studies suggest that cachexia associated with uraemia is caused by leptin signalling through the hypothalamic MC4-Rs. Adiponectin monomer is a 244-amino acid protein with high structural homology to collagen VIII, X, and complement Clq. Plasma adiponectin concentration is almost 3-times higher in haemodialysis patients with chronic kidney disease than in healthy subjects. Interest concerning adiponectin derives from its potential protective role for the cardiovascular system. Elevated adiponectin in hemodialyzed patients and nephrotic syndrome, two entities prone to cardiovascular events, may act as a protective factor against atherosclerosis in these patients. There are many cytokines reported to be secreted from adipose tissue; like tumor necrosis factor- , Interleukin-6. TNF- has been recognized as the prototype of an anorectic cytokine. In dialysis patients, elevated TNF- levels has been reported to be associated with anorexia. This cytokine causes muscle wasting by stimulating protein catabolism via the ubiquitin proteasome pathway. The potential causes of elevated plasma IL-6 levels in ESRD patients may be related to the loss of kidney function, uraemia per se and its sequelae, and dialysis related factors. IL-6 has been shown to stimulate the breakdown of muscle protein and promote cancer-related wasting. The close association between IL-6 and muscle wasting in HD patients provides compelling evidence that this cytokine may be catabolic also in this patient group. Resistin is a member of cysteine-rich secreted proteins (108 amino acids). It is unclear at present whether human resistin plays a role similar to that of murine resistin and if it does, how important human resistin is in ESRD. Visfatin is a ubiquitous intracellular enzyme. Visfatin has been reported to be positively associated with surrogate markers of endothelial damage in CKD stage 5 patients. This review focused on adipocytokines as an important cause of cachexia in end stage renal disease patients, diagnosis, and management strategies of uremic cachexia