{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T09:41:16Z","timestamp":1762508476395,"version":"build-2065373602"},"reference-count":93,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T00:00:00Z","timestamp":1620864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>The goal of this retrospective study was to document any alterations in plasma amino acids (AAs) in subjects with cardiorenal syndrome type 2 (CRS 2). We analyzed data from sixteen patients with CRS 2 and eight healthy subjects (control group, C), whose plasma arterial (A) and venous (V) AA concentrations had been measured. Compared to C, the group of CRS 2 patients showed significant reductions by more than 90% in A (p &lt; 0.01) and V (p &lt; 0.01) individual AAs, whereas negative A-V differences that indicated a net muscle AA release (muscle hypercatabolism) were found in 59% of CRS 2 patients (p &lt; 0.03). No significant differences in plasma A and V AA concentrations nor in A-V differences were found between patients with mild kidney damage (N = 5; estimated glomerular filtration rate, eGFR \u2265 60 mL\/min\/1.73 m2) and patients with moderate-severe kidney damage (N = 11; eGFR &lt; 60 mL\/min\/1.73 m2). Several plasma arterial AAs correlated with hemodynamic variables, but not with GFR. The study showed that patients with CRS 2 had very low concentrations of circulating AAs, independent of the degree of GFR damage.<\/jats:p>","DOI":"10.3390\/nu13051632","type":"journal-article","created":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T03:08:12Z","timestamp":1620875292000},"page":"1632","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Altered Amino Acid Metabolism in Patients with Cardiorenal Syndrome Type 2: Is It a Problem for Protein and Exercise Prescriptions?"],"prefix":"10.3390","volume":"13","author":[{"given":"Roberto","family":"Aquilani","sequence":"first","affiliation":[{"name":"Department of Biology and Biotechnology \u201cLazzaro Spallanzani\u201d, University of Pavia, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Maestri","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering of the Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, 27040 Montescano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maurizia","family":"Dossena","sequence":"additional","affiliation":[{"name":"Department of Biology and Biotechnology \u201cLazzaro Spallanzani\u201d, University of Pavia, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1884-5058","authenticated-orcid":false,"given":"Maria Teresa","family":"La Rovere","sequence":"additional","affiliation":[{"name":"Department of Cardiac Rehabilitation of the Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, 27040 Montescano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Buonocore","sequence":"additional","affiliation":[{"name":"Department of Biology and Biotechnology \u201cLazzaro Spallanzani\u201d, University of Pavia, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Boschi","sequence":"additional","affiliation":[{"name":"Department of Drug Sciences, University of Pavia, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuela","family":"Verri","sequence":"additional","affiliation":[{"name":"Department of Biology and Biotechnology \u201cLazzaro Spallanzani\u201d, University of Pavia, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e840","DOI":"10.1161\/CIR.0000000000000664","article-title":"Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association","volume":"139","author":"Rangaswami","year":"2019","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1159\/000349968","article-title":"Pathophysiology of Cardiorenal Syndrome Type 2 in Stable Chronic Heart Failure: Workgroup Statements from the Eleventh Consensus Conference of the Acute Dialysis Quality Initiative (ADQI)","volume":"182","author":"Cruz","year":"2013","journal-title":"Contrib. Nephrol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1161\/CIRCULATIONAHA.105.580506","article-title":"Renal Function as a Predictor of Outcome in a Broad Spectrum of Patients with Heart Failure","volume":"113","author":"Hillege","year":"2006","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1093\/eurheartj\/ehi696","article-title":"Incidence of renal dysfunction over 6 months in patients with chronic heart failure due to left ventricular systolic dysfunction: Contributing factors and relationship to prognosis","volume":"27","author":"Nikitin","year":"2006","journal-title":"Eur. Hear. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1093\/eurheartj\/ehp507","article-title":"Cardio-renal syndromes: Report from the consensus conference of the Acute Dialysis Quality Initiative","volume":"31","author":"Ronco","year":"2010","journal-title":"Eur. Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1161\/CIRCULATIONAHA.117.028814","article-title":"Cardiorenal Syndrome Revisited","volume":"138","author":"Zannad","year":"2018","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1093\/eurheartj\/ehs224","article-title":"Iron deficiency and heart failure: Diagnostic dilemmas and therapeutic perspectives","volume":"34","author":"Jankowska","year":"2013","journal-title":"Eur. Hear. J."},{"key":"ref_8","first-page":"26","article-title":"Prognostic factors in heart failure patients with cardiac cachexia","volume":"17","author":"Sato","year":"2020","journal-title":"J. Geriatr. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1097\/HJR.0b013e32831e94f8","article-title":"Effects of a 14-month low-cost maintenance training program in patients with chronic systolic heart failure: A randomized study","volume":"16","author":"Prescott","year":"2009","journal-title":"Eur. J. Cardiovasc. Prev. Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Aquilani, R., La Rovere, M.T., Corbellini, D., Pasini, E., Verri, M., Barbieri, A., Condino, A.M., and Boschi, F. (2017). Plasma Amino Acid Abnormalities in Chronic Heart Failure. Mechanisms, Potential Risks and Targets in Human Myocardium Metabolism. Nutrients, 9.","DOI":"10.3390\/nu9111251"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1038\/ki.2015.247","article-title":"Insulin sensitivity of muscle protein metabolism is altered in patients with chronic kidney disease and metabolic acidosis","volume":"88","author":"Garibotto","year":"2015","journal-title":"Kidney Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1159\/000486629","article-title":"High Right Ventricular Stroke Work Index Is Associated with Worse Kidney Function in Patients with Heart Failure with Preserved Ejection Fraction","volume":"8","author":"Kanjanahattakij","year":"2018","journal-title":"Cardiorenal Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1159\/000500715","article-title":"Neurohormonal, Endocrine, and Immune Dysregulation and Inflammation in Cardiorenal Syndrome","volume":"9","author":"Clementi","year":"2019","journal-title":"Cardiorenal Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1007\/BF00806915","article-title":"Amino acids and the kidney","volume":"1","author":"Young","year":"1991","journal-title":"Amino Acids"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/j.clnu.2010.02.005","article-title":"Amino acid and protein metabolism in the human kidney and in patients with chronic kidney disease","volume":"29","author":"Garibotto","year":"2010","journal-title":"Clin. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1159\/000375130","article-title":"Direct Evidence of Podocyte Damage in Cardiorenal Syndrome Type 2: Preliminary Evidence","volume":"5","author":"Rajapreyar","year":"2015","journal-title":"Cardiorenal Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.cardfail.2009.07.003","article-title":"Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Predicting Worsening Renal Function in Acute Decompensated Heart Failure","volume":"16","author":"Aghel","year":"2010","journal-title":"J. Card. Fail."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1056\/NEJM199503093321006","article-title":"Hypoxia of the Renal Medulla\u2013Its Implications for Disease","volume":"332","author":"Brezis","year":"1995","journal-title":"N. Engl. J. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1016\/j.amjcard.2012.06.035","article-title":"Relation of Systemic and Urinary Neutrophil Gelatinase-Associated Lipocalin Levels to Different Aspects of Impaired Renal Function in Patients with Acute Decompensated Heart Failure","volume":"110","author":"Shrestha","year":"2012","journal-title":"Am. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1177\/0884533611399923","article-title":"Invited Review: The Kidney: Medical Nutrition Therapy\u2014Yesterday and Today","volume":"26","year":"2011","journal-title":"Nutr. Clin. Pr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2426","DOI":"10.1681\/ASN.V10112426","article-title":"Dietary protein restriction and the progression of chronic renal disease: What have all of the results of the MDRD study shown? Modification of Diet in Renal Disease Study group","volume":"10","author":"Levey","year":"1999","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1038\/ki.2009.188","article-title":"Foreword","volume":"76","author":"Eckardt","year":"2009","journal-title":"Kidney Int."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Aquilani, R., Brugnatelli, S., Dossena, M., Maestri, R., Delfanti, S., Buonocore, D., Boschi, F., Simeti, E., Condino, A.M., and Verri, M. (2019). Oxaliplatin-Fluoropyrimidine Combination (XELOX) Therapy Does Not Affect Plasma Amino Acid Levels and Plasma Markers of Oxidative Stress in Colorectal Cancer Surgery Patients: A Pilot Study. Nutrients, 11.","DOI":"10.3390\/nu11112667"},{"key":"ref_24","first-page":"1202","article-title":"Branched chain amino acid profile in early chronic kidney disease","volume":"23","author":"Kumar","year":"2012","journal-title":"Saudi J. Kidney Dis. Transplant."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1093\/ajcn\/82.2.342","article-title":"Inflammation contributes to low plasma amino acid concentrations in patients with chronic kidney disease","volume":"82","author":"Suliman","year":"2005","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1053\/j.jrn.2019.12.003","article-title":"Differences and Effects of Metabolic Fate of Individual Amino Acid Loss in High-Efficiency Hemodialysis and Hemodiafiltration","volume":"30","author":"Murtas","year":"2020","journal-title":"J. Ren. Nutr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1038\/nrneph.2017.107","article-title":"Mitochondrial energetics in the kidney","volume":"13","author":"Bhargava","year":"2017","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2705","DOI":"10.1093\/eurheartj\/ehr190","article-title":"Clinical outcome of renal tubular damage in chronic heart failure","volume":"32","author":"Damman","year":"2011","journal-title":"Eur. Hear. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"37","DOI":"10.2215\/CJN.06000613","article-title":"Plasma and Urinary Amino Acid Metabolomic Profiling in Patients with Different Levels of Kidney Function","volume":"9","author":"Duranton","year":"2014","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1053\/euhj.1998.1446","article-title":"Cytokines and neurohormones relating to body composition alterations in the wasting syndrome of chronic heart failure","volume":"20","author":"Anker","year":"1999","journal-title":"Eur. Hear. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.clnu.2011.02.009","article-title":"Insulin resistance of amino acid and protein metabolism in type 2 diabetes","volume":"30","author":"Tessari","year":"2011","journal-title":"Clin. Nutr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1038\/sj.ki.5001984","article-title":"Insulin resistance is associated with skeletal muscle protein breakdown in non-diabetic chronic hemodialysis patients","volume":"71","author":"Siew","year":"2007","journal-title":"Kidney Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1016\/j.ajkd.2003.07.016","article-title":"Malnutrition-inflammation complex syndrome in dialysis patients: Causes and consequences","volume":"42","author":"Ikizler","year":"2003","journal-title":"Am. J. Kidney Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s10741-011-9261-3","article-title":"Inflammatory activation: Cardiac, renal, and cardio-renal interactions in patients with the cardiorenal syndrome","volume":"17","author":"Colombo","year":"2012","journal-title":"Hear. Fail. Rev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.1093\/oxfordjournals.eurheartj.a014752","article-title":"Biochemical analysis of muscle biopsy in overnight fasting patients with severe chronic heart failure","volume":"17","author":"Opasich","year":"1996","journal-title":"Eur. Hear. J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"281","DOI":"10.3109\/00365599709070349","article-title":"Altered muscle energy metabolism in post-absorptive patients with chronic renal failure","volume":"31","author":"Pastoris","year":"1997","journal-title":"Scand. J. Urol. Nephrol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1006\/cyto.2001.0918","article-title":"High Tumour Necrosis Factor-\u0391 Levels Are Associated with Exercise Intolerance And Neurohormonal Activation In Chronic Heart Failure Patients","volume":"15","author":"Cicoira","year":"2001","journal-title":"Cytokine"},{"key":"ref_38","first-page":"761","article-title":"Plasma amino acid levels with a note on membrane transport: Characteristics, regulation, and metabolic significance","volume":"18","author":"Cynober","year":"2002","journal-title":"Nutrients"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1158\/0008-5472.CAN-13-1052","article-title":"Cancer Usurps Skeletal Muscle as an Energy Repository","volume":"74","author":"Luo","year":"2014","journal-title":"Cancer Res."},{"key":"ref_40","first-page":"220","article-title":"Pathogenic Gut Flora in Patients with Chronic Heart Failure","volume":"4","author":"Pasini","year":"2016","journal-title":"JACC: Heart Fail."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1038\/ki.2015.255","article-title":"Probiotics and chronic kidney disease","volume":"88","author":"Koppe","year":"2015","journal-title":"Kidney Int."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000345969","article-title":"Role of Urea in Intestinal Barrier Dysfunction and Disruption of Epithelial Tight Junction in Chronic Kidney Disease","volume":"37","author":"Vaziri","year":"2013","journal-title":"Am. J. Nephrol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1136\/gut.29.6.809","article-title":"Nitrogen losses from the human small bowel: Obligatory losses and the effect of physical form of food","volume":"29","author":"Chacko","year":"1988","journal-title":"Gut"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.clnu.2008.02.005","article-title":"Citrulline as a biomarker of intestinal failure due to enterocyte mass reduction","volume":"27","author":"Crenn","year":"2008","journal-title":"Clin. Nutr."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"F916","DOI":"10.1152\/ajprenal.1990.259.6.F916","article-title":"Localization of arginine synthesis along rat nephron","volume":"259","author":"Levillain","year":"1990","journal-title":"Am. J. Physiol. Physiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1002\/clc.4960080507","article-title":"Therapeutic effect of taurine in congestive heart failure: A double-blind crossover trial","volume":"8","author":"Azuma","year":"1985","journal-title":"Clin. Cardiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.ijcard.2011.03.032","article-title":"Preserved muscle protein metabolism in obese patients with chronic heart failure","volume":"160","author":"Aquilani","year":"2012","journal-title":"Int. J. Cardiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1093\/ndt\/gfm542","article-title":"Cardiovascular remodelling and extracellular fluid excess in early stages of chronic kidney disease","volume":"23","author":"Essig","year":"2008","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1177\/0148607190014006569","article-title":"Role of the Lungs in Maintaining Amino Acid Homeostasis","volume":"14","author":"Plumley","year":"1990","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_50","first-page":"1002","article-title":"Lung anabolic activity in patients with chronic heart failure: Potential implications for clinical practice","volume":"28","author":"Aquilani","year":"2012","journal-title":"Nutrients"},{"key":"ref_51","first-page":"723","article-title":"Renal hyperplasia and hypertrophy","volume":"Volume 1","author":"Alpern","year":"2008","journal-title":"Seldin and Giebisch\u2019s The Kidney: Physiology and Pathophysiology"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.1097\/01.ASN.0000127865.26968.36","article-title":"Kidney Protein Dynamics and Ammoniagenesis in Humans with Chronic Metabolic Acidosis","volume":"15","author":"Garibotto","year":"2004","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.cbpa.2019.04.017","article-title":"Comparative physiology investigations support a role for histidine-containing dipeptides in intracellular acid\u2013base regulation of skeletal muscle","volume":"234","author":"Dolan","year":"2019","journal-title":"Comp. Biochem. Physiol. Part. A Mol. Integr. Physiol."},{"key":"ref_54","first-page":"E1105","article-title":"Human protein metabolism: Its measurement and regulation","volume":"283","author":"Liu","year":"2002","journal-title":"Am. J. Physiol. Metab."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1056\/NEJM199007263230405","article-title":"Elevated Circulating Levels of Tumor Necrosis Factor in Severe Chronic Heart Failure","volume":"323","author":"Levine","year":"1990","journal-title":"N. Engl. J. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1038\/sj.ki.5002391","article-title":"Cytokine gene polymorphism and progression of renal and cardiovascular diseases","volume":"72","author":"Rao","year":"2007","journal-title":"Kidney Int."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1301\/00296640260085949","article-title":"The Role of Cytokines in Regulating Protein Metabolism and Muscle Function","volume":"60","author":"Zoico","year":"2002","journal-title":"Nutr. Rev."},{"key":"ref_58","first-page":"871","article-title":"Skeletal muscle myocytes undergo protein loss and reactive oxygen-mediated NF-\u03baB activation in response to tumor necrosis factor \u03b1","volume":"12","author":"Li","year":"1998","journal-title":"FASEB J."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/00024382-199607000-00004","article-title":"Sepsis Inhibits Synthesis of Myofibrillar And Sarcoplasmic Proteins","volume":"6","author":"Vary","year":"1996","journal-title":"Shock"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2363","DOI":"10.1126\/science.289.5488.2363","article-title":"NF-kappa B-Induced Loss of MyoD Messenger RNA: Possible Role in Muscle Decay and Cachexia","volume":"289","author":"Guttridge","year":"2000","journal-title":"Science"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1690","DOI":"10.1161\/01.CIR.102.14.1690","article-title":"Cardiac-Specific Overexpression of Tumor Necrosis Factor-\u03b1 Causes Oxidative Stress and Contractile Dysfunction in Mouse Diaphragm","volume":"102","author":"Li","year":"2000","journal-title":"Circulation"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1042\/cs0890431","article-title":"Interleukin-6 Induces Proteolysis by Activating Intracellular Proteases (Cathepsins B and L, Proteasome) in C2C12 Myotubes","volume":"89","author":"Ebisui","year":"1995","journal-title":"Clin. Sci."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1159\/000321848","article-title":"Intestinal-Renal Syndrome: Mirage or Reality?","volume":"31","author":"Ritz","year":"2011","journal-title":"Blood Purif."},{"key":"ref_64","first-page":"E219","article-title":"Reduced synthesis of muscle proteins in chronic renal failure","volume":"278","author":"Adey","year":"2000","journal-title":"Am. J. Physiol. Metab."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1002\/ncp.10232","article-title":"Pathophysiology of Critical Illness and Role of Nutrition","volume":"34","author":"Sharma","year":"2019","journal-title":"Nutr. Clin. Pract."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1080\/713774003","article-title":"Microcirculatory Dysfunction in Chronic Venous Insufficiency (CVI)","volume":"7","author":"Steins","year":"2000","journal-title":"Microcirculation"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1038\/ki.1994.187","article-title":"Skeletal muscle protein synthesis and degradation in patients with chronic renal failure","volume":"45","author":"Garibotto","year":"1994","journal-title":"Kidney Int."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1054\/jcaf.2003.23","article-title":"Growth hormone resistance in chronic heart failure and its therapeutic implications","volume":"9","author":"Cicoira","year":"2003","journal-title":"J. Card. Fail."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1053\/j.ajkd.2004.09.034","article-title":"Insulin resistance in patients with chronic kidney disease","volume":"45","author":"Kobayashi","year":"2005","journal-title":"Am. J. Kidney Dis."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"212S","DOI":"10.1093\/jn\/136.1.212S","article-title":"The Regulation of Body and Skeletal Muscle Protein Metabolism by Hormones and Amino Acids","volume":"136","author":"Liu","year":"2006","journal-title":"J. Nutr."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.ijcard.2013.09.014","article-title":"Pathophysiology of cardiorenal syndrome in decompensated heart failure: Role of lung\u2013right heart\u2013kidney interaction","volume":"169","author":"Guazzi","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"2199","DOI":"10.1016\/j.jacc.2016.02.058","article-title":"Reduced Cardiac Index Is Not the Dominant Driver of Renal Dysfunction in Heart Failure","volume":"67","author":"Hanberg","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Aquilani, R., Maestri, R., Boselli, M., Achilli, M.P., Arrigoni, N., Bruni, M., Dossena, M., Verri, M., Buonocore, D., and Pasini, E. (2019). The relationship between plasma amino acids and circulating albumin and haemoglobin in postabsorptive stroke patients. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0219756"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1182\/blood.V50.6.1093.1093","article-title":"Effect of protein deprivation on erythropoiesis","volume":"50","author":"Anagnostou","year":"1977","journal-title":"Blood"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"288S","DOI":"10.1093\/jn\/136.1.288S","article-title":"Branched-Chain Amino Acids and Immunity","volume":"136","author":"Calder","year":"2006","journal-title":"J. Nutr."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1017\/S000711450769936X","article-title":"Amino acids and immune function","volume":"98","author":"Li","year":"2007","journal-title":"Br. J. Nutr."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"264S","DOI":"10.1093\/jn\/136.1.264S","article-title":"Branched-Chain Amino Acids as Fuels and Anabolic Signals in Human Muscle","volume":"136","author":"Rennie","year":"2006","journal-title":"J. Nutr."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"299S","DOI":"10.1093\/jn\/136.1.299S","article-title":"Application of Branched-Chain Amino Acids in Human Pathological States: Renal Failure","volume":"136","author":"Cano","year":"2006","journal-title":"J. Nutr."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1177\/0884533611436116","article-title":"Effects of Gut Microbes on Nutrient Absorption and Energy Regulation","volume":"27","author":"Ilhan","year":"2012","journal-title":"Nutr. Clin. Pr."},{"key":"ref_80","unstructured":"Early, L.E., and Gottschalk, C.W. (1979). Disorders of Hydrogen Ion Metabolism. Strauss and Welt\u2019s Diseases of the Kidney, Little Brown. [3rd ed.]."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1007\/s40520-013-0099-5","article-title":"Plasma kinetic of ingested essential amino acids in healthy elderly people","volume":"25","author":"Condino","year":"2013","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/j.ejheart.2008.09.002","article-title":"Adequate energy-protein intake is not enough to improve nutritional and metabolic status in muscle-depleted patients with chronic heart failure","volume":"10","author":"Aquilani","year":"2008","journal-title":"Eur. J. Hear. Fail."},{"key":"ref_83","first-page":"1","article-title":"Essential Amino Acids and Exercise Tolerance in Elderly Muscle-Depleted Subjects with Chronic Diseases: A Rehabilitation without Rehabilitation?","volume":"2014","author":"Aquilani","year":"2014","journal-title":"BioMed Res. Int."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1038\/ki.2013.147","article-title":"Prevention and treatment of protein energy wasting in chronic kidney disease patients: A consensus statement by the International Society of Renal Nutrition and Metabolism","volume":"84","author":"Ikizler","year":"2013","journal-title":"Kidney Int."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1111\/sms.12714","article-title":"\u201cExercise as medicine\u201d in chronic kidney disease","volume":"26","author":"Wilkinson","year":"2016","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_86","first-page":"1443","article-title":"Exercise training in advanced chronic kidney disease","volume":"147","year":"2019","journal-title":"Revista M\u00e9dica De Chile"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.jacc.2004.10.003","article-title":"Increased skeletal muscle amino acid release with light exercise in deconditioned patients with heart failure","volume":"45","author":"Aquilani","year":"2005","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1002\/ncp.10208","article-title":"Metabolic Support of the Patient on Continuous Renal Replacement Therapy","volume":"33","author":"Nystrom","year":"2018","journal-title":"Nutr. Clin. Pract."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s13539-011-0038-2","article-title":"Cardio-renal cachexia syndromes (CRCS): Pathophysiological foundations of a vicious pathological circle","volume":"2","author":"Cicoira","year":"2011","journal-title":"J. Cachex Sarcopenia Muscle"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1080\/14789450.2019.1592682","article-title":"Protein biomarkers for cardiorenal syndrome","volume":"16","author":"Petra","year":"2019","journal-title":"Expert Rev. Proteom."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000369260","article-title":"\u03b22-Microglobulin and TIMP1 Are Linked Together in Cardiorenal Remodeling and Failure","volume":"5","author":"Vianello","year":"2015","journal-title":"Cardiorenal Med."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1111\/nep.12632","article-title":"N-acteyl-\u00df-D-glucosaminidase and kidney injury molecule-1: New predictors for long-term progression of chronic kidney disease in patients with heart failure","volume":"21","author":"Jungbauer","year":"2016","journal-title":"Nephrology"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"3265","DOI":"10.1093\/ndt\/gfp010","article-title":"Kidney injury molecule-1 (KIM-1): A urinary biomarker and much more","volume":"24","author":"Bonventre","year":"2009","journal-title":"Nephrol. Dial. Transplant."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/5\/1632\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:00:00Z","timestamp":1760162400000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/5\/1632"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,13]]},"references-count":93,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5]]}},"alternative-id":["nu13051632"],"URL":"https:\/\/doi.org\/10.3390\/nu13051632","relation":{},"ISSN":["2072-6643"],"issn-type":[{"type":"electronic","value":"2072-6643"}],"subject":[],"published":{"date-parts":[[2021,5,13]]}}}