{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T16:57:11Z","timestamp":1787677031684,"version":"build-2784847793"},"reference-count":108,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T00:00:00Z","timestamp":1666656000000},"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>Protein energy malnutrition is recognized as a leading cause of morbidity and mortality in dialysis patients. Protein\u2013energy-wasting process is observed in about 45% of the dialysis population using common biomarkers worldwide. Although several factors are implicated in protein energy wasting, inflammation and oxidative stress mechanisms play a central role in this pathogenic process. In this in-depth review, we analyzed the implication of sodium and water accumulation, as well as the role of fluid overload and fluid management, as major contributors to protein\u2013energy-wasting process. Fluid overload and fluid depletion mimic a tide up and down phenomenon that contributes to inducing hypercatabolism and stimulates oxidation phosphorylation mechanisms at the cellular level in particular muscles. This endogenous metabolic water production may contribute to hyponatremia. In addition, salt tissue accumulation likely contributes to hypercatabolic state through locally inflammatory and immune-mediated mechanisms but also contributes to the perturbation of hormone receptors (i.e., insulin or growth hormone resistance). It is time to act more precisely on sodium and fluid imbalance to mitigate both nutritional and cardiovascular risks. Personalized management of sodium and fluid, using available tools including sodium management tool, has the potential to more adequately restore sodium and water homeostasis and to improve nutritional status and outcomes of dialysis patients.<\/jats:p>","DOI":"10.3390\/nu14214489","type":"journal-article","created":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T02:47:26Z","timestamp":1666752446000},"page":"4489","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Fluid Overload and Tissue Sodium Accumulation as Main Drivers of Protein Energy Malnutrition in Dialysis Patients"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6854-2816","authenticated-orcid":false,"given":"Bernard","family":"Canaud","sequence":"first","affiliation":[{"name":"School of Medicine, Montpellier University, 34000 Montpellier, France"},{"name":"Global Medical Office, FMC-France, 94260 Fresnes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9563-5217","authenticated-orcid":false,"given":"Marion","family":"Morena-Carrere","sequence":"additional","affiliation":[{"name":"PhyMedExp, Department of Biochemistry and Hormonology, INSERM, CNRS, University Hospital Center of Montpellier, University of Montpellier, 34000 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helene","family":"Leray-Moragues","sequence":"additional","affiliation":[{"name":"Charles Mion Foundation, AIDER-Sant\u00e9, 34000 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8563-7278","authenticated-orcid":false,"given":"Jean-Paul","family":"Cristol","sequence":"additional","affiliation":[{"name":"PhyMedExp, Department of Biochemistry and Hormonology, INSERM, CNRS, University Hospital Center of Montpellier, University of Montpellier, 34000 Montpellier, France"},{"name":"Charles Mion Foundation, AIDER-Sant\u00e9, 34000 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,25]]},"reference":[{"key":"ref_1","first-page":"246","article-title":"Nutritional status as a predictor of morbidity and mortality in maintenance dialysis patients","volume":"43","author":"Kopple","year":"1997","journal-title":"Asaio J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/S0272-6386(12)81083-3","article-title":"Malnutrition in hemodialysis patients","volume":"21","author":"Hakim","year":"1993","journal-title":"Am. 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