慢性肾脏疾病患者肾功能下降使代谢环境显著改变（如代谢性酸中毒、血脂异常、胰岛素抵抗），代谢性酸中 毒与慢性肾脏疾病患者的蛋白质分解代谢增加有关。肾功能下降也可引起激素水平紊乱，激素水平改变与抑制慢性肾脏疾 病患者食欲有关，导致营养素摄入不足。慢性肾脏疾病患者肠道菌群的显著改变是导致患者慢性炎症状态的一个重要因素， 慢性炎症状态可增加静息能量消耗和代谢。蛋白质能量消耗本质上是身体蛋白质和能量储备地减少，在进展期慢性肾脏疾 病患者和终末期透析的慢性肾脏患者中很常见。蛋白质能量消耗增加、营养素摄入不足、静息能量消耗增加这些因素最终 可使慢性肾脏疾病患者发生营养不良。营养不良会增加儿童和成人慢性肾脏疾病发病率和死亡率的风险。食欲下降、饮食 摄入减少，透析患者营养素丢失，激素失衡，炎症，分解代谢增强等多种因素相互作用易使慢性肾脏疾病患者发生营养不良。了解慢性肾脏疾病患者营养不良的病理生理机制有利于我们制定相关干预措施，以促进慢性肾脏疾病患儿的生长 发育和减轻临床的不良结局。

The metabolic milieu in chronic kidney disease (CKD) is significantly altered due to renal functional decline (such as metabolic acidosis, dyslipidemia, insulin resistance), and metabolic acidosis is associated with increased protein catabolism in patients with CKD. Renal functional decline could also cause hormonal imbalance and it is implicated in the suppression of appetite in patients with CKD. In the end it leads to inadequate nutrient intake. The intestinal microbial flora is significantly altered in patients with CKD and plays a pathogenic role in the chronic inflammatory state seen in CKD. Chronic inflammatory state increases resting energy expenditure and catabolism. Protein-energy wasting, which essentially refers to decreased body protein mass and energy reserves, is common in advanced chronic kidney disease patients and end-stage kidney disease patients undergoing chronic dialysis. Increased protein catabolism, inadequate nutrient intake and increased resting energy expenditure and catabolism could lead to protein-energy wasting (PEW) in patients with CKD. Malnutrition can increase the risk of morbidity and mortality in children and adults with chronic kidney disease. Decreased appetite, reduced dietary intake, loss of nutrients in dialysis patients, hormone imbalance, inflammation, increased catabolism and other factors interact easily to cause malnutrition in patients with chronic kidney disease. A better understanding of pathophysiologic mechanisms of protein-energy wasting in patients with CKD might lead to the development of novel and effective therapies for malnutrition