Association of Inflammation, Oxidative Stress and Dietary Inadequacy with Protein-Energy Wasting in Pre-Dialysis Chronic Kidney Disease

Background Protein-energy wasting (PEW) is a well-recognized metabolic condition in chronic kidney disease (CKD) and is associated with morbidity, mortality, hospitalization, and rapid progression to dialysis dependence. Its pathogenesis is multifactorial; however, data regarding the association of inadequate dietary intake, inflammation, and oxidative stress (OS) markers associated with PEW in pre-dialysis CKD (PD-CKD) stages remain limited in Indian populations. This study aimed to examine the association of inadequate dietary intake and oxidative and inflammatory markers with PEW and evaluate factors independently associated with PEW in patients with PD-CKD. Materials and Methods A cross-sectional observational study enrolled 224 patients with PD-CKD. PEW was diagnosed according to the ISRNM criteria; 3-day dietary recall, inflammatory markers (IL-6, TNF-α, CRP, and IL-10), and OS markers (GR, SOD, and MDA) were measured by ELISA. Multivariable regression analysis was performed to evaluate independently associated factors with PEW after adjustment for age, sex, eGFR and hypertension. Results PEW prevalence was 45.5% among patients with PD-CKD stages 2–5. Multivariable regression analysis after adjustment for age, sex, eGFR and hypertension revealed that TNF-α (AOR = 1.086, p = 0.013), GR (AOR = 1.137, p = 0.002), SOD (AOR = 0.054, p <0.001), and MDA (AOR = 1.115, p = 0.016) remained significantly associated with PEW, whereas IL-6 showed a borderline association ( p = 0.055). Conclusion PEW was evident as early as CKD stage 2. Persistent inflammation and OS were significantly associated with PEW, highlighting the combined effect of metabolic, inflammatory, and nutritional burden with declining eGFR in patients with PD-CKD.