Table 3.

Causes of PEW

Nutrition	Inflammation
Poor appetite	The cause of the CKD
Abnormal taste	↑cytokine imbalance as CKD progresses
Preference for salt and water	Dialysis related infection
Multiple medications	CVL, exit site and peritonitis
Inadequate dialysis	Dialysis related inflammation
Leptin/ghrelin imbalance	Water impurity
Vomiting	Bio-incompatibility of dialyser and lines
Gastro-oesophageal reflux	↓response to anabolic hormones GH and IGF-1
Delayed clearance of polypeptide hormones affecting gastrointestinal motility	Fluid overload → poor tissue perfusion and absorption of gut toxins
Raised intra-abdominal pressure during PD	Metabolic acidosis
Loss of nutrients in dialysate	Oxidative stress
Fluid restriction	Abnormal gut microbiota
Fasting for medical procedures	Retention of uraemic molecules
Acute intercurrent illnesses	Retention of indoxyl sulphate and p-cresyl sulphate
	Post-transplant
	Use of steroids
	The failing graft
	Vitamin D deficiency