An introduction to CKD-MBD research: restart for the future

The effect of a training program on the self-care efficacy of hemodialysis patients with mineral and bone disorders: A quasi-experimental study

Background and Aims

Patients who have chronic kidney disease (CKD) and mineral and bone disorders (MBD) often do not know much about their diseases. A training program can help them improve their quality of life. This study aimed to assess the effect of a training program on the self-care efficacy of the hemodialysis patients with MBDs in southeastern Iran.

Method

We conducted a quasi-experimental study involving 49 patients with CKD-MBD in southeastern Iran in 2021. The patients were randomly assigned to either the control or intervention group. The intervention group received 12 self-care training sessions delivered through WhatsApp, whereas the control group received routine information. We administered CKD-MBD knowledge and behavior questionnaires of the intervention, and measured laboratory parameters before and 1 month after the intervention. The data were analyzed by SPSS15 with descriptive and analytical statistics. Paired t test, independent t, analysis of covariance, and Mann-Whitney U tests were using for data analysis.

Results

The mean knowledge scores of the control group were 4.78 ± 1.78 and 6.22 ± 2.11 before and after the intervention, respectively (p = 0.200), whereas the mean knowledge scores of the intervention group were 6.08 ± 2.24 and 22.23 ± 4.55 before and after the intervention, respectively (p = 0.001). The mean behavior scores of the control and intervention groups were 75.61 ± 7.13 and 73.85 ± 7.49 before the intervention, respectively (p = 0.070), but they received the mean scores of 78.87 ± 5.58 and 82.50 ± 5.35 after the intervention, respectively (p = 0.001). The result showed a significant increase in the mean knowledge and behavior scores after the intervention. The researchers found no significant difference in the mean scores of the laboratory parameters between them before and after the intervention (p = 0.090); therefore, the intervention could not affect the laboratory parameters.

Conclusion

To sum up, the study found that the training program improved the knowledge and behavior of hemodialysis patients with MBD. WhatsApp was a good and cheap way to teach them self-care, and it helped them do it better. These results implied that this training program could help the patients have a better quality of life.

Disorders of Calcium and Phosphorus Metabolism and the Proteomics/Metabolomics-Based Research

Since calcium and phosphorus play vital roles in a multitude of physiologic systems, disorders of calcium and phosphorus metabolism always lead to severe consequences such as skeletal-related and cardiovascular morbidity, or even life-threatening. Physiologically, the maintenance of calcium and phosphorus homeostasis is achieved via a variety of concerted actions of hormones such as parathyroid hormone (PTH), vitamin D, and fibroblast growth factor (FGF23), which could be regulated mainly at three organs, the intestine, kidney, and bone. Disruption of any organ or factor might lead to disorders of calcium and phosphorus metabolism. Currently, lacking of accurate diagnostic approaches and unknown molecular basis of pathophysiology will result in patients being unable to receive a precise diagnosis and personalized treatment timely. Therefore, it is urgent to identify early diagnostic biomarkers and develop therapeutic strategies. Fortunately, proteomics and metabolomics offer promising tools to discover novel indicators and further understanding of pathological mechanisms. Therefore, in this review, we will give a systematic introduction on PTH-1,25(OH)₂D-FGF23 axis in the disorders of calcium and phosphorus metabolism, diagnostic biomarkers identified, and potential altered metabolic pathways involved.

The impact of a nutritional intervention based on egg white for phosphorus control in hemodialyis patients

BACKGROUND AND AIMS

Here we describe a dietary intervention for hyperphosphatemia in dialysis patients based on the partial replacement of meat and fish, which are one of the main sources of alimentary phosphorous, with egg white, a virtually phosphorous-free protein source. This intervention aims to reduce phosphorous intake without causing protein wasting.

PATIENTS AND METHODS

As many as 23 hyperphosphatemic patients (15 male and 8 female, mean age 53.0 ± 10.0 years) on chronic standard 4 h, three times weekly, bicarbonate hemodialysis were enrolled in this open-label, randomized controlled trial. Patients in the intervention group were instructed to replace fish or meat with egg white in three meals a week for three months whereas diet was unchanged in the control group.

RESULTS

Serum phosphate concentrations were significantly lower in the intervention group than in controls after three (4.9 ± 1.0 vs 6.6 ± 0.8; p < 0.001) but not after one month of treatment. Phosphate concentrations decreased more from baseline in the intervention than in the control group both after one (-1,2 ± 1,1 vs 0,5 ± 1,1; p = 0.004) and after three (-1,7 ± 1,1 vs -0,6 ± 1,1; p < 0.001) months of follow-up. No change either in body weight or in body composition assessed with bioelectrical impedance analysis or in serum albumin concentration was observed in either group.

CONCLUSION

The partial replacement of meat and fish with egg white induces a significant decrease in serum phosphate without causing protein malnutrition and could represent a useful instrument to control serum phosphate levels in hemodialysis patients. CLINICALTRIALS.

GOV IDENTIFIER

NCT03236701.