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Petrakis I, Bacharaki D, Kyriazis P, Balafa O, Dounousi E, Tsirpanlis G, Theodoridis M, Tsotsorou O, Markaki A, Georgoulidou A, Triantafyllis G, Giannikouris I, Kokkalis A, Stavroulopoulos A, Stylianou K. Cardiovascular and All-Cause Mortality Is Affected by Serum Magnesium and Diet Pattern in a Cohort of Dialysis Patients. J Clin Med 2024; 13:4024. [PMID: 39064068 PMCID: PMC11277800 DOI: 10.3390/jcm13144024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Hypomagnesaemia is associated with an increased overall mortality in patients with chronic kidney disease on dialysis (CKD-5D). Mediterranean-style diet (MD), having a high magnesium content, can serve as a form of dietary magnesium supplementation. We examined whether there is a potential link between increased Mediterranean Diet score (MDS) and elevated serum magnesium (sMg) to assess its impact on reducing mortality risk in CKD-5D patients. Methods: In this multi-center prospective observational study, 117 CKD-5D patients (66 on hemodialysis and 51 on peritoneal dialysis) with a mean age of 62 ± 15 years were studied for a median follow-up period of 68 months. After baseline assessment, including measurement of sMg and MDS, all patients were followed up for cardiovascular (CV) and all-cause mortality. Results: Forty deaths occurred, 58% of which were cardiovascular. Patients who were above the median value of sMg (2.2 mg/dL) had a 66% reduction in CV (crude HR, 0.34; 95% CI, 0.11-0.70), and 49% reduction in all-cause (crude HR, 0.51; 95% CI, 0.27-0.96) mortality, even after adjustment for age, malnutrition inflammation score, left ventricular mass index, peripheral vascular disease and diabetes. Similar results were obtained when sMg was analyzed as a continuous variable. sMg was associated directly with MDS (r = 0.230; p = 0.012). Conclusions: Higher sMg levels are strongly and independently associated with reduced CV and all-cause mortality in CKD-5D patients. A strong correlation exists between MDS and sMg. Elevated sMg levels, achieved through MD adherence, can significantly reduce CV mortality, implicating MD as a mediator of the association between sMg and CV mortality.
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Affiliation(s)
- Ioannis Petrakis
- Nephrology Department, University General Hospital of Heraklion, 71500 Heraklion, Greece;
| | - Dimitra Bacharaki
- Nephrology Department, Attikon University Hospital, 12462 Athens, Greece; (D.B.); (O.T.)
| | - Periklis Kyriazis
- Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Olga Balafa
- Nephrology Department, University Hospital of Ioannina, 45500 Ioannina, Greece; (O.B.); (E.D.)
| | - Evangelia Dounousi
- Nephrology Department, University Hospital of Ioannina, 45500 Ioannina, Greece; (O.B.); (E.D.)
| | - George Tsirpanlis
- Nephrology Department, General Hospital of Athens “G. Gennimatas”, 11527 Athens, Greece;
| | - Marios Theodoridis
- Department of Nephrology, Democritus University of Thrace, 68150 Alexandroupolis, Greece;
| | - Ourania Tsotsorou
- Nephrology Department, Attikon University Hospital, 12462 Athens, Greece; (D.B.); (O.T.)
| | - Anastasia Markaki
- Department of Nutrition and Dietetics, Hellenic Mediterranean University, 71410 Heraklion, Greece;
| | | | - George Triantafyllis
- Department of Nephrology, Hemodialysis Unit, Mediterraneo Hospital, 16675 Glyfada, Greece; (G.T.); (I.G.)
| | - Ioannis Giannikouris
- Department of Nephrology, Hemodialysis Unit, Mediterraneo Hospital, 16675 Glyfada, Greece; (G.T.); (I.G.)
| | | | - Aristeides Stavroulopoulos
- Nephrology Department, General Clinic of Kalithea, IASIO Hospital, 17675 Athens, Greece;
- NEPHROEXPERT—Athens Kidney Institute, 17675 Athens, Greece
| | - Kostas Stylianou
- Nephrology Department, University General Hospital of Heraklion, 71500 Heraklion, Greece;
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2
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Ralph DL, Ha D, Lei H, Priver TS, Smith SD, McFarlin BE, Schwindt S, Pandya D, Koepsell H, Pastor-Soler NM, Edwards A, McDonough AA. Potassium-Alkali-Enriched Diet, Hypertension, and Proteinuria following Uninephrectomy. J Am Soc Nephrol 2024:00001751-990000000-00357. [PMID: 38913441 DOI: 10.1681/asn.0000000000000420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/10/2024] [Indexed: 06/26/2024] Open
Abstract
Key Points
A K-alkali–enriched diet blunted post-uninephrectomy hypertension and facilitated acid clearance by suppressing Na+ reabsorption.Uninephrectomy-associated proteinuria could be attributed to elevated single-nephron GFR and downregulation of megalin, which reduced fractional protein endocytosis.
Background
Losing or donating a kidney is associated with risks of developing hypertension and albuminuria. Few studies address mechanisms or interventions. We investigate the potential benefits of a K+- alkali–enriched diet and the mechanisms underlying proteinuria.
Methods
Male Sprague Dawley rats were fed either a 2% NaCl+0.95% KCl diet (HNa-LK) or a 0.74% NaCl+3% K+-alkali diet (HK-alk) for 3 weeks before uninephrectomy and then maintained on respective diets for 12 weeks. BP (by tail-cuff), urine, blood, and kidney proteins were analyzed before and after uninephrectomy.
Results
Before uninephrectomy, HK-alk–fed versus HNa-LK–fed rats exhibited similar BPs and plasma [K+], [Na+], but lower proximal (NHE3, sodium bicarbonate cotransporter 1, NaPi2) and higher distal (NCC, ENaC, and pendrin) transporter abundance, a pattern facilitating K+ and HCO3
− secretion. After uninephrectomy, single-nephron GFR increased 50% and Li+ clearance doubled with both diets; in HK-alk versus HNa-LK, the increase in BP was less and ammoniagenesis was lower, abundance of proximal tubule transporters remained lower, ENaC-α fell, and NCCp increased, consistent with K+ conservation. After uninephrectomy, independent of diet, albuminuria increased eight-fold and abundance of endocytic receptors was reduced (megalin by 44%, disabled homolog 2 by 25%–35%) and kidney injury molecule-1 was increased.
Conclusions
The K-alkali–enriched diet blunted post-uninephrectomy hypertension and facilitated acid clearance by suppressing proximal Na+ transporters and increasing K+-alkali secretion. Furthermore, uninephrectomy-associated proteinuria could be attributed, at least in part, to elevated single-nephron GFR coupled with downregulation of megalin, which reduced fractional protein endocytosis and Vmax.
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Affiliation(s)
- Donna L Ralph
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Darren Ha
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Hillmin Lei
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Taylor S Priver
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Scotti D Smith
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Brandon E McFarlin
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Seth Schwindt
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Drishti Pandya
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Hermann Koepsell
- Institute for Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany
| | - Nuria M Pastor-Soler
- Division of Nephrology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Aurelie Edwards
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts
| | - Alicia A McDonough
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, California
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Larkins NG, Craig JC. Hypertension and Cardiovascular Risk Among Children with Chronic Kidney Disease. Curr Hypertens Rep 2024:10.1007/s11906-024-01308-1. [PMID: 38806767 DOI: 10.1007/s11906-024-01308-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE OF REVIEW Cardiovascular disease is the most common cause of mortality across the lifespan of children with chronic kidney disease (CKD). Hypertension is a common and important contributor, but other factors such as obesity, dyslipidemia and mineral bone disease play a role. This narrative review focusses on studies published in the past five years that have investigated hypertension and cardiovascular risk among children with CKD. RECENT FINDINGS Cohort studies such as Chronic Kidney Disease in Children (CKiD) and Cardiovascular Comorbidity in Children with CKD (4C) have continued to develop our understanding of blood pressure (BP) phenotypes, and of progressive changes in the structure and function of the heart and blood vessels occurring in children with CKD. Metabolic risk factors, such as dyslipidemia, may represent an under-recognized component of care. Trial data are less common than observational evidence, but support lifestyle interventions currently used, mainly the low sodium dietary approaches to stop hypertension (DASH) diet. The findings of the recently reported Hypertension Optimal Treatment in Children with Chronic Kidney Disease trial (HOT-KID) are described in relation to the use of office BP treatment targets. Cardiovascular health is critical to the long-term outcomes of children with CKD. Recognizing and treating hypertension remains a critical component to improving outcomes, along with measures to improve concurrent cardiovascular risk factors. Some cardiovascular changes may not be reversible with transplantation and further research is needed for children at all stages of CKD.
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Affiliation(s)
- Nicholas G Larkins
- Department of Nephrology and Hypertension, Perth Children's Hospital, Nedlands, Australia.
- Medical School, University of Western Australia, Perth, Australia.
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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4
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Patel MJ, Emerenini C, Wang X, Bottiglieri T, Kitzman H. Metabolomic and Physiological Effects of a Cardiorenal Protective Diet Intervention in African American Adults with Chronic Kidney Disease. Metabolites 2024; 14:300. [PMID: 38921435 PMCID: PMC11205948 DOI: 10.3390/metabo14060300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024] Open
Abstract
Chronic kidney disease (CKD) impacts 14% of adults in the United States, and African American (AA) individuals are disproportionately affected, with more than 3 times higher risk of kidney failure as compared to White individuals. This study evaluated the effects of base-producing fruit and vegetables (FVs) on cardiorenal outcomes in AA persons with CKD and hypertension (HTN) in a low socioeconomic area. The "Cardiorenal Protective Diet" prospective randomized trial evaluated the effects of a 6-week, community-based FV intervention compared to a waitlist control (WL) in 91 AA adults (age = 58.3 ± 10.1 years, 66% female, 48% income ≤ USD 25K). Biometric and metabolomic variables were collected at baseline and 6 weeks post-intervention. The change in health outcomes for both groups was statistically insignificant (p > 0.05), though small reductions in albumin to creatinine ratio, body mass index, total cholesterol, and systolic blood pressure were observed in the FV group. Metabolomic profiling identified key markers (p < 0.05), including C3, C5, 1-Met-His, kynurenine, PC ae 38:5, and choline, indicating kidney function decline in the WL group. Overall, delivering a directed cardiorenal protective diet intervention improved cardiorenal outcomes in AA adults with CKD and HTN. Additionally, metabolomic profiling may serve as a prognostic technique for the early identification of biomarkers as indicators for worsening CKD and increased CVD risk.
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Affiliation(s)
- Meera J. Patel
- Peter J. O’Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Chiamaka Emerenini
- College of Natural Sciences, University of Texas at Austin, Austin, TX 78712, USA;
| | - Xuan Wang
- Center of Metabolomics, Institute of Metabolic Disease, Baylor Scott & White Research Institute, Dallas, TX 75204, USA; (X.W.); (T.B.)
| | - Teodoro Bottiglieri
- Center of Metabolomics, Institute of Metabolic Disease, Baylor Scott & White Research Institute, Dallas, TX 75204, USA; (X.W.); (T.B.)
| | - Heather Kitzman
- Peter J. O’Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX 75390, USA;
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5
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Raphael KL. Metabolic Acidosis in CKD: Pathogenesis, Adverse Effects, and Treatment Effects. Int J Mol Sci 2024; 25:5187. [PMID: 38791238 PMCID: PMC11121226 DOI: 10.3390/ijms25105187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/28/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
Metabolic acidosis is a frequent complication of chronic kidney disease and is associated with a number of adverse outcomes, including worsening kidney function, poor musculoskeletal health, cardiovascular events, and death. Mechanisms that prevent metabolic acidosis detrimentally promote further kidney damage, creating a cycle between acid accumulation and acid-mediated kidney injury. Disrupting this cycle through the provision of alkali, most commonly using sodium bicarbonate, is hypothesized to preserve kidney function while also mitigating adverse effects of excess acid on bone and muscle. However, results from clinical trials have been conflicting. There is also significant interest to determine whether sodium bicarbonate might improve patient outcomes for those who do not have overt metabolic acidosis. Such individuals are hypothesized to be experiencing acid-mediated organ damage despite having a normal serum bicarbonate concentration, a state often referred to as subclinical metabolic acidosis. Results from small- to medium-sized trials in individuals with subclinical metabolic acidosis have also been inconclusive. Well-powered clinical trials to determine the efficacy and safety of sodium bicarbonate are necessary to determine if this intervention improves patient outcomes.
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Affiliation(s)
- Kalani L. Raphael
- Division of Nephrology & Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, USA;
- Medicine Section, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT 84148, USA
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Amir S, Kim H, Hu EA, Ricardo AC, Mills KT, He J, Fischer MJ, Pradhan N, Tan TC, Navaneethan SD, Dobre M, Anderson CAM, Appel LJ, Rebholz CM. Adherence to Plant-Based Diets and Risk of CKD Progression and All-Cause Mortality: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2024; 83:624-635. [PMID: 38103719 PMCID: PMC11034716 DOI: 10.1053/j.ajkd.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/15/2023] [Accepted: 09/18/2023] [Indexed: 12/19/2023]
Abstract
RATIONALE & OBJECTIVE Studies have shown that generally healthy individuals who consume diets rich in plant foods have a lower risk of incident chronic kidney disease (CKD) and cardiovascular disease. This study investigated the prospective associations of plant-based diets with the risk of CKD progression and all-cause mortality in individuals with CKD. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 2,539 participants with CKD recruited between 2003-2008 into the Chronic Renal Insufficiency Cohort (CRIC) Study. EXPOSURE Responses on the Diet History Questionnaire were used to calculate scores for the overall plant-based diet index, healthy plant-based diet index, and unhealthy plant-based diet index. OUTCOME (1) CKD progression defined as≥50% estimated glomerular filtration rate decline from baseline or kidney replacement therapy (dialysis, transplant) and (2) all-cause mortality. ANALYTICAL APPROACH Cox proportional hazards models to compute hazard ratios and 95% confidence intervals adjusting for lifestyle, socioeconomic, and clinical covariates. RESULTS There were 977 CKD progression events and 836 deaths during a median follow-up period of 7 and 12 years, respectively. Participants with the highest versus lowest adherence to overall plant-based diets and healthy plant-based diets had 26% (HR, 0.74 [95% CI, 0.62-0.88], P trend<0.001) and 21% (HR, 0.79 [95% CI, 0.66-0.95], P trend=0.03) lower risks of all-cause mortality, respectively. Each 10-point higher score of unhealthy plant-based diets was modestly associated with a higher risk of CKD progression (HR, 1.14 [95% CI, 1.03-1.25) and all-cause mortality (HR, 1.11 [95% CI, 1.00-1.23). LIMITATIONS Self-reported diet may be subject to measurement error. CONCLUSIONS Adherence to an overall plant-based diet and a healthy plant-based diet is associated with a reduced risk of all-cause mortality among individuals with CKD. An unhealthy plant-based was associated with an elevated risk of CKD progression and all-cause mortality. PLAIN-LANGUAGE SUMMARY Plant-based diets are healthful dietary patterns that have been linked to a lower risk of chronic diseases. However, the impact of plant-based diets on clinical outcomes in patients with chronic kidney disease (CKD) is not well established. In 2,539 individuals with CKD, we examined the associations of adherence to 3 different types of plant-based diets with the risks of CKD progression and all-cause mortality. We found that following an overall plant-based diet and a healthy plant-based diet was associated with a lower risk of all-cause mortality. By contrast, following an unhealthy plant-based diet was associated with a higher risk of CKD progression and all-cause mortality. These results suggest that the quality of plant-based diets may be important for CKD management.
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Affiliation(s)
- Saira Amir
- Department of Medicine, UNC Health Southeastern, Lumberton, North Carolina; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Hyunju Kim
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Ana C Ricardo
- Division of Nephrology, Department of Medicine, University of Illinois, Chicago, Illinois
| | - Katherine T Mills
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Jiang He
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Michael J Fischer
- Division of Nephrology, Department of Medicine, University of Illinois, Chicago, Illinois
| | - Nishigandha Pradhan
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Thida C Tan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Mirela Dobre
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Cheryl A M Anderson
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California-San Diego, San Diego, California
| | - Lawrence J Appel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Casey M Rebholz
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
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Kohagura K. Effect of Combined DASH Diet with Sodium Restriction on Renal Function. KIDNEY360 2024; 5:487-488. [PMID: 38662535 PMCID: PMC11093539 DOI: 10.34067/kid.0000000000000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Affiliation(s)
- Kentaro Kohagura
- Dialysis Unit, University of the Ryukyus Hospital, Nishihara-cho, Okinawa, Japan
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Stevens PE, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, Herrington WG, Hill G, Inker LA, Kazancıoğlu R, Lamb E, Lin P, Madero M, McIntyre N, Morrow K, Roberts G, Sabanayagam D, Schaeffner E, Shlipak M, Shroff R, Tangri N, Thanachayanont T, Ulasi I, Wong G, Yang CW, Zhang L, Levin A. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int 2024; 105:S117-S314. [PMID: 38490803 DOI: 10.1016/j.kint.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 03/17/2024]
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Morales-Alvarez MC, Nissaisorakarn V, Appel LJ, Miller ER, Christenson RH, Rebuck H, Rosas SE, William JH, Juraschek SP. Effects of Reduced Dietary Sodium and the DASH Diet on GFR: The DASH-Sodium Trial. KIDNEY360 2024; 5:569-576. [PMID: 38326949 PMCID: PMC11093532 DOI: 10.34067/kid.0000000000000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/01/2024] [Indexed: 02/09/2024]
Abstract
Key Points Sodium reduction over a 4-week period decreased eGFR. Combining sodium reduction with the Dietary Approaches to Stop Hypertension diet resulted in larger reductions in eGFR. Changes in diastolic BP seem partially responsible for the observed dietary effects. Background A potassium-rich Dietary Approaches to Stop Hypertension (DASH) diet combined with low sodium reduces BP. However, the effects of sodium reduction in combination with the DASH diet on kidney function are unknown. We determined the effects of sodium reduction and the DASH diet, on eGFR using cystatin C. Methods DASH-sodium was a controlled, feeding study in adults with elevated or stage 1 hypertension, randomly assigned to the DASH or a control diet. On their assigned diet, participants consumed each of three sodium levels for 30 days after a 2-week run-in period of a high sodium-control diet. The three sodium levels were low (50 mmol/d), medium (100 mmol/d), and high (150 mmol/d). The primary outcome was change in eGFR based on cystatin C. Results Cystatin C was measured in 409 of the original 412 participants, of which 207 were assigned the DASH diet and 202 to the control diet. Compared with control, the DASH diet did not affect eGFR (β =−0.96 ml/min per 1.73 m2; 95% confidence interval [CI], −2.74 to 0.83). By contrast, low versus high sodium intake decreased eGFR (β =−2.36 ml/min per 1.73 m2; 95% CI, −3.64 to −1.07). Together, compared with the high sodium-control diet, the low sodium-DASH diet decreased eGFR by 3.10 ml/min per 1.73 m2 (95% CI, −5.46 to −0.73). This effect was attenuated with adjustment for diastolic BP and 24-hour urinary potassium excretion. Conclusions A combined low sodium-DASH diet reduced eGFR over a 4-week period. Future research should focus on the effect of these dietary interventions on subclinical kidney injury and their long-term effect on progression to CKD. Clinical Trial registration number ClinicalTrials.gov, NCT00000608 .
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Affiliation(s)
- Martha Catalina Morales-Alvarez
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Voravech Nissaisorakarn
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Lawrence J. Appel
- The Johns Hopkins Bloomberg School of Public Health, The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Edgar R. Miller
- The Johns Hopkins Bloomberg School of Public Health, The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert H. Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Heather Rebuck
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sylvia E. Rosas
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey H. William
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Stephen P. Juraschek
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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10
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Biruete A, Leal-Escobar G, Espinosa-Cuevas Á, Mojica L, Kistler BM. Dieta de la Milpa: A Culturally-Concordant Plant-Based Dietary Pattern for Hispanic/Latine People with Chronic Kidney Disease. Nutrients 2024; 16:574. [PMID: 38474703 DOI: 10.3390/nu16050574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 03/14/2024] Open
Abstract
Chronic kidney disease (CKD) disproportionately affects minorities in the United States, including the Hispanic/Latine population, and is a public health concern in Latin American countries. An emphasis on healthy dietary patterns, including the Mediterranean and the Dietary Approaches to Stop Hypertension (DASH) diets, has been suggested as they are associated with a lower incidence of CKD, slower CKD progression, and lower mortality in kidney failure. However, their applicability may be limited in people from Latin America. The Dieta de la Milpa (Diet of the Cornfield) was recently described as the dietary pattern of choice for people from Mesoamerica (Central Mexico and Central America). This dietary pattern highlights the intake of four plant-based staple foods from this geographical region, corn/maize, common beans, pumpkins/squashes, and chilies, complemented with seasonal and local intake of plant-based foods and a lower intake of animal-based foods, collectively classified into ten food groups. Limited preclinical and clinical studies suggest several health benefits, including cardiometabolic health, but there is currently no data concerning CKD. In this narrative review, we describe and highlight the potential benefits of the Dieta de la Milpa in CKD, including acid-base balance, protein source, potassium and phosphorus management, impact on the gut microbiota, inflammation, and cultural appropriateness. Despite these potential benefits, this dietary pattern has not been tested in people with CKD. Therefore, we suggest key research questions targeting measurement of adherence, feasibility, and effectiveness of the Dieta de la Milpa in people with CKD.
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Affiliation(s)
- Annabel Biruete
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Gabriela Leal-Escobar
- Departamento de Nefrología, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
| | - Ángeles Espinosa-Cuevas
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Luis Mojica
- Tecnología Alimentaria, Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco (CIATEJ), Zapopan 45019, Mexico
| | - Brandon M Kistler
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
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11
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Li L, Zhao J, Wang J, Xiong Q, Lin X, Guo X, Peng F, Liang W, Zuo X, Ying C. The arsenic-lowering effect of inulin-type prebiotics in end-stage renal disease: a randomized crossover trial. Food Funct 2024; 15:355-371. [PMID: 38093628 DOI: 10.1039/d3fo01843a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Background: Circulatory imbalance of trace elements is frequent in end-stage renal disease (ESRD), leading to a deficiency of essential elements and excess of toxic elements. The present study aimed to investigate whether inulin-type fructans (ITFs) could ameliorate the circulatory imbalance by modulating gut microbiota and regulating the absorption and elimination of trace elements. Methods: Peritoneal dialysis patients were enrolled in a randomized crossover trial, undergoing interventions with ITFs (10 g d-1) and maltodextrin (placebo) over a 9-month period (with a 3-month washout). The primary outcomes included essential elements Mn, Fe, Co, Cu, Zn, Se, Sr, and Mo and potential toxic elements V, Cr, Ni, As, Cd, Ba, Tl, Pb, Th, and U in plasma. Secondary outcomes included the gut microbiome, short chain fatty acids (SCFAs), bile acids (BAs), and daily removal of trace elements through urine, dialysate and feces. Results: Among the 44 participants initially randomized, 29 completed the prebiotic, placebo or both interventions. The daily dietary intake of macronutrients and trace elements remained consistent throughout the study. The administration of 10 g d-1 ITFs significantly reduced plasma arsenic (As) by 1.03 μg L-1 (95%CI: -1.74, -0.33) (FDR-adjusted P = 0.045) down from the baseline of 3.54 μg L-1 (IQRs: 2.61-4.40) and increased the As clearance rate by urine and dialysis (P = 0.033). Positive changes in gut microbiota were also observed, including an increase in the Firmicutes/Bacteroidetes ratio (P = 0.050), a trend towards higher fecal SCFAs (P = 0.082), and elevated excretion of primary BAs (P = 0.035). However, there were no significant changes in plasma concentrations of other trace elements or their daily removal by urine, dialysis and feces. Conclusions: The daily administration of 10 g d-1 ITFs proved to be effective in reducing the circulating retention of As but demonstrated to be ineffective for other trace elements in ESRD. These sentences are ok to include but as "The clinical trial registry number is ChiCTR-INR-17013739 (https://www.chictr.org.cn/showproj.aspx?proj=21228)".
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Affiliation(s)
- Li Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Jing Zhao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Jinxue Wang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Qianqian Xiong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Xuechun Lin
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Xiaolei Guo
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Fan Peng
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Wangqun Liang
- Division of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuezhi Zuo
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Chenjiang Ying
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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12
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Fajardo VC, Barreto SM, Coelho CG, Diniz MDFH, Molina MDCB, Ribeiro ALP, Telles RW. Adherence to the Dietary Approaches to Stop Hypertension (DASH) and Serum Urate Concentrations: A Longitudinal Analysis from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). J Nutr 2024; 154:133-142. [PMID: 37992809 DOI: 10.1016/j.tjnut.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Increased serum urate (SU) and hyperuricemia (HU) are associated with chronic noncommunicable diseases and mortality. SU concentrations are affected by several factors, including diet, and are expected to rise with age. We investigated whether the Dietary Approaches to Stop Hypertension (DASH) diet alter this trend. OBJECTIVE The objective was to assess whether adherence to the DASH diet predicts a longitudinal change in SU concentrations and risk of HU in 8 y of follow-up. METHODS Longitudinal analyses using baseline (2008-2010, aged 35-74 y), second (2012-2014), and third (2016-2018) visits data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The inclusion criteria were having complete food frequency questionnaire (FFQ) and urinary sodium measurement, in addition to having SU measurement at the 1st visit and at least 1 of the 2 follow-up visits. For the HU incidence analyses, participants had also to be free from HU at baseline. The final samples included 12575 individuals for the SU change analyses and 10549 for the HU incidence analyses. Adherence to DASH diet was assessed as continuous value. HU was defined as SU>6.8 mg/dL and/or urate-lowering therapy use. Mixed-effect linear and Poisson regressions (incidence rate ratio [IRR] and 95% confidence interval [CI]) were used in the analyses, adjusted for confounders. RESULTS The mean age was 51.4 (8.7) y, and 55.4% were females. SU means (standard deviation) were 5.4 (1.4) at 1st visit, 5.2 (1.4) at 2nd visit, and 5.1(1.3) mg/dL at 3rd visit. The HU incidence rate was 8.87 per 1000 person-y. Each additional point in adherence to the DASH diet accelerated SU decline (P< 0.01) and lowered the incidence of HU by 4.3% (IRR: 0.957; 95% CI: 0.938,0.977) in adjusted model. CONCLUSION The present study findings reinforce the importance of encouraging the DASH diet as a healthy dietary pattern to control and reduce the SU concentrations and risk of HU.
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Affiliation(s)
- Virgínia C Fajardo
- Universidade Federal de Minas Gerais, PhD Student of Post-graduate Program in Ciências Aplicadas à Saúde do Adulto, Belo Horizonte, Brazil
| | - Sandhi Maria Barreto
- Department of Preventive Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Hospital das Clínicas da UFMG/Ebserh, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Carolina G Coelho
- Department of Preventive Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Hospital das Clínicas da UFMG/Ebserh, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria de Fátima Hs Diniz
- Hospital das Clínicas da UFMG/Ebserh, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria Del Carmen B Molina
- Universidade Federal de Ouro Preto, Ouro Preto, Brazil and Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Antonio Luiz P Ribeiro
- Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Telehealth Center, Hospital das Clínicas da UFMG/Ebserh, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rosa W Telles
- Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Rheumatology Service, Hospital das Clínicas da UFMG/Ebserh, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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13
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Kitzman H, Montgomery AH, Khan M, Mamun A, Tecson KM, Allison P, Simoni J, Wesson DE. The Fruit and Veggies for Kidney Health Study: A Prospective Randomized Trial. Kidney Med 2023; 5:100736. [PMID: 38046912 PMCID: PMC10692733 DOI: 10.1016/j.xkme.2023.100736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Rationale & Objective Providing fruits and vegetables (F&Vs) to health care system patients with elevated urine albumin-creatinine ratio (ACR) reduced ACR, slowed chronic kidney disease (CKD) progression and reduced cardiovascular disease (CVD) risk factors in previous studies. This study evaluated a community-based strategy in lower-income populations to identify African Americans with elevated ACR before health care system involvement and sustain them in a 6-month F&V protocol with (F&V + Cook) and without (F&V Only) cooking instructions, with the hypothesis that adjuvant cooking instructions with F&Vs would further reduce ACR. Study Design Prospective, randomized, parallel 2-arm design. Setting & Participants African American adults with ACR >10 mg/g creatinine randomized to 1 of 2 study arms. Interventions Two cups/day of F&Vs with or without cooking instructions in participants followed 6 months. Outcomes Participants sustaining the F&V protocol and between-group indicators of CVD risk, kidney injury, and dietary intake at 6 weeks and 6 months. Results A total of 142 African American adults (mean age, 57.0 years; ACR, 27.4 mg/g; body mass index, 34.4; 24.9% CKD 1; 24.8% CKD 2; 50.4% CKD 3; 55% female) randomized to F&V Only (n=72) or F&V + Cook (n=70), and 71% were retained at 6 months. Participants received 90% of available F&V pick-ups over 6 weeks and 69% over 6 months. In the adjusted model, 6-month ACR was 31% lower for F&V + Cook than F&V Only (P = 0.02). Net 6-week F&V intake significantly increased and biometric variables improved for participants combined into a single group. Limitations Small sample size, low-baseline ACR, and potential nonresponse bias for 24-hour dietary recall measure. Conclusions These data support the feasibility of identifying community-dwelling African Americans with ACR indicating elevated CVD and CKD risk and sustaining a F&V protocol shown to improve kidney outcomes and CVD risk factors and provides preliminary evidence that cooking instructions adjuvant to F&Vs are needed to lower ACR. Funding National Institute on Diabetes, Digestive, and Kidney Diseases grant "Reducing chronic kidney disease burden in an underserved population" (R21DK113440). Trial Registration NCT03832166. Plain-Language Summary African Americans, particularly those in low-income communities, have increased rates of chronic kidney disease (CKD) with worsening outcomes over time. Giving fruits and vegetables to individuals with CKD identified in health care systems was previously shown to reduce kidney damage, measured by urine protein albumin, and slow kidney function decline. We recruited African Americans in low-income communities with increased urine albumin levels. They received fruits and vegetables for 6 months, and we tested whether added cooking instructions further reduced urine albumin levels. Most participants continued to receive fruits and vegetables throughout the 6 months. Those given cooking instructions had lower urine albumin levels after 6 months, indicating decreased kidney damage. Providing cooking instructions with fruits and vegetables appears to lessen kidney damage more than just fruits and vegetables alone.
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Affiliation(s)
- Heather Kitzman
- Baylor Scott and White Health and Wellness Center, Dallas, TX
- Robbins Institute for Health Policy and Leadership, Baylor University, Waco, TX
- University of Texas Southwestern Medical Center, Peter O’Donnell Jr. School of Public Health, Dallas, TX
| | | | - Mahbuba Khan
- Baylor Scott and White Health and Wellness Center, Dallas, TX
| | - Abdullah Mamun
- Baylor Scott and White Health and Wellness Center, Dallas, TX
| | - Kristen M. Tecson
- Baylor Heart and Vascular Institute, Baylor Scott & White Research Institute, Dallas, TX
- Texas A&M Health Sciences Center College of Medicine Department of Internal Medicine, Dallas, TX
| | | | - Jan Simoni
- Texas Tech University Health Sciences Center Department of Surgery, Lubbock, TX
| | - Donald E. Wesson
- Dell Medical School – The University of Texas at Austin, Austin, TX
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14
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Rhee CM, Wang AYM, Biruete A, Kistler B, Kovesdy CP, Zarantonello D, Ko GJ, Piccoli GB, Garibotto G, Brunori G, Sumida K, Lambert K, Moore LW, Han SH, Narasaki Y, Kalantar-Zadeh K. Nutritional and Dietary Management of Chronic Kidney Disease Under Conservative and Preservative Kidney Care Without Dialysis. J Ren Nutr 2023; 33:S56-S66. [PMID: 37394104 PMCID: PMC10756934 DOI: 10.1053/j.jrn.2023.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/28/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023] Open
Abstract
While dialysis has been the prevailing treatment paradigm for patients with advanced chronic kidney disease (CKD), emphasis on conservative and preservative management in which dietary interventions are a major cornerstone have emerged. Based on high-quality evidence, international guidelines support the utilization of low-protein diets as an intervention to reduce CKD progression and mortality risk, although the precise thresholds (if any) for dietary protein intake vary across recommendations. There is also increasing evidence demonstrating that plant-dominant low-protein diets reduce the risk of developing incident CKD, CKD progression, and its related complications including cardiometabolic disease, metabolic acidosis, mineral and bone disorders, and uremic toxin generation. In this review, we discuss the premise for conservative and preservative dietary interventions, specific dietary approaches used in conservative and preservative care, potential benefits of a plant-dominant low-protein diet, and practical implementation of these nutritional strategies without dialysis.
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Affiliation(s)
- Connie M Rhee
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, California.
| | - Angela Yee-Moon Wang
- University Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Annabel Biruete
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brandon Kistler
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee; Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
| | - Diana Zarantonello
- Nephrology and Dialysis Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Gang Jee Ko
- Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | | | | | - Giuliano Brunori
- Nephrology and Dialysis Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Keiichi Sumida
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Seung Hyeok Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoko Narasaki
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, California
| | - Kamyar Kalantar-Zadeh
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California
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15
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Pan J, Xu X, Wang Z, Ma T, Dong J. Dietary Potassium and Clinical Outcomes among Patients on Peritoneal Dialysis. Nutrients 2023; 15:4271. [PMID: 37836555 PMCID: PMC10574508 DOI: 10.3390/nu15194271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The association between dietary potassium and clinical prognosis is unclear in patients with chronic kidney disease (CKD). Here, we explored the association between dietary potassium intake and all-cause and cardiovascular (CV) mortality in peritoneal dialysis (PD) patients. METHODS Here, we present a retrospective analysis of a prospective study. Patients that began incident PD in our center between 1 October 2002 and 31 August 2014 were screened. We recorded all demographic and clinical data at baseline. Repeated measurements were recorded at regular intervals to calculate time-averaged values. Spline regression analysis and Cox proportional regression models were used to evaluate the relationship between dietary potassium and mortality. RESULTS We followed 881 PD patients for 45.0 (21.5, 80.0) months; 467 patients died, of which 189 (40.5%) died of CV death and 93 were still on PD treatment. Compared with those who had baseline dietary potassium ≥1200 mg/d, the majority of patients with lower dietary potassium were female, older, or poorly educated. They were prone to have poorer nutritional status, CV disease, and diabetes mellitus (p < 0.05). In the unadjusted analysis, both baseline and time-averaged dietary potassium <1200 mg/d predicted higher all-cause and CV mortality (p < 0.001~0.01). After adjusting for demographic and laboratory data, the association between potassium intake and all-cause and CV mortality weakened, which even disappeared after additional adjustment for dietary fiber, protein, and energy intake. CONCLUSIONS Dietary potassium in PD patients was not independently associated with all-cause and CV mortality.
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Affiliation(s)
- Jinru Pan
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100871, China; (J.P.); (X.X.); (Z.W.); (T.M.)
- Key Laboratory of Renal Disease, Ministry of Health, Beijing 100034, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing 100034, China
| | - Xiao Xu
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100871, China; (J.P.); (X.X.); (Z.W.); (T.M.)
- Key Laboratory of Renal Disease, Ministry of Health, Beijing 100034, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing 100034, China
| | - Zi Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100871, China; (J.P.); (X.X.); (Z.W.); (T.M.)
- Key Laboratory of Renal Disease, Ministry of Health, Beijing 100034, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing 100034, China
| | - Tiantian Ma
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100871, China; (J.P.); (X.X.); (Z.W.); (T.M.)
- Key Laboratory of Renal Disease, Ministry of Health, Beijing 100034, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing 100034, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100871, China; (J.P.); (X.X.); (Z.W.); (T.M.)
- Key Laboratory of Renal Disease, Ministry of Health, Beijing 100034, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing 100034, China
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16
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Theodoridis X, Triantafyllou A, Chrysoula L, Mermigkas F, Chroni V, Dipla K, Gkaliagkousi E, Chourdakis M. Impact of the Level of Adherence to the DASH Diet on Blood Pressure: A Systematic Review and Meta-Analysis. Metabolites 2023; 13:924. [PMID: 37623868 PMCID: PMC10456469 DOI: 10.3390/metabo13080924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction: the objective of our study was to systematically review the current literature and perform a meta-analysis to evaluate the effect of the level of adherence to the DASH diet on blood pressure. Methods: The identification of relevant studies, data extraction and critical appraisal of the included studies were performed independently by two reviewers. A random-effects model was employed to synthesize the available evidence using the standardized mean difference (SMD) as the appropriate effect size. Results: A total of 37 and 29 articles were included in the qualitative and quantitative analysis, respectively. The pooled effect for systolic blood pressure was SMD = -0.18 (95%CI: -0.32 to -0.04; I2 = 94%; PI: -0.93 to 0.57) and for diastolic blood pressure it was SMD = -0.13 (95%CI: -0.19 to -0.06; I2 = 94%; PI: -0.42 to 0.17). Conclusions: Our findings showed that greater adherence to the DASH diet has a beneficial effect on blood pressure compared to the lowest adherence. Increased compliance with DASH diet recommendations might also have a positive effect on cardiometabolic factors and overall health status. Future studies should aim to standardize the tools of adherence to the DASH diet and utilize rigorous study designs to establish a clearer understanding of the potential benefits of the level of adherence to the DASH diet in blood pressure management.
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Affiliation(s)
- Xenophon Theodoridis
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (X.T.); (L.C.); (F.M.); (V.C.)
- 3rd Clinic of Internal Medicine, Papageorgiou Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (A.T.); (E.G.)
| | - Areti Triantafyllou
- 3rd Clinic of Internal Medicine, Papageorgiou Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (A.T.); (E.G.)
| | - Lydia Chrysoula
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (X.T.); (L.C.); (F.M.); (V.C.)
| | - Fotios Mermigkas
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (X.T.); (L.C.); (F.M.); (V.C.)
| | - Violeta Chroni
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (X.T.); (L.C.); (F.M.); (V.C.)
| | - Konstantina Dipla
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, 62110 Thessaloniki, Greece;
| | - Eugenia Gkaliagkousi
- 3rd Clinic of Internal Medicine, Papageorgiou Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (A.T.); (E.G.)
| | - Michail Chourdakis
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (X.T.); (L.C.); (F.M.); (V.C.)
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17
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Ilori TO, Solarin A, Manmak M, Raji YR, Braimoh R, Kwakyi E, Umeizudike T, Ajepe T, Bolanle O, Ripiye N, Eduful E, Adebile T, Ijeoma C, Mumuni AA, Chern J, Akinpelu M, Ulasi I, Arogundade F, Salako BL, Gbadegesin R, Parekh RS, Dupuis J, Amira CO, Adu D, Anderson CA, Ojo A, Waikar SS. Rationale and Design of the Diet, CKD, and Apolipoprotein L1 Study in Low-Income and Middle-Income Countries. Kidney Int Rep 2023; 8:764-774. [PMID: 37069986 PMCID: PMC10105057 DOI: 10.1016/j.ekir.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction Diet, chronic kidney disease (CKD), and Apolipoprotein L1 (APOL1) (DCA) Study is examining the role of dietary factors in CKD progression and APOL1 nephropathy. We describe enrollment and retention efforts and highlight facilitators and barriers to enrollment and operational challenges, as well as accommodations made in the study protocol. Methods The DCA study is enrolling participants in 7 centers in West Africa. Participants who consented were invited to complete dietary recalls and 24-hour urine collections in year 1. We conducted focus groups and semistructured interviews among study personnel to identify facilitators and barriers to enrollment as well as retention and operational challenges in the execution of the study protocol. We analyzed emerging themes using content analyses. Results A total of 712 participants were enrolled in 18 months with 1256 24-hour urine and 1260 dietary recalls. Barriers to enrollment were the following: (i) a lack of understanding of research, (ii) the burden of research visits, and (iii) incorporating cultural and traditional nuances when designing research protocols. Factors facilitating enrollment were the following: (i) designing convenient research visits, (ii) building rapport and increased communication between the research team and participants, and (iii) cultural sensitivity - adapting research protocols for the populations involved. Offering home visits, providing free dietary counseling, reducing the volume of study blood collection, and reducing the frequency of visits were some changes made in the study protocol that increased participant satisfaction. Conclusion Adopting a participant-centered approach with accommodations in the protocol for cultural adaptability and incorporating participant feedback is vital for carrying out research in low-income and middle-income regions.
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Affiliation(s)
- Titilayo O. Ilori
- Division of Nephrology, Department of Medicine, Boston Medical Center, Boston University School of Medicine Boston, Massachusetts, USA
| | - Adaobi Solarin
- Department of Pediatrics and Child Health, College of Medicine, Lagos State University, Nigeria
| | - Mamven Manmak
- Department of Internal Medicine, University of Abuja, Nigeria
| | - Yemi R. Raji
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rotimi Braimoh
- Department of Medicine, College of Medicine, University of Lagos, Nigeria
| | - Edward Kwakyi
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Ghana
| | | | - Titilope Ajepe
- Department of Physiotherapy, College of Medicine, University of Lagos, Nigeria
| | - Omotoso Bolanle
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Nanna Ripiye
- Department of Internal Medicine, University of Abuja, Nigeria
| | - Ernestina Eduful
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Ghana
| | - Temitayo Adebile
- Division of Nephrology, Department of Medicine, Boston Medical Center, Boston University School of Medicine Boston, Massachusetts, USA
| | | | - Amisu A. Mumuni
- Department of Medicine, College of Medicine, Lagos State University, Nigeria
| | - Jessica Chern
- Division of Nephrology, Department of Medicine, Boston Medical Center, Boston University School of Medicine Boston, Massachusetts, USA
| | - Morenikeji Akinpelu
- Division of Nephrology, Department of Medicine, Boston Medical Center, Boston University School of Medicine Boston, Massachusetts, USA
| | | | - Fatiu Arogundade
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Babatunde L. Salako
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rasheed Gbadegesin
- Department of Pediatrics, Department of Medicine, Duke University School of Medicine, North Carolina, USA
| | - Rulan S. Parekh
- Department of Medicine, Women’s College Hospital, Hospital for Sick Children and University of Toronto, Ontario, Canada
| | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | | | - Dwomoa Adu
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Ghana
| | - Cheryl A.M. Anderson
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
| | - Akinlolu Ojo
- Department of Medicine, Kansas University Medical Center, The University of Kansas, Kansas, USA
| | - Sushrut S. Waikar
- Division of Nephrology, Department of Medicine, Boston Medical Center, Boston University School of Medicine Boston, Massachusetts, USA
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Betz MV, Nemec KB, Zisman AL. Patient Perception of Plant Based Diets for Kidney Disease. J Ren Nutr 2023; 33:243-248. [PMID: 36155085 DOI: 10.1053/j.jrn.2022.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Plant-based diets can delay the progression of chronic kidney disease (CKD) and help manage complications and comorbid conditions such as hypertension, acidosis, diabetes, and cardiovascular disease. The objective of this study was to understand nephrology patients' familiarity, perception, and use of plant-based diets. DESIGN & METHODS A survey was shared via the National Kidney Foundation's social media channels. Analysis included 844 responses. Survey items were evaluated with descriptive statistics. Differences across items were determined using chi-square tests. RESULTS Most respondents were 61-70 years of age (26.7%, n = 225), female (56.5%, n = 477) and achieved a Bachelor's or advanced degree (49.9%, n = 421). The majority of respondents suffered from nondialysis-dependent CKD (34%) or received a kidney transplant (34%). About half (45%) of respondents were familiar with plant-based diets and most (58%) were aware that plant-based diets can improve CKD. Twenty-two percent reported following some version of a vegetarian diet, and 29% reported "eating less meat". Respondents were not confident (Mdn = 2, IQR = 2, on a scale of 1-5) in their ability to plan a balanced plant-based meal, and were moderately confident that a plant-based diet could help blood pressure (Mdn = 3, IQR = 2) and slow progression of CKD (Mdn = 3, IGR = 2). Family eating preference, meal planning skills, preference for meat, figuring out what is healthy to eat, food cost, time constraints, and ease of cooking were rated as equal barriers to following a plant-based diet (Mdn = 3). A sample meal plan, individual counseling session with a Registered Dietitian Nutritionist (RDN), handouts, and cooking classes were resources rated most helpful to transition to a plant-based diet (Mdn = 4). CONCLUSION Approximately half of respondents were aware that plant-based diets can be beneficial for CKD. Many patients are following a vegetarian or plant-based eating pattern. More research should be done to see how effective RDNs are in educating and moving patients toward a plant-based eating pattern, as they are an underutilized resource in the CKD population.
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Affiliation(s)
- Melanie V Betz
- Chronic Kidney Disease Nutrition & Education Specialist, Section of Nephrology, University of Chicago Medicine, Chicago, IL.
| | - Kelly B Nemec
- Transplant Dietitian II, Transplant Surgery, University of Chicago Medicine, Chicago, IL
| | - Anna L Zisman
- Associate Professor of Medicine, Section of Nephrology, University of Chicago Medicine, Chicago, IL
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Mirzababaei A, Abaj F, Hajishizari S, Bahrampour N, Noori S, Barekzai AM, Hosseininasab D, Clark CCT, Mirzaei K. The association of dietary approaches to stop hypertension (DASH) with the odds of diabetic nephropathy and metabolic markers in women: a case-control study. BMC Womens Health 2023; 23:63. [PMID: 36782160 PMCID: PMC9926721 DOI: 10.1186/s12905-022-02140-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/20/2022] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVES Epidemiologic studies have reported that diet is associated with diabetes and its complications through different pathways. We sought to examine the associations between the Dietary Approaches to Stop Hypertension (DASH) diet and the odds of diabetic nephropathy (DN) developing in Iranian women with existing type 2 diabetes. METHODS In this case-control study, 105 women with DN and 105 controls, matched for age and diabetes duration, were selected from the Kowsar Diabetes Clinic in Semnan, Iran. DASH, estimated using dietary intake, was assessed using a validated and reliable food frequency questionnaire with 147 items. Anthropometric measurements were assessed for all subjects. Logistic regression was performed to examine the association between DASH and the odds of developing DN. RESULTS After controlling for potential confounders, subjects in the highest intake of DASH diet adherence have 84% lower odds of DN, compared to those with the lowest intake (OR = 0.16, 95% CI = 0.07-0.34, P < 0.001). Among DASH diet subcategories, intakes of vegetables (80%), fruits (88%), nuts and legumes (87%), and low-fat dairy (73%) decreased the risk of DN after adjustment for confounders (P < 0.001). CONCLUSIONS This study showed that the DASH diet is associated with lower odds of DN development in women with type 2 diabetes.
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Affiliation(s)
- Atieh Mirzababaei
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6117, Tehran, Iran
| | - Faezeh Abaj
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6117, Tehran, Iran
| | - Sara Hajishizari
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6117, Tehran, Iran
| | - Niki Bahrampour
- grid.411463.50000 0001 0706 2472Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Sahar Noori
- grid.411463.50000 0001 0706 2472Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Ahmad Mujtaba Barekzai
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6117, Tehran, Iran
| | - Dorsa Hosseininasab
- grid.411463.50000 0001 0706 2472Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Cain C. T. Clark
- grid.8096.70000000106754565Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB UK
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6117, Tehran, Iran. .,Food Microbiology Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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20
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Paradigm shift in lifestyle modification for solitary kidney after donor nephrectomy. Curr Opin Nephrol Hypertens 2023; 32:67-75. [PMID: 36444664 DOI: 10.1097/mnh.0000000000000853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Living donor kidney transplantation potentially leads to long-term complications including chronic kidney disease, end-stage kidney disease, elevated blood pressure, and pregnancy-associated hypertension. Given living donors generally do not have underlying medical conditions, lifestyle modifications, particularly dietary interventions may prevent those complications and improve their health outcomes. RECENT FINDINGS Glomerular hyperfiltration occurs as physiologic adaptation during an initial postdonor nephrectomy period. In the long-term, these adaptations may become pathologic consequences resulting from hyperfiltration-mediated kidney injury and ultimately secondary focal segmental glomerulosclerosis in the solitary kidney. Dietary interventions to slow a decline in kidney function include low protein intake of <0.8 g/kg/day and low sodium consumption of 2-4 g/day as well as certain health dietary patterns. There is no evidence regarding the quantity and quality of protein that can be recommended for living kidney donors and the same for sodium. Plant Dominant (PLADO) diets, Dietary Approaches to Stop Hypertension (DASH), Mediterranean, and vegetarian diets may be favorable for living kidney donors with solitary kidney but the evidence is still lacking. SUMMARY Although dietary interventions may provide benefits and kidney health for living kidney donors, further studies including clinical trials are required to incorporate them into clinical practice guidelines.
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21
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Sourij H, Edlinger R, Prischl FC, Kaser S, Horn S, Antlanger M, Paulweber B, Aberer F, Brix J, Cejka D, Stingl H, Kautzky-Willer A, Schmaldienst S, Clodi M, Rosenkranz A, Mayer G, Oberbauer R, Säemann M. [Diabetic kidney disease (update 2023) : Position paper of the Austrian Diabetes Association and the Austrian Society for Nephrology]. Wien Klin Wochenschr 2023; 135:182-194. [PMID: 37101040 PMCID: PMC10133372 DOI: 10.1007/s00508-022-02147-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 04/28/2023]
Abstract
Epidemiological investigations have shown that approximately 2-3% of all Austrians have diabetes mellitus with renal involvement, leaving 250,000 people in Austria affected. The risk of occurrence and progression of this disease can be attenuated by lifestyle interventions as well as optimization of blood pressure, blood glucose control and special drug classes. The present article represents the joint recommendations of the Austrian Diabetes Association and the Austrian Society of Nephrology for the diagnostic and treatment strategies of diabetic kidney disease.
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Affiliation(s)
- Harald Sourij
- Klinische Abteilung für Endokrinologie und Diabetologie, Trials Unit für Interdisziplinäre Metabolische Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich.
| | - Roland Edlinger
- 3. Medizinische Abteilung mit Stoffwechselerkrankungen und Nephrologie, Klinik Hietzing, Wien, Österreich
| | - Friedrich C Prischl
- Abteilung für Innere Medizin IV, Klinikum Wels-Grieskirchen, Wels, Österreich
| | - Susanne Kaser
- Universitätsklinik für Innere Medizin I, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Sabine Horn
- Abteilung für Innere Medizin, LKH Villach, Villach, Österreich
| | - Marlies Antlanger
- Universitätsklinik für Innere Medizin 2, Kepler Universitätsklinikum Linz, Linz, Österreich
| | - Bernhard Paulweber
- Universitätsklinik für Innere Medizin I, Landeskrankenhaus Salzburg, Uniklinikum der PMU, Salzburg, Österreich
| | - Felix Aberer
- Klinische Abteilung für Endokrinologie und Diabetologie, Medizinische Universität Graz, Graz, Österreich
| | - Johanna Brix
- 1. Medizinischen Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
| | - Daniel Cejka
- Abteilung für Innere Medizin 3, Ordensklinikum Linz, Elisabethinen, Linz, Österreich
| | - Harald Stingl
- Abteilung für Innere Medizin, LKH Melk, Melk, Österreich
| | - Alexandra Kautzky-Willer
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | | | - Martin Clodi
- Abteilung für Innere Medizin, Krankenhaus Barmherzige Brüder Linz, Linz, Österreich
| | - Alexander Rosenkranz
- Klinische Abteilung für Nephrologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Gert Mayer
- Nephrologie und Hypertensiologie, Universitätsklinik für Innere Medizin IV, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Rainer Oberbauer
- Klinische Abteilung für Nephrologie und Dialyse, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Marcus Säemann
- 6. Medizinische Abteilung mit Nephrologie & Dialyse, Klinik Ottakring, Wien, Österreich
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22
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Tyson CC, Svetkey LP, Lin PH, Granados I, Kennedy D, Dunbar KT, Redd C, Bennett G, Boulware LE, Fish LJ. Self-Perceived Barriers and Facilitators to Dietary Approaches to Stop Hypertension Diet Adherence Among Black Americans With Chronic Kidney Disease: A Qualitative Study. J Ren Nutr 2023; 33:59-68. [PMID: 35597318 PMCID: PMC10344422 DOI: 10.1053/j.jrn.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/25/2022] [Accepted: 05/01/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE The Dietary Approaches to Stop Hypertension (DASH) eating plan improves hypertension in Black individuals and is associated with favorable chronic kidney disease (CKD) outcomes. Yet, adherence to DASH is low among US adults in general, particularly among Black Americans. We assessed perceptions about DASH, its cultural compatibility, and barriers and facilitators to DASH adherence in Black adults with CKD. DESIGN AND METHODS We conducted focus groups and semistructured individual interviews involving 22 Black men and women with CKD Stages 3-4 from outpatient clinics at a US academic medical center. Transcripts of audio-recorded interviews were analyzed using thematic analysis. RESULTS Among participants (2 focus groups [N = 8 and 5] and 9 individual interviews), 13 (59%) had CKD Stage 3, 13 (59%) were female, the median age was 61 years, and 19 (90%) had hypertension. After receiving information about DASH, participants perceived it as culturally compatible based on 3 emergent themes: (1) Black individuals already eat DASH-recommended foods ("Blacks eat pretty much like this"), (2) traditional recipes (e.g., southern or soul food) can be modified into healthy versions ("you can come up with decent substitutes to make it just as good"), and ( 3) diet is not uniform among Black individuals ("I can't say that I eat traditional"). Perceived barriers to DASH adherence included unfamiliarity with serving sizes, poor cooking skills, unsupportive household members, and high cost of healthy food. Eleven (52%) reported after paying monthly bills that they "rarely" or "never" had leftover money to purchase healthy food. Perceived facilitators included having local access to healthy food, living alone or with supportive household members, and having willpower and internal/external motivation for change. CONCLUSIONS Black adults with CKD viewed DASH as a healthy, culturally compatible diet. Recognizing that diet in Black adults is not uniform, interventions should emphasize person-centered, rather than stereotypically culture-centered, approaches to DASH adherence.
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Affiliation(s)
- Crystal C Tyson
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
| | - Laura P Svetkey
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Stedman Nutrition & Metabolism Center, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Pao-Hwa Lin
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Stedman Nutrition & Metabolism Center, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Isa Granados
- Duke Cancer Institute, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Kayla T Dunbar
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Cynthia Redd
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Gary Bennett
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Department of Psychology and Neuroscience, Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
| | - L Ebony Boulware
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Laura J Fish
- Duke Cancer Institute, Duke University, Durham, North Carolina; Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina
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Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
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Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
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Ravikumar NPG, Pao AC, Raphael KL. Acid-Mediated Kidney Injury Across the Spectrum of Metabolic Acidosis. Adv Chronic Kidney Dis 2022; 29:406-415. [PMID: 36175078 DOI: 10.1053/j.ackd.2022.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/15/2022] [Accepted: 04/25/2022] [Indexed: 01/25/2023]
Abstract
Metabolic acidosis affects about 15% of patients with chronic kidney disease. As kidney function declines, the kidneys progressively fail to eliminate acid, primarily reflected by a decrease in ammonium and titratable acid excretion. Several studies have shown that the net acid load remains unchanged in patients with reduced kidney function; the ensuing acid accumulation can precede overt metabolic acidosis, and thus, indicators of urinary acid or potential base excretion, such as ammonium and citrate, may serve as early signals of impending metabolic acidosis. Acid retention, with or without overt metabolic acidosis, initiates compensatory responses that can promote tubulointerstitial fibrosis via intrarenal complement activation and upregulation of endothelin-1, angiotensin II, and aldosterone pathways. The net effect is a cycle between acid accumulation and kidney injury. Results from small- to medium-sized interventional trials suggest that interrupting this cycle through base administration can prevent further kidney injury. While these findings inform current clinical practice guidelines, large-scale clinical trials are still necessary to prove that base therapy can limit chronic kidney disease progression or associated adverse events.
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Affiliation(s)
- Naveen P G Ravikumar
- Division of Nephrology & Hypertension, Department of Medicine, Oregon Health & Science University, Portland, OR; Veterans Affairs Portland Health Care System, Portland, OR
| | - Alan C Pao
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Kalani L Raphael
- Division of Nephrology & Hypertension, Department of Medicine, Oregon Health & Science University, Portland, OR; Veterans Affairs Portland Health Care System, Portland, OR.
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Garagarza C, Valente A, Caetano C, Ramos I, Sebastião J, Pinto M, Oliveira T, Ferreira A, Guerreiro CS. Potassium Intake-(Un)Expected Non-Predictor of Higher Serum Potassium Levels in Hemodialysis DASH Diet Consumers. Nutrients 2022; 14:nu14102071. [PMID: 35631212 PMCID: PMC9146185 DOI: 10.3390/nu14102071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 02/01/2023] Open
Abstract
As high serum potassium levels can lead to adverse outcomes in hemodialysis (HD) patients, dietary potassium is frequently restricted in these patients. However, recent studies have questioned whether dietary potassium really affects serum potassium levels. The dietary approaches to stop hypertension (DASH) diet is considered a healthy dietary pattern that has been related to lower risk of developing end-stage kidney disease. The aim of this study was to analyze the association between a dietary pattern with high content of potassium-rich foods and serum potassium levels in HD patients. This was an observational, cross-sectional, multicenter study with 582 HD patients from 37 dialysis centers. Clinical and biochemical data were registered. Dietary intake was obtained using the Food Frequency Questionnaire. Adherence to the DASH dietary pattern was obtained from Fung’s DASH index. All statistical tests were performed using SPSS 26.0 software. A p-value lower than 0.05 was considered statistically significant. Patients’ mean age was 67.8 ± 17.7 years and median HD vintage was 65 (43−104) months. Mean serum potassium was 5.3 ± 0.67 mEq/L, dietary potassium intake was 2465 ± 1005 mg/day and mean Fung´s Dash Index was 23.9 ± 3.9. Compared to the lower adherence to the DASH dietary pattern, patients with a higher adherence to the DASH dietary pattern were older (p < 0.001); presented lower serum potassium (p = 0.021), serum sodium (p = 0.028), total fat intake (p = 0.001) and sodium intake (p < 0.001); and had higher carbohydrate intake (p < 0.001), fiber intake (p < 0.001), potassium intake (p < 0.001), phosphorus intake (p < 0.001) and body mass index (p = 0.002). A higher adherence to this dietary pattern was a predictor of lower serum potassium levels (p = 0.004), even in the adjusted model (p = 0.016). Following the DASH dietary pattern, which is rich in potassium, is not associated with increased serum potassium levels in HD patients. Furthermore, a higher adherence to the DASH dietary pattern predicts lower serum potassium levels. Therefore, generalized dietary potassium restrictions may not be adequate, at least for those with a DASH diet plan.
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Affiliation(s)
- Cristina Garagarza
- Nutrition Department, Nephrocare, 1250-191 Lisbon, Portugal; (A.V.); (C.C.); (I.R.); (J.S.); (M.P.); (T.O.)
- Nutrition Laboratory, Faculty of Medicine, Lisbon University, 1649-004 Lisbon, Portugal;
- Correspondence:
| | - Ana Valente
- Nutrition Department, Nephrocare, 1250-191 Lisbon, Portugal; (A.V.); (C.C.); (I.R.); (J.S.); (M.P.); (T.O.)
| | - Cristina Caetano
- Nutrition Department, Nephrocare, 1250-191 Lisbon, Portugal; (A.V.); (C.C.); (I.R.); (J.S.); (M.P.); (T.O.)
| | - Inês Ramos
- Nutrition Department, Nephrocare, 1250-191 Lisbon, Portugal; (A.V.); (C.C.); (I.R.); (J.S.); (M.P.); (T.O.)
| | - Joana Sebastião
- Nutrition Department, Nephrocare, 1250-191 Lisbon, Portugal; (A.V.); (C.C.); (I.R.); (J.S.); (M.P.); (T.O.)
| | - Mariana Pinto
- Nutrition Department, Nephrocare, 1250-191 Lisbon, Portugal; (A.V.); (C.C.); (I.R.); (J.S.); (M.P.); (T.O.)
| | - Telma Oliveira
- Nutrition Department, Nephrocare, 1250-191 Lisbon, Portugal; (A.V.); (C.C.); (I.R.); (J.S.); (M.P.); (T.O.)
| | - Aníbal Ferreira
- Nephrology Department, Dialysis Unit Vila Franca de Xira, 2600-076 Vila Franca de Xira, Portugal;
- Faculty of Medical Sciences, Nova Medical School, 1169-056 Lisbon, Portugal
| | - Catarina Sousa Guerreiro
- Nutrition Laboratory, Faculty of Medicine, Lisbon University, 1649-004 Lisbon, Portugal;
- Institute of Environmental Health, Faculty of Medicine, Lisbon University, 1649-004 Lisbon, Portugal
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Schrauben SJ, Apple BJ, Chang AR. Modifiable Lifestyle Behaviors and CKD Progression: A Narrative Review. KIDNEY360 2022; 3:752-778. [PMID: 35721622 DOI: 10.34067/kid.0003122021] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/07/2022] [Indexed: 12/19/2022]
Abstract
Living a healthy lifestyle is one of the safest and most cost-effective ways to improve one's quality of life and prevent and/or manage chronic disease. As such, current CKD management guidelines recommend that patients adhere to a healthy diet, perform ≥150 minutes per week of physical activity, manage their body weight, abstain from tobacco use, and limit alcohol. However, there are limited studies that investigate the relationship between these lifestyle factors and the progression of CKD among people with established CKD. In this narrative review, we examine the reported frequencies of health lifestyle behavior engagement among individuals with non-dialysis-dependent CKD and the existing literature that examines the influences of diet, physical activity, weight management, alcohol consumption, and tobacco use on the progression of CKD, as measured by decline in GFR, incident ESKD, or elevated proteinuria or albuminuria in individuals with CKD. Many of the available studies are limited by length of follow-up and small sample sizes, and meta-analyses were limited because the studies were sparse and had heterogeneous classifications of behaviors and/or referent groups and of CKD progression. Further research should be done to determine optimal methods to assess behaviors to better understand the levels at which healthy lifestyle behaviors are needed to slow CKD progression, to investigate the effect of combining multiple lifestyle behaviors on important clinical outcomes in CKD, and to develop effective techniques for behavior change. Despite the lack of evidence of efficacy from large trials on the ability of lifestyle behaviors to slow CKD progression, maintaining a healthy lifestyle remains a cornerstone of CKD management given the undisputed benefits of healthy lifestyle behaviors on cardiovascular health, BP control, and survival.
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Affiliation(s)
- Sarah J Schrauben
- Renal, Electrolyte-Hypertension Division, Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin J Apple
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Alex R Chang
- Kidney Health Research Institute, Department of Population Health Sciences, Geisinger Health, Danville, Pennsylvania
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Ertuglu LA, Demiray A, Afsar B, Ortiz A, Kanbay M. The Use of Healthy Eating Index 2015 and Healthy Beverage Index for Predicting and Modifying Cardiovascular and Renal Outcomes. Curr Nutr Rep 2022; 11:526-535. [PMID: 35476188 DOI: 10.1007/s13668-022-00415-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW With the wide recognition of the importance of dietary patterns rather than isolated nutrient groups on health outcomes, numerous diet quality indices have been designed to evaluate the overall food intake quality in the last two decades. RECENT FINDINGS The newest version of the Healthy Eating Index (HEI), HEI-2015, is a diet quality index that measures adherence to the recommendations of the 2015-2020 Dietary Guidelines for Americans. While the key nutrient groups are included in most diet quality indices, differences in other components and the scoring system differentiate HEI. The Healthy Beverage Index (HBI) was recently introduced. Previous literature has confirmed the association of the older versions of HEI with metabolic syndrome, inflammatory markers, and negative health outcomes including cardiovascular disease, type 2 diabetes mellitus, chronic kidney disease, and all-cause mortality. This review presents the existing evidence on the association of HEI-2015 and HBI with health markers and long-term outcome, provides guidance on their use, and identifies persisting challenges such as the development of simple, unified, and objective tools to characterize healthy diets in routine clinical practice.
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Affiliation(s)
- Lale A Ertuglu
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Atalay Demiray
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Baris Afsar
- Division of Nephrology, Department of Internal Medicine, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Alberto Ortiz
- Department of Medicine, School of Medicine, IIS-Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, Madrid, Spain
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, 34010, Istanbul, Turkey.
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Kim J, Dorgan JF, Kim H, Kwon O, Kim Y, Kim Y, Ko KS, Park YJ, Park H, Jung S. Association between Use of Nutrition Labels and Risk of Chronic Kidney Disease: The Korean National Health and Nutrition Examination Survey (KNHANES) 2008-2019. Nutrients 2022; 14:nu14091731. [PMID: 35565698 PMCID: PMC9105550 DOI: 10.3390/nu14091731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022] Open
Abstract
Nutrition labeling on food packages is increasingly found to promote healthier food choices associated with lower risk of chronic kidney disease (CKD). To examine associations between nutrition labels use and CKD risk, we conducted a nationally representative cross-sectional study of 32,080 adults from the 2008−2019 Korean National Health and Nutrition Examination Survey. Nutrition labels use was collected via self-reported questionnaires. Ascertainment and severity of CKD was determined by estimated glomerular filtration rate or proteinuria. In multivariable-adjusted (MV) logistic regression models, increasing awareness and use of nutrition labels was significantly associated with lower CKD risk (MV-adjusted OR “nutrition labels aware and use” group vs. “nutrition labels unaware” group [95% CIs]: 0.75 [0.59−0.95], Ptrend:0.03). This inverse association varied with CKD’s risk of progression, with 21% and 42% reduced risk observed for CKD subtypes with “moderate” and “high” risk of progression, respectively (all Ptrend ≤ 0.04). Furthermore, the nutrition labels use and CKD risk association significantly differed by age, with 35% reduced risk observed in the older group aged 49 years or older, but not in the younger group (Pinteraction < 0.001). Our results suggest increasing perception and use of nutrition labels may contribute to CKD prevention and its early asymptomatic progression, especially in older adults.
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Affiliation(s)
- Jonghee Kim
- Department of Clinical Healthcare, Ewha Womans University, Seoul 03760, Korea;
| | - Joanne F. Dorgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Hyesook Kim
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea; (H.K.); (O.K.); (Y.K.); (Y.K.); (K.S.K.); (Y.J.P.)
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Korea;
| | - Oran Kwon
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea; (H.K.); (O.K.); (Y.K.); (Y.K.); (K.S.K.); (Y.J.P.)
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Korea;
| | - Yangha Kim
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea; (H.K.); (O.K.); (Y.K.); (Y.K.); (K.S.K.); (Y.J.P.)
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Korea;
| | - Yuri Kim
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea; (H.K.); (O.K.); (Y.K.); (Y.K.); (K.S.K.); (Y.J.P.)
| | - Kwang Suk Ko
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea; (H.K.); (O.K.); (Y.K.); (Y.K.); (K.S.K.); (Y.J.P.)
| | - Yoon Jung Park
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea; (H.K.); (O.K.); (Y.K.); (Y.K.); (K.S.K.); (Y.J.P.)
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Korea;
| | - Hyesook Park
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Korea;
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Korea
| | - Seungyoun Jung
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea; (H.K.); (O.K.); (Y.K.); (Y.K.); (K.S.K.); (Y.J.P.)
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Korea;
- Correspondence: ; Tel.: +82-02-3277-2627
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Kwon YJ, Lee HS, Park GE, Lee JW. Association Between Dietary Fiber Intake and All-Cause and Cardiovascular Mortality in Middle Aged and Elderly Adults With Chronic Kidney Disease. Front Nutr 2022; 9:863391. [PMID: 35520287 PMCID: PMC9062480 DOI: 10.3389/fnut.2022.863391] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background and AimsDespite accumulating evidence on the benefits of dietary fiber in the general population, there is a lack of representative data on mortality in patients with chronic kidney disease (CKD). This study examined the role of dietary fiber intake on all-cause and cardiovascular mortality in patients with CKD using representative Korean cohort data.MethodsThe study included 3,892 participants with estimated glomerular filtration rates <60 mL/min/1.73 m2 from the Korean Genome and Epidemiology Study. Mortality status was followed by data linkage with national data sources. Nutritional status was assessed using a validated food frequency questionnaire. Dietary fiber was categorized into quintiles (Q). A multivariable Cox proportional hazards regression model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cardiovascular mortality.ResultsThe average daily fiber intake of patients with CKD was 5.1 g/day. During the 10.1-year follow-up period, 602 (149 cardiovascular) deaths were documented. The HR (95% CI) for all-cause mortality in the highest quintile compared with that in the lowest quintile was 0.63 (0.46–0.87) after adjusting for age, sex, BMI, smoking, alcohol intake, exercise, total calorie intake, hypertension, diabetes, and dyslipidemia (P = 0.005). The HR (95% CI) for cardiovascular mortality in the highest quintile compared with that in the lowest quintile was 0.56 (0.29–1.08) after adjusting for same confounders (P = 0.082).ConclusionIn conclusion, we observed an inverse association between dietary fiber intake and all-cause mortality in CKD patients. Small increments in fiber intake reduced the risk of all-cause mortality by 37%. This finding highlights the need for inexpensive but important dietary modification strategies for encouraging fiber intake in the Korean CKD population.
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Affiliation(s)
- Yu-Jin Kwon
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, South Korea
| | - Go Eun Park
- Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji-Won Lee
- Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- *Correspondence: Ji-Won Lee
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Rezazadegan M, Mirjalili F, Jalilpiran Y, Aziz M, Jayedi A, Setayesh L, Yekaninejad MS, Casazza K, Mirzaei K. The Association Between Dietary Diversity Score and Odds of Diabetic Nephropathy: A Case-Control Study. Front Nutr 2022; 9:767415. [PMID: 35433795 PMCID: PMC9012530 DOI: 10.3389/fnut.2022.767415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
A dietary diversity score (DDS) may be a useful strategy for monitoring risks associated with chronic diseases. Few studies have investigated the relationship between DDS and the progression to chronic kidney disease (CKD). A better understanding of the relationship between DDS and diabetic nephropathy (DN) may provide insight for monitoring the overall diet and clinical outcomes. This case-control study included 105 women with DN and 105 controls with age and diabetes duration-matched to evaluate the extent to which DDS is associated with DN. Dietary intake was assessed using the food frequency questionnaire (FFQ). DDS was calculated based on the method using five food groups: bread/grains, vegetables, fruits, meats, and dairies. Conditional logistic regression was performed to examine the association between DDS and odds of DN. Anthropometric measures and physical activity levels were evaluated using standard protocols. In a fully adjusted model [controlled for age, body mass index (BMI), energy intake, physical activity, diabetes duration, cardiovascular disease history, and drug usage], greater adherence (the third vs. the first tertile) to DDS [odds ratio (OR) = 0.13; 95% CI (0.05–0.35)], vegetables group [OR = 0.09; 95% CI (0.02–0.36)], and fruits group [OR = 0.05; 95% CI (0.01–0.20)] were significantly associated with lower odds of DN. However, we did not observe any significant relationship between other DDS components and the odds of DN. Our findings showed that higher DDS might be associated with reduced odds of DN. However, more prospective studies are warranted to confirm these findings.
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Affiliation(s)
- Mahsa Rezazadegan
- Department of Clinical Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Mirjalili
- Department of Clinical Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yahya Jalilpiran
- Department of Clinical Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Monireh Aziz
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Jayedi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Leila Setayesh
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Krista Casazza
- Marieb College of Health and Human Services, Florida Gulf Coast University, Florida, FL, United States
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- *Correspondence: Khadijeh Mirzaei
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Karimi K, Rahsepar M. Optimization of the Urea Removal in a Wearable Dialysis Device Using Nitrogen-Doped and Phosphorus-Doped Graphene. ACS OMEGA 2022; 7:4083-4094. [PMID: 35155902 PMCID: PMC8829914 DOI: 10.1021/acsomega.1c05495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/12/2022] [Indexed: 05/31/2023]
Abstract
Dialysis has been recognized as an essential treatment for end-stage renal disease (ESRD). This therapy, however, suffers from several limitations leading to numerous complications in the patients. As dialysis cannot completely substitute healthy kidney functions, the health condition of an ESRD patient is ultimately affected. Wearable artificial kidney (WAK) can resolve the restrictions of blood purification by the dialysis method. However, absorbing large amounts of urea produced in the body is one of the main challenges of these WAK and overcoming this is necessary to improve both functionality and footprint of the device. This study investigates the adsorption capabilities of N- and P-doped graphene nanosorbents for the first time by using molecular dynamic simulation. Urea removal on carbon nanosheets was simulated with different percentages of phosphorus and nitrogen dopants along with the pristine graphene. Specifically, the effects of interaction energy, adsorption percentage, gyration radius, hydrogen bonding, and other molecular dynamic analyses on urea removal were also investigated. The results from this study match well with the existing research, demonstrating the accuracy of the model. The results further suggest that graphene nanosheets doped by 10% nitrogen are likely the most effective in removing urea given that it is associated with the maximum radial distribution function (RDF), the maximum reduction in gyration radius, a high number of hydrogen bonds, and the most negative adsorption energy. This molecular study offers attractive suggestions for the novel adsorbents of artificial kidney devices and paves the way for the development of novel and enhanced urea adsorbents.
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Betz MV, Nemec KB, Zisman AL. Plant-based Diets in Kidney Disease: Nephrology Professionals' Perspective. J Ren Nutr 2021; 32:552-559. [PMID: 34776341 DOI: 10.1053/j.jrn.2021.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/26/2021] [Accepted: 09/27/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Plant-based diets can delay the progression of chronic kidney disease (CKD) and help manage complications and co-morbid conditions such as hypertension, acidosis, diabetes, and cardiovascular disease. However, it is unclear how often plant-based diets are recommended to patients with kidney disease. The objective of this study was to understand nephrology professionals' familiarity, perception, and recommendation of plant-based diets to people with kidney disease. DESIGN AND METHODS A survey to understand perception of recommendation of plant-based diets for patients with CKD was developed. Nephrology professionals from the National Kidney Foundation's member directory were e-mailed a link to complete the survey online. This directory includes professionals who work in a variety of nephrology settings, including both CKD and end-stage renal disease care. Survey items were evaluated with descriptive statistics. Differences across items were determined using chi-square tests and t-tests. RESULTS A total of 3,901 professionals were sent the survey, and 644 completed the survey. A majority were dietitians (58%) and worked in dialysis clinics (54%). Most (88%) had heard of using plant-based diets for kidney disease treatment, and a majority (88%) believed it could improve CKD management, cardiovascular disease (90%), hypertension (90%), diabetes (84%), high cholesterol (90%), and obesity (84%). Dietitians were more likely to report plant-based diets as beneficial for each health condition (P < .05). Professionals were most confident that a plant-based diet could help control hypertension (3.75 ± 0.99 on a scale of 1-5), compared with delaying progression of CKD (3.68 ± 1.15) or treating acidosis (3.68 ± 1.13). Dietitians felt more confident in their ability to plan a balanced plant-based diet compared with other specialties (3.49 vs. 2.74, P < .001). CONCLUSION Nephrology professionals who work in nondialysis-dependent CKD settings, and those who work with patients on dialysis, are aware of the benefits of plant-based diets in kidney disease. However, plant-based diets are not routinely being offered as a treatment option. Nephrology practices should work to increase dietitian referrals to offer patients support in transitioning to a plant-based diet.
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Affiliation(s)
- Melanie V Betz
- Chronic Kidney Disease Nutrition & Education Specialist, Section of Nephrology, University of Chicago Medicine, Chicago, IL.
| | - Kelly B Nemec
- Transplant Dietitian II, Transplant Surgery, University of Chicago Medicine, Chicago, IL
| | - Anna L Zisman
- Associate Professor of Medicine, Section of Nephrology, University of Chicago Medicine, Chicago, IL
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Jacobson MH, Wu Y, Liu M, Kannan K, Li AJ, Robinson M, Warady BA, Furth S, Trachtman H, Trasande L. Organophosphate pesticides and progression of chronic kidney disease among children: A prospective cohort study. ENVIRONMENT INTERNATIONAL 2021; 155:106597. [PMID: 33951537 PMCID: PMC8292180 DOI: 10.1016/j.envint.2021.106597] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND Growing evidence suggests that exposure to environmental chemicals, such as pesticides, impacts renal function and chronic kidney disease (CKD). However, it is not clear if pesticides may affect CKD progression and no studies exist in children. OBJECTIVES The objective of this study was to examine associations between serially measured urinary OP pesticide metabolites and clinical and laboratory measures of kidney function over time among children with CKD. METHODS This study used data on 618 participants enrolled in the CKD in Children study (CKiD), a cohort study of pediatric CKD patients from the US and Canada. Children were followed over an average of 3.0 years (standard deviation (SD) = 1.6) between 2005 and 2015. In serially collected urine samples over time, six nonspecific dialkyl phosphate (DAP) metabolites of OP pesticides were measured. Biomarkers of tubular injury (kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL)) and oxidant stress (8-hydroxy-2'-deoxyguanosine (8-OHdG) and F2-isoprostane) were determined in the same specimens. Estimated glomerular filtration rate (eGFR), proteinuria, and blood pressure were assessed annually. RESULTS DAPs were associated with increased KIM-1 and 8-OHdG throughout follow-up. A standard deviation increase in ∑diethyl metabolites was associated with increases of 11.9% (95% Confidence Interval (CI): 4.8%, 19.4%) and 13.2% (95% CI: 9.3%, 17.2%) in KIM-1 and 8-OHdG over time, respectively. DAPs were associated with lower eGFR at baseline and higher eGFR over subsequent years. CONCLUSIONS These findings provide preliminary evidence suggesting that urinary DAP metabolites are associated with subclinical kidney injury among children with CKD, which may signal the potential for clinical events to manifest in the future. The results from this study are significant from both a clinical and public health perspective, given that OP pesticide exposure is a modifiable risk factor.
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Affiliation(s)
- Melanie H Jacobson
- Department of Pediatrics, Division of Environmental Pediatrics, NYU Langone Medical Center, New York, NY, USA.
| | - Yinxiang Wu
- Department of Population Health, NYU Langone Medical Center, New York, NY, USA
| | - Mengling Liu
- Department of Pediatrics, Division of Environmental Pediatrics, NYU Langone Medical Center, New York, NY, USA; Department of Environmental Medicine, NYU Langone Medical Center, New York, NY
| | - Kurunthachalam Kannan
- Department of Pediatrics, Division of Environmental Pediatrics, NYU Langone Medical Center, New York, NY, USA
| | - Adela Jing Li
- Department of Pediatrics, Division of Environmental Pediatrics, NYU Langone Medical Center, New York, NY, USA
| | - Morgan Robinson
- Department of Pediatrics, Division of Environmental Pediatrics, NYU Langone Medical Center, New York, NY, USA
| | - Bradley A Warady
- Division of Nephrology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Susan Furth
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Howard Trachtman
- Department of Pediatrics, Division of Nephrology, NYU Langone Medical Center, New York, NY, USA
| | - Leonardo Trasande
- Department of Pediatrics, Division of Environmental Pediatrics, NYU Langone Medical Center, New York, NY, USA; Department of Population Health, NYU Langone Medical Center, New York, NY, USA; Department of Environmental Medicine, NYU Langone Medical Center, New York, NY; NYU Wagner School of Public Service, New York, NY, USA; NYU College of Global Public Health, New York, NY, USA
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Ryu H, Yang YJ, Kang E, Ahn C, Yang SJ, Oh KH. Greater adherence to the dietary approaches to stop hypertension dietary pattern is associated with preserved muscle strength in patients with autosomal dominant polycystic kidney disease: a single-center cross-sectional study. Nutr Res 2021; 93:99-110. [PMID: 34461351 DOI: 10.1016/j.nutres.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022]
Abstract
The present study aimed to determine whether certain diets lower the risk of low muscle strength in patients with autosomal dominant polycystic kidney disease (ADPKD). In this cross-sectional study, outpatient ADPKD patients were enrolled from a tertiary care hospital. Muscle strength was assessed on the basis of handgrip strength (HGS), and dietary pattern indices were calculated using dietary intake data. Among the 68 participants included in this study, 19 (27.9%) had low HGS. Cystatin C concentrations were significantly higher in all participants, and in women in the low compared to the normal HGS group in the unadjusted analyses (P = 0.004). Among analyzed dietary pattern indices, the Dietary Approaches to Stop Hypertension (DASH) score was lower, for all participants and men, in the low compared to the normal HGS group (P < 0.05). Especially, the component score for whole grains of the DASH score was significantly lower in men in the low compared to the normal HGS group in unadjusted analyses. The DASH score was positively correlated with HGS in men (r = 0.387, P = 0.046). In addition, logistic regression analysis showed that the DASH score was negatively associated with low HGS, for all participants (odds ratio = 0.851, P = 0.049) and men (odds ratio = 0.716, P = 0.043), after adjusting for age, sex, and body weight. These findings suggest that the DASH dietary pattern may promote the preservation of muscle strength in ADPKD patients. The DASH diet can be considered as a nutritional strategy to maintain muscle strength and prevent sarcopenia in ADPKD patients.
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Affiliation(s)
- Hyunjin Ryu
- Department of Internal Medicine, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Yun Jung Yang
- Department of Food and Nutrition, Seoul Women's University, Seoul, 01797, Republic of Korea
| | - Eunjeong Kang
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Curie Ahn
- Department of Internal Medicine, National Medical Center, Seoul, 04564, Republic of Korea
| | - Soo Jin Yang
- Department of Food and Nutrition, Seoul Women's University, Seoul, 01797, Republic of Korea.
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, 03080, Republic of Korea.
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Eckert I, Koehler IC, Bauer J, Busnello FM, Silva FM. Effects of different sources of dietary protein on markers of kidney function in individuals with diabetes: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev 2021; 80:812-825. [PMID: 34338778 DOI: 10.1093/nutrit/nuab042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT The type of dietary protein may modulate markers of diabetic kidney disease; however, no attempt to summarize the evidence from randomized controlled trials (RCTs) has been performed to date. OBJECTIVE To assess the effects of different types of dietary protein on urinary albumin excretion and glomerular filtration rate in individuals with diabetes. DATA SOURCES MEDLINE, EMBASE, and Scopus were searched for all published RCTs, with no language restriction, up to July 2020. DATA EXTRACTION Study selection and data extraction were performed independently by 3 authors. Risk of bias was assessed independently by 2 authors, and the GRADE approach was used to assess the quality of the evidence. RESULTS Twelve RCTs were included, of which 11 (involving 228 participants) were compiled in meta-analyses of random-effects models. Interventions consisted of diets emphasizing plant or white meat protein, with reduced intake of animal or red meat protein. Pooled data from crossover trials (n = 8) favored intervention diets for urinary albumin excretion (ratio of means, 0.86; 95% confidence interval 0.80 to 0.94; I2 = 4%) and glomerular filtration rate (ratio of means, 0.90; 95% confidence interval 0.87 to 0.94; I2 = 45%), compared with control diets. Results from parallel-design studies (n = 3), however, were not statistically significant for any outcome. The quality of the evidence ranged from very low to moderate, and most studies were judged with at least some concerns in terms of risk of bias. CONCLUSION This meta-analysis found weak evidence for small to moderate improvements in markers of kidney function in favor of interventions with lower animal protein (or red meat protein) compared with usual diets in short-term crossover trials. These findings require confirmation in well-designed randomized controlled trials.
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Affiliation(s)
- Igor Eckert
- I. Eckert is with the Undergraduate Nutrition Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. I.C. Koehler is with the Undergraduate Medical Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. J. Bauer is with the Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. F.M. Busnello and F.M. Silva are with the Department of Nutrition and Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil
| | - Igor C Koehler
- I. Eckert is with the Undergraduate Nutrition Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. I.C. Koehler is with the Undergraduate Medical Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. J. Bauer is with the Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. F.M. Busnello and F.M. Silva are with the Department of Nutrition and Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil
| | - Julia Bauer
- I. Eckert is with the Undergraduate Nutrition Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. I.C. Koehler is with the Undergraduate Medical Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. J. Bauer is with the Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. F.M. Busnello and F.M. Silva are with the Department of Nutrition and Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil
| | - Fernanda M Busnello
- I. Eckert is with the Undergraduate Nutrition Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. I.C. Koehler is with the Undergraduate Medical Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. J. Bauer is with the Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. F.M. Busnello and F.M. Silva are with the Department of Nutrition and Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil
| | - Flávia M Silva
- I. Eckert is with the Undergraduate Nutrition Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. I.C. Koehler is with the Undergraduate Medical Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. J. Bauer is with the Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. F.M. Busnello and F.M. Silva are with the Department of Nutrition and Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil
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36
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Abstract
Acid-related injury from chronic metabolic acidosis is recognized through growing evidence of its deleterious effects, including kidney and other organ injury. Progressive acid accumulation precedes the signature manifestation of chronic metabolic acidosis, decreased plasma bicarbonate concentration. Acid accumulation that is not enough to manifest as metabolic acidosis, known as eubicarbonatemic acidosis, also appears to cause kidney injury, with exacerbated progression of CKD. Chronic engagement of mechanisms to mitigate the acid challenge from Western-type diets also appears to cause kidney injury. Rather than considering chronic metabolic acidosis as the only acid-related condition requiring intervention to reduce kidney injury, this review supports consideration of acid-related injury as a continuum. This "acid stress" continuum has chronic metabolic acidosis at its most extreme end, and high-acid-producing diets at its less extreme, yet detrimental, end.
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Affiliation(s)
- Donald E. Wesson
- Department of Internal Medicine, Texas A&M Health Science Center College of Medicine, Dallas, Texas
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37
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Rhee CM, Kalantar-Zadeh K, Moore LW. Medical Nutrition Therapy for Diabetic Kidney Disease. J Ren Nutr 2021; 31:229-232. [PMID: 33990265 DOI: 10.1053/j.jrn.2021.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/13/2021] [Indexed: 12/22/2022] Open
Affiliation(s)
- Connie M Rhee
- University of California Irvine, Orange, California.
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38
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Quintela BCSF, Carioca AAF, de Oliveira JGR, Fraser SDS, da Silva Junior GB. Dietary patterns and chronic kidney disease outcomes: A systematic review. Nephrology (Carlton) 2021; 26:603-612. [PMID: 33864650 DOI: 10.1111/nep.13883] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 07/09/2020] [Accepted: 04/14/2021] [Indexed: 01/11/2023]
Abstract
Chronic kidney disease (CKD) is a serious public health problem and its prevalence is growing in many countries, often related to issues resulting from the lifestyle in growing economies and the population's life expectancy. Nutritional therapy is a beneficial but still neglected strategy for preventing CKD and delaying disease progression. The aim of this study was to assess the association of dietary patterns with CKD development and progression. Observational studies conducted in adult humans and the correlation between the adopted dietary pattern and prevalent and incident cases of CKD were assessed. A significant association was observed between unhealthy dietary patterns and an increased risk of developing or worsening CKD, as well as an adverse effect. Whereas healthy eating patterns characterized by the consumption of fruit, vegetables and dietary fibre showed nephroprotective outcomes.
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Affiliation(s)
| | | | | | - Simon D S Fraser
- Academic Unit of Primary Care and Population Science, Faculty of Medicine, University of Southampton, Southampton, Hampshire, United Kingdom
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39
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Miri Jahromi A, Zandi P, Khedri M, Ghasemy E, Maleki R, Tayebi L. Molecular insight into optimizing the N- and P-doped fullerenes for urea removal in wearable artificial kidneys. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:49. [PMID: 33891249 PMCID: PMC8065003 DOI: 10.1007/s10856-021-06525-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/01/2021] [Indexed: 06/12/2023]
Abstract
Urea is the result of the breakdown of proteins in the liver, the excess of which circulates in the blood and is adsorbed by the kidneys. However, in the case of kidney diseases, some products, specifically urea, cannot be removed from the blood by the kidneys and causes serious health problems. The end-stage renal disease (ESRD) patients are not able to purify their blood, which endangers their life. ESRD patients require dialysis, a costly and difficult method of urea removal from the blood. Wearable artificial kidneys (WAKs) are consequently designed to remove the waste from blood. Regarding the great amount of daily urea production in the body, WAKs should contain strong and selective urea adsorbents. Fullerenes-which possess fascinating chemical properties-have been considered herein to develop novel urea removal adsorbents. Molecular dynamics (MD) has enabled researchers to study the interaction of different materials and can pave the way toward facilitating the development of wearable devices. In this study, urea adsorption by N-doped fullerenes and P-doped fullerenes were assessed through MD simulations. The urea adsorption was simulated by five samples of fullerenes, with phosphorous and different nitrogen dopant contents. For comparing the urea adsorption capacity in the performed simulations, detailed characteristics-including the energy analysis, radius of gyration, radial distribution function (RDF), root-mean-square fluctuation (RMSD), and H-bond analyses were investigated. It had been determined that the fullerene containing 8% nitrogen-with the highest reduction in the radius of gyration, the maximum RDF, a high adsorption energy, and a high number of hydrogen bonds-adsorbs urea more efficiently.
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Affiliation(s)
- Ahmad Miri Jahromi
- Computational Biology and Chemistry Group (CBCG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Pegah Zandi
- School of Metallurgy and Materials Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Mohammad Khedri
- Computational Biology and Chemistry Group (CBCG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Ebrahim Ghasemy
- Nanotechnology Department, School of New Technologies, Iran University of Science and Technology, Tehran, Iran
| | - Reza Maleki
- Computational Biology and Chemistry Group (CBCG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| | - Lobat Tayebi
- Marquette University School of Dentistry, Milwaukee, WI, 53233, USA.
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40
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Apetrii M, Timofte D, Voroneanu L, Covic A. Nutrition in Chronic Kidney Disease-The Role of Proteins and Specific Diets. Nutrients 2021; 13:956. [PMID: 33809492 PMCID: PMC7999704 DOI: 10.3390/nu13030956] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/04/2021] [Accepted: 03/12/2021] [Indexed: 12/18/2022] Open
Abstract
Chronic kidney disease (CKD) is a global public health burden, needing comprehensive management for preventing and delaying the progression to advanced CKD. The role of nutritional therapy as a strategy to slow CKD progression and uremia has been recommended for more than a century. Although a consistent body of evidence suggest a benefit of protein restriction therapy, patients' adherence and compliance have to be considered when prescribing nutritional therapy in advanced CKD patients. Therefore, these prescriptions need to be individualized since some patients may prefer to enjoy their food without restriction, despite knowing the potential importance of dietary therapy in reducing uremic manifestations, maintaining protein-energy status.
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Affiliation(s)
- Mugurel Apetrii
- Department of Nephrology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (M.A.); (L.V.); (A.C.)
| | - Daniel Timofte
- Surgical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Luminita Voroneanu
- Department of Nephrology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (M.A.); (L.V.); (A.C.)
| | - Adrian Covic
- Department of Nephrology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (M.A.); (L.V.); (A.C.)
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41
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Hu EA, Coresh J, Anderson CAM, Appel LJ, Grams ME, Crews DC, Mills KT, He J, Scialla J, Rahman M, Navaneethan SD, Lash JP, Ricardo AC, Feldman HI, Weir MR, Shou H, Rebholz CM. Adherence to Healthy Dietary Patterns and Risk of CKD Progression and All-Cause Mortality: Findings From the CRIC (Chronic Renal Insufficiency Cohort) Study. Am J Kidney Dis 2021; 77:235-244. [PMID: 32768632 PMCID: PMC7855760 DOI: 10.1053/j.ajkd.2020.04.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/23/2020] [Indexed: 02/07/2023]
Abstract
RATIONALE & OBJECTIVE Current dietary guidelines recommend that patients with chronic kidney disease (CKD) restrict individual nutrients, such as sodium, potassium, phosphorus, and protein. This approach can be difficult for patients to implement and ignores important nutrient interactions. Dietary patterns are an alternative method to intervene on diet. Our objective was to define the associations of 4 healthy dietary patterns with risk for CKD progression and all-cause mortality among people with CKD. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 2,403 participants aged 21 to 74 years with estimated glomerular filtration rates of 20 to 70mL/min/1.73m2 and dietary data in the Chronic Renal Insufficiency Cohort (CRIC) Study. EXPOSURES Healthy Eating Index-2015, Alternative Healthy Eating Index-2010, alternate Mediterranean diet (aMed), and Dietary Approaches to Stop Hypertension (DASH) diet scores were calculated from food frequency questionnaires. OUTCOMES (1) CKD progression defined as≥50% estimated glomerular filtration rate decline, kidney transplantation, or dialysis and (2) all-cause mortality. ANALYTICAL APPROACH Cox proportional hazards regression models adjusted for demographic, lifestyle, and clinical covariates to estimate hazard ratios (HRs) and 95% CIs. RESULTS There were 855 cases of CKD progression and 773 deaths during a maximum of 14 years. Compared with participants with the lowest adherence, the most highly adherent tertile of Alternative Healthy Eating Index-2010, aMed, and DASH had lower adjusted risk for CKD progression, with the strongest results for aMed (HR, 0.75; 95% CI, 0.62-0.90). Compared with participants with the lowest adherence, the highest adherence tertiles for all scores had lower adjusted risk for all-cause mortality for each index (24%-31% lower risk). LIMITATIONS Self-reported dietary intake. CONCLUSIONS Greater adherence to several healthy dietary patterns is associated with lower risk for CKD progression and all-cause mortality among people with CKD. Guidance to adopt healthy dietary patterns can be considered as a strategy for managing CKD.
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Affiliation(s)
- Emily A Hu
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Cheryl A M Anderson
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Morgan E Grams
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD; Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Deidra C Crews
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD; Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Katherine T Mills
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Julia Scialla
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA; Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA
| | - Mahboob Rahman
- Division of Nephrology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | - James P Lash
- Department of Medicine, University of Illinois, Chicago, IL
| | - Ana C Ricardo
- Department of Medicine, University of Illinois, Chicago, IL
| | - Harold I Feldman
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Matthew R Weir
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD
| | - Haochang Shou
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Casey M Rebholz
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
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42
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Silva Junior GB, Fraser SDS, Néri AKM, Xavier RMF, Mota RMS, Lopes AA, Mill JG, Barreto SM, Luft VC, Chor D, Santos CAST, Lotufo PA, Matos SMA. Association between dietary patterns and renal function in a cross-sectional study using baseline data from the ELSA-Brasil cohort. ACTA ACUST UNITED AC 2020; 53:e10230. [PMID: 33146283 PMCID: PMC7643924 DOI: 10.1590/1414-431x202010230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/24/2020] [Indexed: 01/16/2023]
Abstract
Previous analyses of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) identified four main dietary patterns (DP). The aim of this study was to explore the association between the previously defined DP and renal function (RF). A cross-sectional study using the ELSA-Brasil baseline data was carried out. DP (“traditional”, “fruits and vegetables”, “bakery”, and “low sugar/low fat), metabolic syndrome (MS) using the Joint Interim Statement criteria, microalbuminuria (MA), and glomerular filtration rate (eGFR) through the CKD-EPI equation were evaluated. Abnormal RF was defined as eGFR<60 mL·min-1·(1.73 m2)-1 and MA≥3.0 mg/dL. Factors associated with RF were determined and mediation analysis was performed to investigate the association between DP, MS, and RF. A total of 15,105 participants were recruited, with a mean age of 52±9 years; 8,134 participants (54%) were females. The mediation analysis identified indirect associations between “bakery” and “fruits and vegetables”, and both were associated with decreased eGFR and albuminuria in both genders, compared with “traditional” and “low sugar/low fat” patterns in the general population. There was a direct association of the “bakery” pattern with MA in men (OR: 1.17, 95%CI: 1.92-1.48). The “fruits and vegetables” pattern also showed a direct association with reduced eGFR in women (OR: 1.65, 95%CI: 1.28-2.12), although there was no significance after adjustment. The “fruits and vegetables” and “bakery” DPs were associated with renal dysfunction. The only independent, direct association was between “bakery” DP and MA in men, raising concerns about DP and renal damage in men.
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Affiliation(s)
- G B Silva Junior
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brasil.,Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza, CE, Brasil
| | - S D S Fraser
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - A K M Néri
- Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza, CE, Brasil
| | - R M F Xavier
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brasil.,Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza, CE, Brasil
| | - R M S Mota
- Departamento de Estatística e Matemática Aplicada, Centro de Ciências, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - A A Lopes
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brasil
| | - J G Mill
- Departamento de Ciências Fisiológicas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - S M Barreto
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - V C Luft
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - D Chor
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - C A S T Santos
- Laboratório de Epidemiologia Molecular e Bioestatísticas, Centro de Pesquisa Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brasil
| | - P A Lotufo
- Divisão de Medicina Interna, Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - S M A Matos
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brasil
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43
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Yazdi F, Morreale P, Reisin E. First Course DASH, Second Course Mediterranean: Comparing Renal Outcomes for Two “Heart-Healthy” Diets. Curr Hypertens Rep 2020; 22:54. [DOI: 10.1007/s11906-020-01054-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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44
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Raphael KL. The Dietary Approaches to Stop Hypertension (DASH) diet in chronic kidney disease: should we embrace it? Kidney Int 2020; 95:1296-1298. [PMID: 31122706 DOI: 10.1016/j.kint.2019.01.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 01/29/2019] [Indexed: 01/16/2023]
Abstract
The Dietary Approaches to Stop Hypertension (DASH) diet lowers blood pressure and cardiovascular disease risk. In this issue, Banerjee et al. report that the DASH diet is associated with lower risk of end-stage kidney disease in individuals with stage 3 chronic kidney disease and hypertension. This association was particulary strong among those with diabetes. The DASH diet may have an important role in preventing end-stage kidney disease in select individuals with chronic kidney disease.
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Affiliation(s)
- Kalani L Raphael
- Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA; Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah, USA.
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45
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Carrero JJ, González-Ortiz A, Avesani CM, Bakker SJL, Bellizzi V, Chauveau P, Clase CM, Cupisti A, Espinosa-Cuevas A, Molina P, Moreau K, Piccoli GB, Post A, Sezer S, Fouque D. Plant-based diets to manage the risks and complications of chronic kidney disease. Nat Rev Nephrol 2020; 16:525-542. [PMID: 32528189 DOI: 10.1038/s41581-020-0297-2] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2020] [Indexed: 02/07/2023]
Abstract
Traditional dietary recommendations for patients with chronic kidney disease (CKD) focus on the quantity of nutrients consumed. Without appropriate dietary counselling, these restrictions can result in a low intake of fruits and vegetables and a lack of diversity in the diet. Plant nutrients and plant-based diets could have beneficial effects in patients with CKD: increased fibre intake shifts the gut microbiota towards reduced production of uraemic toxins; plant fats, particularly olive oil, have anti-atherogenic effects; plant anions might mitigate metabolic acidosis and slow CKD progression; and as plant phosphorus has a lower bioavailability than animal phosphorus, plant-based diets might enable better control of hyperphosphataemia. Current evidence suggests that promoting the adoption of plant-based diets has few risks but potential benefits for the primary prevention of CKD, as well as for delaying progression in patients with CKD G3-5. These diets might also help to manage and prevent some of the symptoms and metabolic complications of CKD. We suggest that restriction of plant foods as a strategy to prevent hyperkalaemia or undernutrition should be individualized to avoid depriving patients with CKD of these potential beneficial effects of plant-based diets. However, research is needed to address knowledge gaps, particularly regarding the relevance and extent of diet-induced hyperkalaemia in patients undergoing dialysis.
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Affiliation(s)
- Juan J Carrero
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Ailema González-Ortiz
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador, Zubirán, Mexico
| | - Carla M Avesani
- Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Vincenzo Bellizzi
- Nephrology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Philippe Chauveau
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux et Aurad-Aquitaine, Bordeaux, France
| | - Catherine M Clase
- Departments of Medicine and Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Angeles Espinosa-Cuevas
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador, Zubirán, Mexico
| | - Pablo Molina
- Department of Nephrology, Hospital Universitari Dr Peset, Universitat de València, València, Spain
| | - Karine Moreau
- Renal transplant unit, Pellegrin Hospital, Bordeaux, France
| | - Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.,Nephrologie, Centre Hospitalier Le Mans, Le Mans, France
| | - Adrian Post
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Siren Sezer
- Department of Nephrology, Baskent University School of Medicine, Ankara, Turkey
| | - Denis Fouque
- Department of Nephrology, Université de Lyon, Carmen, Hospital Lyon-Sud, Lyon, France
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46
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Conley M, Lioufas N, Toussaint ND, Elder GJ, Badve SV, Hawley CM, Pascoe EM, Pedagogos E, Valks A, Campbell KL. Dietary Phosphate Consumption in Australians With Stages 3b and 4 Chronic Kidney Disease. J Ren Nutr 2020; 31:155-163. [PMID: 32466982 DOI: 10.1053/j.jrn.2020.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/10/2020] [Accepted: 02/16/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Dietary phosphate modification is a common therapy to treat hyperphosphatemia in individuals with chronic kidney disease (CKD). However, current dietary intake and common food sources of phosphate typically consumed by individuals with CKD are not well characterized. This study examined a cohort of CKD patients to determine total dietary intake and common food sources of phosphate, including phosphate additives. DESIGN AND METHODS Participants with CKD stages 3b and 4 recruited to a substudy of the "IMPROVE-CKD (IMpact of Phosphate Reduction On Vascular End-points in Chronic Kidney Disease) Study" completed a 7-day self-administered diet record at baseline. Diet histories were analyzed and daily phosphate intakes determined using FoodWorks V.9 (Xyris). The proportion of phosphate contributed by each food group was determined using the AUSNUT 2011-2013 Food Classification System. Ingredient lists of packaged food items consumed were reviewed to determine frequency of phosphate-based additives. RESULTS Ninety participants (mean eGFR 26.5 mL/min/1.73 m2) completed this substudy. Mean phosphate intake of participants was 1544 ± 347 mg/day, with 96% of individuals exceeding the recommended daily intake of phosphate (1000 mg/day). The highest sources of dietary phosphate were milk-based products (25%) and meat and poultry products/dishes (25%). Phosphate-based food additives were identified in 39% (n = 331/845) of packaged foods consumed by participants. CONCLUSION Dietary phosphate intakes of Australians with CKD are high and come from a variety of sources. Managing dietary phosphate intake requires a patient-centered, tailored approach with an emphasis on maintaining nutritional adequacy and awareness of phosphate additives.
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Affiliation(s)
- Marguerite Conley
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
| | - Nicole Lioufas
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia; Department of Nephrology, Western Health, St Albans, Victoria, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia
| | - Grahame J Elder
- Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia; Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Sunil V Badve
- Department of Renal Medicine, St George Hospital, Sydney, NSW, Australia; Renal and Metabolic Division, George Institute for Global Health, University of New South Wales Medicine, Sydney, NSW, Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Eugenia Pedagogos
- Department of Nephrology, Western Health, St Albans, Victoria, Australia; Department of Nephrology, Alfred Health, Melbourne, Victoria, Australia
| | - Andrea Valks
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Katrina L Campbell
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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47
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Bansal S, Pergola PE. Current Management of Hyperkalemia in Patients on Dialysis. Kidney Int Rep 2020; 5:779-789. [PMID: 32518860 PMCID: PMC7270720 DOI: 10.1016/j.ekir.2020.02.1028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 02/07/2023] Open
Abstract
Patients with end-stage renal disease (ESRD) on maintenance dialysis have a high risk of developing hyperkalemia, generally defined as serum potassium (K+) concentrations of >5.0 mmol/l, particularly those undergoing maintenance hemodialysis. Currently, the key approaches to the management of hyperkalemia in patients with ESRD are dialysis, dietary K+ restriction, and avoidance of medications that increase hyperkalemia risk. In this review, we highlight the issues and challenges associated with effective management of hyperkalemia in patients undergoing maintenance dialysis using an illustrative case presentation. In addition, we examine the potential nondialysis options for the management of these patients, including use of the newer K+ binder agents patiromer and sodium zirconium cyclosilicate, which may reduce the need for the highly restrictive dialysis diet, with its own implication on nutritional status in patients with ESRD, as well as reducing the risk of potentially life-threatening hyperkalemia.
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Affiliation(s)
- Shweta Bansal
- Division of Nephrology, UT Health at San Antonio, San Antonio, Texas, USA
| | - Pablo E Pergola
- Division of Nephrology, UT Health at San Antonio, San Antonio, Texas, USA.,Renal Associates, P.A., San Antonio, Texas, USA
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Eimery S, Tangestani H, Mansouri S, Kordvarkaneh H, Rahimi-Foroushani A, Shab-Bidar S. Association between dietary patterns with kidney function and serum highly sensitive C-reactive protein in Tehranian elderly: An observational study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2020; 25:19. [PMID: 32174991 PMCID: PMC7053158 DOI: 10.4103/jrms.jrms_812_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 08/26/2019] [Accepted: 12/04/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Accumulating evidence suggests that diet is associated with kidney function. This study was carried out to examine the association between a posteriori dietary patterns and kidney function in older adults. MATERIALS AND METHODS In a cross-sectional study, 266 older adults, aged 60-83 years, were included. Anthropometric measures were recorded. Biochemical measurements of blood and urine samples were measured. Information on diet was collected using a validated semi-quantified food frequency questionnaire with 168 food items and factor analysis performed to derive major dietary patterns. Estimated glomerular filtration rate (eGFR) was calculated using the chronic kidney disease (CKD) Epidemiology Collaboration equation. RESULTS A total of 266 participants with mean body mass index (BMI) 29.75 ± 4.53 kg/m2 and age, 66.2 ± 5.3 years, were included in the current study. Three major dietary patterns were identified using factor analysis based on intake data (28% of the total variance of food intake in the population). After adjustment for age, sex, BMI, and energy intake, we found a positive significant relationship between the first pattern and eGFR (P = 0.031). A positive significant association between adherence to the traditional dietary pattern and urine creatinine was also observed (P = 0.035). In addition, in logistic regression model and after control for covariates, a positive association was observed between adherence to traditional dietary pattern with odds of eGFR < 60 ml/min/1.73 m2 (P = 0.043) and urinary albumin-to-creatinine ratio ≥ 30 mg/g (P = 0.038). CONCLUSION It is concluded that higher adherence to the healthy dietary pattern may improve renal function while Iranian traditional pattern was associated with significantly increased odds of incident CKD and albuminuria.
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Affiliation(s)
- Saragol Eimery
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadith Tangestani
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Mansouri
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Kordvarkaneh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Rahimi-Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Mozaffari H, Ajabshir S, Alizadeh S. Dietary Approaches to Stop Hypertension and risk of chronic kidney disease: A systematic review and meta-analysis of observational studies. Clin Nutr 2019; 39:2035-2044. [PMID: 31669002 DOI: 10.1016/j.clnu.2019.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/16/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND & AIMS Dietary Approaches to Stop Hypertension (DASH) diet has been favorably linked to important risk factors associated with development of chronic kidney disease (CKD), such as insulin resistance, hypertension, and dyslipidemia. However, the protective role of DASH dietary patterns in development of CKD, as measured by estimated glomerular filtration rate (eGFR), remains inconsistent in the literature. The aim of the current systematic review was to summarize the findings of previous observational studies and quantify the potential association between DASH dietary patterns and the risk of CKD using meta-analysis. METHODS A comprehensive search was done with the use of MEDLINE, EMBASE, Web of Sciences, and Scopus databases to find relevant articles published prior to June 2019. Search terms included: ([Dietary Approaches to Stop Hypertension] OR [DASH]) AND ([Kidney Failure, Chronic] OR [Renal Insufficiency, Chronic] OR [Chronic Kidney Disease], OR [CKD] OR [End-Stage Renal Disease] OR [ESRD] OR [Kidney] OR [Renal]). To pool the risk estimates, fixed-effects and random-effects models were applied. Cochrane Q test was performed to detect sources of heterogeneity among the included studies. RESULTS Out of the seven studies included in the systematic review, six were eligible for inclusion in the meta-analysis. The total sample size was 568,213 participants including 16,694 cases of CKD. Combined risk estimates for 2 cross-sectional and 4 prospective cohort studies showed an inverse association between DASH dietary patterns and risk of CKD (Pooled risk estimate: 0.77, 95% CI 0.63-0.94; p = 0.01). Stratified analysis showed a marginally significant relationship between DASH dietary patterns and risk of CKD in prospective cohort studies (Pooled risk estimate: 0.79, 95% CI 0.61-1.01; p = 0.05), and no significant association in cross-sectional studies (Pooled risk estimate: 0.71, 95% CI 0.38-1.34; p = 0.29), respectively. A significant association was observed between DASH dietary patterns and risk of CKD in the studies extracted DASH based on nutrients (Pooled risk estimate: 0.78, 95% CI 0.63-0.97; p = 0.02), compared to the studies extracted DASH based on food groups (Pooled risk estimate: 0.66, 95% CI 0.28-1.58; p = 0.35). CONCLUSIONS The results of the present study showed a significant inverse association between DASH dietary patterns and the risk of developing CKD. Adherence to DASH dietary patterns might have protective effects against CKD development and progression. Further research is required to confirm the certainty of estimates.
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Affiliation(s)
- Hadis Mozaffari
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, Canada; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sahar Ajabshir
- Department of Cellular Biology and Pharmacology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
| | - Shahab Alizadeh
- Department of Clinical Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
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