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Yamamoto T, Isaka Y. Pathological mechanisms of kidney disease in ageing. Nat Rev Nephrol 2024; 20:603-615. [PMID: 39025993 DOI: 10.1038/s41581-024-00868-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/20/2024]
Abstract
The kidney is a metabolically active organ that requires energy to drive processes such as tubular reabsorption and secretion, and shows a decline in function with advancing age. Various molecular mechanisms, including genomic instability, telomere attrition, inflammation, autophagy, mitochondrial function, and changes to the sirtuin and Klotho signalling pathways, are recognized regulators of individual lifespan and pivotal factors that govern kidney ageing. Thus, mechanisms that contribute to ageing not only dictate renal outcomes but also exert a substantial influence over life expectancy. Conversely, kidney dysfunction, in the context of chronic kidney disease (CKD), precipitates an expedited ageing trajectory in individuals, leading to premature ageing and a disconnect between biological and chronological age. As CKD advances, age-related manifestations such as frailty become increasingly conspicuous. Hence, the pursuit of healthy ageing necessitates not only the management of age-related complications but also a comprehensive understanding of the processes and markers that underlie systemic ageing. Here, we examine the hallmarks of ageing, focusing on the mechanisms by which they affect kidney health and contribute to premature organ ageing. We also review diagnostic methodologies and interventions for premature ageing, with special consideration given to the potential of emerging therapeutic avenues to target age-related kidney diseases.
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Affiliation(s)
- Takeshi Yamamoto
- Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan.
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Avesani CM, Heimbürger O, Rubin C, Sallstrom T, Fáxen-Irving G, Lindholm B, Stenvinkel P. Plant-based diet in hyperkalemic chronic kidney disease patients receiving sodium zirconium cyclosilicate: a feasibility clinical trial. Am J Clin Nutr 2024; 120:719-726. [PMID: 39032787 DOI: 10.1016/j.ajcnut.2024.06.025] [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: 03/04/2024] [Revised: 06/25/2024] [Accepted: 06/28/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Plant-based diets (PBD) may induce hyperkalemia in chronic kidney disease (CKD) patients. OBJECTIVES We explored the safety and feasibility of PBD in hyperkalemic CKD patients receiving the potassium binder sodium zirconium cyclosilicate (SZC). METHODS In the current 6-wk trial, 26 hyperkalemic patients with CKD stage 4-5 not on dialysis received a low-protein low-potassium diet plus SZC for 3 wk and then a PBD with high potassium content delivered as a weekly food basket while continuing SZC for subsequent 3 wk. Plasma potassium was monitored weekly and SZC was titrated to achieve normokalemia. The 24-h urine excretion of potassium and sodium, 24-h food records, dietary quality, nutritional status, Bristol stool scale, Quality of life (QoL), and renal treatment satisfaction were assessed at baseline (week 0), week 3, and week 6. RESULTS Mean plasma potassium decreased from 5.5 to 4.4 mEq/L within 48-72 h after baseline, then rose to 4.7-5.0 mEq/L throughout the remaining study period following dose adjustments of SZC that matched the increased potassium intake of PBD from week 3 to week 6. Over the study period, 24-h urinary potassium excretion decreased from week 0 to week 3 and increased from week 3 to week 6. During the study, 58% of patients had fasting plasma potassium between 3.5 and 5.0 mEq/L and there was no episode of plasma potassium >6.5 mEq/L or <3.0 mEq/L during the study. P-carbon dioxide increased from baseline until week 6 (21 ± 2 to 23 ± 2 mEq/L; P = 0.002; mean ± SD), whereas remaining laboratory values remained unchanged. Fiber intake, dietary quality, the domain physical functioning from QoL, and 1 question of renal treatment satisfaction improved, whereas stool type and frequency did not change after starting PBD. CONCLUSIONS PBD in hyperkalemia-prone CKD patients receiving SZC improved dietary quality and increased the intake of healthy foods, whereas plasma potassium concentration remained stable within normal values for most patients. TRIAL REGISTRATION NUMBER This trial was registered at the https://clinicaltrials.gov/study/NCT04207203 as NCT04207203.
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Affiliation(s)
- Carla Maria Avesani
- Division of Renal Medicine, Baxter Novum, Department of Clinical Science Intervention and Technology. Karolinska Institutet, Solna, Sweden.
| | - Olof Heimbürger
- Division of Renal Medicine, Baxter Novum, Department of Clinical Science Intervention and Technology. Karolinska Institutet, Solna, Sweden
| | - Charlotta Rubin
- Medical Unit of Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden
| | | | - Gerd Fáxen-Irving
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine, Baxter Novum, Department of Clinical Science Intervention and Technology. Karolinska Institutet, Solna, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine, Baxter Novum, Department of Clinical Science Intervention and Technology. Karolinska Institutet, Solna, Sweden
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Heo S, Han M, Ryu H, Kang E, Kim M, Ahn C, Yang SJ, Oh KH. Compliance with a Healthful Plant-Based Diet Is Associated with Kidney Function in Patients with Autosomal Dominant Polycystic Kidney Disease. Nutrients 2024; 16:2749. [PMID: 39203885 PMCID: PMC11356780 DOI: 10.3390/nu16162749] [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: 07/26/2024] [Revised: 08/14/2024] [Accepted: 08/14/2024] [Indexed: 09/03/2024] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is a genetic kidney disorder with multiple cyst formation that progresses to chronic kidney disease (CKD) and end-stage kidney disease. Plant-based diets have attracted considerable attention because they may prevent CKD development. This study investigated whether adherence to a plant-based diet is associated with kidney function in patients with ADPKD. The overall plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI) were calculated using dietary intake data. Among 106 ADPKD patients, 37 (34.91%) were classified as having advanced CKD (eGFR < 60 mL/min/1.73 m2). The overall PDI and hPDI were lower, but the uPDI was higher in patients with advanced CKD than in those with early CKD. The hPDI was negatively correlated with the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio. Moreover, the hPDI was inversely associated with advanced CKD [odds ratio (OR): 0.117 (95% confidence interval (CI): 0.039-0.351), p < 0.001], and the uPDI was positively associated with advanced CKD [OR: 8.450 (95% CI: 2.810-25.409), p < 0.001]. The findings of the current study demonstrate that greater adherence to a healthful plant-based diet is associated with improved kidney function in ADPKD patients.
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Affiliation(s)
- Sumin Heo
- Department of Food and Nutrition, Seoul Women’s University, Seoul 01797, Republic of Korea
| | - Miyeun Han
- Department of Internal Medicine, National Medical Center, Seoul 04564, Republic of Korea
| | - Hyunjin Ryu
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Eunjeong Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Minsang Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, 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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Kim H, Rebholz CM. Plant-based diets for kidney disease prevention and treatment. Curr Opin Nephrol Hypertens 2024:00041552-990000000-00177. [PMID: 39115418 DOI: 10.1097/mnh.0000000000001015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
PURPOSE OF REVIEW Plant-based diets are associated with a lower risk of hypertension, diabetes, cardiovascular disease, and mortality. Using the most recent evidence, we critically appraised the role of plant-based diets in primary and secondary prevention of chronic kidney disease (CKD) with a focus on key nutritional factors (dietary acid load, phosphorus, potassium, sodium, and fiber). RECENT FINDINGS In healthy individuals, observational studies found that greater intake of plant protein and higher adherence to plant-based diets (overall, healthful, and provegetarian) was associated with a lower risk of CKD. In those with CKD, plant-based diets were associated with a lower risk of mortality, improved kidney function, and favorable metabolic profiles (fibroblast growth factor-23, uremic toxins, insulin sensitivity, inflammatory biomarkers). Only few studies reported nutrient content of plant-based diets. These studies found that plant-based diets had lower dietary acid load, lower or no significant difference in phosphorus and sodium, and higher potassium and fiber. One study reported that vegetarian diets were associated with severe vitamin D deficiency compared to nonvegetarian diets. SUMMARY Plant-based diets provide several benefits for prevention and management of CKD, with little risk for individuals with CKD. Incorporation of vitamin D rich foods in plant-based diets may be helpful.
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Affiliation(s)
- Hyunju Kim
- Department of Epidemiology
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington School of Public Health, Seattle, Washington
| | - Casey M Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Pradhan N, Delozier S, Brar S, Perez JA, Rahman M, Dobre M. Dietary Fiber Intake and Clinical Outcomes in Chronic Kidney Disease: A Report From the Chronic Renal Insufficiency Cohort Study. J Ren Nutr 2024:S1051-2276(24)00167-5. [PMID: 39074599 DOI: 10.1053/j.jrn.2024.07.014] [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: 06/30/2023] [Revised: 06/11/2024] [Accepted: 07/21/2024] [Indexed: 07/31/2024] Open
Abstract
OBJECTIVE Dietary interventions are the mainstay of chronic diseases prevention in general population, but the evidence to support such therapeutic approaches in patients with chronic kidney disease (CKD) is less robust. The objective of this study is to examine the association between dietary fiber intake and adverse cardiovascular and kidney outcomes and all-cause mortality in participants with CKD enrolled in the Chronic Renal Insufficiency Cohort study. DESIGN AND METHODS A total of 3791 Chronic Renal Insufficiency Cohort participants with self-reported dietary fiber intake were included in the analyses stratified by tertiles of dietary fiber at study baseline. Hazard ratios for occurrence of all-cause mortality, composite cardiovascular events and composite kidney events were calculated using Cox Proportional Hazards models adjusted for demographic, clinical, and laboratory characteristics, including levels of inflammatory markers, C-reactive protein and interleukin-6. RESULTS Mean daily dietary fiber intake was 15.2 g/day. During a median (standard deviation) follow up of 14.6 (4.4) years, 1074 deaths from any cause occurred. In multivariable adjusted models, participants in the middle and low dietary fiber tertiles had a 19% (hazard ratio [95% CI]), 1.19 [1.02, 1.39]) and 11% (1.11 [0.95, 1.31]) greater risk of death respectively, compared to those in the highest fiber intake tertile. No statistically significant associations were observed between dietary fiber intake and adverse cardiovascular and kidney outcomes. Higher dietary fiber intake was not significantly associated with lower levels of C-reactive protein and interleukin-6. CONCLUSION A lower intake of dietary fiber was not associated with all-cause mortality in participants with CKD after adjustments for kidney function and inflammatory biomarkers. There was no significant association between dietary fiber intake and adverse kidney and cardiovascular outcomes. Future randomized intervention trials are needed to identify whether a high dietary fiber intake translates into improved clinical outcomes in CKD.
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Affiliation(s)
- Nishigandha Pradhan
- Division of Nephrology and Hypertension, Case Western Reserve University, University Hospital Cleveland Medical Center, Cleveland, Ohio.
| | - Sarah Delozier
- Clinical Research Unit, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sumeet Brar
- Department of Medicine, Stanford University, Palo Alto, California
| | - Jaime Abraham Perez
- Clinical Research Unit, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Mahboob Rahman
- Division of Nephrology and Hypertension, Case Western Reserve University, University Hospital Cleveland Medical Center, Cleveland, Ohio
| | - Mirela Dobre
- Division of Nephrology and Hypertension, Case Western Reserve University, University Hospital Cleveland Medical Center, Cleveland, Ohio
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Wu Y, Chen J, Tao Y, Xiao M, Xiong J, Chen A, Ma X, Li L, Jia H, Zhang Q, Xue Y, Jia Y, Zheng Z. Association between dietary protein intake and mortality among patients with diabetic kidney disease. Diabetes Metab Syndr 2024; 18:103091. [PMID: 39084052 DOI: 10.1016/j.dsx.2024.103091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
AIMS This study aimed to investigate the association between dietary protein intake and mortality among patients with diabetic kidney disease. METHODS The research encompassed a total of 2901 participants diagnosed with diabetic kidney disease, drawn from the National Health and Nutrition Examination Survey (NHANES). To determine outcomes related to all-cause and cardiovascular mortality, connections were established with the National Death Index up until December 31, 2019. Estimations of hazard ratios (HRs) and their corresponding 95 % confidence intervals (CIs) were conducted using Cox proportional hazard ratio models. RESULTS During the 261,239 person-years of follow-up, 1236 deaths were recorded. After multivariate adjustment, the weighted hazard ratio (HR) and 95 % CIs for participants with 1.0-1.2 g/kg of protein intake was 0.65 (0.44, 0.96) for all-cause mortality. A higher proportion of animal protein intake was found to be associated with an increased mortality risk. Stratified analyses showed that higher protein intake benefited older participants. CONCLUSIONS In diabetic kidney disease patients, 1.0-1.2 g/kg of protein was associated with lower mortality and 0.6-1.2 g/kg of protein especially benefitted patients ≥60 years.
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Affiliation(s)
- Yichuan Wu
- Department of Endocrinology & Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China; De Feng Academy, Southern Medical University, Guangzhou, China.
| | - Jiaqi Chen
- Department of Endocrinology & Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Yuan Tao
- Department of Endocrinology & Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China; De Feng Academy, Southern Medical University, Guangzhou, China.
| | - Manlu Xiao
- Department of Endocrinology & Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Jingrong Xiong
- Department of Endocrinology & Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China; De Feng Academy, Southern Medical University, Guangzhou, China.
| | - Aomiao Chen
- Department of Endocrinology & Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China; De Feng Academy, Southern Medical University, Guangzhou, China.
| | - Xiaoqin Ma
- Department of Endocrinology & Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Linna Li
- Department of Endocrinology & Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Hongxia Jia
- Department of Endocrinology & Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Qian Zhang
- Department of Endocrinology & Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Yaoming Xue
- Department of Endocrinology & Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Yijie Jia
- Department of Endocrinology & Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China; De Feng Academy, Southern Medical University, Guangzhou, China.
| | - Zongji Zheng
- Department of Endocrinology & Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China; De Feng Academy, Southern Medical University, Guangzhou, China.
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Teng W, Zhou Z, Cao J, Guo Q. Recent Advances of Natural Pentacyclic Triterpenoids as Bioactive Delivery System for Synergetic Biological Applications. Foods 2024; 13:2226. [PMID: 39063310 PMCID: PMC11275325 DOI: 10.3390/foods13142226] [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: 06/17/2024] [Revised: 07/11/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Bioactive compounds have drawn much attention according to their various health benefits. However, poor dissolvability, low stability and limited bioavailability largely narrow their applications. Although a variety of nontoxic ingredients have been rapidly developed as vehicles to deliver bioactive compounds in the last few years, most of them are non-bioactive. Pentacyclic triterpenoids, owing to their unique self-assembly and co-assembly behaviors and different physiological functions, can construct bioactive carriers due to their higher biodegradability, biocompatibility and lower toxicity. In this paper, the basic classification, biological activities and physicochemical properties of pentacyclic triterpenoids were summarized. Additionally, applications of self-assembled and co-assembled pentacyclic triterpenoids as bioactive delivery systems to load bioactive components and future research directions were discussed. This study emphasizes the potential of pentacyclic triterpenoids as bioactive delivery systems, offering a new perspective for constructing self- or co-assemblies for further synergetic biological applications.
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Affiliation(s)
- Wendi Teng
- Key Laboratory of Geriatric Nutrition and Health, School of Food and Health, Beijing Technology and Business University, Beijing 100048, China; (W.T.); (Z.Z.); (J.C.)
| | - Zixiao Zhou
- Key Laboratory of Geriatric Nutrition and Health, School of Food and Health, Beijing Technology and Business University, Beijing 100048, China; (W.T.); (Z.Z.); (J.C.)
| | - Jinxuan Cao
- Key Laboratory of Geriatric Nutrition and Health, School of Food and Health, Beijing Technology and Business University, Beijing 100048, China; (W.T.); (Z.Z.); (J.C.)
| | - Qing Guo
- State Key Laboratory of Food Nutrition and Safety, School of Food Science and Technology, Tianjin University of Science and Technology, Tianjin 300457, China
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Tain YL, Chang CI, Hou CY, Chang-Chien GP, Lin SF, Hsu CN. Resveratrol Propionate Ester Supplement Exerts Antihypertensive Effect in Juvenile Rats Exposed to an Adenine Diet via Gut Microbiota Modulation. Nutrients 2024; 16:2131. [PMID: 38999878 PMCID: PMC11243104 DOI: 10.3390/nu16132131] [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: 05/28/2024] [Revised: 06/23/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
Resveratrol, acting as a prebiotic, and propionate, functioning as a postbiotic, hold promise for preventing hypertension in chronic kidney disease (CKD). Previously, we employed propionate to enhance the bioavailability of resveratrol through esterification, resulting in the production of a resveratrol propionate ester (RPE) mixture. In this study, we purified 3-O-propanoylresveratrol (RPE2) and 3,4'-di-O-propanoylresveratrol (RPE4) and investigated their protective effects in a juvenile rat adenine-induced CKD model. To this end, male Sprague Dawley rats aged three weeks (n = 40) were divided into five groups: control; CKD (rats fed adenine); CKRSV (CKD rats treated with 50 mg/L resveratrol); CDRPE2 (CKD rats treated with 25 mg/L RPE2); and CKRPE4 (CKD rats treated with 25 mg/L RPE 4). RPE2 and PRE4 similarly exhibited blood pressure-lowering effects comparable to those of resveratrol, along with increased nitric oxide (NO) availability. Furthermore, RPE2 and RPE4 positively influenced plasma short-chain fatty acid (SCFA) levels and induced distinct alterations in the gut microbial composition of adenine-fed juvenile rats. The supplementation of RPE2 and RPE4, by restoring NO, elevating SCFAs, and modulating the gut microbiota, holds potential for ameliorating CKD-induced hypertension.
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Affiliation(s)
- You-Lin Tain
- Division of Pediatric Nephrology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 330, Taiwan
| | - Chi-I Chang
- Department of Biological Science and Technology, National Pingtung University of Science and Technology, Pingtung 912, Taiwan
- Traditional Herbal Medicine Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
| | - Chih-Yao Hou
- Department of Seafood Science, National Kaohsiung University of Science and Technology, Kaohsiung 811, Taiwan
| | - Guo-Ping Chang-Chien
- Institute of Environmental Toxin and Emerging-Contaminant, Cheng Shiu University, Kaohsiung 833, Taiwan
- Super Micro Mass Research and Technology Center, Cheng Shiu University, Kaohsiung 833, Taiwan
- Center for Environmental Toxin and Emerging-Contaminant Research, Cheng Shiu University, Kaohsiung 833, Taiwan
| | - Shu-Fen Lin
- Institute of Environmental Toxin and Emerging-Contaminant, Cheng Shiu University, Kaohsiung 833, Taiwan
- Super Micro Mass Research and Technology Center, Cheng Shiu University, Kaohsiung 833, Taiwan
- Center for Environmental Toxin and Emerging-Contaminant Research, Cheng Shiu University, Kaohsiung 833, Taiwan
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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Francis M, Westerman KE, Manning AK, Ye K. Gene-vegetarianism interactions in calcium, estimated glomerular filtration rate, and testosterone identified in genome-wide analysis across 30 biomarkers. PLoS Genet 2024; 20:e1011288. [PMID: 38990837 PMCID: PMC11239071 DOI: 10.1371/journal.pgen.1011288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 05/03/2024] [Indexed: 07/13/2024] Open
Abstract
We examined the associations of vegetarianism with metabolic biomarkers using traditional and genetic epidemiology. First, we addressed inconsistencies in self-reported vegetarianism among UK Biobank participants by utilizing data from two dietary surveys to find a cohort of strict European vegetarians (N = 2,312). Vegetarians were matched 1:4 with nonvegetarians for non-genetic association analyses, revealing significant effects of vegetarianism in 15 of 30 biomarkers. Cholesterol measures plus vitamin D were significantly lower in vegetarians, while triglycerides were higher. A genome-wide association study revealed no genome-wide significant (GWS; 5×10-8) associations with vegetarian behavior. We performed genome-wide gene-vegetarianism interaction analyses for the biomarkers, and detected a GWS interaction impacting calcium at rs72952628 (P = 4.47×10-8). rs72952628 is in MMAA, a B12 metabolic pathway gene; B12 has major deficiency potential in vegetarians. Gene-based interaction tests revealed two significant genes, RNF168 in testosterone (P = 1.45×10-6) and DOCK4 in estimated glomerular filtration rate (eGFR) (P = 6.76×10-7), which have previously been associated with testicular and renal traits, respectively. These nutrigenetic findings indicate genotype can modify the associations between vegetarianism and health outcomes.
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Affiliation(s)
- Michael Francis
- Institute of Bioinformatics, University of Georgia, Athens, Georgia, United States of America
| | - Kenneth E. Westerman
- Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Boston, Massachusetts, United States of America
| | - Alisa K. Manning
- Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Boston, Massachusetts, United States of America
| | - Kaixiong Ye
- Institute of Bioinformatics, University of Georgia, Athens, Georgia, United States of America
- Department of Genetics, University of Georgia, Athens, Georgia, United States of America
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10
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Biruete A, Shin A, Kistler BM, Moe SM. Feeling gutted in chronic kidney disease (CKD): Gastrointestinal disorders and therapies to improve gastrointestinal health in individuals CKD, including those undergoing dialysis. Semin Dial 2024; 37:334-349. [PMID: 34708456 PMCID: PMC9043041 DOI: 10.1111/sdi.13030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/21/2021] [Indexed: 12/15/2022]
Abstract
Chronic kidney disease (CKD) affects 9.1% of the population worldwide. CKD may lead to structural and functional gastrointestinal alterations, including impairment in the intestinal barrier, digestion and absorption of nutrients, motility, and changes to the gut microbiome. These changes can lead to increased gastrointestinal symptoms in people with CKD, even in early grades of kidney dysfunction. Gastrointestinal symptoms have been associated with lower quality of life and reduced nutritional status. Therefore, there has been considerable interest in improving gastrointestinal health in this clinical population. Gastrointestinal health can be influenced by lifestyle and medications, particularly in advanced grades of kidney dysfunction. Therapies focused on gastrointestinal health have been studied, including the use of probiotics, prebiotics, and synbiotics, yielding limited and conflicting results. This review summarizes the alterations in the gastrointestinal tract structure and function and provides an overview of potential nutritional interventions that kidney disease professionals can provide to improve gastrointestinal health in individuals with CKD.
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Affiliation(s)
- Annabel Biruete
- Department of Nutrition and Dietetics, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrea Shin
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Brandon M. Kistler
- Department of Nutrition and Health Science, Ball State University, Muncie, Indiana, USA
| | - Sharon M. Moe
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Anatomy, Cell Biology, and Anatomy, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Liu WS, Liang SS, Cheng MM, Wu MT, Li SY, Cheng TT, Liu TY, Tsai CY, Lai YT, Lin CH, Wang HT, Tsou HH. How renal toxins respond to renal function deterioration and oral toxic adsorbent in pH-controlled releasing capsule. ENVIRONMENTAL TOXICOLOGY 2024; 39:3930-3943. [PMID: 38572829 DOI: 10.1002/tox.24248] [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: 01/02/2024] [Revised: 03/08/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024]
Abstract
The number of patients with chronic kidney disease (CKD) is increasing. Oral toxin adsorbents may provide some value. Several uremic toxins, including indoxyl sulfate (IS), p-cresol (PCS), acrolein, per- and poly-fluoroalkyl substances (PFAS), and inflammation markers (interleukin 6 [IL-6] and tumor necrosis factor [TNF]-alpha) have been shown to be related to CKD progression. A total of 81 patients taking oral activated charcoal toxin adsorbents (AC-134), which were embedded in capsules that dissolved in the terminal ileum, three times a day for 1 month, were recruited. The renal function, hemoglobulin (Hb), inflammation markers, three PFAS (PFOA, PFOS, and PFNA), and acrolein were quantified. Compared with the baseline, an improved glomerular filtration rate (GFR) and significantly lower acrolein were noted. Furthermore, the CKD stage 4 and 5 group had significantly higher concentrations of IS, PCS, IL-6, and TNF but lower levels of Hb and PFAS compared with the CKD Stage 3 group at baseline and after the intervention. Hb was increased only in the CKD Stage 3 group after the trial (p = .032). Acrolein did not differ between the different CKD stage groups. Patients with improved GFR (responders) (about 77%) and nonresponders had similar baseline GFR. Responders had higher acrolein and PFOA levels throughout the study and a more significant reduction in acrolein, indicating a better digestion function. Both the higher PFOA and lower acrolein may be related to improved eGFR (and possibly to improvements in proteinuria, which we did not measure. Proteinuria is associated with PFAS loss in the urine), AC-134 showed the potential to improve the GFR and decrease acrolein, which might better indicate renal function change. Future studies are needed with longer follow-ups.
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Affiliation(s)
- Wen-Sheng Liu
- Division of Nephrology, Department of Medicine, Taipei City Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- College of Science and Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Department of Special Education, University of Taipei, Taipei, Taiwan
| | - Shih-Shin Liang
- Institute of Biomedical Science, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Biotechnology, College of Life Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Mei Cheng
- Division of nephrology, Department of internal medicine, West Garden Hospital, Taipei, Taiwan
| | - Ming-Tsan Wu
- Department of internal medicine, Fu-Ling clinic, New Taipei City, Taiwan
| | - Szu-Yuan Li
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Division of Nephrology, and Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tien-Tien Cheng
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Tsung-Yun Liu
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Ching-Yao Tsai
- Institute of Public Health, Department of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
- Department of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yen-Ting Lai
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Nursing, College of Medical Technology and Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Chien-Hung Lin
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- College of Science and Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
- Division of Pediatric Immunology and Nephrology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiang-Tsui Wang
- Department of Pharmacology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Han-Hsing Tsou
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Kim Forest Enterprise Co., Ltd., New Taipei City, Taiwan
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12
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Xie C, Yang S, Li Y, Zhang M, Xu Q, Wan Z, Song L, Lv Y, Luo D, Li Q, Wang Y, Chen H, Mei S. Associations of exposure to organochlorine pesticides and polychlorinated biphenyls with chronic kidney disease among adults: the modifying effects of lifestyle. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:45192-45203. [PMID: 38961018 DOI: 10.1007/s11356-024-34201-0] [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: 01/25/2024] [Accepted: 06/27/2024] [Indexed: 07/05/2024]
Abstract
Exposure to organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) has been reported to be associated with renal impairment and chronic kidney disease (CKD). Nevertheless, the research results thus far have exhibited inconsistency, and the effect of lifestyle on their association is not clear. In this study, we assessed the correlation between serum OCPs/PCBs and CKD and renal function indicators including estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR) among 1721 Chinese adults. In order to further investigate the potential impact of lifestyle, we conducted joint associations of lifestyle and OCPs/PCBs on CKD. We found a negative correlation between p,p'-DDE and eGFR, while logistic regression results showed a positive correlation between PCB-153 and CKD (OR, 1.92; 95% CI, 1.21, 3.06). Quantile g-computation regression analyses showed that the association between co-exposure to OCPs/PCBs and CKD was not significant, but p,p'-DDE and PCB-153 were the main contributors to the negative and positive co-exposure effects of eGFR and CKD, respectively, which is consistent with the regression results. Participants with both relatively high PCB-153 exposure and an unhealthy lifestyle had the highest risk of CKD, in the joint association analysis. The observed associations were generally supported by the FAS-eGFR method. Our research findings suggest that exposure to OCPs/PCBs may be associated with decreased eGFR and increased prevalence of CKD in humans, and a healthy lifestyle can to some extent alleviate the adverse association between PCB-153 exposure and CKD.
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Affiliation(s)
- Chang Xie
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Sijie Yang
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Yaping Li
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Mingye Zhang
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Qitong Xu
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Zhengce Wan
- Health Management Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lulu Song
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yongman Lv
- Health Management Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dan Luo
- Analytical Application Center, Shimadzu (China) Co., LTD., Wuhan Branch, No 96 Linjiang Avenue, Wuhan, 430060, China
| | - Qiang Li
- Analytical Application Center, Shimadzu (China) Co., LTD., Wuhan Branch, No 96 Linjiang Avenue, Wuhan, 430060, China
| | - Youjie Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hui Chen
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Surong Mei
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, 430030, Hubei, China.
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13
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Sussman-Dabach EJ, Joshi S, Dupuis L, White JA, Siavoshi M, Slukhinsky S, Singh B, Kalantar-Zadeh K. Preventing potential pitfalls of a liberalized potassium diet in the hemodialysis population. Semin Dial 2024; 37:317-325. [PMID: 34378234 DOI: 10.1111/sdi.13006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/08/2021] [Indexed: 12/23/2022]
Abstract
Emerging research suggests that a more liberalized diet, specifically a more plant-based diet resulting in liberalization of potassium intake, for people receiving hemodialysis is necessary and the benefits outweigh previously thought risks. If the prescribed hemodialysis diet is to be liberalized, the need to illuminate and prevent potential pitfalls of a liberalized potassium diet is warranted. This paper explores such topics as partial to full adherence to a liberalized diet and its consequences if any, the advantages of a high-fiber intake, the theoretical risk of anemia when consuming a more plant-dominant diet, the potential benefits against renal acid load and effect on metabolic acidosis with increased fruit and vegetable intake, the putative change in serum potassium levels, carbohydrate quality, and the healthfulness of meat substitutes. The benefits of a more plant-based diet for the hemodialysis population are multifold; however, the possible pitfalls of this type of diet must be reviewed and addressed upon meal planning in order to be avoided.
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Affiliation(s)
- Elizabeth J Sussman-Dabach
- Department of Family and Consumer Sciences, California State University, Northridge, Northridge, California, USA
| | - Shivam Joshi
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Department of Medicine, NYC Health + Hospitals/Bellevue, New York, New York, USA
| | - Léonie Dupuis
- College of Medicine, University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Jennifer A White
- Department of Family and Consumer Sciences, California State University, Northridge, Northridge, California, USA
| | - Mehrnaz Siavoshi
- Department of Family and Consumer Sciences, California State University, Northridge, Northridge, California, USA
| | | | - Bhupinder Singh
- University of California, Irvine, School of Medicine, Irvine, California, USA
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14
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Desloovere A, Polderman N, Renken-Terhaerdt J, Shaw V, Anderson C, Greenbaum LA, Nelms CL, Qizalbash L, Stabouli S, Tuokkola J, Warady BA, Vande Walle J, Paglialonga F, Shroff R, Snauwaert E. The Management of Dietary Fiber Intake in Children With Chronic Kidney Disease - Clinical Practice Recommendations From the Pediatric Renal Nutrition Taskforce. J Ren Nutr 2024:S1051-2276(24)00095-5. [PMID: 38866350 DOI: 10.1053/j.jrn.2024.05.008] [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: 11/20/2023] [Revised: 04/18/2024] [Accepted: 05/21/2024] [Indexed: 06/14/2024] Open
Abstract
The benefits of dietary fiber are widely accepted. Nevertheless, a substantial proportion of children fail to meet the recommended intake of dietary fiber. Achieving adequate fiber intake is especially challenging in children with chronic kidney disease (CKD). An international team of pediatric renal dietitians and pediatric nephrologists from the Pediatric Renal Nutrition Taskforce (PRNT) has developed clinical practice recommendations (CPRs) for the dietary intake of fiber in children and adolescents with CKD. In this CPR paper, we propose a definition of fiber, provide advice on the requirements and assessment of fiber intake, and offer practical guidance on optimizing dietary fiber intake in children with CKD. In addition, given the paucity of available evidence and to achieve consensus from international experts, a Delphi survey was performed in which all the clinical practice recommendations were reviewed.
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Affiliation(s)
- An Desloovere
- Department of Pediatric Nephrology, Ghent University Hospital, Member of the European Reference Network for Rare Kidney Disease (ERKNet), Ghent, Belgium
| | - Nonnie Polderman
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - José Renken-Terhaerdt
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vanessa Shaw
- Department of Pediatric Nephrology, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Caroline Anderson
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Larry A Greenbaum
- Department of Pediatric Nephrology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Christina L Nelms
- Department of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, Missouri
| | - Leila Qizalbash
- Department of Pediatric Nephrology, Great Northern Children's Hospital, Newcastle upon Tyne, United Kingdom
| | - Stella Stabouli
- Pediatric Nephrology Unit, 1st Pediatric Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jetta Tuokkola
- Children's Hospital and Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Bradley A Warady
- Department of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, Missouri
| | - Johan Vande Walle
- Department of Pediatric Nephrology, Ghent University Hospital, Member of the European Reference Network for Rare Kidney Disease (ERKNet), Ghent, Belgium
| | - Fabio Paglialonga
- Department of Pediatric Nephrology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rukshana Shroff
- Department of Pediatric Nephrology, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Evelien Snauwaert
- Department of Pediatric Nephrology, Ghent University Hospital, Member of the European Reference Network for Rare Kidney Disease (ERKNet), Ghent, Belgium.
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15
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Lockwood MB, Sung C, Alvernaz SA, Lee JR, Chin JL, Nayebpour M, Bernabé BP, Tussing-Humphreys LM, Li H, Spaggiari M, Martinino A, Park CG, Chlipala GE, Doorenbos AZ, Green SJ. The Gut Microbiome and Symptom Burden After Kidney Transplantation: An Overview and Research Opportunities. Biol Res Nurs 2024:10998004241256031. [PMID: 38836469 DOI: 10.1177/10998004241256031] [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: 06/06/2024]
Abstract
Many kidney transplant recipients continue to experience high symptom burden despite restoration of kidney function. High symptom burden is a significant driver of quality of life. In the post-transplant setting, high symptom burden has been linked to negative outcomes including medication non-adherence, allograft rejection, graft loss, and even mortality. Symbiotic bacteria (microbiota) in the human gastrointestinal tract critically interact with the immune, endocrine, and neurological systems to maintain homeostasis of the host. The gut microbiome has been proposed as an underlying mechanism mediating symptoms in several chronic medical conditions including irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia, and psychoneurological disorders via the gut-brain-microbiota axis, a bidirectional signaling pathway between the enteric and central nervous system. Post-transplant exposure to antibiotics, antivirals, and immunosuppressant medications results in significant alterations in gut microbiota community composition and function, which in turn alter these commensal microorganisms' protective effects. This overview will discuss the current state of the science on the effects of the gut microbiome on symptom burden in kidney transplantation and future directions to guide this field of study.
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Affiliation(s)
- Mark B Lockwood
- Department of Biobehavioral Nursing Science, University of Illinois Chicago College of Nursing, Chicago, IL, USA
| | - Choa Sung
- Post-Doctoral Fellow, Department of Biobehavioral Nursing Science, University of Illinois Chicago College of Nursing, Chicago, IL, USA
| | - Suzanne A Alvernaz
- Graduate Student, Department of Biomedical Engineering, University of Illinois ChicagoColleges of Engineering and Medicine, Chicago, IL, USA
| | - John R Lee
- Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jennifer L Chin
- Medical Student, Touro College of Osteopathic Medicine, Middletown, NY, USA
| | - Mehdi Nayebpour
- Virginia BioAnalytics LLC, Washington, District of Columbia, USA
| | - Beatriz Peñalver Bernabé
- Graduate Student, Department of Biomedical Engineering, University of Illinois ChicagoColleges of Engineering and Medicine, Chicago, IL, USA
| | - Lisa M Tussing-Humphreys
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Hongjin Li
- Department of Biobehavioral Nursing Science, University of Illinois Chicago College of Nursing, Chicago, IL, USA
| | - Mario Spaggiari
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Alessandro Martinino
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Chang G Park
- Department of Population Health Nursing Science, Office of Research Facilitation, University of Illinois Chicago, Chicago, IL, USA
| | - George E Chlipala
- Research Core Facility, Research Resources Center, University of Illinois Chicago, Chicago, IL, USA
| | - Ardith Z Doorenbos
- Department of Biobehavioral Nursing Science, University of Illinois ChicagoCollege of Nursing, Chicago, IL, USA
| | - Stefan J Green
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
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16
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Pethő ÁG, Tapolyai M, Csongrádi É, Orosz P. Management of chronic kidney disease: The current novel and forgotten therapies. J Clin Transl Endocrinol 2024; 36:100354. [PMID: 38828402 PMCID: PMC11143912 DOI: 10.1016/j.jcte.2024.100354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
Chronic kidney disease (CKD) is a progressive and incurable condition that imposes a significant burden on an aging society. Although the exact prevalence of this disease is unknown, it is estimated to affect at least 800 million people worldwide. Patients with diabetes or hypertension are at a higher risk of developing chronic kidney damage. As the kidneys play a crucial role in vital physiological processes, damage to these organs can disrupt the balance of water and electrolytes, regulation of blood pressure, elimination of toxins, and metabolism of vitamin D. Early diagnosis is paramount to prevent potential complications. Treatment options such as dietary modifications and medications can help slow disease progression. In our narrative review, we have summarized the available therapeutic options to slow the progression of chronic kidney disease. Many new drug treatments have recently become available, offering a beacon of hope and optimism in CKD management. Nonetheless, disease prevention remains the most critical step in disease management. Given the significant impact of CKD on public health, there is a pressing need for further research. With the development of new technologies and advancements in medical knowledge, we hope to find more effective diagnostic tools and treatments for CKD patients.
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Affiliation(s)
- Ákos Géza Pethő
- Faculty of Medicine, Semmelweis University, Department of Internal
Medicine and Oncology, Budapest, Hungary
| | - Mihály Tapolyai
- Medicine Service, Ralph H. Johnson VA Medical Center, Charleston, SC,
USA
- Department of Nephrology, Szent Margit Kórhaz, Budapest,
Hungary
| | - Éva Csongrádi
- Faculty of Medicine, University of Debrecen, Debrecen,
Hungary
| | - Petronella Orosz
- Bethesda Children’s Hospital, 1146 Budapest, Hungary
- Department of Pediatrics, Faculty of Medicine, University of Debrecen,
4032 Debrecen, Hungary
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17
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Kraselnik A. Risk of Bone Fracture on Vegetarian and Vegan Diets. Curr Nutr Rep 2024; 13:331-339. [PMID: 38554239 DOI: 10.1007/s13668-024-00533-z] [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: 03/20/2024] [Indexed: 04/01/2024]
Abstract
PURPOSE OF REVIEW Bone fractures can have a devastating effect on health, especially in the elderly, undermining their independence for daily activities, and increasing the risk of comorbidities and mortality. Nutrition is a key factor in maintaining an optimal bone health across the lifespan. The number of people that choose to avoid meat or even all animal products is increasing globally, for a diversity of reasons. Properly planned vegetarian and vegan diets are widely recognized as a healthy dietary pattern, but the long-term impact of these diets on bone health and more specifically risk of bone fractures is less clear. Classic studies have observed a slightly lower bone mineral density in vegetarians but have many limitations, including inadequate adjusting for relevant confounding factors, and cross-sectional design. The aim of this review is to summarize and put into context the current evidence on the effect of vegetarian and vegan diets on bone health, with a focus on fracture risk. RECENT FINDINGS In recent years, results from many large prospective studies have emerged, which allowed us to assess the risk of incident bone fractures in vegetarians. In these studies, vegetarian and especially vegan diets were associated with an increased risk of bone fractures. In many recent prospective cohort studies, vegetarian and especially vegan diets were associated with an increased risk of bone fractures. At least part of this risk could be due to a lower body mass index and a lower intake of nutrients such as calcium, vitamin D, and protein. Some evidence suggests that combined vitamin D and calcium supplementation and other factors such as consumption of protein-rich foods may attenuate this risk. The eventual deleterious effect of vegetarian diets on bone health should be contextualized and balanced with its benefits, such as lower risk of cardiovascular disease and cancer.
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Affiliation(s)
- Ariel Kraselnik
- Sociedad Argentina de Medicina de Estilo de Vida (SAMEV), Av. Córdoba 3239, Ciudad Autónoma de Buenos Aires, Argentina.
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18
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Stanford J, Stefoska-Needham A, Lambert K, Batterham MJ, Charlton K. Association between plant-based diet quality and chronic kidney disease in Australian adults. Public Health Nutr 2024; 27:e142. [PMID: 38757167 DOI: 10.1017/s1368980024001095] [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] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To examine associations between three different plant-based diet quality indices, chronic kidney disease (CKD) prevalence and related risk factors in a nationally representative sample of the Australian population. DESIGN Cross-sectional analysis. Three plant-based diet scores were calculated using data from two 24-h recalls: an overall plant-based diet index (PDI), a healthy PDI (hPDI) and an unhealthy PDI (uPDI). Consumption of plant and animal ingredients from 'core' and 'discretionary' products was also differentiated. Associations between the three PDI scores and CKD prevalence, BMI, waist circumference (WC), blood pressure (BP) measures, blood cholesterol, apo B, fasting TAG, blood glucose levels (BGL) and HbA1c were examined. SETTING Australian Health Survey 2011-2013. PARTICIPANTS n 2060 adults aged ≥ 18 years (males: n 928; females: n 1132). RESULTS A higher uPDI score was associated with a 3·7 % higher odds of moderate-severe CKD (OR: 1·037 (1·0057-1·0697); P = 0·021)). A higher uPDI score was also associated with increased TAG (P = 0·032) and BGL (P < 0·001), but lower total- and LDL-cholesterol (P = 0·035 and P = 0·009, respectively). In contrast, a higher overall PDI score was inversely associated with WC (P < 0·001) and systolic BP (P = 0·044), while higher scores for both the overall PDI and hPDI were inversely associated with BMI (P < 0·001 and P = 0·019, respectively). CONCLUSIONS A higher uPDI score reflecting greater intakes of refined grains, salty plant-based foods and added sugars were associated with increased CKD prevalence, TAG and BGL. In the Australian population, attention to diet quality remains paramount, even in those with higher intakes of plant foods and who wish to reduce the risk of CKD.
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Affiliation(s)
- Jordan Stanford
- Nutrition and Dietetics Department, School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Anita Stefoska-Needham
- Nutrition and Dietetics Department, School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Kelly Lambert
- Nutrition and Dietetics Department, School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Marijka J Batterham
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
- Director of the National Institute for Applied Statistics Research Australia and the Statistical Consulting Centre, School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, NSW, Australia
| | - Karen Charlton
- Nutrition and Dietetics Department, School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
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19
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Renouf D, Wong MMY. From Prophecy to Plate: How to Actualize a Planetary Menu for Kidney Disease Nutrition. Can J Kidney Health Dis 2024; 11:20543581241244965. [PMID: 38712334 PMCID: PMC11072064 DOI: 10.1177/20543581241244965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/12/2024] [Indexed: 05/08/2024] Open
Affiliation(s)
- Dani Renouf
- Providence Health Care, Vancouver, BC, Canada
- BC Renal, Vancouver, Canada
| | - Michelle M. Y. Wong
- BC Renal, Vancouver, Canada
- Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, Canada
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20
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de Jong MF, Nemeth E, Rawee P, Bramham K, Eisenga MF. Anemia in Pregnancy With CKD. Kidney Int Rep 2024; 9:1183-1197. [PMID: 38707831 PMCID: PMC11069017 DOI: 10.1016/j.ekir.2024.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 12/05/2023] [Accepted: 01/08/2024] [Indexed: 05/07/2024] Open
Abstract
Chronic kidney disease (CKD), anemia, and iron deficiency are global health issues affecting individuals in both high-income and low-income countries. In pregnancy, both CKD and iron deficiency anemia increase the risk of adverse maternal and neonatal outcomes, including increased maternal morbidity and mortality, stillbirth, perinatal death, preterm birth, and low birthweight. However, it is unknown to which extent iron deficiency anemia contributes to adverse outcomes in CKD pregnancy. Furthermore, little is known regarding the prevalence, pathophysiology, and treatment of iron deficiency and anemia in pregnant women with CKD. Therefore, there are many unanswered questions regarding optimal management with oral or i.v. iron and recombinant human erythropoietin (rhEPO) in these women. In this review, we present a short overview of the (patho)physiology of anemia in healthy pregnancy and in people living with CKD. We present an evaluation of the literature on iron deficiency, anemia, and nutritional deficits in pregnant women with CKD; and we evaluate current knowledge gaps. Finally, we propose research priorities regarding anemia in pregnant women with CKD.
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Affiliation(s)
- Margriet F.C. de Jong
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, The Netherlands
| | - Elizabeta Nemeth
- Department of Medicine, University of California, Los Angeles, California, USA
| | - Pien Rawee
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, The Netherlands
| | - Kate Bramham
- Department of Women and Children’s Health, King’s College London, London, UK
| | - Michele F. Eisenga
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, The Netherlands
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21
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Padoan F, Guarnaroli M, Brugnara M, Piacentini G, Pietrobelli A, Pecoraro L. Role of Nutrients in Pediatric Non-Dialysis Chronic Kidney Disease: From Pathogenesis to Correct Supplementation. Biomedicines 2024; 12:911. [PMID: 38672265 PMCID: PMC11048674 DOI: 10.3390/biomedicines12040911] [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: 03/16/2024] [Revised: 04/05/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Nutrition management is fundamental for children with chronic kidney disease (CKD). Fluid balance and low-protein and low-sodium diets are the more stressed fields from a nutritional point of view. At the same time, the role of micronutrients is often underestimated. Starting from the causes that could lead to potential micronutrient deficiencies in these patients, this review considers all micronutrients that could be administered in CKD to improve the prognosis of this disease.
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Affiliation(s)
| | | | - Milena Brugnara
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (A.P.)
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22
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Yin YH, Li CH, Huang HP, Zhang C, Zhang SB, Li SM, Chen J. A novel enzyme-based functional correlation algorithm for multi-omics reveals the potential mechanisms of traditional Chinese medicines: Taking Jian-Pi-Yi-Shen formula as an example. J Pharm Biomed Anal 2024; 241:115973. [PMID: 38237547 DOI: 10.1016/j.jpba.2024.115973] [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: 10/17/2023] [Revised: 12/21/2023] [Accepted: 01/08/2024] [Indexed: 02/21/2024]
Abstract
The integrated analysis of host metabolome and intestinal microbiome is an opportunity to explore the complex therapeutic mechanisms of traditional Chinese medicines. Currently, researchers mainly employ various statistical correlation analytical methods to investigate metabolome-microbiome correlations. However, these conventional correlation techniques often focus on statistical correlations and their biological meanings are always ignored, especially the functional relevance between them. Here, we developed a novel enzyme-based functional correlation (EBFC) algorithm to further improve the interpretability and the identified scope of microbe-metabolite correlations based on the conventional Spearman's analysis. The proposed EBFC algorithm is successfully utilized to reveal the therapeutic mechanisms of Jian-Pi-Yi-Shen (JPYS) formula on the treatment of adenine-induced chronic kidney disease (CKD) rats. JPYS, a TCM formula for treating CKD, has beneficial clinical effects. We tentatively revealed the potential mechanism of JPYS for treating CKD rats from the perspective of the serum metabolome, gut microbiome, and their interactions. Specifically, 11 metabolites and 19 bacterial genera in the CKD rats were significantly regulated to approaching normal status after JPYS treatment, suggesting that JPYS could ameliorate the pathological symptoms of CKD rats by reshaping the disturbed metabolome and gut microbiota. Further correlation analysis between the significantly perturbed metabolites, microbiota, and the related enzymes provided more strong evidence for the study of host metabolism-microbiota interactions and the therapeutic mechanism of JPYS on CKD rats. In conclusion, these findings will help us to deeply understand the pathogenesis of CKD and provide new insights into the therapeutic mechanism of JPYS.
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Affiliation(s)
- Ying-Hao Yin
- Shenzhen Key Laboratory of Hospital Chinese Medicine Preparation, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen 518033, China
| | - Chang-Hui Li
- Shenzhen Key Laboratory of Hospital Chinese Medicine Preparation, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen 518033, China
| | - Hai-Piao Huang
- Shenzhen Key Laboratory of Hospital Chinese Medicine Preparation, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen 518033, China
| | - Chi Zhang
- Shenzhen Key Laboratory of Hospital Chinese Medicine Preparation, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen 518033, China
| | - Shang-Bin Zhang
- Shenzhen Key Laboratory of Hospital Chinese Medicine Preparation, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen 518033, China
| | - Shun-Min Li
- Shenzhen Key Laboratory of Hospital Chinese Medicine Preparation, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen 518033, China
| | - Jianping Chen
- Shenzhen Key Laboratory of Hospital Chinese Medicine Preparation, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen 518033, China.
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23
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Ghajavand B, Avesani C, Stenvinkel P, Bruchfeld A. Unlocking the Potential of Brewers' Spent Grain: A Sustainable Model to Use Beer for Better Outcome in Chronic Kidney Disease. J Ren Nutr 2024:S1051-2276(24)00057-8. [PMID: 38621435 DOI: 10.1053/j.jrn.2024.03.007] [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: 01/02/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/17/2024] Open
Abstract
The rising global incidence of chronic inflammatory diseases calls for innovative and sustainable medical solutions. Brewers' spent grain (BSG), a byproduct of beer production, presents a unique opportunity in this regard. This review explores the multifaceted health benefits of BSG, with a focus on managing chronic kidney disease (CKD). BSG is identified as a potent prebiotic with potential as a therapeutic agent in CKD. We emphasize the role of gut dysbiosis in CKD and discuss how BSG could help mitigate metabolic derangements resulting from dysbiosis and CKD. Fermentation of BSG further enhances its positive impact on gut health. Incorporating fermented BSG as a key component in preventive health care could promote a more sustainable and healthier future. By optimizing the use of this typically discarded byproduct, we can align proactive health-care strategies with responsible resource management, benefiting both people and the environment.
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Affiliation(s)
- Babak Ghajavand
- Department of Renal Medicine, Linköping University Hospital, Linköping, Sweden.
| | - Carla Avesani
- Department of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Department of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Annette Bruchfeld
- Department of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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24
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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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25
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Xie H, Yang N, Yu C, Lu L. Uremic toxins mediate kidney diseases: the role of aryl hydrocarbon receptor. Cell Mol Biol Lett 2024; 29:38. [PMID: 38491448 PMCID: PMC10943832 DOI: 10.1186/s11658-024-00550-4] [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: 10/18/2023] [Accepted: 02/19/2024] [Indexed: 03/18/2024] Open
Abstract
Aryl hydrocarbon receptor (AhR) was originally identified as an environmental sensor that responds to pollutants. Subsequent research has revealed that AhR recognizes multiple exogenous and endogenous molecules, including uremic toxins retained in the body due to the decline in renal function. Therefore, AhR is also considered to be a uremic toxin receptor. As a ligand-activated transcriptional factor, the activation of AhR is involved in cell differentiation and senescence, lipid metabolism and fibrogenesis. The accumulation of uremic toxins in the body is hazardous to all tissues and organs. The identification of the endogenous uremic toxin receptor opens the door to investigating the precise role and molecular mechanism of tissue and organ damage induced by uremic toxins. This review focuses on summarizing recent findings on the role of AhR activation induced by uremic toxins in chronic kidney disease, diabetic nephropathy and acute kidney injury. Furthermore, potential clinical approaches to mitigate the effects of uremic toxins are explored herein, such as enhancing uremic toxin clearance through dialysis, reducing uremic toxin production through dietary interventions or microbial manipulation, and manipulating metabolic pathways induced by uremic toxins through controlling AhR signaling. This information may also shed light on the mechanism of uremic toxin-induced injury to other organs, and provide insights into clinical approaches to manipulate the accumulated uremic toxins.
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Affiliation(s)
- Hongyan Xie
- Department of Nephrology, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, China
| | - Ninghao Yang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, 138 Yixueyuan Road, Shanghai, 200032, China
| | - Chen Yu
- Department of Nephrology, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, China.
| | - Limin Lu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, 138 Yixueyuan Road, Shanghai, 200032, China.
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26
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Mirmohammadali SN, Gallant KMH, Biruete A. Oh, My Gut! New insights on the role of the gastrointestinal tract and the gut microbiome in chronic kidney disease-mineral and bone disorder. Curr Opin Nephrol Hypertens 2024; 33:226-230. [PMID: 38088374 DOI: 10.1097/mnh.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
PURPOSE OF REVIEW The aim of this review is to highlight recent evidence on the role of the gastrointestinal tract and gut microbiome on chronic kidney disease-mineral bone disorder (CKD-MBD) outcomes, including intestinal phosphorus absorption and sensing, and the effect of gut-oriented therapies. RECENT FINDINGS Recent evidence has revealed a complex interplay among mineral metabolism and novel gut-related factors, including paracellular intestinal phosphate absorption, the gut microbiome, and the immune system, prompting a reevaluation of treatment approaches for CKD-MBD. The inhibition of NHE3 limits phosphate transport in the intestine and may lead to changes in the gut microbiome. A study in rats with CKD showed that the supplementation of the fermentable dietary inulin delayed CKD-MBD, lowering circulating phosphorus and parathyroid hormone, reducing bone remodeling and improving cortical parameters, and lowering cardiovascular calcifications. In non-CKD preclinical studies, probiotics and prebiotics improved bone formation mediated through the effect of butyrate facilitating the differentiation of T cells into Tregs, and Tregs stimulating the osteogenic Wnt10b, and butyrate was also necessary for the parathyroid hormone (PTH) bone effects. SUMMARY Recent findings support multiple possible roles for gut-oriented therapies in addressing CKD-MBD prevention and management that should be further explored through clinical and translational studies.
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Affiliation(s)
| | - Kathleen M Hill Gallant
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, Minnesota
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Annabel Biruete
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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27
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Sahin K, Yıldıran H. A Therapeutic Approach in the Management of Chronic Kidney Disease: Plant-Based Dietary Models and Associated Parameters. Curr Nutr Rep 2024; 13:39-48. [PMID: 38172460 DOI: 10.1007/s13668-023-00515-7] [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: 12/11/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Chronic kidney disease is one of the leading causes of death worldwide today. Nutrition and nutrition-related factors have a very important role in both the prevention and management of the disease. Plant-based dietary practices are one of the promising approaches to chronic kidney disease. This review aims to examine the potential benefits and risks of plant-based diet models on symptoms and indices used in diet quality in chronic kidney disease. RECENT FINDINGS Recently, a growing body of evidence has shown that, unlike animal-based diets, diets rich in plant-based nutrients may play an active role in the incidence of chronic kidney disease in many ways and the management of common symptoms, such as metabolic acidosis, uremic toxicity, and hyperphosphatemia. Implementation of existing plant-based dietary patterns in patients with chronic kidney disease may increase the efficacy of the diet and improve patients' quality of life by expanding their food choices. While there are concerns about creatine deficiency, dietary adequacy, and accessibility regarding plant-based diets, available information is limited.
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Affiliation(s)
- Kezban Sahin
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Bandirma Onyedi Eylul University, Balıkesir, 10200, Turkey.
| | - Hilal Yıldıran
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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28
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Moldovan D, Rusu C, Potra A, Tirinescu D, Ticala M, Kacso I. Food to Prevent Vascular Calcification in Chronic Kidney Disease. Nutrients 2024; 16:617. [PMID: 38474744 DOI: 10.3390/nu16050617] [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: 01/30/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Vascular calcification (VC) is a consequence of chronic kidney disease (CKD) which is of paramount importance regarding the survival of CKD patients. VC is far from being controlled with actual medication; as a result, in recent years, diet modulation has become more compelling. The concept of medical nutritional therapy points out the idea that food may prevent or treat diseases. The aim of this review was to evaluate the influence of food habits and nutritional intervention in the occurrence and progression of VC in CKD. Evidence reports the harmfulness of ultra-processed food, food additives, and animal-based proteins due to the increased intake of high absorbable phosphorus, the scarcity of fibers, and the increased production of uremic toxins. Available data are more supportive of a plant-dominant diet, especially for the impact on gut microbiota composition, which varies significantly depending on VC presence. Magnesium has been shown to prevent VC but only in experimental and small clinical studies. Vitamin K has drawn considerable attention due to its activation of VC inhibitors. There are positive studies; unfortunately, recent trials failed to prove its efficacy in preventing VC. Future research is needed and should aim to transform food into a medical intervention to eliminate VC danger in CKD.
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Affiliation(s)
- Diana Moldovan
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, 400347 Cluj-Napoca, Romania
- Nephrology Clinic, Emergency County Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Crina Rusu
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, 400347 Cluj-Napoca, Romania
- Nephrology Clinic, Emergency County Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Alina Potra
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, 400347 Cluj-Napoca, Romania
- Nephrology Clinic, Emergency County Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Dacian Tirinescu
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, 400347 Cluj-Napoca, Romania
- Nephrology Clinic, Emergency County Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Maria Ticala
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, 400347 Cluj-Napoca, Romania
- Nephrology Clinic, Emergency County Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Ina Kacso
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, 400347 Cluj-Napoca, Romania
- Nephrology Clinic, Emergency County Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
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29
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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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30
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Wathanavasin W, Kittiskulnam P, Johansen KL. Plant-based diets in patients with chronic kidney disease. ASIAN BIOMED 2024; 18:2-10. [PMID: 38515633 PMCID: PMC10954082 DOI: 10.2478/abm-2024-0002] [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] [Indexed: 03/23/2024]
Abstract
Dietary protein restriction has been considered to be a nutritional-related strategy to reduce risk for end-stage kidney disease among patients with non-dialysis-dependent chronic kidney disease (CKD). However, there is insufficient evidence to recommend a particular type of protein to slow down the CKD progression. Recently, various plant-based diets could demonstrate some additional benefits such as a blood pressure-lowering effect, a reduction of metabolic acidosis as well as hyperphosphatemia, and gut-derived uremic toxins. Furthermore, the former concerns about the risk of undernutrition and hyperkalemia observed with plant-based diets may be inconsistent in real clinical practice. In this review, we summarize the current evidence of the proposed pleiotropic effects of plant-based diets and their associations with clinical outcomes among pre-dialysis CKD patients.
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Affiliation(s)
- Wannasit Wathanavasin
- Nephrology Unit, Department of Medicine, Charoenkrung Pracharak Hospital, Bangkok Metropolitan Administration, Bangkok10330, Thailand
| | - Piyawan Kittiskulnam
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
- Division of Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok10330, Thailand
- Special Task Force for Activating Research in Renal Nutrition (Renal Nutrition Research Group), Office of Research Affairs, Chulalongkorn University, Bangkok10330, Thailand
| | - Kirsten L. Johansen
- Division of Nephrology, Hennepin Healthcare, Minneapolis, MN55415, USA
- Division of Nephrology, University of Minnesota, Minneapolis, MN55415, USA
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31
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Ding Z, Wu X, Liu C, Ying R, Zhang Y, Zhang S, Zhang Q, Hu H, Dai F. Associations between dietary patterns and renal impairment in individuals with diabetes: a cross-sectional study. J Hum Nutr Diet 2024; 37:193-202. [PMID: 37795524 DOI: 10.1111/jhn.13245] [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: 06/15/2023] [Accepted: 09/13/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND A variety of chronic diseases are affected by diet. To our knowledge, few studies have investigated the relationship between dietary patterns and renal impairment in individuals with diabetes within an Asian population. This study aimed to assess the relationship between renal impairment and dietary patterns in individuals with diabetes within a Chinese population. METHODS In this cross-sectional survey, we analysed data on 1522 participants with diabetes aged 18 years or older who took part in the China National Diabetic Chronic Complications Study. We utilised the Chinese Diabetes Complications Questionnaire, including the semiquantitative food frequency questionnaire (SQFFQ). We identified three dietary patterns using factor analysis: Chinese traditional, healthy and plant-based dietary patterns, and these dietary patterns were used to classify participants into four groups based on the quartiles of their scores. A decrease in the estimated glomerular filtration rate (eGFR; <60 mL/min/1.73 m2 ) and an increase in the albumin-to-creatinine ratio (ACR; ≥3 mg/mmol) were used as indicators of renal impairment. Binary logistic regression models were used to estimate the odds ratio (OR) of the highest quartile (Q4: high intake levels of each dietary pattern) for renal impairment compared to the lowest quartile (Q1: low intake levels of each dietary pattern). RESULTS Among the 1522 participants, there was a 5.5% prevalence of low eGFR, with prevalence rates of 5.2% in men and 5.9% in women, yet the prevalence of albuminuria was as high as 47.9%. After adjusting for confounders, participants in Q4 of the plant-based dietary pattern had a smaller OR for renal impairment than those in Q1. CONCLUSIONS Our findings demonstrated that a plant-based dietary pattern is associated with a reduced risk of renal impairment in a population with diabetes.
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Affiliation(s)
- Ziling Ding
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xingzhe Wu
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Chao Liu
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ruixue Ying
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yi Zhang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Shiqi Zhang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Qiu Zhang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Honglin Hu
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Fang Dai
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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32
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Behrens F, Bartolomaeus H, Wilck N, Holle J. Gut-immune axis and cardiovascular risk in chronic kidney disease. Clin Kidney J 2024; 17:sfad303. [PMID: 38229879 PMCID: PMC10790347 DOI: 10.1093/ckj/sfad303] [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: 08/02/2023] [Indexed: 01/18/2024] Open
Abstract
Patients with chronic kidney disease (CKD) suffer from marked cardiovascular morbidity and mortality, so lowering the cardiovascular risk is paramount to improve quality of life and survival in CKD. Manifold mechanisms are hold accountable for the development of cardiovascular disease (CVD), and recently inflammation arose as novel risk factor significantly contributing to progression of CVD. While the gut microbiome was identified as key regulator of immunity and inflammation in several disease, CKD-related microbiome-immune interaction gains increasing importance. Here, we summarize the latest knowledge on microbiome dysbiosis in CKD, subsequent changes in bacterial and host metabolism and how this drives inflammation and CVD in CKD. Moreover, we outline potential therapeutic targets along the gut-immune-cardiovascular axis that could aid the combat of CVD development and high mortality in CKD.
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Affiliation(s)
- Felix Behrens
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center (ECRC), a cooperation of Charité – Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Institute of Physiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Hendrik Bartolomaeus
- Experimental and Clinical Research Center (ECRC), a cooperation of Charité – Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
- Department of Nephrology und Intensive Medical Care, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Nicola Wilck
- Experimental and Clinical Research Center (ECRC), a cooperation of Charité – Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
- Department of Nephrology und Intensive Medical Care, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Holle
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center (ECRC), a cooperation of Charité – Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
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Oliveira MC, Viney A, Picard E, Barnel C, Fouque D, Koppe L. Dietary Intake and Nutritional Status in Diabetic and Nondiabetic Patients With Chronic Kidney Disease Stage 4-5 (NutriDiab Study). J Ren Nutr 2024; 34:19-25. [PMID: 37321431 DOI: 10.1053/j.jrn.2023.06.006] [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: 04/27/2022] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVES The aim of the present study was to assess the dietary intake and nutritional status of patients with chronic kidney disease (CKD) stage 4-5 according to the presence of diabetes. METHODS This observational and cross-sectional study included adult patients with CKD stage 4-5 referred to a nephrology unit, between October 2018 and March 2019. Daily dietary intake was evaluated by 24-hour dietary inquiry and urine excretion. Nutritional status was assessed by measuring body composition using bioimpedance analysis and muscle function using handgrip strength. Undernutrition was considered using the protein energy wasting score. RESULTS A total of 75 CKD patients were included, 36 (48%) of whom had diabetes; median age (interquartile range) was 71 (60-80) years. The median weight-adjusted dietary energy intake (DEI) was 22.6 (19.1-28.2) kcal/kg/day and the mean weight-adjusted dietary protein intake (DPI) was 0.86 ± 0.19 g/kg/day. There was no significant difference in DEI and DPI between patients with diabetes and those without, except for weight-adjusted DPI which was significantly lower in diabetic patients (P = .022). In univariate analysis, diabetes was associated with weight-adjusted DPI (coefficient [95% confidence interval] -0.237 [-0.446; -0.004] kcal/kg/day; P = .040), but this association did not remain significant in multivariate analysis. Nutritional status did not differ significantly between diabetic and nondiabetic patients except for lean tissue mass, which was lower in diabetic patients (P = .046). The proportion of patients with protein energy wasting was not significantly different between diabetic and nondiabetic patients (13.9% vs. 10.2%, respectively). CONCLUSIONS In the present cohort, DPI and DEI were not significantly different between diabetic and nondiabetic CKD patients. Diabetes was not found to be associated with dietary intakes in CKD stage 4-5 patients.
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Affiliation(s)
- Mariana Cassani Oliveira
- Department of Medical Clinic, Botucatu Medical School, Universidade Estadual Paulista-UNESP, Botucatu, Brazil.
| | - Angelique Viney
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Elodie Picard
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Cécile Barnel
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France; University Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Denis Fouque
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France; University Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Laetitia Koppe
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France; University Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
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Freeman NS, Turner JM. In the "Plant-Based" Era, Patients With Chronic Kidney Disease Should Focus on Eating Healthy. J Ren Nutr 2024; 34:4-10. [PMID: 37648119 DOI: 10.1053/j.jrn.2023.08.010] [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: 05/17/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023] Open
Abstract
In the era of plant-based diets, it is important for Nephrology providers to know the evidence regarding their healthfulness in patients with chronic kidney disease (CKD). A whole food, plant-based diet, which emphasizes fresh, minimally processed or refined plant-based foods and limits animal products, has shown benefits for patients with CKD. These include reduced dietary acid load, lower bioavailability of potassium and phosphorus, increased dietary fiber intake, nutritional adequacy, and cardiovascular and mortality benefits. Potential drawbacks include the need for specific knowledge, skills, and cost involved in preparing varied, healthy, and appetizing plant-based meals, leading to lower acceptability and accessibility to certain populations. Liberalization of the standard CKD diet to include healthy, minimally processed foods such as fruits, vegetables, nuts, legumes, and whole grains is likely beneficial, though more research is needed to determine whether a plant-based-only diet is the optimal way to achieve healthier eating in patients with CKD.
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Affiliation(s)
- Natasha S Freeman
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut.
| | - Jeffrey M Turner
- Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
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Patel V, Aggarwal K, Dhawan A, Singh B, Shah P, Sawhney A, Jain R. Protein supplementation: the double-edged sword. Proc AMIA Symp 2023; 37:118-126. [PMID: 38174000 PMCID: PMC10761008 DOI: 10.1080/08998280.2023.2280417] [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: 08/09/2023] [Accepted: 10/30/2023] [Indexed: 01/05/2024] Open
Abstract
Protein supplements are widely consumed by athletes as well as young adults and teenagers going to the gym and are an excellent source to increase protein intake, build muscle mass, and enhance recovery. They are available in the form of powders, gummies, protein bars, and ready-to-drink shakes and have been shown to have effects on almost every system in the body. Subjects consuming whey protein-based supplements regularly show significantly lower systolic blood pressure, while subjects who consume soy-based protein supplements have been reported to show a significant decrease in their systolic and diastolic blood pressures. Favorable effects of soy protein consumption have been observed on the serum lipid profile, with significant decreases in serum low-density lipoprotein and triglyceride levels. Lower postprandial glucose levels have been observed in diabetic subjects as well, which can be attributed to the lower glycemic index of these supplements. This can lead to an indirect decrease in diabetes-related complications. While these supplements affect the body positively, caution has to be exercised while consuming them in excess, as they have been shown to cause hyperfiltration and increased urinary calcium excretion which can, in turn, lead to chronic kidney disease development. This article focuses on the effects of protein supplementation on the human body, with emphasis on the cardiovascular, endocrine, and renal systems.
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Affiliation(s)
- Vishw Patel
- Department of Medicine, Pandit Deendayal Upadhyay Government Medical College, Rajkot, India
| | - Kanishk Aggarwal
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ashish Dhawan
- Department of Medicine, Gian Sagar Medical College and Hospital, Punjab, India
| | - Bhupinder Singh
- Department of Medicine, Government Medical College, Amritsar, India
| | - Priyanshi Shah
- Department of Medicine, Narendra Modi Medical College, Ahmedabad, India
| | - Aanchal Sawhney
- Department of Internal Medicine, Crozer Chester Medical Center, Upland, Pennsylvania, USA
| | - Rohit Jain
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Pradhan N, Dobre M. Emerging Preventive Strategies in Chronic Kidney Disease: Recent Evidence and Gaps in Knowledge. Curr Atheroscler Rep 2023; 25:1047-1058. [PMID: 38038822 DOI: 10.1007/s11883-023-01172-5] [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] [Accepted: 11/10/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE OF REVIEW Chronic kidney disease (CKD) is increasingly prevalent worldwide and is associated with increased cardiovascular risk. New therapeutic options to slow CKD progression and reduce cardiovascular morbidity and mortality have recently emerged. This review highlights recent evidence and gaps in knowledge in emerging CKD preventive strategies. RECENT FINDINGS EMPA-Kidney trial found that empagliflozin, a sodium-glucose co-transporter 2 inhibitor (SGLT2i) led to 28% lower risk of progression of kidney disease or death from cardiovascular causes, compared to placebo. This reinforced the previous findings from DAPA-CKD and CREDENCE trials and led to inclusion of SGLT2i as the cornerstone of CKD preventive therapy in both diabetic and non-diabetic CKD. Finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist, slowed diabetic kidney disease progression by 23% compared to placebo in a pool analysis of FIDELIO-DKD and FIGARO-DKD trials. Non-pharmacological interventions, including low protein diet, and early CKD detection and risk stratification strategies based on novel biomarkers have also gained momentum. Ongoing efforts to explore the wealth of molecular mechanisms in CKD, added to integrative omics modeling are well posed to lead to novel therapeutic targets in kidney care. While breakthrough pharmacological interventions continue to improve outcomes in CKD, the heterogeneity of kidney diseases warrants additional investigation. Further research into specific kidney disease mechanisms will facilitate the identification of patient populations most likely to benefit from targeted interventions.
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Affiliation(s)
- Nishigandha Pradhan
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Mirela Dobre
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
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37
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Sun Z, Jiao J, Lu G, Liu R, Li Z, Sun Y, Chen Z. Overview of research progress on the association of dietary potassium intake with serum potassium and survival in hemodialysis patients, does dietary potassium restriction really benefit hemodialysis patients? Front Endocrinol (Lausanne) 2023; 14:1285929. [PMID: 38093955 PMCID: PMC10716210 DOI: 10.3389/fendo.2023.1285929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
For the general population, increasing potassium intake can reduce the incidence of cardiovascular and cerebrovascular diseases. However, since hyperkalemia is a common and life-threatening complication in maintenance hemodialysis patients, which can increase the risk of malignant arrhythmia and sudden death, the current mainstream of management for hemodialysis patients is dietary potassium restriction in order to prevent hyperkalemia. Hemodialysis patients are usually advised to reduce dietary potassium intake and limit potassium-rich fruits and vegetables, but there is limited evidence to support this approach can reduce mortality and improve quality of life. There is still no consistent conclusion on the association between dietary potassium intake and serum potassium and survival in hemodialysis patients. According to the current small observational studies, there was little or even no association between dietary potassium intake and serum potassium in hemodialysis patients when assurance of adequate dialysis and specific dietary patterns (such as the plant-based diet mentioned in the article) are being followed, and excessive dietary potassium restriction may not benefit the survival of hemodialysis patients. Additionally, when assessing the effect of diet on serum potassium, researchers should not only focus on the potassium content of foods, but also consider the type of food and the content of other nutrients. However, more large-scale, multi-center clinical trials are required to provide high-quality evidence support. Besides, further research is also needed to determine the optimal daily potassium intake and beneficial dietary patterns for hemodialysis patients.
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Affiliation(s)
- Zuoya Sun
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Jian Jiao
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University, Jinan, Shandong, China
| | - Gang Lu
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ruihong Liu
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zhuo Li
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Yi Sun
- Department of Nephrology, Beijing Huairou Hospital of University of Chinese Academy of Sciences, Beijing, China
| | - Zhiyuan Chen
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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38
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Altamura S, Pietropaoli D, Lombardi F, Del Pinto R, Ferri C. An Overview of Chronic Kidney Disease Pathophysiology: The Impact of Gut Dysbiosis and Oral Disease. Biomedicines 2023; 11:3033. [PMID: 38002033 PMCID: PMC10669155 DOI: 10.3390/biomedicines11113033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/02/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Chronic kidney disease (CKD) is a severe condition and a significant public health issue worldwide, carrying the burden of an increased risk of cardiovascular events and mortality. The traditional factors that promote the onset and progression of CKD are cardiometabolic risk factors like hypertension and diabetes, but non-traditional contributors are escalating. Moreover, gut dysbiosis, inflammation, and an impaired immune response are emerging as crucial mechanisms in the disease pathology. The gut microbiome and kidney disease exert a reciprocal influence commonly referred to as "the gut-kidney axis" through the induction of metabolic, immunological, and endocrine alterations. Periodontal diseases are strictly involved in the gut-kidney axis for their impact on the gut microbiota composition and for the metabolic and immunological alterations occurring in and reciprocally affecting both conditions. This review aims to provide an overview of the dynamic biological interconnections between oral health status, gut, and renal pathophysiology, spotlighting the dynamic oral-gut-kidney axis and raising whether periodontal diseases and gut microbiota can be disease modifiers in CKD. By doing so, we try to offer new insights into therapeutic strategies that may enhance the clinical trajectory of CKD patients, ultimately advancing our quest for improved patient outcomes and well-being.
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Affiliation(s)
- Serena Altamura
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.A.); (D.P.); (C.F.)
- PhD School in Medicine and Public Health, Center of Oral Diseases, Prevention and Translational Research—Dental Clinic, 67100 L’Aquila, Italy
- Oral Diseases and Systemic Interactions Study Group (ODISSY Group), 67100 L’Aquila, Italy
| | - Davide Pietropaoli
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.A.); (D.P.); (C.F.)
- Oral Diseases and Systemic Interactions Study Group (ODISSY Group), 67100 L’Aquila, Italy
- Center of Oral Diseases, Prevention and Translational Research—Dental Clinic, 67100 L’Aquila, Italy
| | - Francesca Lombardi
- Laboratory of Immunology and Immunopathology, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Rita Del Pinto
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.A.); (D.P.); (C.F.)
- Oral Diseases and Systemic Interactions Study Group (ODISSY Group), 67100 L’Aquila, Italy
- Unit of Internal Medicine and Nephrology, Center for Hypertension and Cardiovascular Prevention, San Salvatore Hospital, 67100 L’Aquila, Italy
| | - Claudio Ferri
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.A.); (D.P.); (C.F.)
- Oral Diseases and Systemic Interactions Study Group (ODISSY Group), 67100 L’Aquila, Italy
- Unit of Internal Medicine and Nephrology, Center for Hypertension and Cardiovascular Prevention, San Salvatore Hospital, 67100 L’Aquila, Italy
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Yee-Moon Wang A, Kistler BM, Lambert K, Sumida K, Moore LW, Kalantar-Zadeh K. Nutrition and Metabolism for Kidney Health and Disease Management: 45 years of Development and Future Directions Under the International Society of Renal Nutrition and Metabolism. J Ren Nutr 2023; 33:S1-S5. [PMID: 37683983 DOI: 10.1053/j.jrn.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Affiliation(s)
- Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
| | - Brandon M Kistler
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Kelly Lambert
- Faculty of Science, Medicine and Health, School of Medicine, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - 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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40
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Avesani CM, Cardozo LFMF, Yee-Moon Wang A, Shiels PG, Lambert K, Lindholm B, Stenvinkel P, Mafra D. Planetary Health, Nutrition, and Chronic Kidney Disease: Connecting the Dots for a Sustainable Future. J Ren Nutr 2023; 33:S40-S48. [PMID: 36182058 DOI: 10.1053/j.jrn.2022.09.003] [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: 07/11/2022] [Revised: 08/18/2022] [Accepted: 09/11/2022] [Indexed: 11/11/2022] Open
Abstract
The increasing consumption of ultra-processed food (UPF) and the global chain of food production have a negative impact on human health and planetary health. These foods have been replacing the consumption of nonprocessed healthy foods. This shift has not only worsened human health by increasing the risk of the development of noncommunicable diseases, but also resulted in environmental perturbations. This review aims to bring awareness of the problems caused by the industrialized food production chain, addressing the negative effects it has on the environment and human health, with special reference to chronic kidney disease (CKD). We discuss possible solutions focusing on the benefits of adopting plant-based diets with low UPF content to promote a sustainable and healthy food production and diet for patients with CKD. For a sustainable future we need to "connect the dots" of planetary health, food production, and nutrition in the context of CKD.
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Affiliation(s)
- Carla Maria Avesani
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Instituted, Stockholm, Sweden.
| | - Ludmila F M F Cardozo
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Paul G Shiels
- Wolfson Wohl Translational Research Centre, University of Glasgow, Scotland
| | - Kelly Lambert
- Discipline of Nutrition and Dietetics, School of Medicine, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Instituted, Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Instituted, Stockholm, Sweden
| | - Denise Mafra
- Graduate Program in Biological Sciences - Physiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
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Sumida K, Biruete A, Kistler BM, Khor BH, Ebrahim Z, Giannini R, Sussman-Dabach EJ, Avesani CM, Chan M, Lambert K, Yee-Moon Wang A, Clegg DJ, Burrowes JD, Palmer BF, Carrero JJ, Kovesdy CP. New Insights Into Dietary Approaches to Potassium Management in Chronic Kidney Disease. J Ren Nutr 2023; 33:S6-S12. [PMID: 37610407 PMCID: PMC10872890 DOI: 10.1053/j.jrn.2022.12.003] [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: 07/06/2022] [Revised: 10/07/2022] [Accepted: 12/13/2022] [Indexed: 08/24/2023] Open
Abstract
Potassium disorders are one of the most common electrolyte abnormalities in patients with chronic kidney disease (CKD), contributing to poor clinical outcomes. Maintaining serum potassium levels within the physiologically normal range is critically important in these patients. Dietary potassium restriction has long been considered a core strategy for the management of chronic hyperkalemia in patients with CKD. However, this has been challenged by recent evidence suggesting a paradigm shift toward fostering more liberalized, plant-based dietary patterns. The advent of novel potassium binders and an improved understanding of gastrointestinal processes involved in potassium homeostasis (e.g., gastrointestinal potassium wasting) may facilitate a paradigm shift and incorporation of heart-healthy potassium-enriched food sources. Nevertheless, uncertainty regarding the risk-benefit of plant-based diets in the context of potassium management in CKD remains, requiring well-designed clinical trials to determine the efficacy of dietary potassium manipulation toward improvement of clinical outcomes in patients with CKD.
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Affiliation(s)
- Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
| | - Annabel Biruete
- Department of Nutrition and Dietetics, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana; Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Brandon M Kistler
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Department of Nutrition and Health Science, Ball State University, Muncie, Indiana
| | - Ban-Hock Khor
- Faculty of Food Science and Nutrition, University Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Zarina Ebrahim
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Rossella Giannini
- Division of Metabolic Diseases and Clinical Nutrition, University Hospital of Modena, Modena, Italy
| | - Elizabeth J Sussman-Dabach
- Department of Family and Consumer Sciences, California State University, Northridge, Northridge, California
| | - Carla Maria Avesani
- Division of Renal Medicine, Baxter Novum. Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Maria Chan
- Departments of Nutrition and Dietetics and Renal Medicine, The St. George Hospital, Kogarah, New South Wales, Australia
| | - Kelly Lambert
- Faculty of Science, Medicine and Health, School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Deborah J Clegg
- Department of Internal Medicine, Paul Foster School of Medicine, Texas Tech Medical Center, El Paso, Texas
| | - Jerrilynn D Burrowes
- Department of Health Sciences and Administration, Program in Nutrition and Dietetics, Long Island University-Post, Greenvale, New York
| | - Biff F Palmer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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Burstad KM, Cladis DP, Wiese GN, Butler M, Hill Gallant KM. Effects of Plant-Based Protein Consumption on Kidney Function and Mineral Bone Disorder Outcomes in Adults With Stage 3-5 Chronic Kidney Disease: A Systematic Review. J Ren Nutr 2023; 33:717-730. [PMID: 37116624 DOI: 10.1053/j.jrn.2023.04.004] [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: 10/18/2022] [Revised: 02/13/2023] [Accepted: 04/07/2023] [Indexed: 04/30/2023] Open
Abstract
INTRODUCTION Plant-based protein is of growing interest for dietary management of chronic kidney disease (CKD) and is hypothesized to preserve kidney function and reduce CKD-mineral bone disorder (MBD) complications, among other benefits. This systematic review aimed to summarize the available clinical trial evidence for the effect of plant-based protein on kidney function and CKD-MBD outcomes in adults with stage 3-5 CKD not on dialysis. METHODS Searches of Medline, Embase, Agricola, CAB abstracts, Web of Science, Scopus, and hand searching were performed. Clinical trials with ≥8 participants ≥18 years of age with an estimated glomerular filtration rate <60 mL/min/1.73 m2 but not on dialysis were included. Additionally, only clinical trials with ≥1-week interventions with ≥50% dietary protein from plant-based sources and reported at least one outcome for both kidney function and CKD-MBD outcomes were included. Of the 10,962 identified abstracts, 32 met inclusion criteria and were assessed for risk of bias. RESULTS Results for kidney function and CKD-MBD outcomes were heterogenous, with most studies having suboptimal methodological quality. In most of the studies (27/32), protein source was altered only secondarily to low-protein diet interventions. Thus, data synthesis and interpretation were focused on a subset of five studies that investigated a change in protein source only (i.e., animal vs. plant). Of this subset, four studies reported no change in kidney function, while one study reported a decrease. Three studies reported no change in serum phosphorus, and one study reported lower serum phosphorus following a vegetarian diet. Further, limited data and inconclusive results were observed for phosphaturic hormones, parathyroid hormone, and fibroblast growth factor-23. CONCLUSION Current clinical trial evidence on plant-based protein interventions for preserving kidney function and preventing CKD-MBD is limited to inform clinical guidelines at this time. This systematic review emphasizes the ongoing need to research the effects of plant-based protein on kidney function and CKD-MBD outcomes.
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Affiliation(s)
- Kendal M Burstad
- Department of Food Science and Nutrition, University of Minnesota, Saint Paul, Minnesota
| | - Dennis P Cladis
- Department of Food Science and Nutrition, University of Minnesota, Saint Paul, Minnesota
| | | | - Mary Butler
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Kathleen M Hill Gallant
- Department of Food Science and Nutrition, University of Minnesota, Saint Paul, Minnesota; Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
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43
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Babich JS, Dupuis L, Kalantar-Zadeh K, Joshi S. Hyperkalemia and Plant-Based Diets in Chronic Kidney Disease. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:487-495. [PMID: 38453264 DOI: 10.1053/j.akdh.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 10/05/2023] [Accepted: 10/11/2023] [Indexed: 03/09/2024]
Abstract
Traditional dietary guidelines for patients with kidney disease recommend restriction of plant foods due to concerns about hyperkalemia and associated adverse events. Studies conducted over several decades have shown that the basis for these guidelines does not match the evidence. Serum potassium levels can be elevated in patients with reduced kidney function after consumption of foods with potassium-based additives or with highly concentrated potassium content such as juices, dried fruit, or purees. However, plant foods may have certain qualities that may blunt potassium retention including their alkalinizing effects, the lack of bioavailable potassium, and the impact of dietary fiber in organic plant foods on colonic potassium excretion. Furthermore, there are many benefits of plant foods that patients with kidney disease may be missing by excluding them from their diets by recommending the historical low-potassium "renal diet." Revised dietary recommendations for kidney health may encourage patient-centered kidney recipes that revolve around plant foods and do not restrict them.
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Affiliation(s)
- John Sebastian Babich
- SUNY Upstate Medical University Norton College of Medicine, Syracuse, NY; Volunteer Services, NYC Health + Hospitals/Bellevue, New York, NY
| | - Léonie Dupuis
- University of Central Florida College of Medicine, Orlando, FL
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Shivam Joshi
- Department of Veteran Affairs, Orlando, FL; Department of Medicine, New York University Grossman School of Medicine, New York, NY.
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44
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Biruete A, Hill Gallant KM, Lloyd L, Meade A, Moe SM, St-Jules DE, Kistler BM. 'Phos'tering a Clear Message: The Evolution of Dietary Phosphorus Management in Chronic Kidney Disease. J Ren Nutr 2023; 33:S13-S20. [PMID: 37343779 PMCID: PMC10728341 DOI: 10.1053/j.jrn.2023.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 04/21/2023] [Accepted: 05/04/2023] [Indexed: 06/23/2023] Open
Abstract
Phosphorus is a vital nutrient, but disturbances in phosphorus homeostasis are central to chronic kidney disease-mineral and bone disorder. To minimize disturbances, traditional dietary guidance focused on a numerical phosphorus target leading to the exclusion of many healthy foods and implementation challenges. Contemporary phosphorus guidance focuses on dietary source, avoiding additives, and emphasizing low-phosphorus bioaccessibility foods, leading to a more liberal approach. Additional work is needed to demonstrate the efficacy of these contemporary approaches and understand the influence of specific foods, processing, and cooking methods. Unfortunately, patient education using traditional and contemporary strategies may give mixed messages, particularly related to plant-based foods. Thus, greater clarity on the effects of specific foods and dietary patterns may improve phosphorus education. This review aims to discuss the evolution of dietary phosphorus management while highlighting areas for future research that can help move the field toward stronger evidence-based guidance to prevent and treat hyperphosphatemia.
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Affiliation(s)
- Annabel Biruete
- Department of Nutrition and Dietetics, Indiana University-Purdue University Indianapolis, Indianapolis; Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis; Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Kathleen M Hill Gallant
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis; Department of Food Science and Nutrition, University of Minnesota, St. Paul
| | - Lyn Lloyd
- Nutrition and Dietetics, Auckland City Hospital, Auckland, New Zealand
| | - Anthony Meade
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
| | - Sharon M Moe
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis
| | | | - Brandon M Kistler
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Department of Nutrition and Health Science, Ball State University, Muncie.
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45
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Kelly JT, Gonzalez-Ortiz A, St-Jules DE, Carrero JJ. Animal Protein Intake and Possible Cardiovascular Risk in People With Chronic Kidney Disease: Mechanisms and Evidence. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:480-486. [PMID: 38453263 DOI: 10.1053/j.akdh.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Individuals with chronic kidney disease (CKD) have an increased risk of cardiovascular disease (CVD), and the kidney function is a critical determinant of this risk. CKD is also a major cause of complications and disease progression in patients with CVD. Practice guidelines suggest that CVD risk in CKD patients can be managed through healthy lifestyle and dietary behaviors. Assessing the impact of diet on heart and kidney health is complex because numerous bioactive compounds from diet may contribute to or prevent CVD or CKD via a myriad of pathways and mechanisms. The objective of this review was to provide a discussion of the mechanisms and evidence linking protein-rich foods and CVD risk in people with CKD. This review highlights the current evidence-based strategies for primary CKD prevention that incorporate a healthy dietary pattern, while tertiary prevention strategies focus on avoiding excess protein and reducing dietary acid load. The effect of protein restriction for improving CVD and CKD outcomes is conflicting; however, these approaches show no negative effects on kidney health. Low-protein and very low-protein diets are promising interventions for reducing the progression of CKD and CVD. Animal-sourced protein may be more detrimental to kidney health than plant-sourced protein due to specific acid load, amino acid composition, generation of uremic toxins, accompanying saturated fat content, low fiber composition, and higher generation of advanced glycation end-products. There are no one-size fits all nutrition prescriptions. Personalized nutrition interventions that target the unique risk factors for CVD associated with reduced kidney function are required to improve the health of people living with CKD.
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Affiliation(s)
- Jaimon T Kelly
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Ailema Gonzalez-Ortiz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Translational Research Center, Instituto Nacional de Pediatría, Mexico
| | | | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Lambert K, Rinninella E, Biruete A, Sumida K, Stanford J, Raoul P, Mele MC, Wang AYM, Mafra D. Targeting the Gut Microbiota in Kidney Disease: The Future in Renal Nutrition and Metabolism. J Ren Nutr 2023; 33:S30-S39. [PMID: 37632511 PMCID: PMC10872791 DOI: 10.1053/j.jrn.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/05/2022] [Accepted: 12/10/2022] [Indexed: 08/28/2023] Open
Abstract
There is increasing interest in the therapeutic potential of manipulating the gut microbiome of patients with chronic kidney disease (CKD). This is because there is a substantial deviation from a balanced gut microbiota profile in CKD, with many deleterious downstream effects. Nutritional interventions such as plant-based diets with reduced animal protein intake and the use of probiotics, prebiotics, and synbiotics may alter the microbiome. This article aims to briefly describe what is known about the gut microbiome in patients with CKD, factors contributing to gut dysbiosis, and outline important evidence gaps. Future potential therapies, including restoring the microbiota with food and microbiota-based and metabolomic-based therapies, are also discussed.
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Affiliation(s)
- Kelly Lambert
- School of Medical, Indigenous, and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.
| | - Emanuele Rinninella
- Clinical Nutrition Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Annabel Biruete
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Tennessee
| | - Jordan Stanford
- School of Medical, Indigenous, and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Pauline Raoul
- Clinical Nutrition Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Cristina Mele
- Clinical Nutrition Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Denise Mafra
- Professor, Graduate Program in Nutrition Sciences, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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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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48
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Dąbek B, Dybiec J, Frąk W, Fularski P, Lisińska W, Radzioch E, Młynarska E, Rysz J, Franczyk B. Novel Therapeutic Approaches in the Management of Chronic Kidney Disease. Biomedicines 2023; 11:2746. [PMID: 37893119 PMCID: PMC10604464 DOI: 10.3390/biomedicines11102746] [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: 08/31/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
Chronic kidney disease (CKD) is a progressive and incurable disease that impairs kidney function. Its prevalence is estimated to affect up to 800 million individuals within the general population, and patients with diabetes and hypertension are particularly at risk. This disorder disrupts the physiological mechanisms of the body, including water and electrolyte balance, blood pressure regulation, the excretion of toxins, and vitamin D metabolism. Consequently, patients are exposed to risks such as hyperkalemia, hyperphosphatemia, metabolic acidosis, and blood pressure abnormalities. These risks can be reduced by implementing appropriate diagnostic methods, followed by non-pharmacological (such as physical activity, dietary, and lifestyle adjustment) and pharmacological strategies after diagnosis. Selecting the appropriate diet and suitable pharmacological treatment is imperative in maintaining kidney function as long as possible. Drugs such as finerenone, canakinumab, and pentoxifylline hold promise for improved outcomes among CKD patients. When these interventions prove insufficient, renal replacement therapy becomes essential. This is particularly critical in preserving residual renal function while awaiting renal transplantation or for patients deemed ineligible for such a procedure. The aim of this study is to present the current state of knowledge and recent advances, providing novel insights into the treatment of chronic kidney disease.
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Affiliation(s)
- Bartłomiej Dąbek
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Jill Dybiec
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Weronika Frąk
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Piotr Fularski
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Wiktoria Lisińska
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Ewa Radzioch
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Ewelina Młynarska
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Beata Franczyk
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
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49
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AlSahow A. Moderate stepwise restriction of potassium intake to reduce risk of hyperkalemia in chronic kidney disease: A literature review. World J Nephrol 2023; 12:73-81. [PMID: 37766841 PMCID: PMC10520754 DOI: 10.5527/wjn.v12.i4.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 09/20/2023] Open
Abstract
A potassium-rich diet has several cardiovascular and renal health benefits; however, it is not recommended for patients with advanced chronic kidney disease or end-stage kidney disease because of the risk of life-threatening hyperkalemia. To assess the strength of evidence supporting potassium intake restriction in chronic kidney disease, the medical literature was searched looking for the current recommended approach and for evidence in support for such an approach. There is a lack of strong evidence supporting intense restriction of dietary potassium intake. There are several ways to reduce potassium intake without depriving the patient from fruits and vegetables, such as identifying hidden sources of potassium (processed food and preservatives) and soaking or boiling food to remove potassium. An individualized and gradual reduction of dietary potassium intake in people at risk of hyperkalemia is recommended. The current potassium dietary advice in chronic kidney disease needs to be reevaluated, individualized, and gradually introduced.
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Affiliation(s)
- Ali AlSahow
- Department of Nephrology, Jahra Hospital, Jahra 00004, Kuwait
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50
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Darzi M, Rouhani MH, Keshavarz SA. The association between plant and animal protein intake and quality of life in patients undergoing hemodialysis. Front Nutr 2023; 10:1219976. [PMID: 37794969 PMCID: PMC10546620 DOI: 10.3389/fnut.2023.1219976] [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: 05/09/2023] [Accepted: 09/01/2023] [Indexed: 10/06/2023] Open
Abstract
Background Hemodialysis (HD) patients often experience a significant reduction in quality of life (QOL). The source of dietary protein intake may influence the renal function and complications of HD patients. The present study assessed the relationship between plant and animal protein intake and QOL in HD patients. Methods 264 adult patients under dialysis for at least three months were included in this cross-sectional study. Dietary intakes were collected using a valid and reliable 168-item semi-quantitative food frequency questionnaire (FFQ) over the past year. Total, animal, and plant proteins were calculated for each patient. To evaluate QOL, Kidney Disease Quality of Life Short Form (KDQOL-SF 1/3) was used. Anthropometric measures were assessed according to standard protocols. Results In this study, the average age of participants was 58.62 ± 15.26 years old; most (73.5%) were men. The mean of total, plant, and animal proteins intake were 66.40 ± 34.29 g/d, 34.60 ± 18.24 g/d, and 31.80 ± 22.21 g/d. Furthermore, the mean score of QOL was 59.29 ± 18.68. After adjustment for potential confounders, a significant positive association was found between total dietary protein intake and QOL (β = 0.12; p = 0.03). Moreover, there was a significant association between plant-based protein intake and QOL (β = 0.26; p < 0.001). However, the association between animal protein intake and QOL was insignificant (β = 0.03; p = 0.60). Conclusion Higher total and plant proteins intake were associated with better QOL in HD patients. Further studies, particularly prospective ones, are needed to corroborate these associations.
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Affiliation(s)
- Melika Darzi
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad Hossein Rouhani
- Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed-Ali Keshavarz
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
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