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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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Ekmeiro-Salvador JE, Storz MA. The Impact of Plant-Based Diets on Dietary Acid Load Metrics in Venezuela: A Cross-Sectional Study. Nutrients 2023; 15:2745. [PMID: 37375649 DOI: 10.3390/nu15122745] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Dietary acid load (DAL) is an important determinant of the acid-base balance in humans and has been associated with several chronic non-communicable diseases. Plant-based diets, including vegetarian and vegan diets, decrease DAL-although their alkalizing potential varies substantially. Their net effect on common DAL scores, including potential renal acid load and net endogenous acid production, has been insufficiently quantified and is poorly understood-particularly in populations outside of Europe and North America. We assessed the associations between three plant-based dietary patterns (flexitarian vs. lacto-ovo-vegetarian vs. vegan diet) and DAL scores in a healthy Venezuelan population in the metropolitan area of Puerto La Cruz, Venezuela. Substantial differences in DAL scores were observed, whereby the vegan diet yielded the highest alkalizing potential, followed by the lacto-ovo-vegetarian and the flexitarian diet. DAL scores were substantially lower in comparison to European and North American plant-based populations, probably due to the higher potassium intake (exceeding 4000 mg/d in vegans), the higher magnesium intake (390.31 ± 1.79 mg/d in vegans) and the lower intake of protein in vegans and lacto-ovo-vegetarians. Additional studies in other non-industrialized populations are warranted to allow for a better understanding of the (numeric) impact of plant-based dietary patterns on DAL scores, potentially allowing for an establishment of reference ranges in the near future.
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Affiliation(s)
| | - Maximilian Andreas Storz
- Department of Internal Medicine II, Centre for Complementary Medicine, Freiburg University Hospital Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
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Bae SR, Bicki A, Coufal S, Jin E, Ku E. Cardiovascular disease risk factors and lifestyle modification strategies after pediatric kidney transplantation: what are we dealing with, and what can we target? Pediatr Nephrol 2023; 38:663-671. [PMID: 35552523 PMCID: PMC10799690 DOI: 10.1007/s00467-022-05589-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 01/19/2023]
Abstract
Kidney transplantation in pediatric patients can lead to partial improvement of some of the cardiometabolic parameters that increase the risk for cardiovascular disease (CVD) in patients with chronic kidney disease. However, even after restoration of kidney function, transplant recipients remain at risk for CVD due to the continual presence of traditional and non-traditional risk factors, including the side effects of immunosuppression and chronic inflammation. This educational review describes the prevalence of CVD risk factors in pediatric kidney transplant recipients and presents available evidence for therapeutic lifestyle changes and other non-pharmacologic strategies that can be used to improve traditional and modifiable CVD risk factors. Although trial-grade evidence for interventions that improve CVD in pediatric kidney transplant recipients is limited, potential strategies include lowering dietary sodium and saturated fat intake and increasing physical activity levels. Intensive follow-up may help patients achieve guideline-recommended goals for reducing their overall CVD risk.
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Affiliation(s)
- Se Ri Bae
- University of California, Davis, School of Medicine, Sacramento, CA, USA
| | - Alexandra Bicki
- Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
| | - Sarah Coufal
- Division of Nephrology, Department of Medicine and Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Ethan Jin
- College of Osteopathic Medicine, Touro University, Vallejo, CA, USA
| | - Elaine Ku
- Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
- Division of Nephrology, Department of Medicine and Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Ekramzadeh M, Moore LW, Kalantar-Zadeh K, Kopple JD. Phytate and Kidney Health: The Roles of Dietary Phytate in Inhibiting Intestinal Phosphorus Absorption and Intravenous Phytate in Decreasing Soft Tissue Calcification. J Ren Nutr 2023; 33:225-227. [PMID: 36638857 DOI: 10.1053/j.jrn.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Affiliation(s)
- Maryam Ekramzadeh
- Division of Nephrology and Hypertension and The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension and The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California; David Geffen School of Medicine at UCLA and the UCLA Fielding School of Public Health, Los Angeles, California
| | - Joel D Kopple
- Division of Nephrology and Hypertension and The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California; David Geffen School of Medicine at UCLA and the UCLA Fielding School of Public Health, Los Angeles, California
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Kalantar-Zadeh K, Moore LW. Functional Nutrition, Naturopathic Nutrition, and Integrative and Holistic Renal Nutrition in Kidney Health and Value-Based Kidney Care Models. J Ren Nutr 2022; 32:493-497. [PMID: 35843458 DOI: 10.1053/j.jrn.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, CA, USA.
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
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Stress Reactivity, Susceptibility to Hypertension, and Differential Expression of Genes in Hypertensive Compared to Normotensive Patients. Int J Mol Sci 2022; 23:ijms23052835. [PMID: 35269977 PMCID: PMC8911431 DOI: 10.3390/ijms23052835] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/14/2022] [Accepted: 02/28/2022] [Indexed: 12/14/2022] Open
Abstract
Although half of hypertensive patients have hypertensive parents, known hypertension-related human loci identified by genome-wide analysis explain only 3% of hypertension heredity. Therefore, mainstream transcriptome profiling of hypertensive subjects addresses differentially expressed genes (DEGs) specific to gender, age, and comorbidities in accordance with predictive preventive personalized participatory medicine treating patients according to their symptoms, individual lifestyle, and genetic background. Within this mainstream paradigm, here, we determined whether, among the known hypertension-related DEGs that we could find, there is any genome-wide hypertension theranostic molecular marker applicable to everyone, everywhere, anytime. Therefore, we sequenced the hippocampal transcriptome of tame and aggressive rats, corresponding to low and high stress reactivity, an increase of which raises hypertensive risk; we identified stress-reactivity-related rat DEGs and compared them with their known homologous hypertension-related animal DEGs. This yielded significant correlations between stress reactivity-related and hypertension-related fold changes (log2 values) of these DEG homologs. We found principal components, PC1 and PC2, corresponding to a half-difference and half-sum of these log2 values. Using the DEGs of hypertensive versus normotensive patients (as the control), we verified the correlations and principal components. This analysis highlighted downregulation of β-protocadherins and hemoglobin as whole-genome hypertension theranostic molecular markers associated with a wide vascular inner diameter and low blood viscosity, respectively.
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Acceptability of Plant-Based Diets for People with Chronic Kidney Disease: Perspectives of Renal Dietitians. Nutrients 2022; 14:nu14010216. [PMID: 35011091 PMCID: PMC8747619 DOI: 10.3390/nu14010216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 12/24/2021] [Accepted: 01/01/2022] [Indexed: 02/08/2023] Open
Abstract
The purpose of this study was to explore the perspective of renal dietitians regarding plant-based diets for chronic kidney disease (CKD) management and evaluate the acceptability of a hypothetical plant-based dietary prescription aiming for the consumption of 30 unique plant foods per week. This study used an exploratory mixed methods design. Forty-six renal dietitians participated in either an online survey (n = 35) or an in-depth interview (n = 11). Dietitians perceived that plant-based diets could address multiple clinical concerns relevant to CKD. Forty percent of survey respondents reported the hypothetical dietary prescription was realistic for people with CKD, 34.3% were unsure, and 25.7% perceived it as unrealistic. Strengths of the hypothetical prescription included shifting the focus to whole foods and using practical resources like recipes. Limited staffing, time, and follow-up opportunities with patients, as well as differing nutrition philosophies were the most commonly reported challenges to implementation; while a supportive multidisciplinary team was identified as an important enabler. To increase patient acceptance of plant-based dietary approaches, education about plant food benefits was recommended, as was implementing small, incremental dietary changes. Successful implementation of plant-based diets is perceived to require frequent patient contact and ongoing education and support by a dietitian. Buy-in from the multidisciplinary team was also considered imperative.
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