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de Lorenzo A, Bomback AS, Mihic N. High Protein Diets and Glomerular Hyperfiltration in Athletes and Bodybuilders: Is Chronic Kidney Disease the Real Finish Line? Sports Med 2024:10.1007/s40279-024-02086-1. [PMID: 39196487 DOI: 10.1007/s40279-024-02086-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/29/2024]
Abstract
Several observational and experimental studies in humans have suggested that high protein intake (PI) causes intraglomerular hypertension leading to hyperfiltration. This phenomenon results in progressive loss of renal function with long-term exposure to high-protein diets (HPDs), even in healthy people. The recommended daily allowance for PI is 0.83 g/kg per day, which meets the protein requirement for approximately 98% of the population. A HPD is defined as a protein consumption > 1.5 g/kg per day. Athletes and bodybuilders are encouraged to follow HPDs to optimize muscle protein balance, increase lean body mass, and enhance performance. A series of studies in resistance-trained athletes looking at HPD has been published concluding that there are no harmful effects of HPD on renal health. However, the aim of these studies was to evaluate body composition changes and they were not designed to assess safety or kidney outcomes. Here we review the effects of HPD on kidney health in athletes and healthy individuals with normal kidney function.
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Affiliation(s)
- Alberto de Lorenzo
- Department of Nephrology, Hospital Universitario HM Sanchinarro, Madrid, Spain.
- Department of Nephrology, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain.
| | - Andrew S Bomback
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, Presbyterian Hospital, New York, USA
| | - Niko Mihic
- Chief Medical Officer of Real Madrid CF, Madrid, Spain
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2
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Cheng Y, Zheng G, Song Z, Zhang G, Rao X, Zeng T. Association between dietary protein intake and risk of chronic kidney disease: a systematic review and meta-analysis. Front Nutr 2024; 11:1408424. [PMID: 38946781 PMCID: PMC11212527 DOI: 10.3389/fnut.2024.1408424] [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: 03/28/2024] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
Objective There is suggestive data indicating a correlation among dietary protein intake and the progression of chronic kidney disease (CKD). Nonetheless, the exact associations between dietary protein intake and the incidence of CKD have remained uncertain. We performed the first meta-analysis to explore the correlation among total protein, plant protein, animal protein intake and CKD risk. Methods The study conformed the PRISMA statement guidelines. We comprehensively searched PubMed, Web of Science, and Embase until to December 2023. The retrieved studies underwent rigorous evaluation for eligibility, and relevant data were meticulously extracted. The Newcastle-Ottawa Scale (NOS) tool was applied to evaluate the risk of bias. Subsequently, relevant data were extracted and pooled to evaluate the relations among dietary protein intake and CKD incidence. Results Totally, 6,191 articles were identified, six studies were eligible. A total of 148,051 participants with 8,746 CKD cases were included. All studies had a low overall risk of bias. Higher total, plant and animal protein intake were all correlated with decreased CKD incidence, pooled risk ratios (RRs) and 95% confidence intervals (CIs) were as follows: (RR = 0.82, 95% CI = 0.71-0.94, p = 0.005; I2 = 38%, p = 0.17); (RR = 0.77, 95% CI = 0.61-0.97, p = 0.03; I2 = 77%, p = 0.001); (RR = 0.86, 95% CI = 0.76-0.97, p = 0.02; I2 = 0%, p = 0.59), respectively. For fish and seafood within animal protein: RR = 0.84, 95% CI = 0.74-0.94. Subgroup analysis showed that geographical region, sample size, follow-up time, not assessing protein by food frequency questionnaire, using %energy as the measurement index, not adjusting for several covariates may be the sources of heterogeneity for plant protein. A significant non-linear relation among plant protein and incident CKD was observed by dose-response analysis. Conclusion The data showed a lower CKD risk significantly associated higher-level dietary total, plant or animal protein (especially for fish and seafood) intake. Further prospective studies demonstrating the correlations of precise sources, intake and duration of dietary protein and incident CKD are warranted.
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Affiliation(s)
| | | | | | | | | | - Tao Zeng
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
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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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Vukovic V, Hantikainen E, Raftopoulou A, Gögele M, Rainer J, Domingues FS, Pramstaller PP, Garcia-Larsen V, Pattaro C. Association of dietary proteins with serum creatinine and estimated glomerular filtration rate in a general population sample: the CHRIS study. J Nephrol 2023; 36:103-114. [PMID: 35930180 PMCID: PMC9894942 DOI: 10.1007/s40620-022-01409-7] [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: 04/26/2022] [Accepted: 07/14/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Diet is known to affect kidney function. However, population-based studies provide contrasting evidence, resulting in a poor understanding of the effect of proteins from specific foods on kidney health. METHODS We analyzed the effect of total daily protein intake (TDPI) and source-specific daily protein intake (DPI) on fasting serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) in the Cooperative Health Research In South Tyrol (CHRIS) cross-sectional study (n = 5889), using the GA2LEN food frequency questionnaire for TDPI and DPI estimation. We fitted multivariable adjusted mixed models of SCr and eGFR on TDPI and DPI quartiles (Q1-Q4) in the overall sample, and after removing individuals with known hypertension, diabetes or chronic kidney disease (CKD). RESULTS Higher TDPI as well as DPI from overall animal sources, fish, and poultry, were associated with higher SCr (trend test p, ptrend < 0.01), with larger effect after excluding individuals with known hypertension, diabetes or CKD. The eGFR was lower at higher TDPI (Q4 vs Q1: - 1.6 ml/min/1.73 m2; 95% CI - 2.5, - 0.7; ptrend = 3e-4) and DPI from fish (Q4 vs Q1: - 2.1 ml/min/1.73 m2; 95% CI - 2.9, - 1.20; ptrend = 4.3e-6), overall animal source (Q4 vs Q1: - 1.6 ml/min/1.73 m2; 95% CI -2.5, - 0.8), processed meat (Q4 vs Q1: - 1.4 ml/min/1.73 m2; ptrend = 0.027), red meat, offal and processed meat (Q4 vs Q1: - 1.4 ml/min/1.73 m2; ptrend = 0.015) and poultry (Q4 vs Q1: - 0.9 ml/min/1.73 m2; ptrend = 0.015). CONCLUSIONS TDPI and DPI from specific animal sources were positively associated with SCr and negatively associated with eGFR. Lacking an alternative marker of kidney function, confounding involving muscle mass metabolism cannot be fully excluded.
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Affiliation(s)
- Vladimir Vukovic
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), Via Volta 21, 39100, Bolzano, Italy. .,Department of Epidemiology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000, Novi Sad, Serbia. .,Centre for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia.
| | - Essi Hantikainen
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), Via Volta 21, 39100, Bolzano, Italy
| | - Athina Raftopoulou
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), Via Volta 21, 39100, Bolzano, Italy.,Department of Economics, University of Patras, Patras, Greece
| | - Martin Gögele
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), Via Volta 21, 39100, Bolzano, Italy
| | - Johannes Rainer
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), Via Volta 21, 39100, Bolzano, Italy
| | - Francisco S Domingues
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), Via Volta 21, 39100, Bolzano, Italy
| | - Peter P Pramstaller
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), Via Volta 21, 39100, Bolzano, Italy
| | - Vanessa Garcia-Larsen
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cristian Pattaro
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), Via Volta 21, 39100, Bolzano, Italy.
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Urinalysis of individuals with renal hyperfiltration using ATR-FTIR spectroscopy. Sci Rep 2022; 12:20887. [PMID: 36463336 PMCID: PMC9719484 DOI: 10.1038/s41598-022-25535-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 11/30/2022] [Indexed: 12/04/2022] Open
Abstract
Abnormal increased glomerular filtration rate (GFR), otherwise known as renal hyperfiltration (RHf), is associated with an increased risk of chronic kidney disease and cardiovascular mortality. Although it is not considered as a disease alone in medicine today, early detection of RHf is essential to reducing risk in a timely manner. However, detecting RHf is a challenge since it does not have a practical biochemical marker that can be followed or quantified. In this study, we tested the ability of ATR-FTIR spectroscopy to distinguish 17 individuals with RHf (hyperfiltraters; RHf (+)), from 20 who have normal GFR (normofiltraters; RHf(-)), using urine samples. Spectra collected from hyperfiltraters were significantly different from the control group at positions 1621, 1390, 1346, 933 and 783/cm. Intensity changes at these positions could be followed directly from the absorbance spectra without the need for pre-processing. They were tentatively attributed to urea, citrate, creatinine, phosphate groups, and uric acid, respectively. Using principal component analysis (PCA), major peaks of the second derivative forms for the classification of two groups were determined. Peaks at 1540, 1492, 1390, 1200, 1000 and 840/cm were significantly different between the two groups. Statistical analysis showed that the spectra of normofiltraters are similar; however, those of hyperfiltraters show diversity at multiple positions that can be observed both from the absorbance spectra and the second derivative profiles. This observation implies that RHf can simultaneously affect the excretion of many substances, and that a spectroscopic analysis of urine can be used as a rapid and non-invasive pre-screening tool.
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Oh D, Park SH, Lee S, Yang E, Choi HY, Park HC, Jhee JH. High Triglyceride-Glucose Index with Renal Hyperfiltration and Albuminuria in Young Adults: The Korea National Health and Nutrition Examination Survey (KNHANES V, VI, and VIII). J Clin Med 2022; 11:jcm11216419. [PMID: 36362646 PMCID: PMC9655420 DOI: 10.3390/jcm11216419] [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: 09/30/2022] [Revised: 10/22/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: High triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance, is associated with an increased risk of albuminuria in adults. However, the relationship between high TyG index associated with renal hyperfiltration (RHF) and albuminuria among young adults is unclear. Methods: A total of 5420 participants aged 19−39 years were enrolled from the Korean National Health and Nutrition Examination Survey (2011−2014 and 2019) and their TyG index levels were analyzed. RHF was defined as eGFR with residuals > 90th percentile after adjusting for age, sex, weight, and height. Albuminuria was defined as urinary albumin-to-creatinine ratio ≥ 30 mg/g Cr. Logistic regression analyses were used to evaluate the association between TyG index, RHF, and albuminuria. Results: The mean age was 30.7 ± 6.0 years and 46.4% were male. The prevalence of albuminuria and RHF was higher in the higher tertiles of TyG index. In our multivariable model, high TyG index showed higher risk of albuminuria (odds ratio (OR) per 1.0 increase in TyG index, 1.56; 95% confidence interval (CI), 1.24−1.95 and OR in the highest tertile, 1.65; 95% CI, 1.08−2.52). High TyG index was associated with higher risk of RHF (OR per 1.0 increase in TyG index, 1.56; 95% CI, 1.32−1.84 and OR in the highest tertile, 1.73; 95% CI, 1.31−2.30). When participants were divided into with or without RHF, high-TyG index-associated high risk of albuminuria was only observed in those with RHF. Participants with concurrent high TyG index and RHF showed the highest risk of albuminuria. Mediation analysis showed that 54.2% of the relation between TyG index and albuminuria was mediated by RHF (95% CI of indirect effect, 0.27−0.76). Finally, incorporating TyG index into our basic model improved the predictive value for albuminuria only in participants with RHF. Conclusion: High TyG index associated with RHF was the strongest risk factor for albuminuria in this study. Early identification of high TyG index with RHF may prevent future development of CKD in relatively healthy and young adults.
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Affiliation(s)
- Donghwan Oh
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Seoul 06273, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Sang Ho Park
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Seoul 06273, Korea
| | - Seoyoung Lee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Seoul 06273, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Eunji Yang
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Seoul 06273, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Hoon Young Choi
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Seoul 06273, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Hyeong Cheon Park
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Seoul 06273, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jong Hyun Jhee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Seoul 06273, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Correspondence: ; Tel.: +82-2-2019-4368; Fax: +82-2-3463-3882
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Yang E, Park SH, Lee S, Oh D, Choi HY, Park HC, Jhee JH. Pulse pressure and the risk of renal hyperfiltration in young adults: Results from Korea National Health and Nutrition Examination Survey (2010–2019). Front Med (Lausanne) 2022; 9:911267. [PMID: 36177333 PMCID: PMC9513024 DOI: 10.3389/fmed.2022.911267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/08/2022] [Indexed: 11/26/2022] Open
Abstract
Background High pulse pressure (PP) is associated with increased risk of decline of kidney function. However, little is known about the association between PP and RHF in young adults. This study aimed to evaluate the association between PP and RHF in healthy young adults. Methods Data were retrieved from the Korea National Health and Nutrition Examination Survey from 2010 to 2019. A total of 10,365 participants aged 19–39 years with no hypertension and normal kidney function were analyzed. RHF was defined as logarithm transformed estimated glomerular filtration rate (eGFR) with residuals >90th percentile after adjustment for sex, logarithm transformed age, weight, and height. Participants were divided into tertile based on PP levels. Results The prevalence of RHF was higher in higher PP tertile group (6.6, 10.5, and 12.7% in T1, T2, and T3; P for trend < 0.001). In multivariable logistic regression analyses, the risk for RHF was increased in higher PP tertiles compared to the lowest tertile [odds ratio (OR), 1.42; 95% confidence interval (CI), 1.19–1.69 in T2; OR, 1.44; 95% CI, 1.20–1.73 in T3]. When PP levels were treated as continuous variable, the risk of RHF was increased 2.36 per 1.0 increase of PP (P < 0.001). In subgroup analyses stratified sex, histories of diabetes or dyslipidemia, and isolated systolic hypertension or isolated diastolic hypertension, there were no significant interactions with PP for the risk for RHF, suggesting that high PP was associated with increased risk of RHF regardless of subgroups. However, the subgroup with BMI showed significant interaction with PP for the risk of RHF, indicating that participants with BMI ≥ 25 kg/m2 were at higher risk of RHF with increasing PP levels than those with BMI < 25 kg/m2 (OR, 1.89; 95% CI, 1.25–2.87 in BMI < 25 kg/m2; OR, 3.16; 95% CI, 1.74–5.73 in BMI ≥ 25 kg/m2; P for interaction = 0.01). Conclusion High PP is associated with an increased risk of RHF in healthy young adults and this association is prominent in obese young adults. The assessment of PP and associated RHF may give benefit to early detect the potential risk of CKD development in young adults.
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Affiliation(s)
- Eunji Yang
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Ho Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seoyoung Lee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Donghwan Oh
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hoon Young Choi
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyeong Cheon Park
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Hyun Jhee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- *Correspondence: Jong Hyun Jhee,
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Tidmas V, Brazier J, Hawkins J, Forbes SC, Bottoms L, Farrington K. Nutritional and Non-Nutritional Strategies in Bodybuilding: Impact on Kidney Function. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074288. [PMID: 35409969 PMCID: PMC8998289 DOI: 10.3390/ijerph19074288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 12/10/2022]
Abstract
Bodybuilders routinely engage in many dietary and other practices purported to be harmful to kidney health. The development of acute kidney injury, focal segmental glomerular sclerosis (FSGS) and nephrocalcinosis may be particular risks. There is little evidence that high-protein diets and moderate creatine supplementation pose risks to individuals with normal kidney function though long-term high protein intake in those with underlying impairment of kidney function is inadvisable. The links between anabolic androgenic steroid use and FSGS are stronger, and there are undoubted dangers of nephrocalcinosis in those taking high doses of vitamins A, D and E. Dehydrating practices, including diuretic misuse, and NSAID use also carry potential risks. It is difficult to predict the effects of multiple practices carried out in concert. Investigations into subclinical kidney damage associated with these practices have rarely been undertaken. Future research is warranted to identify the clinical and subclinical harm associated with individual practices and combinations to enable appropriate and timely advice.
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Affiliation(s)
- Victoria Tidmas
- Centre for Research in Psychology and Sports Science, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK; (V.T.); (L.B.)
| | - Jon Brazier
- Centre for Research in Psychology and Sports Science, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK; (V.T.); (L.B.)
- Correspondence:
| | - Janine Hawkins
- Centre for Health Services and Clinical Research, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK; (J.H.); (K.F.)
| | - Scott C. Forbes
- Department of Physical Education Studies, Brandon University, Brandon, MB R7A 6A9, Canada;
| | - Lindsay Bottoms
- Centre for Research in Psychology and Sports Science, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK; (V.T.); (L.B.)
| | - Ken Farrington
- Centre for Health Services and Clinical Research, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK; (J.H.); (K.F.)
- Renal Unit, Lister Hospital, East and North Herts Trust, Stevenage SG1 4AB, UK
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The Impact of Hepatitis C Virus, Metabolic Disturbance, and Unhealthy Behavior on Chronic Kidney Disease: A Secondary Cross-Sectional Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063558. [PMID: 35329244 PMCID: PMC8952695 DOI: 10.3390/ijerph19063558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is associated with a higher risk of chronic kidney disease (CKD). This study investigates the relationship among HCV, CKD, and understudied confounders, such as unhealthy behaviors and metabolic disturbances. METHODS This cross-sectional study was conducted as part of a community health promotion program in an HCV endemic area of Taiwan from June to December 2019. Multivariable logistic regression analyses adjusted for demographic and clinical characteristics were performed to investigate the association between CKD and HCV seropositivity. RESULTS Of 2387 participants who underwent health check-ups, the mean age was 64.1 years old; females predominated (63.2%), and 306 (12.8%) subjects were seropositive for HCV. CKD, defined as a lower estimated glomerular filtration rate (eGFR) was associated with unhealthy dietary habits, metabolic syndrome, and HCV. Less frequent exercise, higher waist circumference (WC) and HbA1c all affected risk of CKD; HCV increased risk of CKD by 44% compared to non-HCV (OR 1.44, 95% confidence interval (CI) 1.05-1.98) in the multivariable analysis. In the HCV group, lower eGFR was also significantly associated with the severity of metabolic syndrome (MetS) (median eGFR was 86.4, 77.1, and 64.5 mL/min/1.73 m2 for individuals with three and five MetS components, respectively). CONCLUSIONS Beyond metabolic disturbance and irregular exercise, HCV seropositivity is independently associated with CKD in a community survey. Healthy lifestyle promotion might protect against renal function decline in HCV; however, the mechanisms underlying the association need further large-scale investigation.
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Truche AS, Bailly S, Fabre O, Legrand R, Zaoui P. A Specific High-Protein Weight Loss Program Does Not Impair Renal Function in Patients Who Are Overweight/Obese. Nutrients 2022; 14:384. [PMID: 35057566 PMCID: PMC8780753 DOI: 10.3390/nu14020384] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 02/06/2023] Open
Abstract
Although high-protein diets appear to be the most efficient way to lose weight, concerns may arise about their innocuity on renal function. The objective of this study is to assess the impact of a weight loss program on renal function. A multicentric cohort-based study was performed using the RNPC© French national weight loss program. Patients with at least two creatinine measurements at the beginning of the program and at the end of the weight loss phase between 1 January 2016 and 1 July 2021 were included. Renal function was assessed by Modification of Diet in Renal Disease (MDRD) equation-based estimated glomerular filtration rate (eGFR). From 4394 patients with two creatinine measurements included, 1579 (35.9%) had normal eGFR (MDRD 90-120 mL/min/1.73 m2), 210 (4.8%) had hyperfiltration (MDRD > 120 mL/min/1.73 m2), 2383 (54.2%) had chronic kidney disease (CKD) grade 2 (MDRD 60-90 mL/min/1.73 m2), and 221 (5.0%) had CKD grade 3 (MDRD 30-60 mL/min/1.73 m2). Multivariable analyses showed no eGFR change for patients in initial CKD grade 2, normal eGFR and hyperfiltration, and a significant increase in CKD grade 3. The RNPC© program avoids renal function impairment during the two first phases, regardless of the initial eGFR.
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Affiliation(s)
| | - Sébastien Bailly
- HP2 Laboratory, Grenoble Alpes University, INSERM U1300 and Grenoble Alpes University Hospital, 38000 Grenoble, France
| | - Odile Fabre
- Groupe Éthique et Santé, Actiburo 1, Bâtiment A—100 Chemin de l’Aumône Vieille, 13400 Aubagne, France; (O.F.); (R.L.)
| | - Rémy Legrand
- Groupe Éthique et Santé, Actiburo 1, Bâtiment A—100 Chemin de l’Aumône Vieille, 13400 Aubagne, France; (O.F.); (R.L.)
| | - Philippe Zaoui
- Service de Néphrologie, Dialyse, Transplantation Rénale, Grenoble Alpes University Hospital, 38700 La Tronche, France;
- AGDUC, Meylan Dialysis Center, 38240 Meylan, France
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Wahyuni MMD, Haliman CD, Melaniani S, Mahmudiono T. Association between Frequency of Consumption of Pork Se’i and Chronic Kidney Disease in East Nusa Tenggara, Indonesia. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: As a country with various cultures, Indonesia has several regional specialties, one of which is Pork Se’i from East Nusa Tenggara. Studies showed that higher intake of red and processed meat was significantly associated with an increased risk for incident chronic kidney disease (CKD).
AIM: This study was conducted with the goal to find out the relationship between consumption of Pork Se’i and water intake with CKD among patient in RSUD W.Z. Johannes, Kupang, East Nusa Tenggara, Indonesia.
METHODS: This research was an observational study with a case–control design involving 92 respondents at W.Z Hospital Johannes in the period of July 2020. The determination of consumption of Pork Se’i and water was acquired through the use of Semi Quantitative Food Frequency Questionnaire as an instrument. Chi-square test was used as a statistical test for this study.
RESULTS: In the case group, more than half of the respondents (58.7%) were male, while in the control group, more than half of the respondents (60.9%) were female. More than half (58.7%) of case group respondents consume water <1 L/day. More than half (58.7%) of case group respondents consume water <1 L/day, while most of the control group respondents (73.9%) consumed 1 L of water/day. The Pearson Chi-square test showed significant relationship between water consumption and CKD (p = 0.003). The frequency of consumption of Pork Se’i in the case group respondents was mostly in the sometimes (47.8%) and usually (47.8%) categories. Only a small proportion of case respondents (4.3%) rarely consume Pork Se’i. There was a significant relationship between consumption of Pork Se’i with CKD (p = 0.014).
CONCLUSIONS: Our study found that consumption of Pork Se’i has a significant correlation with CKD.
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12
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Severe Cardiac and Metabolic Pathology Induced by Steroid Abuse in a Young Individual. Diagnostics (Basel) 2021; 11:diagnostics11081313. [PMID: 34441248 PMCID: PMC8394374 DOI: 10.3390/diagnostics11081313] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 11/17/2022] Open
Abstract
Androgenic-Anabolic Steroids (AAS) abuse is known to play an important role in causing the systemic inflammatory response and multiple-organ dysfunction in healthy individuals. Although many of the undesirable effects of steroid abuse have been reported, at present, little is known about the effect of anabolic supplements and the correlation between cardiac and metabolic pathology. This paper presents a case of a 25 year old patient with a complex medical history after 6 months of steroid administration. Myocardial infraction, dyslipidemia, obesity, hyperuricemia, secondary diabetes, and chronic renal disease were identified after clinical and para-clinical examinations. The particularities of this case were interpreted in the context of a literature review, highlighting the effect of multi-organ damage as a result of the uncontrolled use of anabolic steroid supplements.
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13
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Cyrino LG, Galpern J, Moore L, Borgi L, Riella LV. A Narrative Review of Dietary Approaches for Kidney Transplant Patients. Kidney Int Rep 2021; 6:1764-1774. [PMID: 34307973 PMCID: PMC8258457 DOI: 10.1016/j.ekir.2021.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/16/2021] [Accepted: 04/12/2021] [Indexed: 12/19/2022] Open
Abstract
A healthy eating pattern has proven to lower the risk of metabolic and cardiovascular diseases. However, there are sparse dietary recommendations for kidney transplant recipients, and the ones available focus only on single nutrients intake, such as sodium, potassium, and proteins, and not on the overall eating pattern. Considering that individuals do not typically consume nutrients in isolation, but as part of a complete dietary pattern, it is challenging for the average transplanted patient to understand and implement specific dietary recommendations. Also, single-nutrient interventions demonstrate largely inconclusive effects, and it seems improbable that they could have a strong enough impact on transplant outcomes. Dietary trends such as plant-based diets, intermittent fasting, low-carb diet/keto-diet, and juicing, have gained major attention from the media. Herein, we review the potential risks and benefits of these diets in kidney transplant recipients and provide an updated dietary recommendation for this population with consideration of current nutritional trends. Overall, the Mediterranean and DASH diets have demonstrated to be the most beneficial dietary patterns to the post kidney transplant population by focusing on less meat and processed foods, while increasing the intake of fresh foods and plant-based choices. We believe that to maintain a healthy lifestyle posttransplant, patients should be educated about the scientific evidence of different diets and choose a dietary pattern that is sustainable long-term.
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Affiliation(s)
- LG Cyrino
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennie Galpern
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lori Moore
- Division of Nephrology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lea Borgi
- Division of Nephrology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Leonardo V. Riella
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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14
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Stenvinkel P, Avesani CM, Gordon LJ, Schalling M, Shiels PG. Biomimetics provides lessons from nature for contemporary ways to improve human health. J Clin Transl Sci 2021; 5:e128. [PMID: 34367673 PMCID: PMC8327543 DOI: 10.1017/cts.2021.790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 02/08/2023] Open
Abstract
Homo sapiens is currently living in serious disharmony with the rest of the natural world. For our species to survive, and for our well-being, we must gather knowledge from multiple perspectives and actively engage in studies of planetary health. The enormous diversity of species, one of the most striking aspects of life on our planet, provides a source of solutions that have been developed through evolution by natural selection by animals living in extreme environments. The food system is central to finding solutions; our current global eating patterns have a negative impact on human health, driven climate change and loss of biodiversity. We propose that the use of solutions derived from nature, an approach termed biomimetics, could mitigate the effects of a changing climate on planetary health as well as human health. For example, activation of the transcription factor Nrf2 may play a role in protecting animals living in extreme environments, or animals exposed to heat stress, pollution and pesticides. In order to meet these challenges, we call for the creation of novel interdisciplinary planetary health research teams.
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Affiliation(s)
- Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden
| | - Carla M. Avesani
- Division of Renal Medicine, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden
| | - Line J. Gordon
- Stockholm Resilience Centre Stockholm University, Stockholm, Sweden
| | - Martin Schalling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Paul G. Shiels
- Institute of Cancer Sciences, Wolfson Wohl Translational Research Centre, University of Glasgow, Bearsden, Glasgow, UK
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15
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Kistler BM, Moore LW, Benner D, Biruete A, Boaz M, Brunori G, Chen J, Drechsler C, Guebre-Egziabher F, Hensley MK, Iseki K, Kovesdy CP, Kuhlmann MK, Saxena A, Wee PT, Brown-Tortorici A, Garibotto G, Price SR, Yee-Moon Wang A, Kalantar-Zadeh K. The International Society of Renal Nutrition and Metabolism Commentary on the National Kidney Foundation and Academy of Nutrition and Dietetics KDOQI Clinical Practice Guideline for Nutrition in Chronic Kidney Disease. J Ren Nutr 2021; 31:116-120.e1. [PMID: 32737016 PMCID: PMC8045140 DOI: 10.1053/j.jrn.2020.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/10/2020] [Indexed: 12/28/2022] Open
Abstract
The Academy of Nutrition and Dietetics and the National Kidney Foundation collaborated to provide an update to the Clinical Practice Guidelines (CPG) for nutrition in chronic kidney disease (CKD). These guidelines provide a valuable update to many aspects of the nutrition care process. They include changes in the recommendations for nutrition screening and assessment, macronutrients, and targets for electrolytes and minerals. The International Society of Renal Nutrition and Metabolism assembled a special review panel of experts and evaluated these recommendations prior to public review. As one of the highlights of the CPG, the recommended dietary protein intake range for patients with diabetic kidney disease is 0.6-0.8 g/kg/day, whereas for CKD patients without diabetes it is 0.55-0.6 g/kg/day. The International Society of Renal Nutrition and Metabolism endorses the CPG with the suggestion that clinicians may consider a more streamlined target of 0.6-0.8 g/kg/day, regardless of CKD etiology, while striving to achieve intakes closer to 0.6 g/kg/day. For implementation of these guidelines, it will be important that all stakeholders work to detect kidney disease early to ensure effective primary and secondary prevention. Once identified, patients should be referred to registered dietitians or the region-specific equivalent, for individualized medical nutrition therapy to slow the progression of CKD. As we turn our attention to the new CPG, we as the renal nutrition community should come together to strengthen the evidence base by standardizing outcomes, increasing collaboration, and funding well-designed observational studies and randomized controlled trials with nutritional and dietary interventions in patients with CKD.
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Affiliation(s)
- Brandon M Kistler
- Department of Nutrition and Health Science, Ball State University, Muncie, Indiana
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | | | - Annabel Biruete
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mona Boaz
- Department of Nutritional Sciences, Ariel University, Ariel, Israel
| | - Giuliano Brunori
- Nephrology and Dialysis Unite, Hospital of Trento, Trento, Italy
| | - Jing Chen
- Division of Nephrology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | | | | | | | | | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Martin K Kuhlmann
- Department of Nephrology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Anita Saxena
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Pieter Ter Wee
- Department of Nephrology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Amanda Brown-Tortorici
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California
| | - Giacomo Garibotto
- Division of Nephrology, Dialysis, and Transplantation, Department of Internal Medicine, University of Genoa and IRCCS AOU San Marino-IST, Genoa, Italy
| | - S Russ Price
- Departments of Internal Medicine and Biochemistry & Molecular Biology, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California.
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16
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Kelly JT, Su G, Zhang L, Qin X, Marshall S, González-Ortiz A, Clase CM, Campbell KL, Xu H, Carrero JJ. Modifiable Lifestyle Factors for Primary Prevention of CKD: A Systematic Review and Meta-Analysis. J Am Soc Nephrol 2021; 32:239-253. [PMID: 32868398 PMCID: PMC7894668 DOI: 10.1681/asn.2020030384] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/20/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Despite increasing incidence of CKD, no evidence-based lifestyle recommendations for CKD primary prevention apparently exist. METHODS To evaluate the consistency of evidence associating modifiable lifestyle factors and CKD incidence, we searched MEDLINE, Embase, CINAHL, and references from eligible studies from database inception through June 2019. We included cohort studies of adults without CKD at baseline that reported lifestyle exposures (diet, physical activity, alcohol consumption, and tobacco smoking). The primary outcome was incident CKD (eGFR<60 ml/min per 1.73 m2). Secondary outcomes included other CKD surrogate measures (RRT, GFR decline, and albuminuria). RESULTS We identified 104 studies of 2,755,719 participants with generally a low risk of bias. Higher dietary potassium intake associated with significantly decreased odds of CKD (odds ratio [OR], 0.78; 95% confidence interval [95% CI], 0.65 to 0.94), as did higher vegetable intake (OR, 0.79; 95% CI, 0.70 to 0.90); higher salt intake associated with significantly increased odds of CKD (OR, 1.21; 95% CI, 1.06 to 1.38). Being physically active versus sedentary associated with lower odds of CKD (OR, 0.82; 95% CI, 0.69 to 0.98). Current and former smokers had significantly increased odds of CKD compared with never smokers (OR, 1.18; 95% CI, 1.10 to 1.27). Compared with no consumption, moderate consumption of alcohol associated with reduced risk of CKD (relative risk, 0.86; 95% CI, 0.79 to 0.93). These associations were consistent, but evidence was predominantly of low to very low certainty. Results for secondary outcomes were consistent with the primary finding. CONCLUSIONS These findings identify modifiable lifestyle factors that consistently predict the incidence of CKD in the community and may inform both public health recommendations and clinical practice.
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Affiliation(s)
- Jaimon T. Kelly
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Guobin Su
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China
| | - La Zhang
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China
| | - Xindong Qin
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China
| | - Skye Marshall
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia,Nutrition Research Australia, Sydney, New South Wales, Australia
| | - Ailema González-Ortiz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Catherine M. Clase
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Katrina L. Campbell
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Hong Xu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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17
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Kim SM, Jung JY. Nutritional management in patients with chronic kidney disease. Korean J Intern Med 2020; 35:1279-1290. [PMID: 32872726 PMCID: PMC7652660 DOI: 10.3904/kjim.2020.408] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022] Open
Abstract
The global prevalence of chronic kidney disease (CKD) is increasing with the aging of populations worldwide. As kidney function declines, the accumulation of metabolic waste products and excessive electrolytes can significantly impair the health of patients with CKD. As nutritional management of patients with CKD is thought to control uremic symptoms and provide beneficial effects on the progression of kidney dysfunction, the diet of patients with CKD should be an important consideration in their care. Many guidelines recommend limiting protein intake in these patients, as high-protein diets aggravate kidney dysfunction. Excess sodium may be associated with CKD progression and all-cause mortality and, therefore, limiting salt intake is generally recommended. Low potassium is associated with muscle weakness and hypertension, whereas high potassium is associated with cardiac arrhythmia. Therefore, recent guidelines recommend adjusting dietary potassium intake on an individual basis to maintain serum potassium levels within the normal range. Appropriate dietary calcium intake is recommended to maintain calcium balance in patients with CKD G3, G4. Given the many dietary considerations for patients with CKD, effective nutritional management is challenging. Individualized strategies are needed to ensure the best outcome for patients with CKD.
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Affiliation(s)
- Sun Moon Kim
- Division of Nephrology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Ji Yong Jung
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
- Department of Internal Medicine, Gachon University College of Medicine, Incheon, Korea
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18
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Dietary Protein Intake and Single-Nephron Glomerular Filtration Rate. Nutrients 2020; 12:nu12092549. [PMID: 32842498 PMCID: PMC7551595 DOI: 10.3390/nu12092549] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 12/25/2022] Open
Abstract
High protein intake can increase glomerular filtration rate (GFR) in response to excretory overload, which may exacerbate the progression of kidney disease. However, the direct association between glomerular hemodynamic response at the single-nephron level and dietary protein intake has not been fully elucidated in humans. In the present study, we evaluated nutritional indices associated with single-nephron GFR (SNGFR) calculated based on corrected creatinine clearance (SNGFRCr). We retrospectively identified 43 living kidney donors who underwent enhanced computed tomography and kidney biopsy at the time of donation at Jikei University Hospital in Tokyo from 2007 to 2018. Total nephron number was estimated with imaging-derived cortical volume and morphometry-derived glomerular density. SNGFRCr was calculated by dividing the corrected creatinine clearance by the number of non-sclerosed glomeruli (NglomNSG). The mean (± standard deviation) NglomNSG/kidney and SNGFRCr were 685,000 ± 242,000 and 61.0 ± 23.9 nL/min, respectively. SNGFRCr was directly associated with estimated protein intake/ideal body weight (p = 0.005) but not with body mass index, mean arterial pressure, albumin, or sodium intake. These findings indicate that greater protein intake may increase SNGFR and lead to glomerular hyperfiltration.
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19
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Kalantar-Zadeh K, Moore LW. Why the Nutritional Management of Acute Versus Chronic Kidney Disease Should Differ. J Ren Nutr 2020; 29:265-268. [PMID: 31230723 DOI: 10.1053/j.jrn.2019.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 05/27/2019] [Indexed: 01/29/2023] Open
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20
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Ko GJ, Rhee CM, Kalantar-Zadeh K, Joshi S. The Effects of High-Protein Diets on Kidney Health and Longevity. J Am Soc Nephrol 2020; 31:1667-1679. [PMID: 32669325 PMCID: PMC7460905 DOI: 10.1681/asn.2020010028] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Although high-protein diets continue to be popular for weight loss and type 2 diabetes, evidence suggests that worsening renal function may occur in individuals with-and perhaps without-impaired kidney function. High dietary protein intake can cause intraglomerular hypertension, which may result in kidney hyperfiltration, glomerular injury, and proteinuria. It is possible that long-term high protein intake may lead to de novo CKD. The quality of dietary protein may also play a role in kidney health. Compared with protein from plant sources, animal protein has been associated with an increased risk of ESKD in several observational studies, including the Singapore Chinese Health Study. Potential mediators of kidney damage from animal protein include dietary acid load, phosphate content, gut microbiome dysbiosis, and resultant inflammation. In light of such findings, adopting current dietary approaches that include a high proportion of protein for weight reduction or glycemic control should be considered with care in those at high risk for kidney disease. Given the possibility of residual confounding within some observational studies and the conflicting evidence from previous trials, long-term studies including those with large sample sizes are warranted to better ascertain the effects of high protein intake on kidney health.
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Affiliation(s)
- Gang-Jee Ko
- Harold Simmons Center for Kidney Disease Research and Epidemiology, School of Medicine, University of California Irvine, Orange, California
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, School of Medicine, University of California Irvine, Orange, California
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, School of Medicine, University of California Irvine, Orange, California
- Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, California
- Los Angeles Biomedical Research Institute at Harbor-University of California, Los Angeles, Torrance, California
| | - Shivam Joshi
- Division of General Internal Medicine, Department of Medicine, New York University School of Medicine, New York, New York
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21
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Clegg DJ, Headley SA, Germain MJ. Impact of Dietary Potassium Restrictions in CKD on Clinical Outcomes: Benefits of a Plant-Based Diet. Kidney Med 2020; 2:476-487. [PMID: 32775988 PMCID: PMC7406842 DOI: 10.1016/j.xkme.2020.04.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In patients with advanced-stage chronic kidney disease (CKD), progressive kidney function decline leads to increased risk for hyperkalemia (serum potassium > 5.0 or >5.5 mEq/L). Medications such as renin-angiotensin-aldosterone system inhibitors pose an additional hyperkalemia risk, especially in patients with CKD. When hyperkalemia develops, clinicians often recommend a diet that is lower in potassium content. This review discusses the barriers to adherence to a low-potassium diet and the impact of dietary restrictions on adverse clinical outcomes. Accumulating evidence indicates that a diet that incorporates potassium-rich foods has multiple health benefits, which may also be attributable to the other vitamin, mineral, and fiber content of potassium-rich foods. These benefits include blood pressure reductions and reduced risks for cardiovascular disease and stroke. High-potassium foods may also prevent CKD progression and reduce mortality risk in patients with CKD. Adjunctive treatment with the newer potassium-binding agents, patiromer and sodium zirconium cyclosilicate, may allow for optimal renin-angiotensin-aldosterone system inhibitor therapy in patients with CKD and hyperkalemia, potentially making it possible for patients with CKD and hyperkalemia to liberalize their diet. This may allow them the health benefits of a high-potassium diet without the increased risk for hyperkalemia, although further studies are needed.
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Affiliation(s)
- Deborah J. Clegg
- Drexel College of Nursing and Health Professions, Philadelphia, PA
| | - Samuel A. Headley
- Department of Exercise Science and Athletic Training, Springfield College, Springfield, MA
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22
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Kalantar-Zadeh K, Joshi S, Schlueter R, Cooke J, Brown-Tortorici A, Donnelly M, Schulman S, Lau WL, Rhee CM, Streja E, Tantisattamo E, Ferrey AJ, Hanna R, Chen JL, Malik S, Nguyen DV, Crowley ST, Kovesdy CP. Plant-Dominant Low-Protein Diet for Conservative Management of Chronic Kidney Disease. Nutrients 2020; 12:E1931. [PMID: 32610641 PMCID: PMC7400005 DOI: 10.3390/nu12071931] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic kidney disease (CKD) affects >10% of the adult population. Each year, approximately 120,000 Americans develop end-stage kidney disease and initiate dialysis, which is costly and associated with functional impairments, worse health-related quality of life, and high early-mortality rates, exceeding 20% in the first year. Recent declarations by the World Kidney Day and the U.S. Government Executive Order seek to implement strategies that reduce the burden of kidney failure by slowing CKD progression and controlling uremia without dialysis. Pragmatic dietary interventions may have a role in improving CKD outcomes and preventing or delaying dialysis initiation. Evidence suggests that a patient-centered plant-dominant low-protein diet (PLADO) of 0.6–0.8 g/kg/day composed of >50% plant-based sources, administered by dietitians trained in non-dialysis CKD care, is promising and consistent with the precision nutrition. The scientific premise of the PLADO stems from the observations that high protein diets with high meat intake not only result in higher cardiovascular disease risk but also higher CKD incidence and faster CKD progression due to increased intraglomerular pressure and glomerular hyperfiltration. Meat intake increases production of nitrogenous end-products, worsens uremia, and may increase the risk of constipation with resulting hyperkalemia from the typical low fiber intake. A plant-dominant, fiber-rich, low-protein diet may lead to favorable alterations in the gut microbiome, which can modulate uremic toxin generation and slow CKD progression, along with reducing cardiovascular risk. PLADO is a heart-healthy, safe, flexible, and feasible diet that could be the centerpiece of a conservative and preservative CKD-management strategy that challenges the prevailing dialysis-centered paradigm.
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Affiliation(s)
- Kamyar Kalantar-Zadeh
- Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine (UCI), Orange, CA 90286, USA; (A.B.-T.); (W.-L.L.); (C.M.R.); (E.S.); (E.T.); (A.J.F.); (R.H.); (D.V.N.)
- Tibor Rubin VA Long Beach Healthcare System, Long Beach, CA 90822, USA;
| | - Shivam Joshi
- Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA;
| | | | - Joanne Cooke
- Kansas City VA Medical Center, Kansas City, MO 64128, USA;
| | - Amanda Brown-Tortorici
- Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine (UCI), Orange, CA 90286, USA; (A.B.-T.); (W.-L.L.); (C.M.R.); (E.S.); (E.T.); (A.J.F.); (R.H.); (D.V.N.)
| | | | - Sherry Schulman
- UCI Health Susan Samueli Center Integrative Health Institute, Irvine, CA 92626, USA; (S.S.); (S.M.)
| | - Wei-Ling Lau
- Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine (UCI), Orange, CA 90286, USA; (A.B.-T.); (W.-L.L.); (C.M.R.); (E.S.); (E.T.); (A.J.F.); (R.H.); (D.V.N.)
| | - Connie M. Rhee
- Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine (UCI), Orange, CA 90286, USA; (A.B.-T.); (W.-L.L.); (C.M.R.); (E.S.); (E.T.); (A.J.F.); (R.H.); (D.V.N.)
| | - Elani Streja
- Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine (UCI), Orange, CA 90286, USA; (A.B.-T.); (W.-L.L.); (C.M.R.); (E.S.); (E.T.); (A.J.F.); (R.H.); (D.V.N.)
- Tibor Rubin VA Long Beach Healthcare System, Long Beach, CA 90822, USA;
| | - Ekamol Tantisattamo
- Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine (UCI), Orange, CA 90286, USA; (A.B.-T.); (W.-L.L.); (C.M.R.); (E.S.); (E.T.); (A.J.F.); (R.H.); (D.V.N.)
| | - Antoney J. Ferrey
- Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine (UCI), Orange, CA 90286, USA; (A.B.-T.); (W.-L.L.); (C.M.R.); (E.S.); (E.T.); (A.J.F.); (R.H.); (D.V.N.)
| | - Ramy Hanna
- Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine (UCI), Orange, CA 90286, USA; (A.B.-T.); (W.-L.L.); (C.M.R.); (E.S.); (E.T.); (A.J.F.); (R.H.); (D.V.N.)
| | - Joline L.T. Chen
- Tibor Rubin VA Long Beach Healthcare System, Long Beach, CA 90822, USA;
| | - Shaista Malik
- UCI Health Susan Samueli Center Integrative Health Institute, Irvine, CA 92626, USA; (S.S.); (S.M.)
| | - Danh V. Nguyen
- Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine (UCI), Orange, CA 90286, USA; (A.B.-T.); (W.-L.L.); (C.M.R.); (E.S.); (E.T.); (A.J.F.); (R.H.); (D.V.N.)
| | - Susan T. Crowley
- VA Connecticut Healthcare System, West Haven, CT 06516, USA;
- Division of Nephrology, Yale University School of Medicine, New Haven, CT 06516, USA
| | - Csaba P. Kovesdy
- Division of Nephrology, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA;
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23
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Kalantar-Zadeh K, Kramer HM, Fouque D. High-protein diet is bad for kidney health: unleashing the taboo. Nephrol Dial Transplant 2020; 35:1-4. [PMID: 31697325 DOI: 10.1093/ndt/gfz216] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 09/17/2019] [Indexed: 12/23/2022] Open
Affiliation(s)
- Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California, Irvine, Orange, CA, USA
| | - Holly M Kramer
- Department of Preventive Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Denis Fouque
- Department of Nephrology, Centre Hospitalier Lyon Sud, Lyon, France
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