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Hajishizari S, Mirzababaei A, Abaj F, Khosroshahi RA, Barekzai AM, Worm N, Abbasy M, Mirzaei K. The association between a low-carbohydrate diet score and the risk of diabetic nephropathy in women: A case-control study. Nutrition 2023; 107:111930. [PMID: 36584662 DOI: 10.1016/j.nut.2022.111930] [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: 06/11/2022] [Revised: 11/05/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Because evidence linking carbohydrate consumption to diabetic nephropathy (DN) is scarce, and the association between a low-carbohydrate diet (LCD) and DN has not been investigated, we sought to investigate whether a higher LCD score is associated with DN among women. METHODS In a case-control study, 105 women with type 2 diabetes mellitus and DN and 105 controls with type 2 diabetes mellitus and without DN who attended Kowsar Diabetes Clinic in Semnan, Iran, were matched for age and diabetes duration. The data related to anthropometric and biochemical measures were collected and a food frequency questionnaire with 147 items was used to assess dietary intake. Based on the food frequency questionnaire, we calculated an LCD score for each study participant. Multivariate logistic regression was performed to examine the association between an LCD score and the odds of developing DN. RESULTS The results of the study demonstrated that the LCD score was not significantly associated with DN in the crude model (odds ratio = 0.39; 95% confidence interval, 0.14-1.07; P = 0.06). However, after adjusting for several confounders, subjects in the top quartile of the LCD score were associated with a 71% lower risk of DN (odds ratio [OR] = 0.29; 95% confidence interval, 0.10-0.86; P = 0.02). A significant trend toward decreased urinary albumin excretion was found with an increase in the LCD score (P = 0.005). CONCLUSIONS A diet low in carbohydrates was inversely associated with risk of DN. Further observational studies, and preferably randomized controlled trials, are needed to confirm the present results.
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Affiliation(s)
- Sara Hajishizari
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Atieh Mirzababaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Faezeh Abaj
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Reza Amiri Khosroshahi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Nicolai Worm
- Department of Nutrition, German University of Applied Sciences for Prevention and Health Care Management, Saarbrücken, Germany
| | - Maryam Abbasy
- National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran; Food Microbiology Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Elliott A, Gibson S. Exploring stakeholder experiences of dietetic service and care delivery: A systematic qualitative review. J Hum Nutr Diet 2023; 36:288-310. [PMID: 35833488 PMCID: PMC10087390 DOI: 10.1111/jhn.13063] [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: 03/23/2022] [Accepted: 06/01/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND There is limited understanding of patients' and healthcare professionals' perceptions and experiences of receiving and delivering dietetic care, respectively. This systematic review of the literature used qualitative synthesis to explore the perceptions and experiences of multiple stakeholders involved in the delivery of nutrition care and dietetic service. METHODS MEDLINE, Embase, CINAHL, Cochrane Library, Scopus, ISI Web of Science, PsycINFO and ProQuest were systematically searched. Study characteristics and perceptions of stakeholders regarding nutrition care services were extracted. Qualitative synthesis was employed and thematic analysis conducted. RESULTS Five themes were identified from 44 studies related to stakeholders' perceptions of dietetic services. Studies included quantitative, qualitative and mixed methods involving patients, families, dietitians and other healthcare professionals. The themes were (1) patients desiring a personalised approach to nutrition care; (2) accessing dietetic service; (3) perceived impact of nutrition care on the patient; (4) relationships between stakeholders; and (5) beliefs about nutrition expertise. Two themes were specific to patients; these were the desire for individualised care and the impact of nutrition care. Within each theme perceptions varied with patients' views often contrasting with those of dietetic service providers. CONCLUSIONS Experiences of dietetic service do not always meet stakeholder expectations which impacts on patient engagement. Seeking stakeholder input is imperative to design dietetic services that engage patients in positive and supportive clinical partnerships.
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Affiliation(s)
- Andrea Elliott
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Simone Gibson
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia
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Yang Y, Yu J, Huo J, Yan Y. Sesamolin Attenuates Kidney Injury, Intestinal Barrier Dysfunction, and Gut Microbiota Imbalance in High-Fat and High-Fructose Diet-Fed Mice. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2023; 71:1562-1576. [PMID: 36630317 DOI: 10.1021/acs.jafc.2c07084] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
This study investigated the effects of sesamolin on kidney injury, intestinal barrier dysfunction, and gut microbiota imbalance in high-fat and high-fructose (HF-HF) diet-fed mice and explored the underlying correlations among them. The results indicated that sesamolin suppressed metabolic disorders and increased renal function parameters. Histological evaluation showed that sesamolin mitigated renal epithelial cell degeneration and brush border damage. Meanwhile, sesamolin inhibited the endotoxin-mediated induction of the Toll-like receptor 4-related IKKα/NF-κB p65 pathway activation. Additionally, sesamolin mitigated intestinal barrier dysfunction and improved the composition of gut microbiota. The correlation results further indicated that changes in the dominant phyla, including Firmicutes, Deferribacterota, Desulfobacterota, and Bacteroidota, were more highly correlated with a reduction in endotoxemia and metabolic disorders, as well as decreases in intestinal proinflammatory response and related renal risk biomarkers. The results of this study suggest that sesamolin attenuates kidney injuries, which might be associated with its effects on the reduction of endotoxemia and related metabolic disorders through the restoration of the intestinal barrier and the modulation of gut microbiota. Thus, sesamolin may be a potential dietary supplement for protection against obesity-associated kidney injury.
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Affiliation(s)
- Yang Yang
- Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry, National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China, College of Life Sciences, Shaanxi Normal University, Xi'an 710119, China
| | - Jing Yu
- Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry, National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China, College of Life Sciences, Shaanxi Normal University, Xi'an 710119, China
| | - Jiayao Huo
- Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry, National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China, College of Life Sciences, Shaanxi Normal University, Xi'an 710119, China
| | - Yaping Yan
- Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry, National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China, College of Life Sciences, Shaanxi Normal University, Xi'an 710119, China
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Charkviani M, Thongprayoon C, Tangpanithandee S, Krisanapan P, Miao J, Mao MA, Cheungpasitporn W. Effects of Mediterranean Diet, DASH Diet, and Plant-Based Diet on Outcomes among End Stage Kidney Disease Patients: A Systematic Review and Meta-Analysis. Clin Pract 2022; 13:41-51. [PMID: 36648844 PMCID: PMC9844348 DOI: 10.3390/clinpract13010004] [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: 11/20/2022] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The Mediterranean, Dietary Approach to Stop Hypertension (DASH), and plant-based diets may provide cardiovascular benefit to the general population. However, data on their effect on end stage kidney disease (ESKD) patients are limited. This systematic review aims to assess the impact of Mediterranean, DASH, and plant-based diets on outcomes among ESKD patients. METHODS A literature review was conducted in EMBASE, MEDLINE, and Cochrane databases from inception through September 2022 to identify studies that assess the clinical outcomes of Mediterranean, DASH, or plant-based diets on ESKD patients on hemodialysis (HD) or peritoneal dialysis (PD). Effect estimates from the individual studies were derived utilizing the random-effect, generic inverse variance approach of DerSimonian and Laird. RESULTS Seven studies with 9400 ESKD patients (8395 HD and 1005 PD) met the eligibility criteria and were included in the data analysis. Pooled odds ratios (ORs) of mortality for ESKD patients who adhered to the Mediterranean versus plant-based diet were 0.49 (95% CI: 0.07-3.54; two studies, I2 = 67%) and 0.87 (95% CI: 0.75-1.01; two studies, I2 = 0%), respectively. Data on mortality for ESKD patients on a DASH diet were limited to one study with an OR of 1.00 (95% CI: 0.89-1.12). The pooled OR of cardiovascular mortality among ESKD patients who adhered to a plant-based diet was 0.86 (95% CI: 0.68-1.08; two studies, I2 = 0%), compared to those who did not. Data on cardiovascular mortality among those with Mediterranean and DASH diet were limited to one study with ORs of 1.14 (95% CI: 0.90-1.43) and 1.19 (95% CI: 0.99-1.43), respectively. Mediterranean diet adherence was found to be associated with reduced risk of left ventricular hypertrophy (LVH) with an OR of 0.82 (95% CI: 0.68-0.99) in a study including 127 ESKD patients. The risk of hyperkalemia was not significant among those with a plant-based diet with an OR of 1.00 (95% CI: 0.94-1.07) in a study including 150 ESKD patients. CONCLUSIONS While our systematic review demonstrated no significant associations of Mediterranean, DASH, and plant-based diets with reduced all-cause mortality or cardiovascular mortality, there was also no evidence that suggested harmful effects of these diets to ESKD patients.
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Affiliation(s)
- Mariam Charkviani
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
| | - Supawit Tangpanithandee
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, Thailand
| | - Pajaree Krisanapan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
| | - Jing Miao
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
| | - Michael A. Mao
- Department of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
- Correspondence:
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Bettiga A, Fiorio F, Liguori F, Marco FD, Quattrini G, Vago R, Giannese D, Salonia A, Montorsi F, Trevisani F. The Impact of a Mediterranean-like Diet with Controlled Protein Intake on the Onco-Nephrological Scenario: Time for a New Perspective. Nutrients 2022; 14:nu14235193. [PMID: 36501223 PMCID: PMC9740301 DOI: 10.3390/nu14235193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
Chronic kidney disease (CKD) represents a frequent comorbidity in cancer patients, especially for patients affected by urological cancers. Unfortunately, impaired kidney function may limit the choice of adequate oncological treatments for their potential nephrotoxicity or due to contraindications in case of a low glomerular filtration rate. For these patients, tailored nephrological and nutritional management is mandatory. The K-DIGO guidelines do not define whether the nutritional management of CKD could be useful also in CKD patients affected by urological cancer. In fact, in clinical practice, oncological patients often receive high-protein diets to avoid malnutrition. In our study, we investigated the nutritional and nephrological impact of a Mediterranean-like diet with a controlled protein intake (MCPD) on a cohort of 82 stage III-IV CKD patients. We compared two cohorts: one of 31 non-oncological CKD patients and the other of 51 oncological patients with CKD. The use of an MCPD had a favorable impact on both the oncological and non-oncological CKD patients with an amelioration in all the investigated parameters and with a better quality of life, with no cases of malnutrition or AKI.
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Affiliation(s)
- Arianna Bettiga
- Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milano, Italy
| | - Francesco Fiorio
- Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milano, Italy
| | - Francesca Liguori
- IRCCS San Raffaele Hospital, Direzione Sanitaria, 20132 Milano, Italy
| | - Federico Di Marco
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, 20132 Milano, Italy
| | - Giulia Quattrini
- Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milano, Italy
| | - Riccardo Vago
- Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milano, Italy
- Faculty of Medicine and Surgery, Università Vita-Salute San Raffaele, 20132 Milano, Italy
| | - Domenico Giannese
- Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy
| | - Andrea Salonia
- Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milano, Italy
- Faculty of Medicine and Surgery, Università Vita-Salute San Raffaele, 20132 Milano, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milano, Italy
- Faculty of Medicine and Surgery, Università Vita-Salute San Raffaele, 20132 Milano, Italy
| | - Francesco Trevisani
- Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milano, Italy
- Faculty of Medicine and Surgery, Università Vita-Salute San Raffaele, 20132 Milano, Italy
- Correspondence: ; Tel.: +39-3497052906
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Meléndez-Salcido CG, Ramírez-Emiliano J, Pérez-Vázquez V. Hypercaloric Diet Promotes Metabolic Disorders and Impaired Kidney Function. Curr Pharm Des 2022; 28:3127-3139. [PMID: 36278446 DOI: 10.2174/1381612829666221020162955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/27/2022] [Indexed: 01/28/2023]
Abstract
Poor dietary habits such as overconsumption of hypercaloric diets characterized by a high content of fructose and fat are related to metabolic abnormalities development such as obesity, diabetes, and dyslipidemia. Accumulating evidence supports the hypothesis that if energy intake gradually exceeds the body's ability to store fat in adipose tissue, the prolonged metabolic imbalance of circulating lipids from endogenous and exogenous sources leads to ectopic fat distribution in the peripheral organs, especially in the heart, liver, and kidney. The kidney is easily affected by dyslipidemia, which induces lipid accumulation and reflects an imbalance between fatty acid supply and fatty acid utilization. This derives from tissue lipotoxicity, oxidative stress, fibrosis, and inflammation, resulting in structural and functional changes that lead to glomerular and tubule-interstitial damage. Some authors indicate that a lipid-lowering pharmacological approach combined with a substantial lifestyle change should be considered to treat chronic kidney disease (CKD). Also, the new therapeutic target identification and the development of new drugs targeting metabolic pathways involved with kidney lipotoxicity could constitute an additional alternative to combat the complex mechanisms involved in impaired kidney function. In this review article, we first provide the pathophysiological evidence regarding the impact of hypercaloric diets, such as high-fat diets and high-fructose diets, on the development of metabolic disorders associated with impaired renal function and the molecular mechanisms underlying tissue lipid deposition. In addition, we present the current progress regarding translational strategies to prevent and/or treat kidney injury related to the consumption of hypercaloric diets.
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Affiliation(s)
- Cecilia Gabriela Meléndez-Salcido
- Departamento de Ciencias Médicas, División de Ciencias de la Salud, Campus León, Universidad de Guanajuato, 20 de enero, 929 Col. Obregón CP 37320. León, Guanajuato, México
| | - Joel Ramírez-Emiliano
- Departamento de Ciencias Médicas, División de Ciencias de la Salud, Campus León, Universidad de Guanajuato, 20 de enero, 929 Col. Obregón CP 37320. León, Guanajuato, México
| | - Victoriano Pérez-Vázquez
- Departamento de Ciencias Médicas, División de Ciencias de la Salud, Campus León, Universidad de Guanajuato, 20 de enero, 929 Col. Obregón CP 37320. León, Guanajuato, México
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Huang MC, Hung SC, Tai TH, Lin TY, Chang CI, Hsu CC. Using a Short Food Frequency Questionnaire to Evaluate Macronutrients, Fiber, Phosphorus, Potassium, and Calcium in Adults with Stages 3-5 Chronic Kidney Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11998. [PMID: 36231298 PMCID: PMC9565822 DOI: 10.3390/ijerph191911998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
The progression of chronic kidney disease (CKD) can be directly or indirectly accelerated by a poor diet and the diet's influence on risk factors for this disease. There have been no food frequency questionnaires (FFQs) developed for the assessment of diet in patients with CKD in Taiwan. This study analyzed the validity of a short FFQ (SFFQ) with 42 items for estimating patient intake of macronutrients, fiber, phosphorus, potassium, and calcium against 3-day dietary records (3-day DRs) in Taiwanese patients with stages 3-5 CKD. In an interview, 107 participants with the help of a dietician filled out an SFFQ and reviewed a 3-day DR the patients had filled out prior to the interview. Partial Pearson correlation coefficients between SFFQ and 3-day DR were 0.722, 0.619, 0.593, 0.572, 0.450, 0.611 and 0.410 for protein, fat, carbohydrate, fiber, phosphorus, potassium, and calcium, respectively, after adjusting for energy intake. Cross-classification analysis revealed 63.5-83.2% similarity in cross-tool estimated intakes of macronutrients, fiber, phosphorus, potassium, and calcium in the same quartiles or adjacent ones. Bland-Altman plots revealed good agreement between the two tools along different intake levels. In conclusion, the newly developed SFFQ had moderate relative validity in estimating the usual intake of key nutrients related to nutrition management of patients with late-stage CKD, suggesting it can be used to assess dietary intakes in a population with CKD, especially in those residing in an Asian region.
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Affiliation(s)
- Meng-Chuan Huang
- Department of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Szu-Chun Hung
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, School of Medicine, Tzu Chi University, Hualien 97002, Taiwan
| | - Tsen-Hua Tai
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, School of Medicine, Tzu Chi University, Hualien 97002, Taiwan
| | - Ting-Yun Lin
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, School of Medicine, Tzu Chi University, Hualien 97002, Taiwan
| | - Chiao-I Chang
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County 35053, Taiwan
- Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan
- Department of Family Medicine, Min-Sheng General Hospital, Taoyuan 33044, Taiwan
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Niyi-Odumosu F. Associations of Physical Activity, Kidney Function, Diet, and Inflammatory Markers in High-Risk Type-2 Diabetes With Early-Stage Chronic Kidney Disease (CKD). THE ASIAN JOURNAL OF KINESIOLOGY 2022. [DOI: 10.15758/ajk.2022.24.3.3] [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
OBJECTIVES Quantitative information and associations of physical activity, kidney function, diet, and inflammation are dearth in high-risk diabetes. Yet could delay type-2 diabetes, late-stage chronic kidney disease (CKD) and could be useful in designing effective interventions. The study aims to quantify the associations of physical activity, kidney function, diet and inflammation in adults with high-risk type-2 diabetes (and early CKD) recruited to a lifestyle education programme.METHODS Baseline, 12-month dietary, accelerometery, and circulating inflammatory markers, Interleukin-6 (IL-6) and C-reactive protein (CRP) data were assessed from 159 (104 male) high-risk diabetes with stage 2 CKD (mean (SD) estimated glomerular filteration rate (eGFR); 77.5(7.6) ml/min/1.73m2, age; 66(6) years, BMI; 31.8(4.2) kg/m2) who were recruited to a lifestyle education programme. Linear regression examined the effects and associations of the outcome measures.RESULTS eGFR decreased by -2.0 (1.7) ml/min/1.73 m2 (P = 0.04) after 12-months, but mean daily steps, moderate to vigorous physical activity (MVPA) levels, intakes of fibre, total and unsaturated fat, and circulating IL-6 and CRP did not change. However, inter-individual responses were highly variable. eGFR correlated positively with baseline IL-6 (r = 0.17, P = 0.02). Unadjusted, there were no associations between change in eGFR (12_0) and change in any of the activity, inflammatory or dietary outcomes. However, the regression models of these outcomes for change in eGFR (12_0) became significant with multiple covariates.CONCLUSION A combination of healthy lifestyle behaviours should be encouraged for a positive effect on future kidney function.
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Cueto-Manzano AM, Romero-García AR, Cortés-Sanabria L, Márquez-Herrera RM, Martin-del-Campo F, Jacobo-Arias F, Pazarín-Villaseñor HL, Rojas-Campos E. Systemic inflammation May limit the effect of protein supplement on nutritional status in peritoneal dialysis. Clin Nutr ESPEN 2022; 49:307-313. [DOI: 10.1016/j.clnesp.2022.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/27/2022] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
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10
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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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11
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Wong MMY, Renouf D, Zheng Y, Sheriff Z, Levin A. Nutritional Status, Nutritional Phenotypes, and Oral Nutritional Supplement Prescription Patterns Among Patients With Non-Dialysis Chronic Kidney Disease in British Columbia. J Ren Nutr 2021; 32:414-422. [PMID: 34924262 DOI: 10.1053/j.jrn.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/25/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Management of protein-energy wasting and undernutrition with oral nutritional supplements (ONS) has not been systematically studied in the non-dialysis chronic kidney disease (CKD-ND) population. We aimed to describe nutritional status, identify phenotypes of patients prescribed ONS, and evaluate ONS prescription patterns among CKD-ND patients in British Columbia. DESIGN AND METHODS This observational study assessed adult CKD-ND patients who entered multidisciplinary CKD clinics during 2013-2018 in British Columbia. Descriptive statistics were used to describe baseline nutrition and inflammation parameters among patients prescribed ONS versus patients not prescribed ONS within 1 year of clinic entry. Hierarchical clustering method with consensus clustering was applied to identify phenotypes of patients prescribed ONS. Multivariable logistic regression was used to assess the associations between ONS prescription and health region/dietitian full-time equivalents per 1,000 CKD patients. RESULTS Of 15,859 CKD-ND patients, 9% of patients entering CKD clinics were prescribed ONS within 1 year of clinic entry, and these patients demonstrated lower baseline estimated glomerular filtration rate, body mass index (BMI), serum albumin, bicarbonate, as well as greater age, serum phosphate, and neutrophil-to-lymphocyte ratio compared with those not receiving ONS. Cluster analysis revealed 5 phenotypes of ONS users: cluster 1 had the highest mean neutrophil-to-lymphocyte ratio; cluster 2 had the lowest mean albumin; cluster 3 had the lowest mean BMI; cluster 4 had the highest mean BMI; and cluster 5 had the lowest mean bicarbonate. There was regional variability in ONS prescription, and an odds ratio for ONS prescription of 1.32 (95% confidence interval 1.16-1.50) for every 1-unit increase in dietitian full-time equivalents per 1,000 patients. Over 3 years of follow-up, overall ONS use among CKD-ND patients remained stable. CONCLUSIONS This study demonstrates appropriate prescribing of ONS to patients with suboptimal nutritional status, although regional variation exists. Patients receiving ONS represent a heterogenous group with phenotypes reflecting several clinical and biochemical features of the protein-energy wasting syndrome. These findings will assist with updating ONS policy, planning quality improvement initiatives, and informing dietitian resource allocation.
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Affiliation(s)
- Michelle M Y Wong
- Department of Medicine, University of British Columbia, Vancouver, BC; BC Renal, Vancouver, BC.
| | | | | | - Zainab Sheriff
- Division of Nephrology, University of British Columbia, Vancouver, BC
| | - Adeera Levin
- BC Renal, Vancouver, BC; St. Paul's Hospital, Vancouver, BC; Division of Nephrology, University of British Columbia, Vancouver, BC
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Kim SM, Kim MH, Ryu DR, Oh HJ. The dietary intake of chronic kidney disease according to stages: Findings from the Korean National Health and Nutritional Examination Survey. PLoS One 2021; 16:e0260242. [PMID: 34843534 PMCID: PMC8629218 DOI: 10.1371/journal.pone.0260242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/07/2021] [Indexed: 11/21/2022] Open
Abstract
Appropriate dietary adjustment in patients with chronic kidney disease (CKD) is important, and nutritional guidelines recommend different dietary management depending on the CKD stage. However, there is no study, to our knowledge, of the characteristics of dietary intake according to CKD stages. We tried to assess the comparison of nutritional intake according to CKD stages. A cross-sectional study was conducted to reveal the characteristics of dietary intake among patients with CKD based on the Korean National Health and Nutritional Examination Survey between 2011 and 2014. Of 16,878 participants, we classified non-CKD (n = 14,952) and CKD (n = 1,926), which was stratified into five groups (I, II, IIIa, IIIb, and IV–V). We investigated the characteristics of dietary intake, such as energy, water, protein, fat, carbohydrate, sodium, potassium, calcium, and phosphorus, according to stage of CKD. We also explored nutritional intake according to CKD stage among patients with early CKD (stage I and II) and advanced CKD (stage IIIa, IIIb, and IV–V). Intake of majority of nutrients and energy tended to be decreased as CKD progressed. In early CKD stage, intake of energy, water, protein, fat, carbohydrate, potassium, calcium and phosphorus seemed to be statistically significant decreased as CKD progressed. In advanced CKD stage, intake of potassium and calcium seemed to be decreased as CKD progressed, but the intake of energy was about to be lower limit. Appropriate dietary education and CKD recognition are needed to improve nutritional intake depending on the CKD stage.
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Affiliation(s)
- Seon-Mi Kim
- Department of Internal Medicine, School of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Min-ho Kim
- Ewha Institute of Convergence Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Dong-Ryeol Ryu
- Research Institute for Human Health Information, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Hyung Jung Oh
- Ewha Institute of Convergence Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
- Research Institute for Human Health Information, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
- * E-mail:
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13
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Kaesler N, Baid-Agrawal S, Grams S, Nadal J, Schmid M, Schneider MP, Eckardt KU, Floege J, Bergmann MM, Schlieper G, Saritas T. Low adherence to CKD-specific dietary recommendations associates with impaired kidney function, dyslipidemia, and inflammation. Eur J Clin Nutr 2021; 75:1389-1397. [PMID: 33531632 PMCID: PMC8416654 DOI: 10.1038/s41430-020-00849-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVES A diet following chronic kidney disease (CKD)-specific recommendations is considered essential for optimal management of patients with CKD. However, data on the adherence to these recommendations and its implications for health-relevant biomarkers are lacking. The objectives were to estimate adherence to CKD-specific dietary recommendations, to identify characteristics and lifestyle variables associated with poor adherence, and to investigate the relationship of adherence with biomarkers. METHODS In this cross-sectional analysis, average dietary intake was estimated in 3193 participants with moderately severe CKD enrolled into the observational multicenter German CKD study using a food frequency questionnaire. A CKD diet score was developed to assess adherence to CKD-specific dietary recommendations based on intake of sodium, potassium, fiber, protein, sugar, and cholesterol. The associations of dietary adherence with characteristics, lifestyle variables, and biomarker levels were determined. RESULTS Logistic regression analysis revealed younger age, higher body mass index, male gender, lower educational attainment, various lifestyle variables (cigarette smoking, infrequent alcohol consumption, low physical activity), and lower estimated glomerular filtrate rate associated with lower adherence to dietary recommendations. Low adherence to dietary recommendations was further associated with dyslipidemia, higher uric acid, and C-reactive protein levels. Associations between low dietary adherence and biomarkers were mostly driven by low intake of fiber and potassium, and high intake of sugar and cholesterol. CONCLUSIONS This study revealed differential characteristics and biomarkers associated with lower adherence to CKD-specific dietary recommendations. Promotion of CKD-specific dietary recommendations may help to mitigate the adverse prognosis in CKD patients.
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Affiliation(s)
- Nadine Kaesler
- Division of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany
| | - Seema Baid-Agrawal
- Department of Nephrology and Transplant Center, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Sabine Grams
- German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Jennifer Nadal
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Markus P Schneider
- Department of Nephrology and Hypertension, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Nephrology and Hypertension, Klinikum Nürnberg, Paracelsus Private Medical University, Nürnberg, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Nephrology and Medical Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Floege
- Division of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany
| | - Manuela M Bergmann
- German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Georg Schlieper
- Division of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany
- Center for Nephrology, Hypertension, and Metabolic Diseases, Hannover, Germany
| | - Turgay Saritas
- Division of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany.
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14
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Amarasiri SS, Attanayake AP, Arawwawala LDAM, Jayatilaka KAPW, Mudduwa LKB. Nephroprotective activity of Vetiveria zizanioides (L.) Nash supplement in doxorubicin-induced nephrotoxicity model of Wistar rats. J Food Biochem 2021; 45:e13901. [PMID: 34396545 DOI: 10.1111/jfbc.13901] [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: 04/19/2021] [Revised: 07/12/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
The nephroprotective effect of standardized aqueous root extract of Vetiveria zizanioides (L.) Nash (Family: Poaceae) was investigated in doxorubicin-induced (20 mg/kg, ip) experimental nephrotoxicity model of Wistar rats. The freeze-dried aqueous refluxed (4 hr) root extract of V. zizanioides (25, 50; equivalent human therapeutic dose and 100 mg/kg) was administered separately to nephrotoxic Wistar rats (n = 6/group). Supplement of V. zizanioides resulted a dose-dependent reduction in raised serum creatinine, β2 -microglobulin, and blood urea nitrogen and a subsequent increase in serum total protein and albumin in nephrotoxic rats (p < .05). An attenuation of the doxorubicin-induced features of renal parenchymal injury was observed on H- and E-stained sections of the kidney tissues. Nootkatone, dehydroaromadendrene, isokhusenic acid, α-vetivone, and isolongifolene were identified in the methanol extract of V. zizanioides based on the GC-MS chromatogram analysis. The findings revealed that the supplement of standardized aqueous root extract of V. zizanioides had a significant dose-dependent nephroprotective activity against doxorubicin-induced experimental nephrotoxicity. PRACTICAL APPLICATIONS: Vetiveria zizanioides is a medicinal plant with a variety of therapeutic applications in kidney-related diseases. Apparently, it is used as a food ingredient due to its fresh and elegant scent and potential bioactivities. The aqueous root extract of V. zizanioides exerted relatively high antioxidant potential in vitro, substantiating the health effects of the plant pertaining to kidney diseases as a potential source of dietary antioxidant. The administration of the plant extract resulted in significant nephroprotection against doxorubicin-induced experimental nephrotoxicity revealing the significance of V. zizanioides as a promising dietary supplement in the management of kidney disease.
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Affiliation(s)
- Sachinthi S Amarasiri
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, University of Ruhuna, Galle, Sri Lanka
| | - Anoja P Attanayake
- Department of Biochemistry, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | | | | | - Lakmini K B Mudduwa
- Department of Pathology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
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15
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Morrison R, Stanford J, Lambert K. Dietary Modelling to Explore the Impact of Potassium Chloride Replacement for Sodium in Bread for Adults with Chronic Kidney Disease. Nutrients 2021; 13:nu13072472. [PMID: 34371980 PMCID: PMC8308590 DOI: 10.3390/nu13072472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 12/12/2022] Open
Abstract
Food manufacturers are increasingly substituting potassium chloride (KCl) in food products so as to reduce the sodium chloride content. Bread and bread products are common staple foods in many Western households and are a target for recipe reformulation using KCl. Given that chronic kidney disease (CKD) is a medical condition of global importance that requires dietary potassium restriction in the later stages, we sought to evaluate the impact and safety of varying levels of KCl substitution in bread products. We undertook a secondary analysis of dietary data from the National Nutrition and Physical Activity Survey 2011–2012 for 12,152 participants (154 participants with CKD). The sodium chloride content in bread and bread-based products was substituted with 20%, 30%, and 40% of KCl. The contribution of these alterations in the dietary potassium intake to the total daily potassium intake were then examined. The replacement of sodium in bread with varying amounts of KCl (20%, 30%, and 40%) resulted in one third of people with CKD exceeding the safe limits for dietary potassium consumption (31.8%, 32.6%, and 33%, respectively). KCl substitution in staple foods such as bread and bread products have serious and potentially fatal consequences for people who need to restrict dietary potassium. Improved food labelling is required for consumers to avoid excessive consumption.
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Affiliation(s)
- Rebecca Morrison
- School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia; (R.M.); (J.S.)
| | - Jordan Stanford
- School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia; (R.M.); (J.S.)
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
| | - Kelly Lambert
- School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia; (R.M.); (J.S.)
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
- Correspondence:
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16
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Ito Y, Ryuzaki M, Sugiyama H, Tomo T, Yamashita AC, Ishikawa Y, Ueda A, Kanazawa Y, Kanno Y, Itami N, Ito M, Kawanishi H, Nakayama M, Tsuruya K, Yokoi H, Fukasawa M, Terawaki H, Nishiyama K, Hataya H, Miura K, Hamada R, Nakakura H, Hattori M, Yuasa H, Nakamoto H. Peritoneal Dialysis Guidelines 2019 Part 1 (Position paper of the Japanese Society for Dialysis Therapy). RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00348-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AbstractApproximately 10 years have passed since the Peritoneal Dialysis Guidelines were formulated in 2009. Much evidence has been reported during the succeeding years, which were not taken into consideration in the previous guidelines, e.g., the next peritoneal dialysis PD trial of encapsulating peritoneal sclerosis (EPS) in Japan, the significance of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), the effects of icodextrin solution, new developments in peritoneal pathology, and a new international recommendation on a proposal for exit-site management. It is essential to incorporate these new developments into the new clinical practice guidelines. Meanwhile, the process of creating such guidelines has changed dramatically worldwide and differs from the process of creating what were “clinical practice guides.” For this revision, we not only conducted systematic reviews using global standard methods but also decided to adopt a two-part structure to create a reference tool, which could be used widely by the society’s members attending a variety of patients. Through a working group consensus, it was decided that Part 1 would present conventional descriptions and Part 2 would pose clinical questions (CQs) in a systematic review format. Thus, Part 1 vastly covers PD that would satisfy the requirements of the members of the Japanese Society for Dialysis Therapy (JSDT). This article is the duplicated publication from the Japanese version of the guidelines and has been reproduced with permission from the JSDT.
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17
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Molina P, Gavela E, Vizcaíno B, Huarte E, Carrero JJ. Optimizing Diet to Slow CKD Progression. Front Med (Lausanne) 2021; 8:654250. [PMID: 34249961 PMCID: PMC8267004 DOI: 10.3389/fmed.2021.654250] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/31/2021] [Indexed: 12/15/2022] Open
Abstract
Due to the unique role of the kidney in the metabolism of nutrients, patients with chronic kidney disease (CKD) lose the ability to excrete solutes and maintain homeostasis. Nutrient intake modifications and monitoring of nutritional status in this population becomes critical, since it can affect important health outcomes, including progression to kidney failure, quality of life, morbidity, and mortality. Although there are multiple hemodynamic and metabolic factors involved in the progression and prognosis of CKD, nutritional interventions are a central component of the care of patients with non-dialysis CKD (ND-CKD) and of the prevention of overweight and possible protein energy-wasting. Here, we review the reno-protective effects of diet in adults with ND-CKD stages 3-5, including transplant patients.
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Affiliation(s)
- Pablo Molina
- Department of Nephrology, Hospital Universitari Dr. Peset, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Eva Gavela
- Department of Nephrology, Hospital Universitari Dr. Peset, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | - Belén Vizcaíno
- Department of Nephrology, Hospital Universitari Dr. Peset, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | - Emma Huarte
- Department of Nephrology, Hospital San Pedro, Logroño, Spain
| | - Juan Jesús Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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18
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Franco BB, Hopman WM, Lamarche MC, Holden RM. Protein energy wasting and long-term outcomes in nondialysis dependent chronic kidney disease. J Ren Care 2021; 48:14-23. [PMID: 34053197 DOI: 10.1111/jorc.12378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/17/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nutritional status and protein energy wasting (PEW) is prevalent in patients with nondialysis-dependent chronic kidney disease (CKD). The relationship between PEW and long-term development of clinically important outcomes remains to be examined. OBJECTIVES To investigate the relationships between PEW, as measured by Subjective Global Assessment (SGA 1-7), and progression to important clinical outcomes: mortality and/or kidney failure. DESIGN Prospective cohort design. PARTICIPANTS One hundred and thirty-nine participants were well-nourished and 37 moderately malnourished patients with CKD 3-5. MEASUREMENTS The outcomes were 2, 5, and 10-year progression to kidney failure (dialysis or transplant) or mortality, kidney failure alone, and mortality alone. SGA was determined by a registered renal dietitian. Food frequency questionnaires were used to assess dietary intake. Clinical and laboratory baseline characteristics were collected. Multivariable regression models and Cox models were created to examine the relationship between SGA and outcomes. RESULTS PEW was associated with the combined outcome of kidney failure or mortality at 2 (p = 0.003), 5 (p = 0.004), but not at 10 (p = 0.73) years. This relationship was primarily driven by the relationship between PEW and kidney failure. In Cox models, the relationship between PEW and kidney failure remained after adjusting for Kidney Failure Risk Equation scores. The multivariable modeling revealed that PEW remained a statistically significant predictor of the combined outcome and ESKD after adjustment for age, estimated glomerular filtration rate (eGFR), sex, albumin-to-creatinine ratio, diabetes, albumin, and protein intake. CONCLUSIONS PEW, determined by the SGA 1-7, is an important prognostic tool. Further research looking at clinically important outcomes are needed to implement nutritional interventions for nondialysis-dependent CKD patients.
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Affiliation(s)
- Bryan B Franco
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Wilma M Hopman
- Clinical Research Centre, Kingston General Hospital, Kingston, Ontario, Canada
| | | | - Rachel M Holden
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
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19
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Lambert K, Bahceci S, Harrison H, Chan M. Implications for Australasian dietitians regarding the 2020 Academy of Nutrition and Dietetics and Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Nutrition in Chronic Kidney Disease. Nutr Diet 2021; 78:374-379. [PMID: 33786973 DOI: 10.1111/1747-0080.12668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Kelly Lambert
- Discipline of Nutrition and Dietetics, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Su Bahceci
- Renal Dietitian, Dietetics Department, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Harriet Harrison
- Renal Dietitian, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Maria Chan
- Department of Renal Medicine, The St. George Hospital, Kogarah, New South Wales, Australia.,Department of Nutrition and Dietetics, The St. George Hospital, Kogarah, New South Wales, Australia
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20
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Dietary patterns and chronic kidney disease risk: a systematic review and updated meta-analysis of observational studies. Nutr J 2021; 20:4. [PMID: 33419440 PMCID: PMC7796538 DOI: 10.1186/s12937-020-00661-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/22/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND A number of studies have reported the association between dietary patterns and the risk of chronic kidney disease (CKD), however a consistent perspective hasn't been established to date. Herein, we conducted this systematic review and meta-analysis of observational studies to assess the association between dietary patterns and CKD. METHODS MEDLINE, EBSCO and references from eligible studies were searched for relevant articles published up to 9 May 2020 that examined the association of common dietary patterns and CKD. The heterogeneity among studies was assessed by Cochran's Q test and I2 methods. RESULTS Seventeen eligible studies, involving 149,958 participants, were included in our systematic review and meta-analysis. The highest compared with the lowest category of healthy dietary pattern was significantly associated with a lower risk of CKD (OR=0.69; CI: 0.57, 0.84; P=0.0001). A higher risk of CKD was shown for the highest compared with the lowest categories of Western-type dietary pattern (OR=1.86; CI: 1.21, 2.86; P=0.005). There were evidence of a lower risk of CKD in the highest compared with the lowest categories of light-moderate drinking pattern (OR=0.76; CI: 0.71, 0.81; P< 0.0001) and heavy drinking pattern (OR=0.67; CI: 0.56, 0.80; P< 0.0001). CONCLUSIONS The results of this systematic review and meta-analysis show that a healthy dietary pattern and alcohol drinking were associated with lower risk of CKD, whereas a Western-type dietary pattern was associated with higher risk of CKD.
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21
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Pei K, Gui T, Li C, Zhang Q, Feng H, Li Y, Wu J, Gai Z. Recent Progress on Lipid Intake and Chronic Kidney Disease. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3680397. [PMID: 32382547 PMCID: PMC7196967 DOI: 10.1155/2020/3680397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/12/2020] [Accepted: 02/18/2020] [Indexed: 12/16/2022]
Abstract
The incidence of chronic kidney disease (CKD) is associated with major abnormalities in circulating lipoproteins and renal lipid metabolism. This article elaborates on the mechanisms of CKD and lipid uptake abnormalities. The viewpoint we supported is that lipid abnormalities directly cause CKD, resulting in forming a vicious cycle. On the theoretical and experiment fronts, this inference has been verified by elaborately elucidating the role of lipid intake and accumulation as well as their influences on CKD. Taken together, these findings suggest that further understanding of lipid metabolism in CKD may lead to novel therapeutic approaches.
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Affiliation(s)
- Ke Pei
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
| | - Ting Gui
- Key Laboratory of Traditional Chinese Medicine for Classical Theory, Ministry of Education, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
| | - Chao Li
- Key Laboratory of Traditional Chinese Medicine for Classical Theory, Ministry of Education, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
| | - Qian Zhang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
| | - Huichao Feng
- Acupuncture and Massage College, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
| | - Yunlun Li
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250011, China
| | - Jibiao Wu
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
| | - Zhibo Gai
- Key Laboratory of Traditional Chinese Medicine for Classical Theory, Ministry of Education, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, University of Zurich, 8006 Zurich, Switzerland
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22
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Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach. Nutrients 2020; 12:nu12030785. [PMID: 32188148 PMCID: PMC7146606 DOI: 10.3390/nu12030785] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 12/11/2022] Open
Abstract
Dialysis and nutrition are two sides of the same coin—dialysis depurates metabolic waste that is typically produced by food intake. Hence, dietetic restrictions are commonly imposed in order to limit potassium and phosphate and avoid fluid overload. Conversely, malnutrition is a major challenge and, albeit to differing degrees, all nutritional markers are associated with survival. Dialysis-related malnutrition has a multifactorial origin related to uremic syndrome and comorbidities but also to dialysis treatment. Both an insufficient dialysis dose and excessive removal are contributing factors. It is thus not surprising that dialysis alone, without proper nutritional management, often fails to be effective in combatting malnutrition. While composite indexes can be used to identify patients with poor prognosis, none is fully satisfactory, and the definitions of malnutrition and protein energy wasting are still controversial. Furthermore, most nutritional markers and interventions were assessed in hemodialysis patients, while hemodiafiltration and peritoneal dialysis have been less extensively studied. The significant loss of albumin in these two dialysis modalities makes it extremely difficult to interpret common markers and scores. Despite these problems, hemodialysis sessions represent a valuable opportunity to monitor nutritional status and prescribe nutritional interventions, and several approaches have been tried. In this concept paper, we review the current evidence on intradialytic nutrition and propose an algorithm for adapting nutritional interventions to individual patients.
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23
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Lambert K, Bird L, Borst AC, Fuller A, Wang Y, Rogers GB, Stanford J, Sanderson-Smith ML, Williams JG, McWhinney BC, Neale EP, Probst Y, Lonergan M. Safety and Efficacy of Using Nuts to Improve Bowel Health in Hemodialysis Patients. J Ren Nutr 2020; 30:462-469. [PMID: 32001127 DOI: 10.1053/j.jrn.2019.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/23/2019] [Accepted: 10/04/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Constipation is common in patients with end-stage kidney disease. Nondrug strategies to manage constipation are challenging because of dietary potassium, phosphate, and fluid restrictions. Nuts are a high-fiber food but are excluded from the diet because of the high potassium and phosphate content. The aim of this study was to examine the safety and efficacy of using nuts to improve constipation in adults undertaking hemodialysis (HD). DESIGN AND METHODS Adult patients undertaking HD were recruited to this nonrandomized, 10-week repeated measures, within-subject, pragmatic clinical trial, conducted in two HD units. The intervention consisted of consumption of 40g of raw almonds daily for four weeks, followed by a two-week washout and four-week control period. The primary safety outcome measures were change in predialysis serum potassium and phosphate levels. The primary efficacy outcome was reduction in constipation, measured using the Bristol Stool Form Scale and Palliative Care Outcome Scale (POS-S) renal symptom score. Secondary outcomes included quality of life, selected uremic toxins, cognition, gut microbiota profile, and symptom burden. RESULTS Twenty patients completed the trial (median age: 67 [interquartile range: 57.5-77.8] years, 51% male). After controlling for dialysis adequacy, anuria, dietary intake, bicarbonate, and parathyroid hormone, there were no statistically significant changes in serum potassium (P = 0.21) or phosphate (P = 0.16) associated with daily consumption of almonds. However, statistically significant improvements in constipation were seen at weeks 2, 3, 4, and 10. There were statistically significant improvements in quality of life (P = 0.030), overall symptom burden (P = 0.002), vomiting (P = 0.020), itching (P = 0.006), and skin changes (P = 0.002). CONCLUSION Daily consumption of almonds for four weeks was safe, effective, and well tolerated. Improvements in quality of life and symptom burden warrant further research to elucidate potential mechanisms. The findings support the potential reinclusion of foods such as nuts into the diet of patients who underwent HD.
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Affiliation(s)
- Kelly Lambert
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia; Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia.
| | - Luke Bird
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Addison C Borst
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Andrew Fuller
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Yanan Wang
- Microbiome and Host Health Programme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Geraint B Rogers
- Microbiome and Host Health Programme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Jordan Stanford
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Martina L Sanderson-Smith
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia; School of Chemistry and Molecular Bioscience, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jonathan G Williams
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia; School of Chemistry and Molecular Bioscience, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Brett C McWhinney
- Department of Chemical Pathology, Pathology Queensland, Brisbane, Queensland, Australia
| | - Elizabeth P Neale
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Yasmine Probst
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Maureen Lonergan
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia; Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
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Lambert K, Bahceci S, Lucan B, Ryan M. A practical guide for the use of very low calorie diets in adults with chronic kidney disease. Nephrology (Carlton) 2019; 25:281-289. [PMID: 31715058 DOI: 10.1111/nep.13680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 10/24/2019] [Accepted: 10/27/2019] [Indexed: 12/11/2022]
Abstract
Obesity is increasingly common in individuals with chronic kidney disease (CKD). Being overweight or obese is associated with both the development and progression of kidney disease. Lifestyle interventions such as the use of very low-calorie diets (VLCD) are being used increasingly for patients with CKD despite warnings from manufacturers that they should be avoided or used with caution. Whilst these diets are effective and can induce rapid weight loss and suppress appetite, their use in patients with chronic and end stage kidney disease is more complex than in the general population. VLCD use in adults with kidney disease requires a more nuanced approach to prescription and closer monitoring for unintended side effects. This review describes the indications and clinical management of patients with CKD undertaking a very low-calorie diet and provides practical guidance regarding how to manage a VLCD, particularly for the latter stages of CKD.
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Affiliation(s)
- Kelly Lambert
- School of Medicine, Faculty of Science, Medicine and Health, and Illawarra Health and Medical Research Institute, University of Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, New South Wales, Australia
| | - Su Bahceci
- Nutrition and Dietetics Department, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Beth Lucan
- Nutrition Services, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Murielle Ryan
- Department of Nutrition, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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25
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Heindel J, Baid-Agrawal S, Rebholz CM, Nadal J, Schmid M, Schaeffner E, Schneider MP, Meiselbach H, Kaesler N, Bergmann M, Ernst S, Krane V, Eckardt KU, Floege J, Schlieper G, Saritas T. Association Between Dietary Patterns and Kidney Function in Patients With Chronic Kidney Disease: A Cross-Sectional Analysis of the German Chronic Kidney Disease Study. J Ren Nutr 2019; 30:296-304. [PMID: 31761711 DOI: 10.1053/j.jrn.2019.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/02/2019] [Accepted: 09/15/2019] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE In the general population, "healthy" dietary patterns are associated with improved health outcomes, but data on associations between observance of specific dietary patterns and kidney function in patients with chronic kidney disease (CKD) are sparse. METHODS Dietary intake was evaluated using food frequency questionnaires in patients with moderately severe CKD under nephrology care enrolled into the observational multicenter German CKD study. The Dietary Approaches to Stop Hypertension (DASH) diet score, Mediterranean diet score, and German Food Pyramid Index (GFPI) were calculated and their association with estimated glomerular filtration rate (eGFR) and albuminuria was assessed by multivariable linear regression analysis, adjusted for gender, age, body mass index, energy intake, smoking status, alcohol intake, education, high-density lipoprotein-cholesterol (HDL- cholesterol), low-density lipoprotein-cholesterol (LDL-cholesterol), hypertension, and diabetes mellitus. RESULTS A total of 2,813 patients (41% women; age 60.1 ± 11.6 years) were included in the analysis. High DASH diet score and GFPI were associated with lower systolic blood pressure and lower intake of antihypertensive medication, higher HDL, and lower uric acid levels. Mediterranean-style diet was associated with lower prevalence of diabetes mellitus. Higher DASH and Mediterranean diet scores were associated with higher eGFR (β-coefficient = 1.226, P < .001; β-coefficient = 0.932, P = .007, respectively). In contrast, GFPI was not associated with eGFR. For the individual components of the dietary patterns, higher intake of nuts and legumes, cereals, fish, and polyunsaturated fats was associated with higher eGFR and higher intake of dairy, composed of low- and whole-fat dairy, was associated with lower eGFR. No association was found between dietary patterns and albuminuria. CONCLUSION Higher observance of the DASH or Mediterranean diet, but not German food pyramid recommendations, was associated with higher eGFR among patients with CKD. Improving dietary habits may offer an opportunity to better control comorbidities and kidney function decline in patients with CKD.
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Affiliation(s)
- Judith Heindel
- Division of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany
| | - Seema Baid-Agrawal
- Department of Nephrology and Transplant Center, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Casey M Rebholz
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer Nadal
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Elke Schaeffner
- Department of Nephrology and Medical Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Markus P Schneider
- Department of Nephrology and Hypertension, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Nephrology and Hypertension, Klinikum Nürnberg, Paracelsus Private Medical University, Nürnberg, Germany
| | - Heike Meiselbach
- Department of Nephrology and Hypertension, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nadine Kaesler
- Division of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany
| | - Manuela Bergmann
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Sabine Ernst
- Division of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany
| | - Vera Krane
- Division of Nephrology, Department of Internal Medicine I, University of Würzburg, Würzburg, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Nephrology and Hypertension, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jürgen Floege
- Division of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany
| | - Georg Schlieper
- Division of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany
| | - Turgay Saritas
- Division of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany.
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Education and Protein Supplementation Improve Nutritional Biomarkers among Hypoalbuminemic Peritoneal Dialysis Patients: A Quasi-Experimental Design. Healthcare (Basel) 2019; 7:healthcare7040135. [PMID: 31694275 PMCID: PMC6956051 DOI: 10.3390/healthcare7040135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 12/31/2022] Open
Abstract
Protein-energy wasting is prevalent in peritoneal dialysis patients, which causes a heavy burden for individuals and healthcare systems. We aimed to investigate the effect of nutritional education, and/or protein supplementation on nutritional biomarkers in hypoalbuminemic peritoneal dialysis patients. A quasi-experimental study was conducted in two dialysis centers at Taipei Tzu Chi Hospital and Shin Kong Wu Ho-Su Memorial Hospital. Patients were allocated in three groups including control (n = 12), milk protein (n = 21) and soy protein (n = 20). All patients received dietary guidelines from dietitians and completed 3-day dietary records during monthly visits for consecutive three months. Nutrients were analyzed using Nutritionist Professional software. Blood urea nitrogen (BUN), creatinine, albumin, total protein, hemoglobin, serum calcium, phosphorus, sodium, and potassium were assessed monthly. Total cholesterol and triglycerides were measured every three months. After three-month intervention, protein intake (percent of total calories), and serum albumin were significantly increased in three groups. Protein, phosphorus intake, and BUN were increased in two intervention groups. Total serum protein increased in control and milk protein groups, and creatinine increased the control group. Serum phosphorus was not significantly changed. Nutritional education alone, or combined with protein supplementation, significantly improve protein intake, and nutritional status by increasing serum albumin, but not serum phosphorus in hypoalbuminemic peritoneal dialysis patients.
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Skoumalova I, Kolarcik P, Madarasova Geckova A, Rosenberger J, Majernikova M, Klein D, van Dijk JP, Reijneveld SA. Is Health Literacy of Dialyzed Patients Related to Their Adherence to Dietary and Fluid Intake Recommendations? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4295. [PMID: 31694265 PMCID: PMC6862452 DOI: 10.3390/ijerph16214295] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 11/16/2022]
Abstract
Non-adherence to dietary and fluid intake recommendations (NADFIR) is an important factor for the effective treatment of dialyzed patients and may be hindered by low health literacy (HL). Therefore, we assessed whether low HL of dialyzed patients is associated with their NADFIR. We performed a multicentric cross-sectional study in 20 dialysis clinics in Slovakia (n = 452; response rate: 70.1%; mean age = 63.6 years; males: 60.7%). We assessed the association between nine domains of HL and non-adherence (high serum potassium, high serum phosphate, relative overhydration, and self-reported NADFIR) using general linear models adjusted for age and gender. Moreover, we assessed the moderation by socioeconomic status (SES). We found higher NADFIR among patients with less sufficient information for health management (high serum phosphate level; odds ratio (OR): 0.77; 95% confidence interval (CI): 0.63-0.94), with a lower ability to actively manage their health (self-reported diet non-adherence; OR: 0.74; 95% CI: 0.62-0.89), and those less able to actively engage with healthcare providers (overhydrated; OR: 0.78; 95% CI: 0.65-0.94). Moreover, SES modified this relation. Low HL affects the adherence of dialyzed patients. This shows a need to support patients with low HL and to train healthcare providers to work with these patients, taking into account their SES.
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Affiliation(s)
- Ivana Skoumalova
- Department of Health Psychology, Faculty of Medicine, PJ Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia; (P.K.); (A.M.G.); (J.R.)
- Graduate School Kosice Institute for Society and Health, PJ Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia;
- Department of Community & Occupational Health, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
| | - Peter Kolarcik
- Department of Health Psychology, Faculty of Medicine, PJ Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia; (P.K.); (A.M.G.); (J.R.)
- Olomouc University Social Health Institute, Palacky University in Olomouc, Univerzitni 22, Olomouc 771 11, Czech Republic
| | - Andrea Madarasova Geckova
- Department of Health Psychology, Faculty of Medicine, PJ Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia; (P.K.); (A.M.G.); (J.R.)
- Department of Community & Occupational Health, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
- Olomouc University Social Health Institute, Palacky University in Olomouc, Univerzitni 22, Olomouc 771 11, Czech Republic
| | - Jaroslav Rosenberger
- Department of Health Psychology, Faculty of Medicine, PJ Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia; (P.K.); (A.M.G.); (J.R.)
- Graduate School Kosice Institute for Society and Health, PJ Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia;
- Olomouc University Social Health Institute, Palacky University in Olomouc, Univerzitni 22, Olomouc 771 11, Czech Republic
- II. Internal Clinic, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia
- FMC-Dialysis Services Slovakia, Trieda SNP 1, 040 11 Kosice, Slovakia;
| | - Maria Majernikova
- FMC-Dialysis Services Slovakia, Trieda SNP 1, 040 11 Kosice, Slovakia;
| | - Daniel Klein
- Institute of Mathematics, Faculty of Science, P. J. Safarik University, Jesenna 5, 040 01 Kosice, Slovakia;
| | - Jitse P. van Dijk
- Graduate School Kosice Institute for Society and Health, PJ Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia;
- Department of Community & Occupational Health, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
- Olomouc University Social Health Institute, Palacky University in Olomouc, Univerzitni 22, Olomouc 771 11, Czech Republic
| | - Sijmen A. Reijneveld
- Department of Community & Occupational Health, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
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Wright M, Southcott E, MacLaughlin H, Wineberg S. Clinical practice guideline on undernutrition in chronic kidney disease. BMC Nephrol 2019; 20:370. [PMID: 31619185 PMCID: PMC6796390 DOI: 10.1186/s12882-019-1530-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 01/12/2023] Open
Affiliation(s)
| | | | | | - Stuart Wineberg
- Patient Representative, c/o The Renal Association, Bristol, UK
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Saglimbene VM, Wong G, Teixeira-Pinto A, Ruospo M, Garcia-Larsen V, Palmer SC, Natale P, Campbell K, Carrero JJ, Stenvinkel P, Gargano L, Murgo AM, Johnson DW, Tonelli M, Gelfman R, Celia E, Ecder T, Bernat AG, Del Castillo D, Timofte D, Török M, Bednarek-Skublewska A, Duława J, Stroumza P, Hansis M, Fabricius E, Felaco P, Wollheim C, Hegbrant J, Craig JC, Strippoli GFM. Dietary Patterns and Mortality in a Multinational Cohort of Adults Receiving Hemodialysis. Am J Kidney Dis 2019; 75:361-372. [PMID: 31515137 DOI: 10.1053/j.ajkd.2019.05.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/26/2019] [Indexed: 12/12/2022]
Abstract
RATIONALE & OBJECTIVE Clinical practice guidelines for dietary intake in hemodialysis focus on individual nutrients. Little is known about associations of dietary patterns with survival. We evaluated the associations of dietary patterns with cardiovascular and all-cause mortality among adults treated by hemodialysis. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 8,110 of 9,757 consecutive adults on hemodialysis (January 2014 to June 2017) treated in a multinational private dialysis network and with analyzable dietary data. EXPOSURES Data-driven dietary patterns based on the GA2LEN food frequency questionnaire. Participants received a score for each identified pattern, with higher scores indicating closer resemblance of their diet to the identified pattern. Quartiles of standardized pattern scores were used as primary exposures. OUTCOMES Cardiovascular and all-cause mortality. ANALYTICAL APPROACH Principal components analysis with varimax rotation to identify common dietary patterns. Adjusted proportional hazards regression analyses with country as a random effect to estimate the associations between dietary pattern scores and mortality. Associations were expressed as adjusted HRs with 95% CIs, using the lowest quartile score as reference. RESULTS During a median follow-up of 2.7 years (18,666 person-years), there were 2,087 deaths (958 cardiovascular). 2 dietary patterns, "fruit and vegetable" and "Western," were identified. For the fruit and vegetable dietary pattern score, adjusted HRs, in ascending quartiles, were 0.94 (95% CI, 0.76-1.15), 0.83 (95% CI, 0.66-1.06), and 0.91 (95% CI, 0.69-1.21) for cardiovascular mortality and 0.95 (95% CI, 0.83-1.09), 0.84 (95% CI, 0.71-0.99), and 0.87 (95% CI, 0.72-1.05) for all-cause mortality. For the Western dietary pattern score, the corresponding estimates were 1.10 (95% CI, 0.90-1.35), 1.11 (95% CI, 0.87-1.41), and 1.09 (95% CI, 0.80-1.49) for cardiovascular mortality and 1.01 (95% CI, 0.88-1.16), 1.00 (95% CI, 0.85-1.18), and 1.14 (95% CI, 0.93-1.41) for all-cause mortality. LIMITATIONS Self-reported food frequency questionnaire, data-driven approach. CONCLUSIONS These findings did not confirm an association between mortality among patients receiving long-term hemodialysis and the extent to which dietary patterns were either high in fruit and vegetables or consistent with a Western diet.
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Affiliation(s)
- Valeria M Saglimbene
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia; Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden.
| | - Germaine Wong
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia; Department of Renal Medicine, Westmead Hospital, Westmead, Australia
| | - Armando Teixeira-Pinto
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia
| | | | - Vanessa Garcia-Larsen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Patrizia Natale
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden; Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Katrina Campbell
- Department of Nutrition and Dietetics, University of Queensland at Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | | | - Angelo M Murgo
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - David W Johnson
- Division of Medicine, Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Woolloongabba, Australia; Translational Research Institute, University of Queensland, Woolloongabba, Australia
| | - Marcello Tonelli
- Cumming School of Medicine, Health Sciences Centre, University of Calgary, Calgary, Alberta, Canada
| | - Rubén Gelfman
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Eduardo Celia
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Tevfik Ecder
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | | | | | - Delia Timofte
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Marietta Török
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Anna Bednarek-Skublewska
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden; Medical University of Lublin, Lublin
| | - Jan Duława
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden; Medical University of Silesia, Katowice, Poland
| | - Paul Stroumza
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Martin Hansis
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | | | - Paolo Felaco
- Nephrology and dialysis Presidio Ospedaliero Penne, Unita' Sanitaria Locale Pescara
| | | | | | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Giovanni F M Strippoli
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia; Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden; Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; Diaverum Academy, Diaverum, Bari, Italy
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Stevenson J, Campbell KL, Brown M, Craig J, Howard K, Howell M, Khalid R, Sud K, Teixeira-Pinto A, Thiagalingam A, Tong A, Chow C, Lee VW. Targeted, structured text messaging to improve dietary and lifestyle behaviours for people on maintenance haemodialysis (KIDNEYTEXT): study protocol for a randomised controlled trial. BMJ Open 2019; 9:e023545. [PMID: 31061013 PMCID: PMC6502028 DOI: 10.1136/bmjopen-2018-023545] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Managing nutrition is critical for reducing morbidity and mortality in patients on haemodialysis but adherence to the complex dietary restrictions remains problematic. Innovative interventions to enhance the delivery of nutritional care are needed. The aim of this phase II trial is to evaluate the feasibility and effectiveness of a targeted mobile phone text messaging system to improve dietary and lifestyle behaviours in patients on long-term haemodialysis. METHODS AND ANALYSIS Single-blinded randomised controlled trial with 6 months of follow-up in 130 patients on haemodialysis who will be randomised to either standard care or KIDNEYTEXT. The KIDNEYTEXT intervention group will receive three text messages per week for 6 months. The text messages provide customised dietary information and advice based on renal dietary guidelines and general healthy eating dietary guidelines, and motivation and support to improve behaviours. The primary outcome is feasibility including recruitment rate, drop-out rate, adherence to renal dietary recommendations, participant satisfaction and a process evaluation using semistructured interviews with a subset of purposively sampled participants. Secondary and exploratory outcomes include a range of clinical and behavioural outcomes and a healthcare utilisation cost analysis will be undertaken. ETHICS AND DISSEMINATION The study has been approved by the Western Sydney Local Health District Human Research Ethics Committee-Westmead. Results will be presented at scientific meetings and published in peer-reviewed publications. TRIAL REGISTRATION NUMBER ACTRN12617001084370; Pre-results.
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Affiliation(s)
- Jessica Stevenson
- The Centre for Kidney Research, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Katrina L Campbell
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Mark Brown
- Renal Medicine, St George Hospital, Kogarah, New South Wales, Australia
- St George Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Jonathan Craig
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten Howard
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Martin Howell
- School of Public Health, University of Sydney – Camperdown and Darlington Campus, Sydney, New South Wales, Australia
| | - Rabia Khalid
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kamal Sud
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Department of Renal Medicine, Nepean Hospital, Sydney, New South Wales, Australia
| | - Armando Teixeira-Pinto
- Screening and Test Evaluation Program (STEP), School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Aravinda Thiagalingam
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Cardiology Department, Westmead Hospital, Westmead, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Clara Chow
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Cardiology Department, Westmead Hospital, Westmead, New South Wales, Australia
| | - Vincent W Lee
- Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
- The Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
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Warner MM, Tong A, Campbell KL, Kelly JT. Patients' Experiences and Perspectives of Telehealth Coaching with a Dietitian to Improve Diet Quality in Chronic Kidney Disease: A Qualitative Interview Study. J Acad Nutr Diet 2019; 119:1362-1374. [PMID: 30979633 DOI: 10.1016/j.jand.2019.01.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 01/25/2019] [Accepted: 01/31/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Dietary behavior change interventions for the self-management of chronic kidney disease (CKD) have the potential to slow disease progression and reduce metabolic complications. Telehealth-delivered dietary interventions may assist in the self-management of CKD, although their acceptability by patients is unknown. OBJECTIVE This study aims to describe the acceptability and experiences of a telehealth coaching intervention that utilized telephone calls and tailored text messages to improve diet quality in patients with stage 3 to 4 CKD. DESIGN Semistructured interview study of adults with CKD. PARTICIPANTS/SETTING Adults with stage 3 to 4 CKD (n=21) aged 28 to 78 (mean 62) years, who completed a 12-week telehealth-delivered dietary intervention in Queensland, Australia, were interviewed from March to July 2017. DATA ANALYSIS Interviews were transcribed verbatim and analyzed thematically. RESULTS Five themes were identified: valuing relationships (receiving tangible and perceptible support, building trust and rapport remotely, motivated by accountability, readily responding to a personalized approach, reassured by health professional expertise); appreciating convenience (integrating easily into lifestyle, talking comfortably in a familiar environment, minimizing travel and wait time burden); empowered with actionable knowledge (comprehending diet-disease mechanisms, practical problem solving for sustainable dietary behavior); increasing diet consciousness (learning from recurrent feedback, prompted by reiteration of messages); making sense of complexity (contextualizing and prioritizing comorbidities, gaining confidence to make dietary decisions, setting and achieving realistic goals). CONCLUSIONS Among adults with stage 3 to 4 CKD, individualized telehealth coaching for improving diet quality was convenient for patients, and they felt supported and empowered to navigate recommendations and prioritize dietary behavior changes. Telehealth-delivered dietary interventions appear to be well accepted by patients as a way of providing regular, tailored contact with a health professional to support dietary management in CKD.
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Morgan K, Jersey S, Mason B, Young A. Guidelines for review of patients on haemodialysis: Are we meeting patient needs? Nutr Diet 2019; 76:166-173. [DOI: 10.1111/1747-0080.12538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 03/12/2019] [Accepted: 03/17/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Kate Morgan
- Department of Nutrition and DieteticsRoyal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Susan Jersey
- Department of Nutrition and DieteticsRoyal Brisbane and Women's Hospital Brisbane Queensland Australia
- School of Exercise and Nutrition SciencesFaculty of Health, Queensland University of Technology Brisbane Queensland Australia
| | - Belinda Mason
- Department of Nutrition and DieteticsRoyal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Adrienne Young
- Department of Nutrition and DieteticsRoyal Brisbane and Women's Hospital Brisbane Queensland Australia
- School of Exercise and Nutrition SciencesFaculty of Health, Queensland University of Technology Brisbane Queensland Australia
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Lambert K, Beer J, Dumont R, Hewitt K, Manley K, Meade A, Salamon K, Campbell K. Weight management strategies for those with chronic kidney disease: A consensus report from the Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology 2016 renal dietitians meeting. Nephrology (Carlton) 2019; 23:912-920. [PMID: 28742255 DOI: 10.1111/nep.13118] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2017] [Indexed: 12/14/2022]
Abstract
AIM The aim of the present study was to develop a consensus report to guide dietetic management of overweight or obese individuals with chronic kidney disease (CKD). METHODS Six statements relating to weight management in CKD guided a comprehensive review of the literature. A summary of the evidence was then presented at the renal nutrition meeting of the 2016 Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology. Majority agreement was defined as group agreement on a statement of between 50-74%, and consensus was considered ≥75% agreement. The recommendations were developed via a mini Delphi process. RESULTS Two statements achieved group consensus: the current guidelines used by dietitians to estimate energy requirements for overweight and obese people with CKD are not relevant and weight loss medications may be unsafe or ineffective in isolation for those with CKD. One statement achieved group agreement: Meal replacement formulas are safe and efficacious in those with CKD. No agreement was achieved on the statements of whether there is strong evidence of benefit for weight loss prior to kidney transplantation; whether traditional weight loss strategies can be used in those with CKD and if bariatric surgery in those with end stage kidney disease is feasible and effective. CONCLUSION There is a limited evidence base to guide the dietetic management of overweight and obese individuals with CKD. Medical or surgical strategies to facilitate weight loss are not recommended in isolation and require a multidisciplinary approach with the involvement of a skilled renal dietitian.
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Affiliation(s)
- Kelly Lambert
- Department of Clinical Nutrition, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Jo Beer
- Younger Adult Rehabilitation Department, Osborne Park Hospital, Stirling, Western Australia, Australia
| | - Ruth Dumont
- Dietetics Department, Dietetics, Joondalup Health Campus, Joondalup, Western Australia, Australia
| | - Katie Hewitt
- Dietetics Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Karen Manley
- Dietetics Department, Austin Health, Heidelberg, Victoria, Australia
| | - Anthony Meade
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Karen Salamon
- Nutrition and Dietetics Department, Nutrition and Dietetics, Monash Medical Centre, Clayton, Victoria, Australia
| | - Katrina Campbell
- Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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Saglimbene VM, Wong G, Ruospo M, Palmer SC, Garcia-Larsen V, Natale P, Teixeira-Pinto A, Campbell KL, Carrero JJ, Stenvinkel P, Gargano L, Murgo AM, Johnson DW, Tonelli M, Gelfman R, Celia E, Ecder T, Bernat AG, Del Castillo D, Timofte D, Török M, Bednarek-Skublewska A, Duława J, Stroumza P, Hoischen S, Hansis M, Fabricius E, Felaco P, Wollheim C, Hegbrant J, Craig JC, Strippoli GFM. Fruit and Vegetable Intake and Mortality in Adults undergoing Maintenance Hemodialysis. Clin J Am Soc Nephrol 2019; 14:250-260. [PMID: 31738182 PMCID: PMC6390927 DOI: 10.2215/cjn.08580718] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/23/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Higher fruit and vegetable intake is associated with lower cardiovascular and all-cause mortality in the general population. It is unclear whether this association occurs in patients on hemodialysis, in whom high fruit and vegetable intake is generally discouraged because of a potential risk of hyperkalemia. We aimed to evaluate the association between fruit and vegetable intake and mortality in hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Fruit and vegetable intake was ascertained by the Global Allergy and Asthma European Network food frequency questionnaire within the Dietary Intake, Death and Hospitalization in Adults with ESKD Treated with Hemodialysis study, a multinational cohort study of 9757 adults on hemodialysis, of whom 8078 (83%) had analyzable dietary data. Adjusted Cox regression analyses clustered by country were conducted to evaluate the association between tertiles of fruit and vegetable intake with all-cause, cardiovascular, and noncardiovascular mortality. Estimates were calculated as hazard ratios with 95% confidence intervals (95% CIs). RESULTS During a median follow up of 2.7 years (18,586 person-years), there were 2082 deaths (954 cardiovascular). The median (interquartile range) number of servings of fruit and vegetables was 8 (4-14) per week; only 4% of the study population consumed at least four servings per day as recommended in the general population. Compared with the lowest tertile of servings per week (0-5.5, median 2), the adjusted hazard ratios for the middle (5.6-10, median 8) and highest (>10, median 17) tertiles were 0.90 (95% CI, 0.81 to 1.00) and 0.80 (95% CI, 0.71 to 0.91) for all-cause mortality, 0.88 (95% CI, 0.76 to 1.02) and 0.77 (95% CI, 0.66 to 0.91) for noncardiovascular mortality and 0.95 (95% CI, 0.81 to 1.11) and 0.84 (95% CI, 0.70 to 1.00) for cardiovascular mortality, respectively. CONCLUSIONS Fruit and vegetable intake in the hemodialysis population is low and a higher consumption is associated with lower all-cause and noncardiovascular death.
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Affiliation(s)
- Valeria M Saglimbene
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia; .,Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Germaine Wong
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia.,Department of Renal Medicine, Westmead Hospital, Westmead, Australia
| | | | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Vanessa Garcia-Larsen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Patrizia Natale
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden.,Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Armando Teixeira-Pinto
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia
| | | | | | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | | | - Angelo M Murgo
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - David W Johnson
- Division of Medicine, Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Woolloongabba, Australia.,Translational Research Institute, University of Queensland, Woolloongabba, Australia
| | - Marcello Tonelli
- Health Sciences Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rubén Gelfman
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Eduardo Celia
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Tevfik Ecder
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | | | | | - Delia Timofte
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Marietta Török
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Anna Bednarek-Skublewska
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden.,Medical University of Lublin, Lublin, Poland
| | - Jan Duława
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden.,Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
| | - Paul Stroumza
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | | | - Martin Hansis
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | | | - Paolo Felaco
- Nephrology and Dialysis Unit, Hospital of the Penne Presidium, Unita' Sanitaria Locale, Pescara, Italy
| | | | | | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia; and
| | - Giovanni F M Strippoli
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia.,Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden.,Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.,Diaverum Academy, Diaverum, Bari, Italy
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Kelly JT, Warner MM, Conley M, Reidlinger DP, Hoffmann T, Craig J, Tong A, Reeves M, Johnson DW, Palmer S, Campbell KL. Feasibility and acceptability of telehealth coaching to promote healthy eating in chronic kidney disease: a mixed-methods process evaluation. BMJ Open 2019; 9:e024551. [PMID: 30700482 PMCID: PMC6352771 DOI: 10.1136/bmjopen-2018-024551] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility and acceptability of a personalised telehealth intervention to support dietary self-management in adults with stage 3-4 chronic kidney disease (CKD). DESIGN Mixed-methods process evaluation embedded in a randomised controlled trial. PARTICIPANTS People with stage 3-4 CKD (estimated glomerular filtration rate [eGFR]15-60 mL/min/1.73 m2). SETTING Participants were recruited from three hospitals in Australia and completed the intervention in ambulatory community settings. INTERVENTION The intervention group received one telephone call per fortnight and 2-8 tailored text messages for 3 months, and then 4-12 tailored text messages for 3 months without telephone calls. The control group received usual care for 3 months then non-tailored education-only text messages for 3 months. MAIN OUTCOME MEASURES Feasibility (recruitment, non-participation and retention rates, intervention fidelity and participant adherence) and acceptability (questionnaire and semistructured interviews). STATISTICAL ANALYSES PERFORMED Descriptive statistics and qualitative content analysis. RESULTS Overall, 80/230 (35%) eligible patients who were approached consented to participate (mean±SD age 61.5±12.6 years). Retention was 93% and 98% in the intervention and control groups, respectively, and 96% of all planned intervention calls were completed. All participants in the intervention arm identified the tailored text messages as useful in supporting dietary self-management. In the control group, 27 (69%) reported the non-tailored text messages were useful in supporting change. Intervention group participants reported that the telehealth programme delivery methods were practical and able to be integrated into their lifestyle. Participants viewed the intervention as an acceptable, personalised alternative to face-face clinic consultations, and were satisfied with the frequency of contact. CONCLUSIONS This telehealth-delivered dietary coaching programme is an acceptable intervention which appears feasible for supporting dietary self-management in stage 3-4 CKD. A larger-scale randomised controlled trial is needed to evaluate the efficacy of the coaching programme on clinical and patient-reported outcomes. TRIAL REGISTRATION NUMBER ACTRN12616001212448; Results.
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Affiliation(s)
- Jaimon T Kelly
- Faculty of Health Science and Medicine, Bond University, Robina, Queensland, Australia
| | - Molly M Warner
- Faculty of Health Science and Medicine, Bond University, Robina, Queensland, Australia
| | - Marguerite Conley
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Dianne P Reidlinger
- Faculty of Health Science and Medicine, Bond University, Robina, Queensland, Australia
| | - Tammy Hoffmann
- Centre for Research in Evidence Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Jonathan Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Sydney School of Public Health, The University of Sydney, Adelaide, South Australia, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Adelaide, South Australia, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Marina Reeves
- Cancer Prevention Research Centre, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
| | - Suetonia Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Katrina L Campbell
- Faculty of Health Science and Medicine, Bond University, Robina, Queensland, Australia
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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36
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Lambert K, Mansfield K, Mullan J. How do patients and carers make sense of renal dietary advice? A qualitative exploration. J Ren Care 2018; 44:238-250. [DOI: 10.1111/jorc.12260] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Kelly Lambert
- Department of Clinical Nutrition, Wollongong Hospital; Illawarra Shoalhaven Local Health District; Wollongong New South Wales Australia
| | - Kylie Mansfield
- Graduate Medicine, Faculty of Science, Medicine and Health; University of Wollongong; Wollongong New South Wales Australia
| | - Judy Mullan
- Graduate Medicine, Faculty of Science, Medicine and Health; University of Wollongong; Wollongong New South Wales Australia
- Director Illawarra Health Information Platform, Australian Health Services Research Institute; University of Wollongong; Wollongong New South Wales Australia
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Vázquez‐Sánchez MÁ, Valero‐Cantero I, Carrión‐Velasco Y, Castro‐López P, Suárez‐Cadenas E, Casals C. Applicability and Clinical Validity of Nursing Outcomes Classification in a Nursing Intervention of Nutritional Counseling for Patients With Malnutrition. Int J Nurs Knowl 2018; 30:168-172. [DOI: 10.1111/2047-3095.12224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | | | | | | | - Cristina Casals
- the Department of Teaching Physical EducationFine Arts and Music, Faculty of Educational SciencesUniversity of Cádiz Cádiz Spain
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38
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Liu PJ, Ma F, Wang QY, He SL. The effects of oral nutritional supplements in patients with maintenance dialysis therapy: A systematic review and meta-analysis of randomized clinical trials. PLoS One 2018; 13:e0203706. [PMID: 30212514 PMCID: PMC6136747 DOI: 10.1371/journal.pone.0203706] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/25/2018] [Indexed: 12/22/2022] Open
Abstract
Background/objective This systematic review aims to determine the potential effects of oral nutritional supplements (ONS) in patients receiving maintenance dialysis therapy (MDT). Methods Electronic databases were searched without language limits through to July 2018. Randomized controlled trials (RCTs) that involved comparisons of ONS versus placebo or routine care are included in this meta-analysis. RevMan 5.3 statistical software was used for meta-analysis. Results 15 articles with 589 subjects were included in our study. There are insufficient comparable data of randomized trials to allow meta-analysis of mortality. Albumin levels may be improved by the macronutrient blends or protein/amino acid supplements in MDT patients. Compared with the control group, serum albumin levels and BMI in the ONS group were increased by 1.58 g/L (95% CI, 0.52–2.63, P = 0.003; I2 = 85%) and 0.40 kg/m2 (95% CI, 0.10–0.71, P = 0.01; I2 = 49%), respectively. In the subgroup analysis of patients receiving hemodialysis, albumin levels in ONS group were increased by 2.17 g/L (95% CI, 0.89–3.45, P<0.001; I2 = 90%). ONS may not influence serum phosphorus and potassium levels. Conclusions Very low-quality evidence suggests that Short-term oral energy or protein/amino acid supplements may improve nutritional status by increasing serum albumin levels and BMI in MDT patients, without influence on serum potassium levels. High-quality and large RCTs, particularly regarding the effects of ONS on mortality and quality of life, are needed to further validate our findings.
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Affiliation(s)
- Peng Ju Liu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, PR China
- * E-mail:
| | - Fang Ma
- Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, PR China
| | - Qi Yan Wang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, PR China
| | - Shu Li He
- Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, PR China
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Lambert K, Mullan J, Mansfield K, Owen P. Should We Recommend Renal Diet-Related Apps to Our Patients? An Evaluation of the Quality and Health Literacy Demand of Renal Diet-Related Mobile Applications. J Ren Nutr 2018; 27:430-438. [PMID: 29056159 DOI: 10.1053/j.jrn.2017.06.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/17/2017] [Accepted: 06/09/2017] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Mobile phone applications (apps) are increasingly being used by patients with chronic kidney disease (CKD). We sought to describe the main purpose of commonly available renal diet apps and to quantify the accuracy of information, technical quality, and health literacy demand of renal diet apps. DESIGN The design was content analysis. All eligible renal diet apps in the Australian Apple App Store, Google Play, Windows Phone, and Blackberry App World were evaluated. SUBJECTS Eligible apps were in English and were related to kidney disease in humans (of any type or stage). Exclusion criteria included apps which were prohibited because of password protection. MAIN OUTCOME MEASURE Renal diet information in the apps was compared with evidence-based guidelines for the management of kidney disease to quantify information accuracy. App information was evaluated using the Silberg Scale. Technical quality and health literacy demand were evaluated using the Mobile Application Rating Scale. RESULTS A total of 21 apps were eligible for evaluation. The main purpose of these apps was to provide food and nutrition information (57.1%) or for educative purposes for CKD patients (38.1%). Only 47.6% (10/21) of apps contained accurate evidence-based information. Overall, app technical quality was considered acceptable (mean Mobile Application Rating Scale score 3.19 ± 0.35 out of 5), with 80.9% of apps scoring acceptable or greater for app technical quality. Scores for health literacy demand also indicated that most apps (15/21, 71.4%) were acceptable. CONCLUSIONS A range of apps currently exist that may provide individuals with CKD with useful food and nutrition information or increase their knowledge of the renal diet. These apps are also mainly of acceptable technical quality and health literacy demand. However, caution is required when using renal diet apps because more than half of the apps evaluated were not accurate and evidence based.
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Affiliation(s)
- Kelly Lambert
- Department of Clinical Nutrition, Wollongong Hospital, Wollongong, New South Wales, Australia; School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.
| | - Judy Mullan
- School of Medicine, Faculty of Science, Medicine and Health, and Director of Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kylie Mansfield
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Paris Owen
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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Fontes BC, Anjos JSD, Black AP, Moreira NX, Mafra D. Effects of Low-Protein Diet on lipid and anthropometric profiles of patients with chronic kidney disease on conservative management. ACTA ACUST UNITED AC 2018; 40:225-232. [PMID: 29944154 PMCID: PMC6533945 DOI: 10.1590/2175-8239-jbn-3842] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 09/04/2017] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Chronic Kidney disease (CKD) patients have a high prevalence of cardiovascular mortality, and among the risk factors are dyslipidemia and obesity, common findings in the early stages of CKD. The aim of this study was to evaluate the effects of low protein diet (LPD) on the lipid and anthropometric profile in non-dialysis CKD patients. METHODS Forty CKD patients were studied (20 men, 62.7 ± 15.2 years, glomerular filtration rate (GFR) 26.16 ± 9.4 mL/min/1.73m2). LPD (0.6g/kg/d) was prescribed for six months and, biochemical and anthropometric parameters like body mass index (BMI), waist circumference and body fat mass (assessed by dual X-ray absorptiometry - DXA) were evaluated before and after six months with LPD. RESULTS After six months of nutritional intervention, patients presented reduction on BMI (from 28.1 ± 5.6 to 27.0 ± 5.3 Kg/m2, p = 0.001), total cholesterol (from 199.7 ± 57.1 to 176.0 ± 43.6mg/dL, p = 0.0001), LDL (from 116.2 ± 48.1 to 97.4 ± 39.1 mg/dL, p = 0,001) and uric acid (from 6.8 ± 1.4 to 6.2 ± 1.3 mg/dL, p = 0.004). In addition, GFR values were increased from 26.2 ± 9.5 to 28.9 ± 12.7mL/min (p = 0.02). The energy, proteins, cholesterol and fiber intake were reduced significantly. CONCLUSION LPD prescribe to non-dialysis CKD patients for six months was able to improve some cardiovascular risk factors as overweight and plasma lipid profile, suggesting that LPD can be also an important tool for protection against cardiovascular diseases in these patients.
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Affiliation(s)
- Bruna Carvalho Fontes
- Universidade Federal Fluminense, Programa de Pós-Graduação em Ciências Cardiovasculares, Niterói, RJ, Brasil
| | - Juliana Saraiva Dos Anjos
- Universidade Federal Fluminense, Programa de Pós-Graduação em Ciências Cardiovasculares, Niterói, RJ, Brasil
| | - Ana Paula Black
- Universidade Federal Fluminense, Programa de Pós-Graduação em Ciências Médicas, Niterói, RJ, Brasil
| | - Nara Xavier Moreira
- Universidade Federal Fluminense, Faculdade de Nutrição, Departamento de Nutrição e Dietética, Niterói, RJ, Brasil
| | - Denise Mafra
- Universidade Federal Fluminense, Programa de Pós-Graduação em Ciências Cardiovasculares, Niterói, RJ, Brasil.,Universidade Federal Fluminense, Programa de Pós-Graduação em Ciências Médicas, Niterói, RJ, Brasil
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41
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Saglimbene VM, Wong G, Craig JC, Ruospo M, Palmer SC, Campbell K, Garcia-Larsen V, Natale P, Teixeira-Pinto A, Carrero JJ, Stenvinkel P, Gargano L, Murgo AM, Johnson DW, Tonelli M, Gelfman R, Celia E, Ecder T, Bernat AG, Del Castillo D, Timofte D, Török M, Bednarek-Skublewska A, Duława J, Stroumza P, Hoischen S, Hansis M, Fabricius E, Felaco P, Wollheim C, Hegbrant J, Strippoli GFM. The Association of Mediterranean and DASH Diets with Mortality in Adults on Hemodialysis: The DIET-HD Multinational Cohort Study. J Am Soc Nephrol 2018; 29:1741-1751. [PMID: 29695436 DOI: 10.1681/asn.2018010008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/28/2018] [Indexed: 12/28/2022] Open
Abstract
Background Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets associate with lower cardiovascular and all-cause mortality in the general population, but the benefits for patients on hemodialysis are uncertain.Methods Mediterranean and DASH diet scores were derived from the GA2LEN Food Frequency Questionnaire within the DIET-HD Study, a multinational cohort study of 9757 adults on hemodialysis. We conducted adjusted Cox regression analyses clustered by country to evaluate the association between diet score tertiles and all-cause and cardiovascular mortality (the lowest tertile was the reference category).Results During the median 2.7-year follow-up, 2087 deaths (829 cardiovascular deaths) occurred. The adjusted hazard ratios (95% confidence intervals) for the middle and highest Mediterranean diet score tertiles were 1.20 (1.01 to 1.41) and 1.14 (0.90 to 1.43), respectively, for cardiovascular mortality and 1.10 (0.99 to 1.22) and 1.01 (0.88 to 1.17), respectively, for all-cause mortality. Corresponding estimates for the same DASH diet score tertiles were 1.01 (0.85 to 1.21) and 1.19 (0.99 to 1.43), respectively, for cardiovascular mortality and 1.03 (0.92 to 1.15) and 1.00 (0.89 to 1.12), respectively, for all-cause mortality. The association between DASH diet score and all-cause death was modified by age (P=0.03); adjusted hazard ratios for the middle and highest DASH diet score tertiles were 1.02 (0.81 to 1.29) and 0.70 (0.53 to 0.94), respectively, for younger patients (≤60 years old) and 1.05 (0.93 to 1.19) and 1.08 (0.95 to 1.23), respectively, for older patients.Conclusions Mediterranean and DASH diets did not associate with cardiovascular or total mortality in hemodialysis.
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Affiliation(s)
- Valeria M Saglimbene
- Sydney School of Public Health, University of Sydney, Sydney, Australia; .,Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia.,Department of Renal Medicine, Westmead Hospital, Westmead, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia
| | - Marinella Ruospo
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden.,Division of Nephrology and Transplantation, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | | | - Vanessa Garcia-Larsen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Patrizia Natale
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden.,Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, University of Sydney, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia
| | | | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | | | - Angelo M Murgo
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - David W Johnson
- Division of Medicine, Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Woolloongabba, Australia.,Translational Research Institute, University of Queensland, Woolloongabba, Australia
| | - Marcello Tonelli
- Cumming School of Medicine, Health Sciences Centre, University of Calgary, Calgary, Alberta, Canada
| | - Rubén Gelfman
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Eduardo Celia
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Tevfik Ecder
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | | | | | - Delia Timofte
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Marietta Török
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Anna Bednarek-Skublewska
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden.,Faculty of Medicine, Medical University of Lublin, Lublin, Poland
| | - Jan Duława
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden.,School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Paul Stroumza
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | | | - Martin Hansis
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | | | - Paolo Felaco
- Nefrología e dialisi, Presidio Ospedaliero Penne, Unità Sanitaria Locale Pescara, Pescara, Italy; and
| | | | | | - Giovanni F M Strippoli
- Sydney School of Public Health, University of Sydney, Sydney, Australia.,Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden.,Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.,Diaverum Academy, Diaverum, Bari, Italy
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Xie Z, McLean R, Marshall M. Dietary Sodium and Other Nutrient Intakes among Patients Undergoing Hemodialysis in New Zealand. Nutrients 2018; 10:nu10040502. [PMID: 29670030 PMCID: PMC5946287 DOI: 10.3390/nu10040502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 01/18/2023] Open
Abstract
This study describes baseline intakes of sodium and other nutrients in a multi-ethnic sample of hemodialysis patients in New Zealand participating in the SoLID Trial between May/2013 to May/2016. Baseline 3-day weighed food record collections were analyzed using Foodworks 8 Professional food composition database, supplemented by other sources of nutrient information. Intakes of dietary sodium and other nutrients were compared with relevant guidelines and clinical recommendations. Eighty-five participants completed a 3-day weighed food record. The mean (SD) sodium intake was 2502 (957) mg/day at and more than half of the participants exceeded recommended intake levels. Sodium intake was positively associated with energy intake. Only 5% of participants met the recommended calorie density; nine percent of participants ate the recommended minimum of 1.2 g/kg of protein per day; 68% of participants were consuming inadequate fiber at baseline. A high proportion of dialysis patients in SoLID Trial did not meet current renal-specific dietary recommendations. The data show excess sodium intake. It is also evident that there was poor adherence to dietary guidelines for a range of other nutrients. A total diet approach is needed to lower sodium intake and improve total diet quality among hemodialysis patients in New Zealand.
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Affiliation(s)
- Zhengxiu Xie
- Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand.
| | - Rachael McLean
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
| | - Mark Marshall
- Department of Renal Medicine, School of Medicine, University of Auckland, Auckland 1023, New Zealand.
- Department of Renal Medicine, Counties Manukau District Health Board, Auckland 2025, New Zealand.
- Baxter Healthcare (Asia) Pte Ltd., Singapore 189720, Singapore.
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43
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Agapito G, Simeoni M, Calabrese B, Caré I, Lamprinoudi T, Guzzi PH, Pujia A, Fuiano G, Cannataro M. DIETOS: A dietary recommender system for chronic diseases monitoring and management. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 153:93-104. [PMID: 29157465 DOI: 10.1016/j.cmpb.2017.10.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/02/2017] [Accepted: 10/10/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Use of mobile and web-based applications for diet and weight management is currently increasing. However, the impact of known apps on clinical outcomes is not well-characterized so far. Moreover, availability of food recommender systems providing high quality nutritional advices to both healthy and diet-related chronic diseases users is very limited. In addition, the potentiality of nutraceutical properties of typical regional foods for improving app utility has not been exerted to this end. We present DIETOS, a recommender system for the adaptive delivery of nutrition contents to improve the quality of life of both healthy subjects and patients with diet-related chronic diseases. DIETOS provides highly specialized nutritional advices in different health conditions. METHODS DIETOS was projected to provide users with health profile and individual nutritional recommendation. Health profiling was based on user answers to dynamic real-time medical questionnaires. Furthermore, DIETOS contains catalogs of typical foods from Calabria, a southern Italian region. Several Calabrian foods have been inserted because of their nutraceutical properties widely reported in several quality studies. DIETOS includes some well known methods for user profiling (overlay profiling) and content adaptation (content selection) coming from general purpose adaptive web systems. RESULTS DIETOS has been validated for usability for both patients and specialists and for assessing the correctness of the profiling and recommendation, by enrolling 20 chronic kidney disease (CKD) patients at the Department of Nephrology and Dialysis, University Hospital, Catanzaro (Italy) and 20 age-matched healthy controls. Recruited subjects were invited to register to DIETOS and answer to medical questions to determine their health status. Based on our results, DIETOS has high specificity and sensitivity, allowing to determine a medical-controlled user's health profile and to perform a fine-grained recommendation that is better adapted to each user health status. The current version of DIETOS, available online at http://www.easyanalysis.it/dietos is not intended to be used by general users, but only for review purpose. CONCLUSIONS DIETOS is a novel food recommender system for healthy people and individuals affected by diet-related chronic diseases. The proposed system builds a users health profile and, accordingly, provides individualized nutritional recommendations, also with attention to food geographical origin.
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Affiliation(s)
- Giuseppe Agapito
- Dep. of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
| | | | - Barbara Calabrese
- Dep. of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
| | - Ilaria Caré
- Clinical Nutrition Unit, University Magna Græcia of Catanzaro, Italy.
| | | | - Pietro H Guzzi
- Dep. of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
| | - Arturo Pujia
- Clinical Nutrition Unit, University Magna Græcia of Catanzaro, Italy.
| | - Giorgio Fuiano
- Nephrology and Dialysis Unit, University Magna Græcia of Catanzaro, Italy.
| | - Mario Cannataro
- Dep. of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
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Lambert K, Mullan J, Mansfield K. An integrative review of the methodology and findings regarding dietary adherence in end stage kidney disease. BMC Nephrol 2017; 18:318. [PMID: 29061163 PMCID: PMC5653982 DOI: 10.1186/s12882-017-0734-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 09/27/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Dietary modification is an important component of the management of end stage kidney disease (ESKD). The diet for ESKD involves modifying energy and protein intake, and altering sodium, phosphate, potassium and fluid intake. There have been no comprehensive reviews to date on this topic. The aims of this integrative review were to (i) describe the methods used to measure dietary adherence (ii) determine the rate of dietary adherence and (iii) describe factors associated with dietary adherence in ESKD. METHODS The Web of Science and Scopus databases were searched using the search terms 'adherence' and 'end stage kidney disease'. Of the 787 potentially eligible papers retrieved, 60 papers of 24,743 patients were included in this review. Of these papers, 44 reported the rate of dietary adherence and 44 papers described factors associated with adherence. RESULTS Most of the evidence regarding dietary adherence is derived from studies of hemodialysis patients (72% of patients). The most common method of measuring dietary adherence in ESKD was subjective techniques (e.g. food diaries or adherence questionnaires). This was followed by indirect methods (e.g. serum potassium, phosphate or interdialytic weight gain). The weighted mean adherence rate to ESKD dietary recommendations was 31.5% and 68.5% for fluid recommendations. Adherence to protein, sodium, phosphate, and potassium recommendations were highly variable due to differences in measurement methods used, and were often derived from a limited evidence base. Socioeconomic status, age, social support and self-efficacy were associated with dietary adherence. However, factors such as taste, the impact of the diet on social eating occasions; and dietetic staffing also appear to play a role in dietary adherence. CONCLUSION Dietary adherence rates in people with ESKD are suboptimal. Further research is required on dietary adherence in patients with ESKD from different social, educational, economic and ethnic groups. This research may identify other factors which may impact upon adherence, and could be used to inform the design of future strategies to improve dietary adherence. Future research that reports not just the rate of adherence to individual components of the nutrient prescription but also the overall quality of the diet would be useful.
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Affiliation(s)
- Kelly Lambert
- Department of Clinical Nutrition, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Level 5, Block C, Crown Street, Wollongong, NSW 2500 Australia
| | - Judy Mullan
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute, University of Wollongong, iC Enterprise 1, Innovation Campus, Wollongong, New South Wales 2522 Australia
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, New South Wales 2522 Australia
| | - Kylie Mansfield
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, New South Wales 2522 Australia
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Roach LA, Lambert K, Holt JL, Meyer BJ. Diet quality in patients with end-stage kidney disease undergoing dialysis. J Ren Care 2017; 43:226-234. [PMID: 28944596 DOI: 10.1111/jorc.12215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND People on haemodialysis (HD) are at risk of consuming a poor quality diet. This includes inadequate intake of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA). OBJECTIVE This study aims to investigate diet quality, with a particular focus on n-3 LCPUFA intake, in a population of incentre HD patients. DESIGN Dietary intake was measured using three 24 hour recalls; the Polyunsaturated food frequency questionnaire (PUFA FFQ) and the Total Diet Score (TDS). Dietary intake was also compared to evidence based practice guidelines (EBPG). Nutritional status was assessed using the Patient Generated Subjective Global Assessment (PG SGA). SUBJECTS A total of 32 dialysis patients were recruited, from two regional HD centres in New South Wales, Australia. MAIN OUTCOME MEASURE Diet quality was the main outcome measure. RESULTS Diet quality of study participants was poor, with the majority not meeting the EBPG for energy, protein and potassium. All participants exceeded the recommended amount of saturated fat. The mean TDS of the dialysis cohort was 10.2, which was significantly higher than the TDS of 9.3 of a healthy disease free cohort (p < 0.05). Positive correlations were found between TDS and LC omega-3 intake (r = 0.392) and TDS and total omega-6 intake (r = 0.363). Only 22% of participants met the suggested dietary target for n-3 LCPUFA intake. CONCLUSION Dialysis patients in this study had suboptimal diet quality. Improvements are required for better adherence to the EBPG. Increased consumption of n-3 LCPUFA fatty acids may also be of benefit.
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Affiliation(s)
- Lauren A Roach
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kelly Lambert
- Illawarra Shoalhaven Local Health District, Department of Clinical Nutrition, Wollongong, New South Wales, Australia
| | - Jane L Holt
- Illawarra Shoalhaven Local Health District, Renal Service, Wollongong, New South Wales, Australia
| | - Barbara J Meyer
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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Affret A, Wagner S, El Fatouhi D, Dow C, Correia E, Niravong M, Clavel-Chapelon F, De Chefdebien J, Fouque D, Stengel B, Boutron-Ruault MC, Fagherazzi G. Validity and reproducibility of a short food frequency questionnaire among patients with chronic kidney disease. BMC Nephrol 2017; 18:297. [PMID: 28915857 PMCID: PMC5599889 DOI: 10.1186/s12882-017-0695-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/22/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A balanced diet is essential to slowing the progression of chronic kidney disease (CKD) and managing the symptoms. Currently, no tool is available to easily and quickly assess energy and macronutrient intake in patients with non end-stage CKD. We aimed to develop and evaluate the validity and reproducibility of a new short 49-item food frequency questionnaire (SFFQ) adapted to patients with CKD. METHODS The CKD-REIN study is a prospective cohort that enrolled 3033 patients with moderate or advanced CKD from a national sample of nephrology clinics. A sub-sample of 201 patients completed the SFFQ twice, at a one-year interval and were included in the reproducibility study. During this interval, 127 patients also completed six 24-h recalls and were included in the validity study. Main nutrient and dietary intakes were computed. Validity was evaluated by calculating crude, energy-adjusted and de-attenuated correlation coefficients (CC) between FFQ and the mean of the 24-h recall results. Bland-Altman plots were performed and cross-classification into quintiles of consumption of each nutrient and food group was computed. Reproducibility between the two SFFQs was evaluated by intraclass CC (ICC). RESULTS Regarding validity, CC ranged from 0.05 to 0.79 (unadjusted CC, median: 0.40) and 0.10 to 0.59 (de-attenuated CC, median: 0.35) for food group and nutrient intakes, respectively. Five of the most important nutrients of interest in CKD, i.e. protein, calcium, phosphorus, potassium, and sodium had de-attenuated CC of 0.46, 0.43, 0.39, 0.32, and 0.12, respectively. The median of classification into the same or adjacent quintiles was 68% and 65% for food and nutrient intakes, respectively, and ranged from 63% to 69% for the five nutrients mentioned before. Bland-Altman plots showed good agreement across the range of intakes. ICC ranged from 0.18 to 0.66 (median: 0.46). CONCLUSIONS The CKD-REIN SFFQ showed acceptable validity and reproducibility in a sample of patients with CKD, notably for CKD nutrients of importance. It can now be used in large-scale epidemiological studies to easily assess the relations between diet and CKD outcomes as well as in clinical routine. It may also serve as a basis for the development of FFQs in international CKD cohort networks.
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Affiliation(s)
- Aurélie Affret
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
| | - Sandra Wagner
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
- FCRIN INI-CRCT, Lyon, France
| | - Douae El Fatouhi
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
| | - Courtney Dow
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
| | - Emmanuelle Correia
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
| | - Maryvonne Niravong
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
| | - Françoise Clavel-Chapelon
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
| | - Julie De Chefdebien
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
| | - Denis Fouque
- FCRIN INI-CRCT, Lyon, France
- Centre Hospitalier Lyon Sud, Lyon, F-69495 Pierre-Bénite, France
- CarMeN, Inserm UMRS 1060, Inserm, Univ Lyon-Sud, Lyon, 69921 Oullins, France
| | - Bénédicte Stengel
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
| | - Marie-Christine Boutron-Ruault
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
- Center for Research in Epidemiology and Population Health (CESP), INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Team 9, Health across generations, Gustave Roussy Institute, 114 rue Edouard Vaillant, 94805 Villejuif Cedex, France
| | - Guy Fagherazzi
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
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Milazi M, Bonner A, Douglas C. Effectiveness of educational or behavioral interventions on adherence to phosphate control in adults receiving hemodialysis: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:971-1010. [PMID: 28398983 DOI: 10.11124/jbisrir-2017-003360] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND People with end-stage kidney disease (ESKD) develop impaired excretion of phosphate. Hyperphosphatemia develops in ESKD as a result of the kidney's reduced ability to excrete ingested phosphate load and is characterized by high bone turnover and increased musculoskeletal morbidity including bone pain and muscle weakness. Increased serum phosphate levels are also associated with cardiovascular disease and associated mortality. These effects are significant considering that cardiovascular disease is the leading cause of death in ESKD, making phosphate control a crucial treatment goal. OBJECTIVES To determine the effectiveness of education or behavioral interventions on adherence to phosphate control in adults with ESKD receiving hemodialysis (HD). INCLUSION CRITERIA TYPES OF PARTICIPANTS Adults aged over 18 years with ESKD undergoing HD, attending dialysis facilities regardless of frequency and duration of treatment sessions per week. Studies with participants receiving hemodiafiltration were excluded. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST All types of educational and behavioral interventions aimed at improving adherence to dietary phosphate restriction, phosphate binder medication and HD. TYPES OF STUDIES Randomized controlled trials (RCTs), non-RCTs, before and after and cohort studies. OUTCOMES Outcome measures included serum phosphate levels, patient knowledge and adherence to phosphate control methods, chronic kidney disease (CKD) self-management behavior and perceived self-efficacy for CKD related to phosphate control. SEARCH STRATEGY A search was conducted in CINAHL, MEDLINE, The Cochrane Library, Embase, Web of Science, PsycINFO and ProQuest Dissertations and Theses Global to find published studies between January 2005 and December 2015. METHODOLOGICAL QUALITY Risk of bias was assessed by three reviewers prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA EXTRACTION Data were extracted using the standardized data extraction tool from JBI-MAStARI. DATA SYNTHESIS Data were pooled using JBI software. Mean differences (95% confidence interval [CI]) and effect size estimates were calculated for continuous outcomes. Meta-analysis using a random-effects model was performed for serum phosphate levels, and where the findings could not be pooled using meta-analysis, results have been presented in a narrative form. Standard GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence assessment of outcomes has been reported. RESULTS A total of 18 studies were included in the review: seven studies focused on dietary phosphate, four studies focused on medications (phosphate binders) and six studies focused on dietary phosphate and medications. Only one study taught patients about diet, medications and HD to control phosphate. Sixteen studies showed significant improvements in phosphate levels. Meta-analysis of eight RCTs favored educational or behavioral interventions over standard care for serum phosphate control, with a weighted mean reduction of -0.23 mmol/l (95% CI -0.37, -0.08) in treatment groups. CONCLUSION Overall, educational or behavioral interventions increase adherence to phosphate control. Studies in this systematic review revealed improved outcomes on serum phosphate levels, patient knowledge and adherence to phosphate control methods, CKD self-management behavior and perceived self-efficacy for CKD related to phosphate control. However, there is a lack of sufficient data on how some of the studies implemented their interventions, suggesting that further research is required. Successful strategies that improve and optimize long-term adherence to phosphate control still need to be formulated.
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Affiliation(s)
- Molly Milazi
- 1School of Nursing, Queensland University of Technology, Brisbane, Australia 2Renal Nursing Professorial Unit, Kidney Health Services, Royal Brisbane and Women's Hospital, Brisbane, Australia 3CEBHA (Centre for Evidence-Based Healthy Ageing): a Joanna Briggs Institute Centre of Excellence
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Snelson M, Clarke RE, Coughlan MT. Stirring the Pot: Can Dietary Modification Alleviate the Burden of CKD? Nutrients 2017; 9:nu9030265. [PMID: 28287463 PMCID: PMC5372928 DOI: 10.3390/nu9030265] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/27/2017] [Accepted: 03/06/2017] [Indexed: 02/06/2023] Open
Abstract
Diet is one of the largest modifiable risk factors for chronic kidney disease (CKD)-related death and disability. CKD is largely a progressive disease; however, it is increasingly appreciated that hallmarks of chronic kidney disease such as albuminuria can regress over time. The factors driving albuminuria resolution remain elusive. Since albuminuria is a strong risk factor for GFR loss, modifiable lifestyle factors that lead to an improvement in albuminuria would likely reduce the burden of CKD in high-risk individuals, such as patients with diabetes. Dietary therapy such as protein and sodium restriction has historically been used in the management of CKD. Evidence is emerging to indicate that other nutrients may influence kidney health, either through metabolic or haemodynamic pathways or via the modification of gut homeostasis. This review focuses on the role of diet in the pathogenesis and progression of CKD and discusses the latest findings related to the mechanisms of diet-induced kidney disease. It is possible that optimizing diet quality or restricting dietary intake could be harnessed as an adjunct therapy for CKD prevention or progression in susceptible individuals, thereby reducing the burden of CKD.
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Affiliation(s)
- Matthew Snelson
- Glycation, Nutrition and Metabolism Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne 3004, Australia.
| | - Rachel E Clarke
- Glycation, Nutrition and Metabolism Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne 3004, Australia.
- Department of Physiology, Monash University, Clayton 3800, Australia.
| | - Melinda T Coughlan
- Glycation, Nutrition and Metabolism Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne 3004, Australia.
- Department of Diabetes, Central Clinical School, Monash University, Alfred Medical Research and Education Precinct, Melbourne 3004, Australia.
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Lambert K, Mullan J, Mansfield K, Koukomous A, Mesiti L. Evaluation of the quality and health literacy demand of online renal diet information. J Hum Nutr Diet 2017; 30:634-645. [DOI: 10.1111/jhn.12466] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K. Lambert
- Department of Clinical Nutrition; Wollongong Hospital; Illawarra Shoalhaven Local Health District, Wollongong NSW Australia
- School of Medicine, Faculty of Science, Medicine and Health; University of Wollongong; Wollongong NSW Australia
| | - J. Mullan
- Discipline of Medicine, Faculty of Science, Medicine and Health; University of Wollongong; Wollongong NSW Australia
- Australian Health Services Research Institute, University of Wollongong; Wollongong NSW Australia
| | - K. Mansfield
- Discipline of Medicine, Faculty of Science, Medicine and Health; University of Wollongong; Wollongong NSW Australia
| | - A. Koukomous
- School of Medicine, Faculty of Science, Medicine and Health; University of Wollongong; Wollongong NSW Australia
| | - L. Mesiti
- School of Medicine, Faculty of Science, Medicine and Health; University of Wollongong; Wollongong NSW Australia
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50
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Hyodo T, Hirawa N, Hayashi M, Than KMM, Tuyen DG, Pattanasittangkur K, Hu LW, Naramura T, Miyamoto K, Yamashita AC. Present status of renal replacement therapy at 2015 in Asian countries (Myanmar, Vietnam, Thailand, China, and Japan). RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-016-0082-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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