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Marrone G, Murri A, Urciuoli S, Di Lauro M, Grazioli E, Vignolini P, Cornali K, Tranchita E, Masci C, Cerulli C, Di Marco L, Mitterhofer AP, Parisi A, Noce A. Functional Foods and Adapted Physical Activity as New Adjuvant Therapy for Chronic Kidney Disease Patients. Nutrients 2024; 16:2325. [PMID: 39064768 PMCID: PMC11279472 DOI: 10.3390/nu16142325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/10/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) will become the fifth leading cause of death in the world by 2040. It is fundamental to prevent and treat this pathology to reduce its impact on national health costs. This trial's aim is to evaluate the effects induced by a combination of consumed functional foods (FFs) with adapted physical activity (APA) on the progression of CKD-related comorbidities. METHODS The study lasted 12 weeks. We divided 40 CKD patients into four groups: mixed (FF + APA), APA, FF and control group (usual care). The FFs were characterized by their total antioxidant capacity and antiradical activity. The APA was performed though an online training protocol, three times per week, 1 h each session. RESULTS At the end of the study, we observed, in the mixed group, a decrease in azotemia (p = 0.0272), diastolic blood pressure (p = 0.0169), and C-reactive protein (p = 0.0313), with increases in the FORD test (p = 0.0203) and fat free mass (p = 0.0258). The APA group showed a reduction in total cholesterol (p = 0.0039). CONCLUSIONS The combination of FFs and APA can help counteract several CKD-related comorbidities, such as arterial hypertension, dyslipidemia and uremic sarcopenia, and improve the CKD patients' quality of life.
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Affiliation(s)
- Giulia Marrone
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (K.C.); (C.M.); (L.D.M.); (A.P.M.); (A.N.)
| | - Arianna Murri
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, 00135 Rome, Italy
| | - Silvia Urciuoli
- Department of Statistics, Computer Science and Application—PHYTOLAB (Pharmaceutical, Cosmetic, Food Supplement, Technology and Analysis), University of Florence, Sesto Fiorentino, 50019 Florence, Italy; (S.U.); (P.V.)
| | - Manuela Di Lauro
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (K.C.); (C.M.); (L.D.M.); (A.P.M.); (A.N.)
| | - Elisa Grazioli
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, 00135 Rome, Italy
| | - Pamela Vignolini
- Department of Statistics, Computer Science and Application—PHYTOLAB (Pharmaceutical, Cosmetic, Food Supplement, Technology and Analysis), University of Florence, Sesto Fiorentino, 50019 Florence, Italy; (S.U.); (P.V.)
| | - Kevin Cornali
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (K.C.); (C.M.); (L.D.M.); (A.P.M.); (A.N.)
| | - Eliana Tranchita
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, 00135 Rome, Italy
| | - Claudia Masci
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (K.C.); (C.M.); (L.D.M.); (A.P.M.); (A.N.)
| | - Claudia Cerulli
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, 00135 Rome, Italy
| | - Luca Di Marco
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (K.C.); (C.M.); (L.D.M.); (A.P.M.); (A.N.)
| | - Anna Paola Mitterhofer
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (K.C.); (C.M.); (L.D.M.); (A.P.M.); (A.N.)
- UOSD Nephrology and Dialysis, Policlinico Tor Vergata, 00133, Rome, Italy
| | - Attilio Parisi
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, 00135 Rome, Italy
| | - Annalisa Noce
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (K.C.); (C.M.); (L.D.M.); (A.P.M.); (A.N.)
- UOSD Nephrology and Dialysis, Policlinico Tor Vergata, 00133, Rome, Italy
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Spahia N, Rroji M, Idrizi A, Spasovski G, Barbullushi M. Sodium and water dynamics in the progression of chronic kidney disease: mechanisms and clinical significance. Int Urol Nephrol 2024; 56:1953-1963. [PMID: 38200365 DOI: 10.1007/s11255-023-03903-8] [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: 09/06/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024]
Abstract
AIM Lifestyle modifications can postpone the progression of chronic kidney disease toward its terminal stage. This mini-review aims to explore the impact of salt and water intake on the progression of chronic kidney disease (CKD) and provide insights into the optimal consumption levels to preserve the glomerular filtration rate. METHODS We reviewed relevant literature to examine the association between salt and water consumption and CKD progression. Our analysis includes discussions on the pathophysiology, findings from clinical trials, and recommended intake guidelines. RESULTS Sodium intake, often linked to cardiovascular risk and CKD progression, has shown a complex J-shaped association in some studies, leading to uncertainty about the ideal salt intake level. Sodium and fluid retention are key factors contributing to hypertension, a well-established risk factor for CKD progression. Low-sodium diets have demonstrated promise in reducing blood pressure and enhancing the effects of renin-angiotensin-aldosterone system inhibitors in non-dialysis CKD patients. However, a debate persists regarding the independent effect of salt restriction on CKD progression. Despite medical recommendations, salt consumption remains high among CKD patients. Additionally, the role of water consumption in CKD remains controversial despite its established benefits for CKD prevention in the general population. CONCLUSION Lifestyle modifications involving salt and water intake can influence the progression of CKD. While low-sodium diets have shown potential for mitigating hypertension and proteinuria in non-dialysis CKD patients, their independent impact on CKD progression warrants further investigation. The role of water consumption in CKD remains uncertain, and there is a need for additional research in this area. Clinicians should consider individualized dietary recommendations for CKD patients to help preserve the glomerular filtration rate and improve overall outcomes.
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Affiliation(s)
- Nereida Spahia
- Department of Nephrology, University Hospital Center "Mother Teresa", Tirana, Albania.
| | - Merita Rroji
- Department of Nephrology, University Hospital Center "Mother Teresa", Tirana, Albania
| | - Alma Idrizi
- Department of Nephrology, University Hospital Center "Mother Teresa", Tirana, Albania
| | - Goce Spasovski
- Department of Nephrology, Medical Faculty, University Sts. Cyril and Methodius, Skopje, North Macedonia
| | - Myftar Barbullushi
- Department of Nephrology, University Hospital Center "Mother Teresa", Tirana, Albania
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Lavenburg LMU, Schaubel DE, Chao AM, Reese PP, Cohen JB. The 10-Year Effects of Intensive Lifestyle Intervention on Kidney Outcomes. Kidney Med 2024; 6:100814. [PMID: 38689836 PMCID: PMC11059390 DOI: 10.1016/j.xkme.2024.100814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Rationale & Objective Limited data exist on longitudinal kidney outcomes after nonsurgical obesity treatments. We investigated the effects of intensive lifestyle intervention on kidney function over 10 years. Study Design Post hoc analysis of Action for Health in Diabetes (Look AHEAD) randomized controlled trial. Setting & Participants We studied 4,901 individuals with type 2 diabetes and body mass index of ≥25 kg/m2 enrolled in Look AHEAD (2001-2015). The original Look AHEAD trial excluded individuals with 4+ urine dipstick protein, serum creatinine level of >1.4 mg/dL (women), 1.5 mg/dL (men), or dialysis dependence. Exposures Intensive lifestyle intervention versus diabetes support and education (ie, usual care). Outcome Primary outcome was estimated glomerular filtration rate (eGFR, mL/min/1.73 m2) slope. Secondary outcomes were mean eGFR, slope, and mean urine albumin to creatinine ratio (UACR, mg/mg). Analytical Approach Linear mixed-effects models with random slopes and intercepts to evaluate the association between randomization arms and within-individual repeated measures of eGFR and UACR. We tested for effect modification by baseline eGFR. Results At baseline, mean eGFR was 89, and 83% had a normal UACR. Over 10 years, there was no difference in eGFR slope (+0.064 per year; 95% CI: -0.036 to 0.16; P = 0.21) between arms. Slope or mean UACR did not differ between arms. Baseline eGFR, categorized as eGFR of <80, 80-100, or >100, did not modify the intervention's effect on eGFR slope or mean. Limitations Loss of muscle may confound creatinine-based eGFR. Conclusions In patients with type 2 diabetes and preserved kidney function, intensive lifestyle intervention did not change eGFR slope over 10 years. Among participants with baseline eGFR <80, lifestyle intervention had a slightly higher longitudinal mean eGFR than usual care. Further studies evaluating the effects of intensive lifestyle intervention in people with kidney disease are needed.
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Affiliation(s)
| | - Douglas E. Schaubel
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Ariana M. Chao
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Peter P. Reese
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA
- Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jordana B. Cohen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA
- Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA
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Drikvandi M, Jorfi S, Cheraghian B, Ahmadi M. Relationship between heavy metal concentrations and Chronic kidney disease in population of Hoveyzeh cohort study: A cross-sectional study in Iran. J Trace Elem Med Biol 2024; 83:127412. [PMID: 38394967 DOI: 10.1016/j.jtemb.2024.127412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/12/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a multifactorial disease whose prevalence is increasing worldwide. CKD affects 700 million to 1 billion people worldwide, with a prevalence of 9.1% to 13.4%. In Iran, the reported prevalence of CKD is 15.14%, even higher than the global prevalence. Some studies introduced heavy metals as possible risk factors of CKD. We conducted the first study in Iran to examine the relationship between 10 selected urinary heavy metals and CKD in the Hovayzeh cohort study population. METHODS In this cross-sectional study, urine samples were collected from two groups of ca ses (suffering from CKD) and controls (without CKD) with equal size (47 people each). Analysis of the 10 sellected heavy metals in the samples was conducted using inductively coupled plasma emission spectroscopy. Basic Information was obtained from the Howayizeh Cohort Study Center. The data was analyzed using SPSS-26 and Excel-2016 software. RESULTS There were no significant differences between urinary heavy metal concentrations of case and control groups (P < 0.05). While, the concentration of As, Cr, Cu, Mn, and Ni exceeded the reference limits of Germany, Canada, England, and Belgium. Se and Cd also surpassed the reference limits of England. After adjusting for confounding variables for each μg/l increase in urinary Cd, Ni, Pb, and Se the OR of CKD increased by 20.2%, 4.8%, 3.1%, and 2.6%, respectively. Although, these relationships were not statistically significant. In addition, two groups of heavy metals had a positive and significant correlation: (1) Se, Zn, As, Cu, and Cr; (2) Pb, Cd, and As; and (3) Cd and Ni. CONCLUSION we found no significant relationship between urinary heavy metal and CKD. However, there was significant positive correlation in some of urinary heavy metals may indicate their shared resources. Furthermore, the concentration of most heavy metals in the urine of the participants was higher than the reference limits of these metals in the urine of healthy people from other countries. Thus, the elevated levels of these metals could still pose a risk to human health. Therefore, it is necessary to conduct prospective studies with a larger sample size in this area.
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Affiliation(s)
- Mehrsa Drikvandi
- Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sahand Jorfi
- Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Environmental Health Engineering, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Bahman Cheraghian
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehdi Ahmadi
- Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Environmental Health Engineering, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Abellán Alemán J, Sabaris RC, Pardo DE, García Donaire JA, Romanos FG, Iriso JI, Penagos LM, Iglesias LJN, de Salinas APM, Pérez-Monteoliva NRR, Lezcano PSR, Saborido MT, Roca FV. Documento de consenso sobre tabaquismo y riesgo vascular. HIPERTENSION Y RIESGO VASCULAR 2024; 41 Suppl 1:S1-S85. [PMID: 38729667 DOI: 10.1016/s1889-1837(24)00075-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Consensus statement on smoking and vascular risk About 22% of the Spanish population are daily smokers. Men are more likely to smoke than women. In Spain, women between 15-25 years of age smoke as much or more than men. Every smoker should be assessed for: physical dependence on nicotine (Fagerström test), social and psychological dependence (Glover Nilsson test), level of motivation to quit (Richmond test), probability of therapy success (Henri-Mondor and Michael-Fiore tests), and stage of behavioral change development (Prochaska and DiClementi). Advice on smoking cessation is highly cost-effective and should always be provided. Smoking is an enhancer of cardiovascular risk because it acts as a pathogen agent in the development of arteriosclerosis and is associated with ischemic heart disease, stroke, and peripheral artery disease. Smoking increases the risk of chronic lung diseases (COPD) and is related to cancers of the lung, female genitalia, larynx, oropharynx, bladder, mouth, esophagus, liver and biliary tract, and stomach, among others. Combined oral contraceptives should be avoided in women smokers older than 35 years of age due to the risk of thromboembolism. In smoking cessation, the involvement of physicians, nurses, psychologists, etc. is important, and their multidisciplinary collaboration is needed. Effective pharmacological treatments for smoking cessation are available. Combined treatments are recommended when smoker's dependence is high. For individuals who are unable to quit smoking, a strategy based on tobacco damage management with a total switch to smokeless products could be a less dangerous alternative for their health than continuing to smoke.
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Affiliation(s)
- José Abellán Alemán
- Sociedad Murciana de Hipertensión Arterial y Riesgo Cardiovascular, Cátedra de Riesgo Cardiovascular, Universidad Católica de Murcia, Murcia, España.
| | - Rafael Crespo Sabaris
- Sociedad Riojana de Hipertensión y Riesgo Vascular, Centro de Salud de Entrena, La Rioja, España
| | - Daniel Escribano Pardo
- Sociedad Aragonesa de Hipertensión y Riesgo Vascular, Centro de Salud Oliver, Zaragoza, España
| | - José Antonio García Donaire
- Sociedad Española de Hipertensión, Unidad de Hipertensión, Servicio de Medicina Interna, Hospital Clínico Universitario San Carlos, Madrid, España
| | - Fernando García Romanos
- Sociedad de Hipertensión y Riesgo Vascular de las Illes Balears, Centro de Salud Santa Catalina, Palma de Mallorca, España
| | - Jesús Iturralde Iriso
- Sociedad Vasca de Hipertensión y Riesgo Vascular, Centro de Salud la Habana-Cuba, Vitoria-Gasteiz, España
| | - Luis Martín Penagos
- Sociedad Cántabra de Hipertensión y Riesgo Vascular, Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - L Javier Nieto Iglesias
- Sociedad Castilla-La Mancha de Hipertensión y Riesgo Vascular, Unidad de Hipertensión y Riesgo Vascular, Servicio de Nefrología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Alfonso Pobes Martínez de Salinas
- Sociedad Asturiana de Hipertensión y Riesgo Vascular, Área de Gestión Clínica, Interáreas de Nefrología VII y VIII del SESPA, Asturias, España
| | | | - Pablo Sánchez-Rubio Lezcano
- Sociedad Aragonesa de Hipertensión y Riesgo Vascular, Servicio de Medicina Interna, Hospital General Universitario San Jorge, Huesca, España
| | - Maribel Troya Saborido
- Sociedad Catalana de Hipertensión y Riesgo Vascular, Servicio de Nefrología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Francisco Valls Roca
- Sociedad Valenciana de Hipertensión y Riesgo Vascular, Centro de Salud de Beniganim, Valencia, España
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Kushner PR, DeMeis J, Stevens P, Gjurovic AM, Malvolti E, Tangri N. Patient and Clinician Perspectives: To Create a Better Future for Chronic Kidney Disease, We Need to Talk About Our Kidneys. Adv Ther 2024; 41:1318-1324. [PMID: 38443646 PMCID: PMC10960902 DOI: 10.1007/s12325-024-02794-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/16/2024] [Indexed: 03/07/2024]
Abstract
Chronic kidney disease (CKD) affects more than one in ten people worldwide. However, results from the REVEAL-CKD study suggest that it is often not diagnosed. Many patients are therefore unaware that they have CKD, putting them at increased risk of disease progression and complications. Empowering patients with knowledge about CKD will allow them to become active participants in their own care, driving improvements in diagnosis rates and changing patient outcomes for the better. In this article, we provide patient and clinician perspectives on the importance of early CKD diagnosis and management. We present an overview of the tests commonly used to diagnose CKD in clinical practice, as well as actionable suggestions for patients, clinicians, and health policymakers that could help improve disease detection and treatment. Navdeep Tangri, a nephrologist and epidemiologist at the University of Manitoba, and Jane DeMeis, a patient living with chronic kidney disease, discuss how results from the REVEAL-CKD study highlight the need for change to improve management of chronic kidney disease. Video Abstract (MP4 141866 KB).
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Affiliation(s)
- Pamela R Kushner
- Department of Family Medicine, University of California Irvine Medical Center, Orange, CA, USA.
| | | | - Petrina Stevens
- Global Patient Engagement, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Ana Marija Gjurovic
- Global Patient Engagement, BioPharmaceuticals Medical, AstraZeneca, Dubai, UAE
| | - Elmas Malvolti
- Global Medical Cardiovascular, Renal and Metabolism, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Navdeep Tangri
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Seven Oaks General Hospital, Winnipeg, MB, Canada
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7
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Rivera-Paredez B, Morales M, Velázquez-Cruz R, Salmerón J, Jiménez-Corona A, Balderas-Arteaga N, González-Villalpando C, Tamayo J, Lajous M, Catzin-Kuhlmann A, Nelson R, Correa-Rotter R, Denova-Gutierréz E. Association between soft drinks intake and low glomerular filtration rate in Mexican adults: Results from RenMex. Clin Nutr 2024; 43:1062-1069. [PMID: 38547595 DOI: 10.1016/j.clnu.2024.03.002] [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: 08/25/2023] [Revised: 01/30/2024] [Accepted: 03/03/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND & AIMS To evaluate the association between soft drinks (SDs) consumption and estimated glomerular filtration rate (eGFR) in a Mexican adult population. METHODS We used data from the RenMex consortium (n = 2095) that included the Mexican Teachers Cohort Study (34-65 years), the Health Workers Cohort Study (18-90 years), and the Comitán Study (19-91 years). In this cross-sectional study, we assessed SDs consumption (cola and flavored soda) using a food frequency questionnaire (FFQ) and estimated eGFR using the CKD Epidemiology Collaboration equation. Quantile regression was used to assess the association between SDs consumption and eGFR with eGFR as a continuous variable. Multinomial logistic regression models were used for eGFR categories derived from quantile regression (mildly decreased eGFR, ≥72.9-87.9 mL/min/1.73 m2 and moderately decreased eGFR, <72.9 mL/min/1.73 m2). RESULTS Mean age of study participants was 47.2 years, 67.5% were women, and 12.2% had diabetes. eGFR was <60 mL/min/1.73 m2 in 3.7% of study participants. Mildly decreased eGFR was present in 14.8%, and moderately decreased eGFR was present in 10.1% of study participants. Quantile regression results showed that SDs consumption was associated with lower eGFR at the 10th, 25th, 50th and 75th percentile. Based on the final adjusted multinomial model, ≥7 servings/week was positively associated with moderately decreased eGFR relative to <1 serving/week (Relative Risk Ratio = 1.95; 95% CI: 1.07-3.57). CONCLUSION Our results suggest that higher SDs consumption is associated with lower eGFR. Encouraging healthy dietary choices should be part of the management and prevention of CKD.
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Affiliation(s)
- Berenice Rivera-Paredez
- Research Center in Policies, Population and Health, School of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Mariluz Morales
- Research Center in Policies, Population and Health, School of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Rafael Velázquez-Cruz
- Genomics of Bone Metabolism Laboratory, National Institute of Genomic Medicine, Mexico City, Mexico
| | - Jorge Salmerón
- Research Center in Policies, Population and Health, School of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Aida Jiménez-Corona
- Department of Ocular Epidemiology and Visual Health, Instituto de Oftalmología Conde de Valenciana, Mexico City, Mexico
| | - Nydia Balderas-Arteaga
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | | | - Martin Lajous
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Andrés Catzin-Kuhlmann
- Dirección de Medicina, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Robert Nelson
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA
| | - Ricardo Correa-Rotter
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Edgar Denova-Gutierréz
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
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Saeed D, Reza T, Shahzad MW, Karim Mandokhail A, Bakht D, Qizilbash FH, Silloca-Cabana EO, Ramadhan A, Bokhari SFH. Navigating the Crossroads: Understanding the Link Between Chronic Kidney Disease and Cardiovascular Health. Cureus 2023; 15:e51362. [PMID: 38292979 PMCID: PMC10825078 DOI: 10.7759/cureus.51362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
Chronic Kidney Disease (CKD) has emerged as a global healthcare challenge affecting a significant portion of the world's population. This comprehensive narrative review delves into the intricate relationship between CKD and cardiovascular disease (CVD). CKD is characterized by kidney damage persisting for at least three months, often with or without a decline in glomerular filtration rate (GFR). It is closely linked with CVD, as individuals with CKD face a high risk of cardiovascular events, making cardiovascular-associated mortality a significant concern in advanced CKD stages. The review emphasizes the importance of precise risk assessment using biomarkers, advanced imaging, and tailored medication strategies to mitigate cardiovascular risks in CKD patients. Lifestyle modifications, early intervention, and patient-centered care are crucial in managing both conditions. Challenges in awareness and recognition of CKD and the need for comprehensive interdisciplinary care are highlighted. Recent advances in research offer promising therapies, such as SGLT2 inhibitors, MRAs, GLP-1R agonists, and selective endothelin receptor antagonists. Stem cell-based therapies, gene editing, and regenerative approaches are under investigation. Patient-physician "risk discussions" and tailored risk assessments are essential for improving patient outcomes. In conclusion, the review underscores the complexity of the interconnected CKD and cardiovascular health domains. Ongoing research, innovative therapies, and personalized healthcare will be instrumental in addressing the challenges, reducing the disease burden, and enhancing well-being for individuals facing CKD and cardiovascular issues. Recognizing the intricate connections between these conditions is imperative for healthcare providers, policymakers, and researchers as they seek to improve the quality of care and outcomes for affected individuals.
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Affiliation(s)
- Danish Saeed
- Internal Medicine, Shaikh Zayed Medical Complex, Lahore, PAK
| | - Taufiqa Reza
- Internal Medicine, Avalon University School of Medicine, Youngstown, USA
| | | | | | - Danyal Bakht
- Medicine and Surgery, Mayo Hospital, Lahore, PAK
| | | | | | - Afif Ramadhan
- General Practice, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Yogyakarta, IDN
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Kanbay M, Copur S, Yilmaz ZY, Tanriover C, Hasbal NB, Ortiz A, Perazella MA. A novel risk factor for malignancy: Albuminuria. Eur J Intern Med 2023; 118:22-31. [PMID: 37741791 DOI: 10.1016/j.ejim.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/03/2023] [Accepted: 09/10/2023] [Indexed: 09/25/2023]
Abstract
Cancer is the second leading cause of death among the adult population following cardiovascular diseases. Prevention and earlier diagnosis are among the cornerstones in the management of malignancies. Albuminuria is a diagnostic criterion for chronic kidney disease and has been associated with multiple conditions including cardiovascular diseases and systemic inflammation while the association between albuminuria and malignancy has been inadequately addressed. Large-scale observational studies with long follow-up periods demonstrate a statistically significant association between albuminuria and overall malignancy incidence, especially urothelial malignancy incidence. However, the underlying pathophysiology linking these two entities is not a straightforward causal relationship but most likely a multidirectional relationship including a causal link. In this narrative review, we evaluate the clinical studies investigating the association between albuminuria and malignancy along with potential underlying mechanisms linking them. We also summarize data on the impact of treatment modalities prescribed for albuminuria and/or proteinuria on the prevention or prognosis of malignancies.
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Affiliation(s)
- Mehmet Kanbay
- Department of Medicine, Section of Nephrology, Koc University School of Medicine, Istanbul, Turkey.
| | - Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Zeynep Y Yilmaz
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Cem Tanriover
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Nuri Baris Hasbal
- Department of Medicine, Section of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Alberto Ortiz
- Department of Medicine, Universidad Autonoma de Madrid and IIS-Fundacion Jimenez Diaz, Madrid, Spain
| | - Mark A Perazella
- Department of Internal Medicine Section of Nephrology, Yale University School of Medicine, CT, USA
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Kim EJ, Cho A, Kim DH, Park HC, Yoon JY, Shon K, Kim E, Koo JR, Lee YK. Geriatric Nutritional Risk Index as a Prognostic Factor for Renal Progression in Patients with Type 2 Diabetes Mellitus. Nutrients 2023; 15:4636. [PMID: 37960289 PMCID: PMC10649929 DOI: 10.3390/nu15214636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
The aim of this study was to evaluate whether the geriatric nutritional risk index (GNRI) is associated with chronic kidney disease (CKD) progression in patients with type 2 diabetes mellitus (DM). In total, 1100 patients with type 2 DM with a follow-up duration > 1 year were included in this longitudinal study. The risk of CKD progression was assessed according to GNRI quartiles. Patients in the lowest GNRI quartile exhibited a significantly lower estimated glomerular filtration rate (eGFR), compared with those in quartile four. Moreover, these patients had poorer glycemic control and lower hemoglobin levels, body mass index, and albumin levels. Additionally, they exhibited a greater annual decline in eGFR. Multivariate logistic regression analysis showed that old age (>60 years), baseline eGFR, the presence of proteinuria, the use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and low GNRI were significantly associated with CKD progression. GNRI may serve as a valuable predictive tool for identifying the risk of adverse renal outcomes in patients with type 2 DM. It may potentially serve as a more feasible measure for assessing the nutritional status of these patients, as well as for predicting their clinical outcomes.
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Affiliation(s)
- Eun Jung Kim
- Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong-si 18450, Republic of Korea; (E.J.K.); (J.-R.K.)
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Graduate School of Kangwon National University, Kangwon 24341, Republic of Korea
| | - Ajin Cho
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Do Hyoung Kim
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Hayne Cho Park
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Joo Yeon Yoon
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Kyungjun Shon
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Eunji Kim
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Ja-Ryong Koo
- Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong-si 18450, Republic of Korea; (E.J.K.); (J.-R.K.)
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
| | - Young-Ki Lee
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
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Kotsis F, Bächle H, Altenbuchinger M, Dönitz J, Njipouombe Nsangou YA, Meiselbach H, Kosch R, Salloch S, Bratan T, Zacharias HU, Schultheiss UT. Expectation of clinical decision support systems: a survey study among nephrologist end-users. BMC Med Inform Decis Mak 2023; 23:239. [PMID: 37884906 PMCID: PMC10605935 DOI: 10.1186/s12911-023-02317-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 09/29/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD), a major public health problem with differing disease etiologies, leads to complications, comorbidities, polypharmacy, and mortality. Monitoring disease progression and personalized treatment efforts are crucial for long-term patient outcomes. Physicians need to integrate different data levels, e.g., clinical parameters, biomarkers, and drug information, with medical knowledge. Clinical decision support systems (CDSS) can tackle these issues and improve patient management. Knowledge about the awareness and implementation of CDSS in Germany within the field of nephrology is scarce. PURPOSE Nephrologists' attitude towards any CDSS and potential CDSS features of interest, like adverse event prediction algorithms, is important for a successful implementation. This survey investigates nephrologists' experiences with and expectations towards a useful CDSS for daily medical routine in the outpatient setting. METHODS The 38-item questionnaire survey was conducted either by telephone or as a do-it-yourself online interview amongst nephrologists across all of Germany. Answers were collected and analysed using the Electronic Data Capture System REDCap, as well as Stata SE 15.1, and Excel. The survey consisted of four modules: experiences with CDSS (M1), expectations towards a helpful CDSS (M2), evaluation of adverse event prediction algorithms (M3), and ethical aspects of CDSS (M4). Descriptive statistical analyses of all questions were conducted. RESULTS The study population comprised 54 physicians, with a response rate of about 80-100% per question. Most participants were aged between 51-60 years (45.1%), 64% were male, and most participants had been working in nephrology out-patient clinics for a median of 10.5 years. Overall, CDSS use was poor (81.2%), often due to lack of knowledge about existing CDSS. Most participants (79%) believed CDSS to be helpful in the management of CKD patients with a high willingness to try out a CDSS. Of all adverse event prediction algorithms, prediction of CKD progression (97.8%) and in-silico simulations of disease progression when changing, e. g., lifestyle or medication (97.7%) were rated most important. The spectrum of answers on ethical aspects of CDSS was diverse. CONCLUSION This survey provides insights into experience with and expectations of out-patient nephrologists on CDSS. Despite the current lack of knowledge on CDSS, the willingness to integrate CDSS into daily patient care, and the need for adverse event prediction algorithms was high.
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Affiliation(s)
- Fruzsina Kotsis
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
- Department of Medicine IV - Nephrology and Primary Care, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Helena Bächle
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Michael Altenbuchinger
- Department of Medical Bioinformatics, University Medical Center Göttingen, Göttingen, Germany
| | - Jürgen Dönitz
- Department of Medical Bioinformatics, University Medical Center Göttingen, Göttingen, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Munich, Germany
| | | | - Heike Meiselbach
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Robin Kosch
- Department of Medical Bioinformatics, University Medical Center Göttingen, Göttingen, Germany
| | - Sabine Salloch
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hanover, Germany
| | - Tanja Bratan
- Competence Center Emerging Technologies, Fraunhofer Institute for Systems and Innovation Research ISI, Karlsruhe, Germany
| | - Helena U Zacharias
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hanover, Germany
| | - Ulla T Schultheiss
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany.
- Department of Medicine IV - Nephrology and Primary Care, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany.
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12
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Yang WC, Hsieh HM, Chen JP, Tsai SF, Chiu HF, Chung MC, Huang ST, Chen YY, Chen CH. Efficacy and Safety of a High-Energy, Low-Protein Formula Replacement Meal for Pre-Dialysis Chronic Kidney Disease Patients: A Randomized Controlled Trial. Nutrients 2023; 15:4506. [PMID: 37960159 PMCID: PMC10648072 DOI: 10.3390/nu15214506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
High-energy, low-protein formulas (HE-LPFs) are commonly used as oral nutritional supplements (ONSs) to help provide extra calories to patients who are adhering to a low-protein diet (LPD) after diagnosis with chronic kidney disease (CKD). This randomized controlled trial aimed to evaluate the efficacy and safety of an HE-LPF as either a partial or a total replacement for one meal in pre-dialysis CKD patients. Stage 4-5 CKD patients received either a once-daily HE-LPF (HE-LPF group) or normal food (control group) for a period of 4 weeks while following an LPD. Overall, 73 patients who completed the study were included in the intention-to-treat population. After analyzing the 3-day food records, the HE-LPF group experienced a significant decrease in the percentage of energy derived from protein (p < 0.05) and an increase in the percentage of energy derived from fat (p < 0.05) compared to the control group. The two groups had no significant differences in body weight, body composition, grip strength, renal function, electrolytes, or metabolic markers. The HE-LPF group had a high adherence (94.9% at week 4), and no adverse effects were observed. HE-LPFs are safe to employ as meal replacements for pre-dialysis CKD patients adhering to an LPD.
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Affiliation(s)
- Wen-Ching Yang
- Department of Food and Nutrition, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (W.-C.Y.); (H.-M.H.)
| | - Hui-Min Hsieh
- Department of Food and Nutrition, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (W.-C.Y.); (H.-M.H.)
| | - Jun-Peng Chen
- Biostatistics Group, Department of Medical Research, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (J.-P.C.); (Y.-Y.C.)
| | - Shang-Feng Tsai
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (S.-F.T.); (H.-F.C.); (M.-C.C.); (S.-T.H.)
- Department of Life Science, Tunghai University, Taichung 407224, Taiwan
- Department of Medicine, National Yang-Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University School of Medicine, Taichung 40227, Taiwan
| | - Hsien-Fu Chiu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (S.-F.T.); (H.-F.C.); (M.-C.C.); (S.-T.H.)
| | - Mu-Chi Chung
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (S.-F.T.); (H.-F.C.); (M.-C.C.); (S.-T.H.)
| | - Shih-Ting Huang
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (S.-F.T.); (H.-F.C.); (M.-C.C.); (S.-T.H.)
| | - Yun-Yu Chen
- Biostatistics Group, Department of Medical Research, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (J.-P.C.); (Y.-Y.C.)
| | - Cheng-Hsu Chen
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (S.-F.T.); (H.-F.C.); (M.-C.C.); (S.-T.H.)
- Department of Life Science, Tunghai University, Taichung 407224, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University School of Medicine, Taichung 40227, Taiwan
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13
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Dąbek B, Dybiec J, Frąk W, Fularski P, Lisińska W, Radzioch E, Młynarska E, Rysz J, Franczyk B. Novel Therapeutic Approaches in the Management of Chronic Kidney Disease. Biomedicines 2023; 11:2746. [PMID: 37893119 PMCID: PMC10604464 DOI: 10.3390/biomedicines11102746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
Chronic kidney disease (CKD) is a progressive and incurable disease that impairs kidney function. Its prevalence is estimated to affect up to 800 million individuals within the general population, and patients with diabetes and hypertension are particularly at risk. This disorder disrupts the physiological mechanisms of the body, including water and electrolyte balance, blood pressure regulation, the excretion of toxins, and vitamin D metabolism. Consequently, patients are exposed to risks such as hyperkalemia, hyperphosphatemia, metabolic acidosis, and blood pressure abnormalities. These risks can be reduced by implementing appropriate diagnostic methods, followed by non-pharmacological (such as physical activity, dietary, and lifestyle adjustment) and pharmacological strategies after diagnosis. Selecting the appropriate diet and suitable pharmacological treatment is imperative in maintaining kidney function as long as possible. Drugs such as finerenone, canakinumab, and pentoxifylline hold promise for improved outcomes among CKD patients. When these interventions prove insufficient, renal replacement therapy becomes essential. This is particularly critical in preserving residual renal function while awaiting renal transplantation or for patients deemed ineligible for such a procedure. The aim of this study is to present the current state of knowledge and recent advances, providing novel insights into the treatment of chronic kidney disease.
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Affiliation(s)
- Bartłomiej Dąbek
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Jill Dybiec
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Weronika Frąk
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Piotr Fularski
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Wiktoria Lisińska
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Ewa Radzioch
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Ewelina Młynarska
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Beata Franczyk
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
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14
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Tang R, Wang X, Li X, Ma H, Liang Z, Heianza Y, Qi L. Adherence to Life's Essential 8 and incident chronic kidney disease: a prospective study of 147,988 UK Biobank participants. Am J Clin Nutr 2023; 118:804-811. [PMID: 37604298 PMCID: PMC10579043 DOI: 10.1016/j.ajcnut.2023.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The American Heart Association recently updated Life's Essential 8 (LE8) score. This amalgamation of health factors, recognized for their individual associations with chronic kidney disease (CKD) risk, provides a robust tool to assess overall cardiovascular health (CVH), which could potentially be extrapolated to predict CKD risk. OBJECTIVES This study aimed to investigate the association between levels of CVH, as measured by the LE8 score, and risk of CKD in the UK Biobank. METHODS A total of 147,988 participants free of CKD and cardiovascular disease from the UK Biobank were included in this prospective study. CVH levels were categorized as low (0-49), moderate (50-79), and high (80-100) using LE8 score. An adjusted Cox proportional hazard model was used to investigate the association between LE8 and CKD. The population attributable-risk (PAR) was also calculated. RESULTS During a median follow-up of 10 y, 1936 CKD cases were documented. A higher LE8 score was associated with a significant lower risk of CKD (P < 0.001), and a linear dose-response relationship was observed. Similar patterns were also found in the associations of the LE8 behavior and biological subscale scores with CKD. Compared with participants with a low CVH category, participants with a moderate CVH were associated with a 39% lower risk of developing CKD (hazard ratio [HR]: 0.61; 95% confidence interval [CI]: 0.52, 0.72); and those with a high CVH had a 57% lower risk of CKD incidence (HR: 0.43; 95% CI: 0.35, 0.53) after adjustment for covariates. Among 8 distinct metrics of LE8 score, the BMI metric had the highest PAR (24.6%; 95% CI: 18.8, 30.2). Of the total CKD risk, 3.2% (95% CI: 1.4, 5.0) was attributable to inadequate or excessive sleep duration. CONCLUSIONS High CVH, defined by LE8, is significantly associated with a lower risk of CKD. These results suggest that promoting optimal cardiovascular health may lower the burden of CKD.
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Affiliation(s)
- Rui Tang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Xuan Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Xiang Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Hao Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Zhaoxia Liang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States; Department of Obstetrical, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
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15
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Guo L, Zhang Y, Lu J, Li X, Zhang C, Song W, Dong Y, Zhou X, Li R. Nicotine promotes renal interstitial fibrosis via upregulation of XIAP in an alpha7-nAChR-dependent manner. Mol Cell Endocrinol 2023; 576:111989. [PMID: 37451424 DOI: 10.1016/j.mce.2023.111989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
Renal fibrosis, characterized by excessive accumulation of the extracellular matrix in the renal tubulointerstitium, can lead to chronic kidney disease (CKD), resulting in a heavy burden on families and society. Clinical studies have shown that smoking is closely associated with CKD deterioration in patients with diabetes, hypertension, polycystic kidney disease, and kidney transplantation. However, the mechanism of action of nicotine in renal fibrosis pathogenesis remains largely unknown. X-linked inhibitor of apoptosis (XIAP), a member of the inhibitor of apoptosis protein (IAP) family, is involved in apoptosis, necroptosis, autophagy, and immune response. Here, the upregulated expression of XIAP and α7 nicotine acetylcholine receptor (α7-nAChR) was determined in the kidneys of the CKD smoking group in human and animal studies. A significant positive correlation between XIAP and cotinine was observed. In addition, the nuclear translocation and transcriptional activity of SP1 were promoted when nicotine bound to α7-nAChR, resulting in XIAP overexpression and renal interstitial fibrosis progression. This phenotype can be reversed by the nicotine receptor subtype α7-nAChR antagonists methyllycaconitine. Our results revealed the complex underlying mechanism of nicotine in promoting renal fibrosis by altering SP1 nucleocytoplasmic translocation and regulating XIAP expression. These results provide novel insights into the pathogenesis and treatment of CKD.
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Affiliation(s)
- Lili Guo
- Shanxi Provincial Key Laboratory of Kidney Disease, Shanxi Provincial People's Hospital, Taiyuan, China; Department of Nephrology, Shanxi Provincial People's Hospital, Taiyuan, China.
| | - Yue Zhang
- The Fifth Clinical Medical College of Shanxi Medical University, Fifth Hospital of Shanxi Medical University, Taiyuan, China
| | - Jian Lu
- Shanxi Provincial Key Laboratory of Kidney Disease, Shanxi Provincial People's Hospital, Taiyuan, China; Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaoyang Li
- Shanxi Provincial Key Laboratory of Kidney Disease, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Chao Zhang
- The Fifth Clinical Medical College of Shanxi Medical University, Fifth Hospital of Shanxi Medical University, Taiyuan, China
| | - Wenzhu Song
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Yafang Dong
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Shanxi Medical University, Taiyuan, China
| | - Xiangyang Zhou
- Preclinical-medicine of Shanxi Medical University, Taiyuan, China
| | - Rongshan Li
- Shanxi Provincial Key Laboratory of Kidney Disease, Shanxi Provincial People's Hospital, Taiyuan, China; Department of Nephrology, Shanxi Provincial People's Hospital, Taiyuan, China.
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16
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Chu CD, Xia F, Du Y, Singh R, Tuot DS, Lamprea-Montealegre JA, Gualtieri R, Liao N, Kong SX, Williamson T, Shlipak MG, Estrella MM. Estimated Prevalence and Testing for Albuminuria in US Adults at Risk for Chronic Kidney Disease. JAMA Netw Open 2023; 6:e2326230. [PMID: 37498594 PMCID: PMC10375308 DOI: 10.1001/jamanetworkopen.2023.26230] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/16/2023] [Indexed: 07/28/2023] Open
Abstract
Importance Albuminuria testing is crucial for guiding evidence-based treatments to mitigate chronic kidney disease (CKD) progression and cardiovascular morbidity, but it is widely underutilized among persons with or at risk for CKD. Objective To estimate the extent of albuminuria underdetection from lack of testing and evaluate its association with CKD treatment in a large US cohort of patients with hypertension or diabetes. Design, Setting, and Participants This cohort study examined adults with hypertension or diabetes, using data from the 2007 to 2018 National Health and Nutrition Examination Surveys (NHANES) and the Optum deidentified electronic health record (EHR) data set of diverse US health care organizations. Analyses were conducted from October 31, 2022, to May 19, 2023. Main Outcomes and Measures Using NHANES as a nationally representative sample, a logistic regression model was developed to estimate albuminuria (urine albumin-creatinine ratio ≥30 mg/g). This model was then applied to active outpatients in the EHR from January 1, 2017, to December 31, 2018. The prevalence of albuminuria among those with and without albuminuria testing during this period was estimated. A multivariable logistic regression was used to examine associations between having albuminuria testing and CKD therapies within the subsequent year (prescription for angiotensin-converting enzyme inhibitor [ACEi] or angiotensin II receptor blocker [ARB], prescription for sodium-glucose cotransporter 2 inhibitor [SGLT2i], and blood pressure control to less than 130/80 mm Hg or less than 140/90 mm Hg on the latest outpatient measure). Results The total EHR study population included 192 108 patients (mean [SD] age, 60.3 [15.1] years; 185 589 [96.6%] with hypertension; 50 507 [26.2%] with diabetes; mean [SD] eGFR, 84 [21] mL/min/1.73 m2). There were 33 629 patients (17.5%) who had albuminuria testing; of whom 11 525 (34.3%) had albuminuria. Among 158 479 patients who were untested, the estimated albuminuria prevalence rate was 13.4% (n = 21 231). Thus, only 35.2% (11 525 of 32 756) of the projected population with albuminuria had been tested. Albuminuria testing was associated with higher adjusted odds of receiving ACEi or ARB treatment (OR, 2.39 [95% CI, 2.32-2.46]), SGLT2i treatment (OR, 8.22 [95% CI, 7.56-8.94]), and having blood pressure controlled to less than 140/90 mm Hg (OR, 1.20 [95% CI, 1.16-1.23]). Conclusions and Relevance In this cohort study of patients with hypertension or diabetes, it was estimated that approximately two-thirds of patients with albuminuria were undetected due to lack of testing. These results suggest that improving detection of CKD with albuminuria testing represents a substantial opportunity to optimize care delivery for reducing CKD progression and cardiovascular complications.
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Affiliation(s)
- Chi D. Chu
- Department of Medicine, University of California, San Francisco
- Kidney Health Research Collaborative, University of California, San Francisco
| | - Fang Xia
- Gilead Sciences Inc, Foster City, California
| | | | | | | | - Julio A. Lamprea-Montealegre
- Department of Medicine, University of California, San Francisco
- Kidney Health Research Collaborative, University of California, San Francisco
| | | | | | | | | | - Michael G. Shlipak
- Department of Medicine, University of California, San Francisco
- Kidney Health Research Collaborative, University of California, San Francisco
- San Francisco VA Health Care System, San Francisco, California
| | - Michelle M. Estrella
- Department of Medicine, University of California, San Francisco
- Kidney Health Research Collaborative, University of California, San Francisco
- San Francisco VA Health Care System, San Francisco, California
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17
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Ray N, Reddy PH. Structural and physiological changes of the kidney with age and its impact on chronic conditions and COVID-19. Ageing Res Rev 2023; 88:101932. [PMID: 37031725 PMCID: PMC10081878 DOI: 10.1016/j.arr.2023.101932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/11/2023]
Abstract
The kidney is an essential organ that removes waste products, balances the body's fluids, releases hormones that regulate blood pressure, produces an active form of vitamin D, promotes healthy bones, and controls the production of red blood cells. Structural and functional abnormalities occur in kidney with age. Alterations in kidney structure are based on physiological functions and environmental pressures. Variations in its structure across vertebrates are primarily due to the nature of alterations in number, complexity, arrangement, and location of the kidney tubules. Globally, individuals aged 65 and older are part of the fastest expanding population demographic, and as a result, a greater number of older patients are receiving a diagnosis of impaired renal function. The purpose of our mini-review is to summarize recent findings of the structural and functional differences between the normal and aging kidney, examine the evolutionary biology of the kidney across species, and demonstrate the role of aging in conditions such as diabetes, chronic kidney disease, and hypertension, along with their impact on SARS-CoV-2. Additional aims include discussing the potential therapeutic strategies to treat aged individuals with kidney health issues and how the impact of a healthy lifestyle, diet, and exercise can improve health conditions with aged kidneys.
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Affiliation(s)
- Nandini Ray
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Public Health, School of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Speech, Language, and Hearing Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Nutritional Sciences, School of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA.
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18
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Albuquerque ACRMDM, Pinto GN, Pereira GA, Silva LF, Fontenele TAS, de Oliveira JGR, da Silva GB. Population knowledge on chronic kidney disease, its risk factors and means of prevention: a population-based study in Fortaleza, Ceará, Brazil. J Bras Nefrol 2023; 45:144-151. [PMID: 36200884 PMCID: PMC10627131 DOI: 10.1590/2175-8239-jbn-2022-0017en] [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: 02/11/2022] [Accepted: 06/20/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) has been increasing significantly. There is evidence that a large part of the population does not have enough knowledge on the subject. OBJECTIVE To investigate the level of knowledge about CKD in the general population, its risk factors and means of prevention. METHODS We ran a cross-sectional study in the population of Fortaleza, Ceará - Brazil, between 2017 and 2020, with the application of a questionnaire on CKD, risk factors and prevention. RESULTS we interviewed 735 volunteers, with a mean age of 38 years, of which 55% were female. Only 17.2% correctly responded to the concept of CKD, and 5.8% knew the concept of creatinine. Low water intake was the most cited risk factor by respondents (79.3%). The main risk factors and direct causes of CKD (diabetes and hypertension) were mentioned less frequently (13.2% and 15.1%, respectively). Men were more correct regarding risk factors and ways to prevent CKD. Older respondents answered more correctly the questions about the definition of CKD (n = 22; 28.6%) and creatinine (n = 7; 9.0%). With regards to education there was a statistically significant correlation in all the questions (p < 0.05). CONCLUSION There is little knowledge about CKD in the general population. Higher level of education is associated with better knowledge. More health education actions are needed so that the population becomes better acquainted with CKD and, consequently, can adopt more adequate prevention and control measures.
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Affiliation(s)
| | - Gustavo Neves Pinto
- Universidade de Fortaleza, Curso de Medicina, Centro de Ciências da
Saúde, Fortaleza, CE, Brasil
| | - Gabriel Araújo Pereira
- Universidade de Fortaleza, Curso de Medicina, Centro de Ciências da
Saúde, Fortaleza, CE, Brasil
| | - Luísa Falcão Silva
- Universidade de Fortaleza, Curso de Medicina, Centro de Ciências da
Saúde, Fortaleza, CE, Brasil
| | | | | | - Geraldo Bezerra da Silva
- Universidade de Fortaleza, Programa de Pós-Graduação em Saúde
Coletiva, Fortaleza, CE, Brasil
- Universidade de Fortaleza, Curso de Medicina, Centro de Ciências da
Saúde, Fortaleza, CE, Brasil
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento
de Medicina Clínica, Fortaleza, CE, Brasil
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19
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Chen JY, Deng S, Wagatsuma Y. Combination of Risks of BMI and Health-Related Lifestyles on Kidney Function in the Prediabetic Japanese Population: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5338. [PMID: 37047953 PMCID: PMC10094487 DOI: 10.3390/ijerph20075338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 06/19/2023]
Abstract
Diabetic overweight patients are more likely to show the progression of kidney damage than the general population. The majority of people in the early stages of kidney damage do not recognize the importance of risk modification, mainly due to the asymptomatic nature of the disease. This study aimed to examine specific risk combinations of lifestyle and BMI regarding the deterioration of kidney function and to explore whether there are gender-based differences among the prediabetic population. Prediabetic participants with normal kidney function were identified via annual health examination from April 2016 to March 2019. The information on health status and lifestyle was collected at enrollment. The study subjects were followed until March 2021 to observe the progression of kidney damage. There were 2241 participants enrolled in this study. Smoking (HR = 3.5, p < 0.001), eating snacks (HR = 3.2, p < 0.001), not engaging in regular exercise (HR = 2.9, p < 0.001), and not having adequate sleep (HR = 3.0, p < 0.001) showed accelerated risks for kidney damage progression among the prediabetic population in males. These lifestyle effects were not observed in females. In conclusion, risk-based modification of lifestyle behavior is important to prevent kidney function damage among the overweight prediabetic population in males.
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Affiliation(s)
- Jou-Yin Chen
- Department of Clinical Trials and Clinical Epidemiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Shiqi Deng
- Department of Clinical Trials and Clinical Epidemiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Yukiko Wagatsuma
- Department of Clinical Trials and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
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20
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Alkhatib L, Velez Diaz LA, Varma S, Chowdhary A, Bapat P, Pan H, Kukreja G, Palabindela P, Selvam SA, Kalra K. Lifestyle Modifications and Nutritional and Therapeutic Interventions in Delaying the Progression of Chronic Kidney Disease: A Review. Cureus 2023; 15:e34572. [PMID: 36874334 PMCID: PMC9981552 DOI: 10.7759/cureus.34572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Chronic kidney disease (CKD) is a debilitating progressive illness that affects more than 10% of the world's population. In this literature review, we discussed the roles of nutritional interventions, lifestyle modifications, hypertension (HTN) and diabetes mellitus (DM) control, and medications in delaying the progression of CKD. Walking, weight loss, low-protein diet (LPD), adherence to the alternate Mediterranean (aMed) diet, and Alternative Healthy Eating Index (AHEI)-2010 slow the progression of CKD. However, smoking and binge alcohol drinking increase the risk of CKD progression. In addition, hyperglycemia, altered lipid metabolism, low-grade inflammation, over-activation of the renin-angiotensin-aldosterone system (RAAS), and overhydration (OH) increase diabetic CKD progression. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend blood pressure (BP) control of <140/90 mmHg in patients without albuminuria and <130/80 mmHg in patients with albuminuria to prevent CKD progression. Medical therapies aim to target epigenetic alterations, fibrosis, and inflammation. Currently, RAAS blockade, sodium-glucose cotransporter-2 (SGLT2) inhibitors, pentoxifylline, and finerenone are approved for managing CKD. In addition, according to the completed Study of Diabetic Nephropathy with Atrasentan (SONAR), atrasentan, an endothelin receptor antagonist (ERA), decreased the risk of renal events in diabetic CKD patients. However, ongoing trials are studying the role of other agents in slowing the progression of CKD.
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Affiliation(s)
- Lean Alkhatib
- Internal Medicine, Royal Medical Services, Amman, JOR
| | | | - Samyukta Varma
- Internal Medicine, Madurai Medical College, Madurai, IND
| | - Arsh Chowdhary
- Nephrology, Smt. Kashibai Navale Medical College and General Hospital, Pune, IND
| | - Prachi Bapat
- General Medicine, Smt. Kashibai Navale Medical College and General Hospital, Pune, IND
| | - Hai Pan
- Pathology, Tianjin University of Chinese Medicine, Tianjin, CHN
| | - Geetika Kukreja
- Internal Medicine and Hematology/Oncology, Henry Ford Health System, Clinton Township, USA
| | | | | | - Kartik Kalra
- Nephrology, Geisinger Medical Center, Danville, USA
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21
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Ahn JW, Lee SM, Seo YH. Factors associated with self-care behavior in patients with pre-dialysis or dialysis-dependent chronic kidney disease. PLoS One 2022; 17:e0274454. [PMID: 36227926 PMCID: PMC9560058 DOI: 10.1371/journal.pone.0274454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/29/2022] [Indexed: 11/07/2022] Open
Abstract
Self-care behavior plays a pivotal role in the management of chronic kidney disease. Improved self-care behavior in patients with chronic kidney disease is a key factor in health management and treatment adherence. This study aimed to evaluate the participants’ general and medical condition-related characteristics, physiological indices and the level of health literacy affecting self-care behavior in patients with chronic kidney disease in South Korea. The data of 278 participants were analyzed using t-test, analysis of variance, correlation coefficient, and linear multiple regression analysis. There were significant differences in self-care behavior scores depending on participants’ age and cohabitation status, employment, and smoking status as well as having dialysis due to end-stage kidney disease; number of comorbidities; levels of serum hemoglobin, calcium, and creatinine; and estimated glomerular filtration rate. The results of regression analysis revealed that not currently working, non-smoker, end-stage kidney disease, and positive response to the “actively managing my health” scale of the Health Literacy Questionnaire significantly affected self-care behavior in patients with chronic kidney disease, and the explanatory power of the model was 32.7%. Therefore, it is necessary to identify each patient’s barriers or needs according to individual characteristics, such as age, cohabitation and employment status, and daily life circumstances, including smoking habits, comorbidities, social support, and level of health literacy to develop efficient support strategies for promoting adequate self-care behavior with CKD.
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Affiliation(s)
- Jung-Won Ahn
- Department of Nursing, Gangneung-Wonju National University, Wonju-si, Gangwon-do, Korea
| | - Sun Mi Lee
- Department of Nursing Science, Pai Chai University, Seo-gu, Daejeon Metropolitan City, Korea
| | - Yon Hee Seo
- Department of Nursing, Yeoju Institute of Technology, Yeoju-si, Gyeonggi-do, Korea
- * E-mail:
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22
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Albuquerque ACRMDM, Pinto GN, Pereira GA, Silva LF, Fontenele TAS, Oliveira JGRD, Silva Junior GBD. Conhecimento da população sobre a doença renal crônica, seus fatores de risco e meios de prevenção: um estudo de base populacional em Fortaleza, Ceará, Brasil. J Bras Nefrol 2022. [DOI: 10.1590/2175-8239-jbn-2022-0017pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Introdução: A doença renal crônica (DRC) vem aumentando de forma significativa. Há evidências de que grande parte da população não tem conhecimento suficiente sobre o assunto. Objetivo: Investigar na população geral o nível de conhecimento sobre a DRC, seus fatores de risco e meios de prevenção. Métodos: Foi realizado estudo transversal na população de Fortaleza, Ceará, Brasil, entre 2017 e 2020, com aplicação de um questionário sobre DRC, fatores de risco e prevenção. Resultados: Foram entrevistados 735 voluntários, com média de idade de 38 anos, dos quais 55% eram do sexo feminino. Apenas 17,2% responderam corretamente ao conceito de DRC, e 5,8% sabiam o conceito de creatinina. A baixa ingestão hídrica foi o fator de risco mais citado pelos entrevistados (79,3%). Os principais fatores de risco e as causas diretas de DRC (diabetes e hipertensão) foram mencionados com menor frequência (13,2% e 15,1%, respectivamente). Os homens tiveram maior acerto com relação aos fatores de risco e às formas de prevenção da DRC. Os entrevistados com idade mais avançada responderam mais corretamente às perguntas sobre a definição de DRC (n = 22; 28,6%) e creatinina (n = 7; 9,0%). No que diz respeito à escolaridade, em todas as perguntas houve correlação estatisticamente significativa (p < 0,05). Conclusão: Há um baixo nível de conhecimento sobre a DRC na população geral. Maior nível de escolaridade associa-se a um melhor conhecimento. São necessárias mais ações de educação em saúde para que a população conheça melhor a DRC e consequentemente possa adotar medidas de prevenção e controle mais adequadas.
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