1,723,034 research outputs found
Reflecting on Remarkable Years at the Journal of Renal Nutrition: Innovation in Dietary and Nutritional Interventions in Kidney Health and Disease
No full textThe impact of the Russian–Ukrainian war for people with chronic diseases
Full text linkPeople with chronic diseases are at high risk of becoming innocent victims of the Russian-Ukrainian war, owing to interruption of their health care. More than 10 million Ukrainian people have left their homes and almost 5 million have left the country. Provision of kidney care for these refugees is an emerging challenge
Dietary approach to recurrent or chronic hyperkalaemia in patients with decreased kidney function
Full text linkWhereas the adequate intake of potassium is relatively high in healthy adults, i.e., 4.7 g per day, a dietary potassium restriction of usually less than 3 g per day is recommended in the management of patients with reduced kidney function, especially those who tend to develop hyperkalaemia including patients who are treated with angiotensin pathway modulators. Most potassium-rich foods are considered heart-healthy nutrients with high fibre, high anti-oxidant vitamins and high alkali content such as fresh fruits and vegetables; hence, the main challenge of dietary potassium management is to maintain high fibre intake and a low net fixed-acid load, because constipation and metabolic acidosis are per se major risk factors for hyperkalaemia. To achieve a careful reduction of dietary potassium load without a decrease in alkali or fibre intake, we recommend the implementation of certain pragmatic dietary interventions as follows: Improving knowledge and education about the type of foods with excess potassium (per serving or per unit of weight); identifying foods that are needed for healthy nutrition in renal patients; classification of foods based on their potassium content normalized per unit of dietary fibre; education about the use of cooking procedures (such as boiling) in order to achieve effective potassium reduction before eating; and attention to hidden sources of potassium, in particular additives in preserved foods and low-sodium salt substitutes. The present paper aims to review dietary potassium handling and gives information about practical approaches to limit potassium load in chronic kidney disease patients at risk of hyperkalaemia
Kidney function in cachexia and sarcopenia: Facts and numbers
Full text linkAbstract Cachexia, in the form of unintentional weight loss >5% in 12 months or less, and secondary sarcopenia in the form of muscle wasting are serious conditions that affect clinical outcomes. A chronic disease state such as chronic kidney disease (CKD) often contributes to these wasting disorders. The purpose of this review is to summarize the prevalence of cachexia and sarcopenia, their relationship with kidney function, and indicators for evaluating kidney function in patients with CKD. It is estimated that approximately half of all persons with CKD will develop cachexia with an estimated annual mortality rate of 20%, but few studies have been conducted on cachexia in CKD. Hence, the true prevalence of cachexia in CKD and its effects on kidney function and patient outcomes remain unclear. Some studies have highlighted the concept of protein‐energy wasting (PEW) which usually include sarcopenia and cachexia. Several studies have examined kidney function and CKD progression in patients with sarcopenia. Most studies use serum creatinine levels to estimate kidney function. However, creatinine may be influenced by muscle mass, and creatinine‐based glomerular filtration rate may overestimate kidney function in patients with reduced muscle mass or muscle wasting. Cystatin C, which is least affected by muscle mass, has been used in some studies, and creatinine‐to‐cystatin‐C ratio has emerged as an important prognostic marker. A previous study incorporating 428 320 participants reported that participants with CKD and sarcopenia had a 33% higher hazard of mortality compared with those without (7% to 66%, P = 0.011), and that those with sarcopenia were twice as likely to develop end‐stage kidney disease (hazard ratio: 1.98; 1.45 to 2.70, P < 0.001). Future studies on cachexia and sarcopenia in patients with CKD are needed to report rigorously defined cachexia concerning kidney function. Moreover, in studies on sarcopenia with CKD, it is desirable to accumulate studies using cystatin C to accurately estimate kidney function
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Dietary phosphorus intake among a diverse cohort of end-stage renal disease hemodialysis patients.
Full text linkBackground: Hyperphosphatemia is a known predictor of mortality in hemodialysis patients. Disruption of serum phosphorus levels have been related to subsequent disruption of parathyroid hormone and calcium homeostasis. These disruptions in mineral and hormone balance may lead to left ventricular fibrosis and hypertrophy, vascular calcification, and eventually sudden cardiac death. Hemodialysis often does not sufficiently remove enough phosphorus to reach recommended concentrations of serum phosphorus, making hyperphosphatemia common among hemodialysis patients. Current renal dietary guidelines recommend for patients to consume a low phosphorus diet in order to reduce the risk of hyperphosphatemia. However, there are few studies to support this dietary practice. In the studies that exist, there have been conflicting reports concerning the outcomes of dietary phosphorus restriction. As lowering dietary phosphorus has the potential to concomitantly reduce intake of heart-healthy macro- and micronutrients, and increase risk of protein energy wasting, there is discussion for liberalization of diet with greater emphasis on serum phosphorus management with a focused reduction in inorganic phosphorus additives and phosphorus binder medications. This study utilized hemodialysis patients participating in the Malnutrition, Diet, and Racial Disparities in Chronic Kidney Disease (MADRAD) study.Objectives: In this dissertation, I measured the association between absoulute dietary phosphorus intake, phosphorus/1000 kcal, and phosphorus-to-protein ratio and mortality in MADRAD study patients (Chapter 2); analyzed data from 3-day diet records collected from MADRAD study patients to gain insight into dietary phosphorus intakes and related dialysis patient clinical and sociodemographic characteristics (Chapter 3); and investigated dialysis patients’ perceptions of the renal diet, behaviors and attitudes of renal clinicians, and how they related to dietary adherence (Chapter 4).Methods: Study participants are enrolled in the Malnutrition, Diet, and Racial Disparities in Chronic Kidney Disease Study. In Chapter 2, primary analyses included examining the association between measures of dietary phosphorus intake (absolute intake, phosphorus/1000 kcal, and phosphorus-to-protein ratio), categorized into tertiles and quartiles, and all-cause mortality. In Chapter 3, primary analyses involved conducting logistic regression analyses to examine the association of sociodemographic, comorbidity, dialysis treatment, health insurance, and dietary intake characteristics with likelihood of above median dietary intakes of phosphorus-to-total-protein ratio, phosphorus-to-plant-protein ratio, phosphorus/1000 kcal, and plant-protein-to-total-protein ratio, respectively. In Chapter 4, a semi-structured interview was conducted with two male hemodialysis patients and their renal clinicians were also observed.Results: In Chapter 2, the lowest intakes of absolute dietary phosphorus intake, phosphorus/1000 kcal, and phosphorus-to-protein ratio were associated with mortality in unadjusted models and various models of expanded levels of adjustment. In expanded case-mix spline analyses that examined the association of daily dietary phosphorus as a continuous variable and mortality risk, there was a trend that daily dietary phosphorus intake in the lowest tertile was associated with higher death risk. In Chapter 3, I found that predictors of dietary phosphorus and protein intake included Black race, female sex, older age, and being single. In Chapter 4, I found that factors associated with patient dietary adherence included social support, self-efficacy, self-discipline, barriers, and cultural food norms. Renal clinicians were perceived as being supportive and encouraging in setting dietary goals and being accountable.Conclusion: The finding that lower dietary phosphorus intake in dialysis patients is associated with greater death risk contradicts current recommendations for dialysis patients to eat a low phosphorus diet. Intake of dietary phosphorus is related to many modifiable and non-modifiable patient characteristics, and dietary recommendations may need to be liberalized with a focus on more enjoyable unprocessed whole foods and reductions in added phosphorus
Obesity (Silver Spring)
Full text link20132014-03-01T00:00:00ZR01 DK078106/DK/NIDDK NIH HHS/United StatesUL1 TR000124/TR/NCATS NIH HHS/United States1142
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Endocrine disorders in kidney disease: Diagnosis and treatment
Full text linkThis comprehensive book examines the complex interplay between endocrine and kidney disorders, and how this inter-relationship impacts patients with chronic kidney disease. Authored by experts in areas of endocrinology and nephrology, chapters cover a variety of topics, including diabetes, metabolic syndrome, thyroid dysfunction, gonadal disorders, dyslipidemia, mineral bone disorders, obesity, and pituitary disorders. These comorbidities are thoroughly examined and provide the clinician, researcher, and trainee with a greater understanding of the impact of endocrine disorders on kidney disease patients, the ability to identify persistent gaps in knowledge for future investigation, and move closer towards the goal of improving the health and survival of the chronic kidney disease population
Association of Body Mass Index with Clinical Outcomes in Non-Dialysis-Dependent Chronic Kidney Disease: A Systematic Review and Meta-Analysis
Full text linkBackgroundPrevious studies have not shown a consistent link between body mass index (BMI) and outcomes such as mortality and kidney disease progression in non-dialysis-dependent chronic kidney disease (CKD) patients. Therefore, we aimed to complete a systematic review and meta-analysis study on this subject.MethodsWe searched MEDLINE, EMBASE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Controlled Trials (CENTRAL), and screened 7,123 retrieved studies for inclusion. Two investigators independently selected the studies using predefined criteria and assessed each study's quality using the Newcastle-Ottawa quality assessment scale. We meta-analyzed the results based on the BMI classification system by the WHO.ResultsWe included 10 studies (with a total sample size of 484,906) in the systematic review and 4 studies in the meta-analyses. The study results were generally heterogeneous. However, following reanalysis of the largest reported study and our meta-analyses, we observed that in stage 3-5 CKD, being underweight was associated with a higher risk of death while being overweight or obese class I was associated with a lower risk of death; however, obesity classes II and III were not associated with risk of death. In addition, reanalysis of the largest available study showed that a higher BMI was associated with an incrementally higher risk of kidney disease progression; however, this association was attenuated in our pooled results. For earlier stages of CKD, we could not complete meta-analyses as the studies were sparse and had heterogeneous BMI classifications and/or referent BMI groups.ConclusionAmong the group of patients with stage 3-5 CKD, we found a differential association between obesity classes I-III and mortality compared to the general population, indicating an obesity paradox in the CKD population
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