Seminars in Dialysis最新文献

We reported a rare case of peritoneal dialysis-associated peritonitis caused by Weissella confusa. In this case, the symptoms of peritonitis were insidious and atypical, with only turbid peritoneal dialysis effluent and no fever or abdominal pain. The peritoneal dialysis effluent showed slightly elevated leukocytes (predominantly lymphocytes). Weissella confusa was confirmed through repeated peritoneal dialysis effluent cultures. Gastroscopy revealed erosive gastritis with a hookworm infection. The patient recovered after antibiotic and deworming treatments. Our report highlights the unusual and atypical symptoms, characterized by insidious onset, turbid peritoneal dialysis fluid, and an absence of typical signs such as fever or abdominal pain.

Excessive dietary phosphorus is a concern among patients with kidney failure undergoing dialysis treatment because it may contribute to hyperparathyroidism and hyperphosphatemia. A long-standing but untested component of the low-phosphorus diet is the promotion of refined grains over whole grains. This paper reviews the scientific premise for restricting whole grains in the dialysis population and estimates phosphorus exposure from grain products based on three grain intake patterns modeled from reported intakes in the general US population, adjusting for the presence of phosphorus additives and phosphorus bioavailability: (1) standard grain intake, (2) 100% refined grain intake, and (3) mixed (50/50 whole and refined grain) intake. Although estimated phosphorus exposure from grains was higher with the mixed grain pattern (231 mg/day) compared to the 100% refined grain pattern (127 mg/day), the amount of additional phosphorus from grains was relatively low. Given the lack of strong evidence for restricting whole grains in people with CKD, as well as the potential health benefits of whole grains, clinical trials are warranted to address the efficacy and health impact of this practice.

Chronic kidney disease (CKD) affects 9.1% of the population worldwide. CKD may lead to structural and functional gastrointestinal alterations, including impairment in the intestinal barrier, digestion and absorption of nutrients, motility, and changes to the gut microbiome. These changes can lead to increased gastrointestinal symptoms in people with CKD, even in early grades of kidney dysfunction. Gastrointestinal symptoms have been associated with lower quality of life and reduced nutritional status. Therefore, there has been considerable interest in improving gastrointestinal health in this clinical population. Gastrointestinal health can be influenced by lifestyle and medications, particularly in advanced grades of kidney dysfunction. Therapies focused on gastrointestinal health have been studied, including the use of probiotics, prebiotics, and synbiotics, yielding limited and conflicting results. This review summarizes the alterations in the gastrointestinal tract structure and function and provides an overview of potential nutritional interventions that kidney disease professionals can provide to improve gastrointestinal health in individuals with CKD.

The role of nutrition in chronic kidney disease (CKD) is well known. However, controversies, misconceptions, and gaps in the literature exist regarding the workforce required to provide nutrition care in CKD. This paper reviews the existing literature on this topic, focusing primarily on the United States. Topics covered in this review include the qualifications and services of the registered dietitian nutritionist (RDN), to which specific patients nutrition care should be provided in CKD and on dialysis, barriers to the utilization of nutrition services, the quantity of nutrition care needed to improve patient outcomes, and the risks of provider burnout. Controversies include whether more staffing is associated with better care and the best measures of staffing. The topics are supported with estimations for the economic impact and practicality of workforce decisions.

Emerging research suggests that a more liberalized diet, specifically a more plant-based diet resulting in liberalization of potassium intake, for people receiving hemodialysis is necessary and the benefits outweigh previously thought risks. If the prescribed hemodialysis diet is to be liberalized, the need to illuminate and prevent potential pitfalls of a liberalized potassium diet is warranted. This paper explores such topics as partial to full adherence to a liberalized diet and its consequences if any, the advantages of a high-fiber intake, the theoretical risk of anemia when consuming a more plant-dominant diet, the potential benefits against renal acid load and effect on metabolic acidosis with increased fruit and vegetable intake, the putative change in serum potassium levels, carbohydrate quality, and the healthfulness of meat substitutes. The benefits of a more plant-based diet for the hemodialysis population are multifold; however, the possible pitfalls of this type of diet must be reviewed and addressed upon meal planning in order to be avoided.

Digital health is increasingly recognized for its value to enhance patient care and clinical care processes. People with chronic kidney disease often find dietary self-management challenging. There is promising evidence that digital health interventions can support people with chronic kidney disease to self-manage their diet, by providing more frequent access to nutritional information and dietitians and by facilitating regular monitoring and feedback. There is some emerging evidence of the impact of digital interventions in chronic kidney disease; however, more research is needed to provide meaningful interpretation of how digital interventions can enhance current practice. Importantly, a number of factors need to be considered when designing, developing, implementing, and evaluating the impact of digital interventions. Consideration of the nutrition service and patients' needs, motivation and digital literacy, type of digital intervention, and the ability to embed the digital intervention into current care processes are critical. This paper overviews the current literature on digital health and self-management, factors to consider when embedding digital interventions and platforms into nutrition care and practical considerations for designing and implementing digital health interventions to enhance the nutritional care of people with chronic kidney disease.

Dietetic practice aims to help people modify their diet to slow disease progression and manage disease-related complications while also meeting their nutritional and personal dietary needs. This can be challenging in people with kidney failure undergoing dialysis, particularly in our current food environment and culture. Fortunately, advancements in nutritional-behavioral science and technology are providing new avenues and resources to help meet the challenge. However, progress is slow, and much of dietetic practice in the dialysis population still relies on the interpretation, translation, and application of low-quality, indirect evidence. This Special Issue of Seminars in Dialysis provides readers with an update on and critical insights into some of the major issues and controversies impacting the field of kidney nutrition today.

Ultraprocessed foods can be a source of potassium additives. Excess potassium consumption can lead to hyperkalemia. How frequently potassium additives are found in the food supply and how they impact potassium content is not well documented. Using the Branded Product Database, ingredient lists were searched for "potassium" to identify products containing additives. For products listing potassium content, accuracy of potassium content reporting and how potassium content differed with additive use was also assessed. A total of 239,089 products were included, 35,102 (14.7%) contained potassium additives, and 13,685 (5.7%) provided potassium content. Potassium additives were most commonly found in dairy products, supplements, and mixed foods (at 37%, 34%, and 28%, respectively). Potassium additives in mixed foods and vegetables and fruits were associated with 71% and 28% more potassium per serving, respectively (p < 0.01). Potassium content increased by 1874 mg (66%) when a 1-day sample menu compared foods with and without additives. Potassium content of foods with and without additives is not well documented. Potassium additives are prevalent and can be associated with increased potassium content. However, more information is needed to better understand how different additives used in different foods change potassium content.

Athletes and fitness enthusiasts are often encouraged to follow high-protein diets to optimize muscle protein synthesis, modify body composition, and enhance performance, yet the safety of these higher protein intakes has been debated. Many people with kidney dysfunction are unaware of their condition, and the potential harm of excess protein intake on the kidneys may not be adequately reported in the sports nutrition literature. Studies suggesting that high-protein intake may be associated with incident kidney disease have led the nephrology community to make conservative recommendations. In contrast, the fitness community suggests that high dietary protein intake is safe and poses no risk of kidney injury. These claims often fail to acknowledge limitations in the internal validity and generalizability of the study results, despite many studies not being adequately powered to support such claims. It is essential to make dietary recommendations that consider the totality of the data and follow the ethical norm of "do no harm." Studies that evaluate the use of high-protein diets among athletes must consider the balance of efficacy with safety. While an intervention may be safe in one population, it does not mean that safety can be assumed for all groups.