Journal of Renal Nutrition最新文献

Background and aims: The effects of alpha-lipoic acid (ALA) supplementation on cardiovascular-related factors have been evaluated in a number of randomized clinical trials (RCTs), with different results. Thus, in this meta-analysis, the effects of ALA on blood levels of inflammatory, lipid, and hematological markers as well as anthropometric indices in patients with chronic kidney disease (CKD) were evaluated.

Methods: Five electronic databases were used to conduct a comprehensive search through October 2023. Risk of bias assessment and data extraction were carried out separately by two reviewers on the included papers. The data were analyzed using the random-effects model in meta-analyses. The data were analyzed using the random-effects model in meta-analyses. We assessed inter-study heterogeneity with I² and Cochran's Q test.

Results: Nine of the 421 potential reports were included. Using random-effects models, no significant changes were observed in weight loss, body mass index (BMI), hemoglobin (Hb), and iron (Fe) following ALA supplementation (600 mg/day). Results exhibited that ALA significantly reduced hs-CRP levels in individuals with CKD (weighted mean difference (WMD) = -2.91 mg/L, 95% CI: -4.65, -1.17, I² = 50.5%, P = 0.09), however, there were no significant variations in levels of interleukin-6 (IL-6) or malondialdehyde (MDA). Regarding lipid profiles, findings revealed that ALA administration had no significant impact on HDL-C and TG levels among patients with CKD. However, compared to the control group, TC levels were considerably lower in CKD patients (WMD = -5.48 mg/dL, 95% CI: -10.55, -0.41, I² = 0.0%, P = 0.50). Moreover, the sensitivity analyses showed that pooled WMDs for LDL-C levels were significantly changed (-6.88 mg/dL, 95% CI, -12.78, -0.98).

Conclusions: These findings revealed that ALA supplementation slightly but significantly reduced blood levels of hs-CRP, TC, and LDL-C, but did not affect IL-6, MDA, HDL-C, weight, BMI, Fe, and Hb in patients with CKD.

Objective: Although it is known that diet quality affects psychological problems in hemodialysis patients, there is need to explain the role of modifiable risk factors in this relationship. Therefore, the aim of this study was a) to investigate the relationship between diet quality and modifiable risk factors to depression and anxiety in end-stage renal disease (ESRD) patients receiving maintenance hemodialysis; b) to explore the mediating roles of modifiable factors in the relationship with diet quality to depression and anxiety.

Methods: This cross-sectional study included 216 patients with ESRD receiving maintenance hemodialysis treatment. We assessed participants' dietary records for Mediterranean-DASH Diet Intervention for Neurodegenerative Delay (MIND) quality, Global Leadership Initiative on Malnutrition (GLIM) criteria for malnutrition and Hospital Anxiety and Depression (HAD)-scale for psychological problems. Furthermore, biochemical findings and anthropometric measurements were performed to evaluate nutritional markers, metabolic risk factors and inflammation. We applied hierarchical regression analysis to estimate modifiable risk factors for depression and anxiety and Structural-Equation-Modeling analysis to determine the mediating role of modifiable risk factors between diet quality and psychological problems.

Results: Depression symptoms were observed in 59.2% (n=128) of the participants, whilst the rate was 35.1% (n=76) for anxiety. Depression and anxiety were found to be negatively correlated with MIND levels after covariate adjusting model, and the rates of explanation were found to be 16.2% and 12.2%, respectively. C-reactive protein (CRP), albumin levels and the presence of malnutrition were shown to be significant predictors of depression (ΔF=14.761 and ΔR²:0.071 for covariate-adjusted model). Albumin levels, CRP, hemodialysis duration, and malnutrition were found to be independent predictors of anxiety (ΔF=16.174 and ΔR²:0.077 for covariate-adjusted model). It was found that CRP and malnutrition partially mediated the association of MIND score with depression, and CRP mediated the association with anxiety.

Conclusion: It was concluded that adherence to the MIND diet is associated with a better nutritional profile and reduced inflammation, which in turn may be linked to fewer psychological problems.These further studies are needed to validate and expand upon our findings.

Objective: This study was designed to determine the effect of 16 weeks of supplementation with Hi-maize 260 resistant starch (RS) on the gut microbiota, uremic toxins (indoxyl sulfate and p-cresyl sulfate [PCS]), markers of inflammation, and oxidative stress along with vascular function in patients with stage G3a-G4 chronic kidney disease (CKD).

Design and methods: This was a double-blind, placebo-controlled, parallel-arm, randomized controlled trial. Sixty-eight patients with stage-G3a-G4 CKD were randomized to either RS with usual care or placebo and usual care. Patients attended four testing sessions as follows: two baseline (BL) visits and follow-up visits at 8 and 16 weeks. Fasting blood samples, resting brachial and central blood pressures, along with arterial stiffness, were collected at visits (1 or 2) and weeks 8 and 16. A stool sample was collected for analysis of microbial composition at BL and week 16. Patients were randomized after the BL visits.

Results: Patients receiving the RS had a reduction in PCS at week 16. This reduction was associated with a decrease in microbial α-diversity between BL and week 16 (Chao1 P = .014, Shannon P = .017, phylogenetic diversity P = .046, and Simpson P = .017) as well as increases in Subdoligranulum (P = .03) and Oscillospiraceae Unclassified Clostridiales Group 002 (P = .02) and decreases in Bacteroides (P = .009).There were no changes in microbial beta diversity and other biomarkers or markers of vascular function following the 16-week period.

Conclusion: Sixteen weeks of supplementation of RS in patients with stage-G3a-G4 CKD led to changes in microbial composition that were associated with a significant reduction in PCS.

The measurement of urinary sodium excretion provides valuable information about an individual's sodium balance and can help in the management of various medical conditions. However, the collection of 24-hour urine samples is subject to errors. Spot urine sodium (uNa) measurements are a reliable alternative to 24-hour urine collections for estimating urinary sodium excretion.

Objective: To assess whether 24-h urinary sodium excretion (24uNa) can be estimated from spot samples in adult patients who attend hospital clinics.

Design: Methods: A cross-sectional study with a development (284 patients) and a validation cohort (229 patients) was conducted at our hospital. A multivariate linear regression model was built which was compared with former models. Concordance analyses and comparison of the ability to correctly classify each patient against a prespecified uNa cut-off value of 130 mmol/24h were performed, assessed by the C-statistic.

Results: The model was well calibrated (slope [95%CI] in internal validation: 0.965 [0.947-0.987], showing good discrimination, and performed robustly in an external validation cohort (slope: 0.811 [0.675-0.946]). The mean bias between the measured and the estimated 24uNa by NaRYC was 24.85 mmol/24h [17.06-32.63]. The NaRYC had the highest values of Pearson coefficient (0.613 p<0.0001), accuracy (P30): 56.8%, and AUC-ROC: 0.822 [0.766-0.869] as compared to other seven equations.

Conclusion: Although the mean bias of the results is quite acceptable, the variability observed in the 95%CI makes not recommend the general use of a spot as a substitute of the 24-hour urine in order to estimate the total urine excretion of Na in a single subject basis.

Objectives: The rising diversity of food preferences and the desire to provide better personalized care provide challenges to renal dietitians working in dialysis clinics. To address this situation, we explored the use of a large language model, specifically, ChatGPT using the GPT-4 model (openai.com), to support nutritional advice given to dialysis patients.

Methods: We tasked ChatGPT-4 with generating a personalized daily meal plan, including nutritional information. Virtual "patients" were generated through Monte Carlo simulation; data from a randomly selected virtual patient were presented to ChatGPT. We provided to ChatGPT patient demographics, food preferences, laboratory data, clinical characteristics, and available budget, to generate a one-day sample menu with recipes and nutritional analyses. The resulting daily recipe recommendations, cooking instructions, and nutritional analyses were reviewed and rated on a five-point Likert scale by an experienced renal dietitian. In addition, the generated content was rated by a renal dietitian and compared with a U. S. Department of Agriculture-approved nutrient analysis software. ChatGPT also analyzed nutrition information of two recipes published online. We also requested a translation of the output into Spanish, Mandarin, Hungarian, German, and Dutch.

Results: ChatGPT generated a daily menu with five recipes. The renal dietitian rated the recipes at 3 (3, 3) [median (Q1, Q3)], the cooking instructions at 5 (5,5), and the nutritional analysis at 2 (2, 2) on the five-point Likert scale. ChatGPT's nutritional analysis underestimated calories by 36% (95% CI: 44-88%), protein by 28% (25-167%), fat 48% (29-81%), phosphorus 54% (15-102%), potassium 49% (40-68%), and sodium 53% (14-139%). The nutritional analysis of online available recipes differed only by 0 to 35%. The translations were rated as reliable by native speakers (4 on the five-point Likert scale).

Conclusion: While ChatGPT-4 shows promise in providing personalized nutritional guidance for diverse dialysis patients, improvements are necessary. This study highlights the importance of thorough qualitative and quantitative evaluation of artificial intelligence-generated content, especially regarding medical use cases.

Objective: Dietary restrictions are common in patients undergoing hemodialysis (HD). These restrictions result in a complex diet that becomes difficult for patients to understand and to follow. Therefore, we aimed to identify dietary needs, barriers, and facilitators that influence the adherence to dietary recommendations as perceived by patients on HD and their caregivers.

Methods: Seventy-two Spanish patients on HD and 57 caregivers participated in this explorative study by replying a questionnaire consisting of 20 and 10 questions respectively. The responses were assessed using a Likert scale varying from 1 to 5 (strongly agree, agree, neither disagree or disagree, disagree, strongly disagree, respectively) to evaluate the perception of patients and caregivers regarding dietary needs, barriers, and facilitators to adhere to the recommended diet. For analysis purposes, the responses were grouped in 3 categories (agree, neither agree or disagree, disagree).

Results: Seventy percent of the patients agreed that knowing the food sources of potassium, protein and phosphate was a need for them to know to be able to adhere to the dietary recommendations. Moreover, patients stated that not being able to eat what they liked, and feeling thirsty, were important barriers. For caregivers, the support of a renal dietitian was mentioned as an important facilitator to assist those they cared for to adhere to the diet.

Conclusions: Knowing food sources of potassium, phosphate, and protein, exploring foods patients like to eat and adjusting fluid intake to avoid feeling thirsty were identified as important by the patients. These findings can be used to develop strategies and educational material to improve the dietary adherence in patients undergoing HD. Moreover, the presence of a renal dietitian was identified as an important resource by the caregivers.