Postexercise vagal dysfunction is linked to noncardiovascular mortality in hemodialysis patients, but the mechanism is unknown. This study aimed to determine the association of cardiovagal neuropathy with systemic inflammation, protein-energy wasting, and noncardiovascular hospitalization.
Methods
This 2-center retrospective cohort study analyzed data from 280 hemodialysis patients who underwent exercise test. Patients were assessed for heart rate (HR) recovery (bpm) for 1 minute after exercise, a marker of vagal function, and were divided into 3 categories (Low: ≤ 6, Mid: 7-11, High: ≥ 12 bpm). We followed 1-year changes in the systemic inflammation-based prognostic score (Glasgow Prognostic Score [GPS]), body weight, and creatinine generation rate (CGR), an indicator of muscle mass, as well as 2-year hospitalization.
Results
The HR recovery category was associated with serum C-reactive protein and albumin levels and GPS. After 1 year, the low HR recovery category was associated with worsening in GPS (low, 0 [0-0.5]; mid, 0 [0-1]; high, 0 [0-0]), weight (low, 100.0 [96.1-102.5]; mid, 101.3 [98.9-105.0]; high, 100.5 [98.2-102.9]%), and CGR (low, 97.0 [88.5-111.4]; mid, 110.2 [90.9-124.8]; high, 106.2 [95.5-115.5]%), and the correlations with GPS and CGR remained consistent after adjusting for confounders such as exercise capacity and hospitalization during the follow-up period. There were 117 patients hospitalized. Compared to the high HR recovery category, the mid (hazard ratio: 1.8, 95% confidence interval [CI]: 1.1-3.1, P = .02) and low (hazard ratio: 2.4, 95% CI: 1.5-4.0, P = .001) categories were independently associated with an increased risk of all-cause hospitalization. For noncardiovascular disease hospitalization, the low HR recovery category was independently associated with increased risk of hospitalization (hazard ratio: 2.1, 95% CI: 1.2-3.7, P = .007).
Conclusions
Vagal neuropathy in this population can contribute to adverse outcomes associated with systemic inflammation and protein-energy wasting.
背景:运动后迷走神经功能障碍与血液透析患者的非心血管死亡率有关，但其机制尚不清楚。本研究旨在确定心血管神经病变与全身性炎症、蛋白质-能量消耗(PEW)和非心血管住院的关系。方法:本双中心回顾性队列研究分析了280例接受运动试验的血液透析患者的资料。评估患者运动后1分钟的心率(HR)恢复(bpm)，这是迷走神经功能的标志，并将其分为三类(低:≤6，中:7-11，高:≥12 bpm)。我们随访了1年的系统性炎症预后评分(格拉斯哥预后评分，GPS)、体重和肌酐生成率(肌肉质量指标)的变化，以及2年的住院情况。结果:HR恢复类别与血清c反应蛋白和白蛋白水平及GPS相关。一年后，低心率恢复类别与GPS恶化相关(低，0 [0-0.5];中，0 [0-1];高，0[0-0])，重(低，100.0 [96.1-102.5];Mid, 101.3 [98.9-105.0];高,100.5 (98.2 - -102.9)%),CGR(低,97.0 (88.5 - -111.4);Mid, 110.2 [90.9-124.8];高，106.2[95.5-115.5]%)，在调整了运动能力和随访期间住院等混杂因素后，与GPS和CGR的相关性保持一致。117名患者住院治疗。与高HR恢复类别相比，中(风险比:1.8,95% CI: 1.1-3.1, p = 0.02)和低(风险比:2.4,95% CI: 1.5-4.0, p = 0.001)类别与全因住院风险增加独立相关。对于非心血管疾病住院，低HR恢复类别与住院风险增加独立相关(风险比:2.1,95% CI: 1.2-3.7, p = 0.007)。结论:该人群的迷走神经病变可导致与全身性炎症和PEW相关的不良结果。
{"title":"Association of Postexercise Vagal Dysfunction With Protein-Energy Wasting and Noncardiovascular Outcomes in Patients Receiving Hemodialysis: A Retrospective Cohort Study","authors":"Naoto Usui RPT, MSc , Junichiro Nakata MD, PhD , Akimi Uehata MD, PhD , Sho Kojima RPT, MSc , Hideki Hisadome MD , Shuji Ando PhD , Masakazu Saitoh RPT, PhD , Akihito Inatsu MD, PhD , Takahiko Tsuchiya MD , Takayuki Mawatari MD , Yusuke Suzuki MD, PhD","doi":"10.1053/j.jrn.2023.11.005","DOIUrl":"10.1053/j.jrn.2023.11.005","url":null,"abstract":"<div><h3>Objective</h3><p>Postexercise vagal dysfunction is linked to noncardiovascular mortality in hemodialysis patients, but the mechanism is unknown. This study aimed to determine the association of cardiovagal neuropathy with systemic inflammation, protein-energy wasting, and noncardiovascular hospitalization.</p></div><div><h3>Methods</h3><p>This 2-center retrospective cohort study analyzed data from 280 hemodialysis patients who underwent exercise test. Patients were assessed for heart rate (HR) recovery (bpm) for 1 minute after exercise, a marker of vagal function, and were divided into 3 categories (Low: ≤ 6, Mid: 7-11, High: ≥ 12 bpm). We followed 1-year changes in the systemic inflammation-based prognostic score (Glasgow Prognostic Score [GPS]), body weight, and creatinine generation rate (CGR), an indicator of muscle mass, as well as 2-year hospitalization.</p></div><div><h3>Results</h3><p>The HR recovery category was associated with serum C-reactive protein and albumin levels and GPS. After 1 year, the low HR recovery category was associated with worsening in GPS (low, 0 [0-0.5]; mid, 0 [0-1]; high, 0 [0-0]), weight (low, 100.0 [96.1-102.5]; mid, 101.3 [98.9-105.0]; high, 100.5 [98.2-102.9]%), and CGR (low, 97.0 [88.5-111.4]; mid, 110.2 [90.9-124.8]; high, 106.2 [95.5-115.5]%), and the correlations with GPS and CGR remained consistent after adjusting for confounders such as exercise capacity and hospitalization during the follow-up period. There were 117 patients hospitalized. Compared to the high HR recovery category, the mid (hazard ratio: 1.8, 95% confidence interval [CI]: 1.1-3.1, <em>P</em> = .02) and low (hazard ratio: 2.4, 95% CI: 1.5-4.0, <em>P</em> = .001) categories were independently associated with an increased risk of all-cause hospitalization. For noncardiovascular disease hospitalization, the low HR recovery category was independently associated with increased risk of hospitalization (hazard ratio: 2.1, 95% CI: 1.2-3.7, <em>P</em> = .007).</p></div><div><h3>Conclusions</h3><p>Vagal neuropathy in this population can contribute to adverse outcomes associated with systemic inflammation and protein-energy wasting.</p></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"34 4","pages":"Pages 321-329"},"PeriodicalIF":3.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138435368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1053/j.jrn.2023.12.003
Brett Tarca PhD , Shilpanjali Jesudason MD, PhD , Paul N. Bennett PhD , Thomas P. Wycherley PhD , Katia E. Ferrar PhD
Objective
People receiving peritoneal dialysis may receive health benefits from physical activity or exercise. However, on-going uncertainty and fear regarding safety may result in this population missing out on the health benefits of participation. The aim of this study was to explore the characteristics and frequency of physical activity and/or exercise-related side effects (e.g., symptoms such as pain or shortness of breath) and negative health events (e.g., stroke or hyper/hypoglycemia) experienced by people receiving peritoneal dialysis.
Methods
An international online survey involving adults receiving peritoneal dialysis was conducted with questions related to nature, occurrence, and impact of side effects and/or negative health events experienced during or soon after participation in physical activity or exercise.
Results
Fifty-two people completed the survey reporting 151 side effects that were related to physical activity and exercise and 67 that were possibly related. Fatigue (58% of respondents), muscle/joint soreness or pain (54%), and dizziness (43%) were the most frequently reported side-effect types. The majority occurred occasionally (58% of all side effects), if not rarely (24%) and participation in on-going physical activity or exercise was typically prevented only occasionally (39%) or not at all (31%). Side effects were mainly self-managed (54% of all side effects) or did not require treatment (19%) and had low (38%) or no effect (30%) on ability to do daily activities.
Conclusions
People receiving peritoneal dialysis generally experience side effects that can be considered a normal response to physical activity or exercise engagement. Furthermore, the risk of serious or peritoneal dialysis-specific side effects as a result of physical activity or exercise appears to be low. The results add to the emerging evidence suggesting physical activity and exercise appear to be safe for people receiving peritoneal dialysis.
{"title":"Characteristics and Frequency of Physical Activity and Exercise-Related Side Effects in People Receiving Peritoneal Dialysis","authors":"Brett Tarca PhD , Shilpanjali Jesudason MD, PhD , Paul N. Bennett PhD , Thomas P. Wycherley PhD , Katia E. Ferrar PhD","doi":"10.1053/j.jrn.2023.12.003","DOIUrl":"10.1053/j.jrn.2023.12.003","url":null,"abstract":"<div><h3>Objective</h3><p>People receiving peritoneal dialysis<span> may receive health benefits from physical activity or exercise. However, on-going uncertainty and fear regarding safety may result in this population missing out on the health benefits of participation. The aim of this study was to explore the characteristics and frequency of physical activity and/or exercise-related side effects (e.g., symptoms such as pain or shortness of breath) and negative health events (e.g., stroke or hyper/hypoglycemia) experienced by people receiving peritoneal dialysis.</span></p></div><div><h3>Methods</h3><p>An international online survey involving adults receiving peritoneal dialysis was conducted with questions related to nature, occurrence, and impact of side effects and/or negative health events experienced during or soon after participation in physical activity or exercise.</p></div><div><h3>Results</h3><p>Fifty-two people completed the survey reporting 151 side effects that were related to physical activity and exercise and 67 that were possibly related. Fatigue (58% of respondents), muscle/joint soreness or pain (54%), and dizziness<span> (43%) were the most frequently reported side-effect types. The majority occurred occasionally (58% of all side effects), if not rarely (24%) and participation in on-going physical activity or exercise was typically prevented only occasionally (39%) or not at all (31%). Side effects were mainly self-managed (54% of all side effects) or did not require treatment (19%) and had low (38%) or no effect (30%) on ability to do daily activities.</span></p></div><div><h3>Conclusions</h3><p>People receiving peritoneal dialysis generally experience side effects that can be considered a normal response to physical activity or exercise engagement. Furthermore, the risk of serious or peritoneal dialysis-specific side effects as a result of physical activity or exercise appears to be low. The results add to the emerging evidence suggesting physical activity and exercise appear to be safe for people receiving peritoneal dialysis.</p></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"34 4","pages":"Pages 359-367"},"PeriodicalIF":3.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138818797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1053/j.jrn.2023.12.002
Rachel Lindeback BND Hons , Rasha Abdo MND, B Nutr Sci , Lyndal Schnabel MND, B Nutr Sci , Renee Le Jambre BND , Sean E. Kennedy MBBS, PhD , Tamarah Katz MSc, Nutr and Diet , Chee Y. Ooi MBBS, Dip Paeds, PhD , Kelly Lambert Adv APD, PhD, BSci, MSc, Grad Cert Mgmt, Grad Cert Health Economics
Objective
Children with chronic kidney disease (CKD) experience many obstacles to achieving optimal dietary intake. Dietary intake patterns remain unexplored or poorly described. This study compares nutritional intake and diet quality of Australian children with CKD to controls.
Methods
A food frequency questionnaire captured intake data and was compared to controls. Nutritional intake was determined using individualized nutrient reference values, and diet quality described using the Australian Guide to Healthy Eating and the Australian Child and Adolescent Recommended Food Score.
Results
Children with CKD (n = 36) and controls (n = 82) were studied. Children with CKD had lower weight and height z scores, but higher body mass index (P < .0001 for all parameters). Children with CKD had adequate energy intake, and excessive protein and sodium intake (336% and 569%). They were significantly less likely to meet requirements for vitamin A (P < .001), thiamine (P = .006), folate (P = .01), vitamin C (P = .008), calcium (P < .0001), iron (P = .01), magnesium (P = .0009), and potassium (P = .002). No child met recommended vegetable intake; however, less than half of children with CKD met fruit (44%), grains (31%), and dairy serves (31%). They were also less likely to meet recommended fruit and dairy serves (P = .04 and P = .01, respectively). Non-core foods provided 36% of energy, and although comparable to controls, was contributed more by takeaway foods (P = .01).
Conclusion
Children with CKD have reduced nutritional intake of key nutrients and consume more takeaways than controls. Attention to increasing core foods, limiting sodium intake, and managing restrictions while promoting nutrient density appears necessary.
目标患有慢性肾脏病（CKD）的儿童在实现最佳膳食摄入量方面遇到许多障碍。膳食摄入模式仍未被探索或描述不清。本研究将澳大利亚慢性肾脏病儿童的营养摄入量和饮食质量与对照组进行了比较。营养摄入量采用个体化营养素参考值确定，饮食质量采用《澳大利亚健康饮食指南》和《澳大利亚儿童和青少年推荐食物评分》进行描述。患有慢性肾脏病的儿童体重和身高 z 分数较低，但体重指数较高（所有参数的 p 均为 0.0001）。患有慢性肾脏病的儿童能量摄入充足，但蛋白质和钠摄入过多（336% 和 569%）。他们达到维生素 A (p<0.001)、硫胺素 (p=0.006)、叶酸 (p=0.01)、维生素 C (p=0.008)、钙 (p=<0.0001)、铁 (p=0.01)、镁 (p= 0.0009) 和钾 (p= 0.002) 要求的可能性明显较低。没有儿童达到推荐的蔬菜摄入量，但不到一半的慢性肾脏病患儿达到了水果（44%）、谷物（31%）和奶制品（31%）的摄入量。他们达到推荐水果和奶制品摄入量的可能性也较低（p= 0.04 和 p= 0.01）。结论与对照组相比，患有慢性肾脏病的儿童主要营养素摄入量减少，外卖摄入量增加。看来有必要注意增加核心食物、限制钠摄入量和管理限制，同时提高营养密度。
{"title":"Does the Nutritional Intake and Diet Quality of Children With Chronic Kidney Disease Differ From Healthy Controls? A Comprehensive Evaluation","authors":"Rachel Lindeback BND Hons , Rasha Abdo MND, B Nutr Sci , Lyndal Schnabel MND, B Nutr Sci , Renee Le Jambre BND , Sean E. Kennedy MBBS, PhD , Tamarah Katz MSc, Nutr and Diet , Chee Y. Ooi MBBS, Dip Paeds, PhD , Kelly Lambert Adv APD, PhD, BSci, MSc, Grad Cert Mgmt, Grad Cert Health Economics","doi":"10.1053/j.jrn.2023.12.002","DOIUrl":"10.1053/j.jrn.2023.12.002","url":null,"abstract":"<div><h3>Objective</h3><p>Children with chronic kidney disease (CKD) experience many obstacles to achieving optimal dietary intake. Dietary intake patterns remain unexplored or poorly described. This study compares nutritional intake and diet quality of Australian children with CKD to controls.</p></div><div><h3>Methods</h3><p>A food frequency questionnaire captured intake data and was compared to controls. Nutritional intake was determined using individualized nutrient reference values, and diet quality described using the Australian Guide to Healthy Eating and the Australian Child and Adolescent Recommended Food Score.</p></div><div><h3>Results</h3><p>Children with CKD (n = 36) and controls (n = 82) were studied. Children with CKD had lower weight and height z scores, but higher body mass index (<em>P</em> < .0001 for all parameters). Children with CKD had adequate energy intake, and excessive protein and sodium intake (336% and 569%). They were significantly less likely to meet requirements for vitamin A (<em>P</em> < .001), thiamine (<em>P</em> = .006), folate (<em>P</em> = .01), vitamin C (<em>P</em> = .008), calcium (<em>P</em> < .0001), iron (<em>P</em> = .01), magnesium (<em>P</em> = .0009), and potassium (<em>P</em> = .002). No child met recommended vegetable intake; however, less than half of children with CKD met fruit (44%), grains (31%), and dairy serves (31%). They were also less likely to meet recommended fruit and dairy serves (<em>P</em> = .04 and <em>P</em> = .01, respectively). Non-core foods provided 36% of energy, and although comparable to controls, was contributed more by takeaway foods (<em>P</em> = .01).</p></div><div><h3>Conclusion</h3><p>Children with CKD have reduced nutritional intake of key nutrients and consume more takeaways than controls. Attention to increasing core foods, limiting sodium intake, and managing restrictions while promoting nutrient density appears necessary.</p></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"34 4","pages":"Pages 283-293"},"PeriodicalIF":3.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1051227623002297/pdfft?md5=2cba3846729aacbf3ff6e2854082d078&pid=1-s2.0-S1051227623002297-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138818817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1053/j.jrn.2023.12.007
Alana Caroline Amorim de Miranda Guimarães Msc , Dejane de Almeida Melo Msc , Victor Nogueira da Cruz Nogueira da Cruz Silveira Msc , Marcos Adriano Garcia Campos MD , Elisângela Milhomem dos Santos PhD , Ana Karina Teixeira da Cunha França PhD , Alcione Miranda dos Santos PhD
Objectives
The prevalence of obesity in the population has increased and excess body adiposity is one of the main nutritional disorders in patients with chronic kidney disease (CKD) on hemodialysis (HD). The objective of this study was to develop equations using anthropometric measurements to predict the total and abdominal body adiposity of patients with CKD on HD.
Methods
This is a cross-sectional study evaluating 323 patients with CKD on HD in city in northeastern Brazil. Measurements and anthropometric indicators were correlated with percentage of body fat (%BF) and visceral fat (VF, in kg) measured by dual energy X-ray absorptiometry. Multiple linear regression models based on different combinations of anthropometric measurements were adjusted to develop the equations, with subsequent cross-validation.
Results
Of the 323 patients, 62.2% were male and 46.5% were aged between 40 and 59 years. The equation selected to estimate %BF included weight, height, waist and hip circumferences, and triceps and suprailiac skin folds, presenting high predictive capacity (R2 = 0.771). The equation selected to estimate VF included weight, height, waist circumference, hip circumference, and sum of skin folds (R22 = 0.796).
Conclusions
The proposed equations efficiently predicted the %BF and VF (kg) of patients with CKD on HD, thereby serving as viable indicators in clinical practice.
{"title":"Equations for Prediction of Body Adiposity in Patients With Chronic Kidney Disease Undergoing Hemodialysis","authors":"Alana Caroline Amorim de Miranda Guimarães Msc , Dejane de Almeida Melo Msc , Victor Nogueira da Cruz Nogueira da Cruz Silveira Msc , Marcos Adriano Garcia Campos MD , Elisângela Milhomem dos Santos PhD , Ana Karina Teixeira da Cunha França PhD , Alcione Miranda dos Santos PhD","doi":"10.1053/j.jrn.2023.12.007","DOIUrl":"10.1053/j.jrn.2023.12.007","url":null,"abstract":"<div><h3>Objectives</h3><p>The prevalence of obesity in the population has increased and excess body adiposity is one of the main nutritional disorders in patients with chronic kidney disease (CKD) on hemodialysis (HD). The objective of this study was to develop equations using anthropometric measurements to predict the total and abdominal body adiposity of patients with CKD on HD.</p></div><div><h3>Methods</h3><p>This is a cross-sectional study evaluating 323 patients with CKD on HD in city in northeastern Brazil. Measurements and anthropometric indicators were correlated with percentage of body fat (%BF) and visceral fat (VF, in kg) measured by dual energy X-ray absorptiometry. Multiple linear regression models based on different combinations of anthropometric measurements were adjusted to develop the equations, with subsequent cross-validation.</p></div><div><h3>Results</h3><p>Of the 323 patients, 62.2% were male and 46.5% were aged between 40 and 59 years. The equation selected to estimate %BF included weight, height, waist and hip circumferences, and triceps and suprailiac skin folds, presenting high predictive capacity (R<sup>2</sup> = 0.771). The equation selected to estimate VF included weight, height, waist circumference, hip circumference, and sum of skin folds (R2<sup>2</sup> = 0.796).</p></div><div><h3>Conclusions</h3><p>The proposed equations efficiently predicted the %BF and VF (kg) of patients with CKD on HD, thereby serving as viable indicators in clinical practice.</p></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"34 4","pages":"Pages 343-349"},"PeriodicalIF":3.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139583100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1053/j.jrn.2023.12.001
Merve Güner MD , Sinem Girgin MD , Serdar Ceylan MD , Berşan Özcan MD , Yelda Öztürk MD , Arzu Okyar Baş MD , Meltem Koca MD , Cafer Balcı , Burcu Balam Doğu , Mustafa Cankurtaran , Tolga Yıldırım , Meltem Halil
Background
Sarcopenia and malnutrition are commonly seen and fundamental indicators of prognosis and are directly associated with increased mortality in maintenance hemodialysis (MHD) patients. We aimed to reveal the frequency of malnutrition and sarcopenia in patients undergoing MHD and investigate the role of muscle ultrasound (US) parameters to predict sarcopenia and malnutrition.
Methods
A total of 45 patients who have undertaken MHD for more than 6 months three times a week were evaluated for the present study. The US measurement was performed on gastrocnemius medialis, rectus femoris (RF), and abdominal muscles, including rectus abdominis, external oblique abdominalis, internal oblique abdominalis, and transversus abdominis. Nutritional status of the participants was assessed by mini-nutritional assessment short-form (MNA-SF).
Results
The prevalence of probable and confirmed sarcopenia was 51.1% (n = 23) and 35.6% (n = 16), respectively. The malnutrition and risk of malnutrition were observed in 31.1% of the whole study population (n = 14). All muscle US measurements were lower in the sarcopenic group; however, the difference is meaningful only for RF cross-sectional area (CSA) (P = .046). The malnourished group had substantially lower muscle thickness and CSA, except for the gastrocnemius muscle thickness. The value of RFCSA to predict sarcopenia and malnutrition was observed as 4.61 cm2, respectively (P < .05). RFCSA was independently associated with sarcopenia (odds ratio: 0.37; 95% confidence interval: 0.17-0.79; P = .011) and malnutrition (odds ratio: 0.45; 95% confidence interval: 0.23-0.87; P = .017).
Conclusion
RFCSA may be a useful and simple predictor for predicting patients undergoing hemodialysis who are at risk of sarcopenia and malnutrition.
{"title":"The Role of Muscle Ultrasonography to Diagnose Malnutrition and Sarcopenia in Maintenance Hemodialysis","authors":"Merve Güner MD , Sinem Girgin MD , Serdar Ceylan MD , Berşan Özcan MD , Yelda Öztürk MD , Arzu Okyar Baş MD , Meltem Koca MD , Cafer Balcı , Burcu Balam Doğu , Mustafa Cankurtaran , Tolga Yıldırım , Meltem Halil","doi":"10.1053/j.jrn.2023.12.001","DOIUrl":"10.1053/j.jrn.2023.12.001","url":null,"abstract":"<div><h3>Background</h3><p>Sarcopenia<span><span><span> and malnutrition are commonly seen and fundamental indicators of prognosis and are directly associated with increased mortality in maintenance hemodialysis (MHD) patients. We aimed to reveal the frequency of malnutrition and sarcopenia </span>in patients undergoing MHD and investigate the role of </span>muscle ultrasound (US) parameters to predict sarcopenia and malnutrition.</span></p></div><div><h3>Methods</h3><p>A total of 45 patients who have undertaken MHD for more than 6 months three times a week were evaluated for the present study. The US measurement was performed on gastrocnemius medialis, rectus femoris (RF), and abdominal muscles, including rectus abdominis, external oblique abdominalis, internal oblique abdominalis, and transversus abdominis. Nutritional status of the participants was assessed by mini-nutritional assessment short-form (MNA-SF).</p></div><div><h3>Results</h3><p>The prevalence of probable and confirmed sarcopenia was 51.1% (n = 23) and 35.6% (n = 16), respectively. The malnutrition and risk of malnutrition were observed in 31.1% of the whole study population (n = 14). All muscle US measurements were lower in the sarcopenic group; however, the difference is meaningful only for RF cross-sectional area (CSA) (<em>P</em><span> = .046). The malnourished group had substantially lower muscle thickness and CSA, except for the gastrocnemius muscle thickness. The value of RFCSA to predict sarcopenia and malnutrition was observed as 4.61 cm</span><sup>2</sup>, respectively (<em>P</em> < .05). RFCSA was independently associated with sarcopenia (odds ratio: 0.37; 95% confidence interval: 0.17-0.79; <em>P</em> = .011) and malnutrition (odds ratio: 0.45; 95% confidence interval: 0.23-0.87; <em>P</em> = .017).</p></div><div><h3>Conclusion</h3><p>RFCSA may be a useful and simple predictor for predicting patients undergoing hemodialysis who are at risk of sarcopenia and malnutrition.</p></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"34 4","pages":"Pages 330-336"},"PeriodicalIF":3.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138818868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1053/j.jrn.2023.11.007
Else-Marie Bladbjerg MSc, PhD , Karin Levy-Schousboe MD, PhD , Marie Frimodt-Møller MD, PhD , Krista D. Kjærgaard MD, PhD , Charlotte Strandhave MD, PhD , Claus L. Brasen MD, PhD , Niels Erik Frandsen MD , Ditte Hansen MD, PhD , Peter Marckmann MD, DMSc
Objective
Patients on dialysis treatment have poor functional vitamin K status, and this may increase the risk of vascular calcification. Vitamin K supplementation may therefore be relevant in patients on dialysis, but the procoagulant effects have not been studied. We evaluated effects of menaquinone-7 (MK-7) supplementation on biomarkers of coagulation in patients on dialysis.
Methods
Double-blinded, placebo-controlled study in 123 patients on dialysis randomized to 52 weeks of vitamin K (MK-7, 360 μg/daily, n = 61) or placebo (n = 62). Measurements at baseline and after 52 weeks of intervention included thrombin generation (endogenous thrombin potential, peak thrombin concentration, time to peak, and lag time); clot activities of vitamin K-dependent coagulation factors (F) II, VII, IX, and X; prothrombin fragment 1 + 2 (F1+2); and proteins induced by vitamin K absence II (PIVKA-II). Between-group differences (vitamin K vs. placebo) at 52 weeks were determined with an analysis of covariance. Within-group changes in vitamin K and placebo groups were analyzed with a paired t-test. Vascular adverse events and serious adverse events were registered based on hospital records, laboratory data, and participant interviews and compared between groups using Fisher’s exact test or Pearson’s Chi-Squared test.
Results
A between-group difference at 52 weeks was observed for PIVKA-II (P < .001). PIVKA-II decreased significantly from baseline to 52 weeks in the vitamin K group, but not in the placebo group. We observed no between-group differences or within-group changes for biomarkers of coagulation, except for FVII clot activity which was reduced in the placebo group (P = .04), and no between-group differences in adverse events and serious adverse events.
Conclusion
One year of vitamin K supplementation in patients on dialysis has no detectable effects on biomarkers of coagulation activation, clot activities of vitamin K-dependent coagulation factors, and vascular events or death, indicating no procoagulant effects of this treatment.
目的：接受透析治疗的患者维生素 K 功能状态较差，这可能会增加血管钙化的风险。因此，透析患者可能需要补充维生素 K，但尚未对其促凝作用进行研究。我们评估了补充月桂醌-7（MK-7）对透析患者凝血生物标志物的影响：双盲安慰剂对照研究：123 名透析患者随机接受为期 52 周的维生素 K（MK-7，每天 360 微克，61 人）或安慰剂（62 人）治疗。基线和干预 52 周后的测量包括凝血酶生成（内源性凝血酶潜能 (ETP)、凝血酶浓度峰值、达到峰值的时间和滞后时间）、维生素 K 依赖性凝血因子 (F)II、VII、IX 和 X 的凝块活性、凝血酶原片段 1+2 (F1+2)，以及维生素 K 缺失 II 诱导的蛋白质 (PIVKA-II)。通过协方差分析确定了 52 周时的组间差异（维生素 K 与安慰剂）。维生素 K 组和安慰剂组的组内变化通过配对 t 检验进行分析。血管不良事件（AE）和严重不良事件（SAE）根据医院记录、实验室数据和受试者访谈进行登记，并采用费舍尔精确检验或皮尔逊秩方检验进行组间比较：结果：PIVKA-II在52周时观察到了组间差异（p结论：维生素K补充剂对糖尿病患者的治疗效果至关重要：对透析患者补充一年的维生素 K 对凝血活化的生物标志物、维生素 K 依赖性凝血因子的凝块活性、血管事件或死亡没有可检测到的影响，表明这种治疗没有促凝作用。
{"title":"No Detectable Coagulation Activation After Vitamin K (MK-7) Supplementation in Patients on Dialysis With Functional Vitamin K Deficiency: A One-Year Randomized, Placebo-Controlled Study","authors":"Else-Marie Bladbjerg MSc, PhD , Karin Levy-Schousboe MD, PhD , Marie Frimodt-Møller MD, PhD , Krista D. Kjærgaard MD, PhD , Charlotte Strandhave MD, PhD , Claus L. Brasen MD, PhD , Niels Erik Frandsen MD , Ditte Hansen MD, PhD , Peter Marckmann MD, DMSc","doi":"10.1053/j.jrn.2023.11.007","DOIUrl":"10.1053/j.jrn.2023.11.007","url":null,"abstract":"<div><h3>Objective</h3><p>Patients on dialysis treatment have poor functional vitamin K status, and this may increase the risk of vascular calcification. Vitamin K supplementation may therefore be relevant in patients on dialysis, but the procoagulant effects have not been studied. We evaluated effects of menaquinone-7 (MK-7) supplementation on biomarkers of coagulation in patients on dialysis.</p></div><div><h3>Methods</h3><p>Double-blinded, placebo-controlled study in 123 patients on dialysis randomized to 52 weeks of vitamin K (MK-7, 360 μg/daily, n = 61) or placebo (n = 62). Measurements at baseline and after 52 weeks of intervention included thrombin generation (endogenous thrombin potential, peak thrombin concentration, time to peak, and lag time); clot activities of vitamin K-dependent coagulation factors (F) II, VII, IX, and X; prothrombin fragment 1 + 2 (F1+2); and proteins induced by vitamin K absence II (PIVKA-II). Between-group differences (vitamin K vs. placebo) at 52 weeks were determined with an analysis of covariance. Within-group changes in vitamin K and placebo groups were analyzed with a paired <em>t</em>-test. Vascular adverse events and serious adverse events were registered based on hospital records, laboratory data, and participant interviews and compared between groups using Fisher’s exact test or Pearson’s Chi-Squared test.</p></div><div><h3>Results</h3><p>A between-group difference at 52 weeks was observed for PIVKA-II (<em>P</em> < .001). PIVKA-II decreased significantly from baseline to 52 weeks in the vitamin K group, but not in the placebo group. We observed no between-group differences or within-group changes for biomarkers of coagulation, except for FVII clot activity which was reduced in the placebo group (<em>P</em> = .04), and no between-group differences in adverse events and serious adverse events.</p></div><div><h3>Conclusion</h3><p>One year of vitamin K supplementation in patients on dialysis has no detectable effects on biomarkers of coagulation activation, clot activities of vitamin K-dependent coagulation factors, and vascular events or death, indicating no procoagulant effects of this treatment.</p></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"34 4","pages":"Pages 337-342"},"PeriodicalIF":3.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138832736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1053/j.jrn.2024.01.003
Shirin Pourafshar PhD, MSCR, RDN , Binu Sharma MS , Jenifer Allen BA , Madeleine Hoang , Hannah Lee , Holly Dressman PhD , Crystal C. Tyson MD, MHS , Indika Mallawaarachchi MS , Pankaj Kumar PhD , Jennie Z. Ma PhD , Pao-Hwa Lin PhD , Julia J. Scialla MD, MHS
Objective
The gut microbiota contributes to metabolic diseases, such as diabetes and hypertension, but is poorly characterized in chronic kidney disease (CKD).
Design and Methods
We enrolled 24 adults within household pairs, in which at least one member had self-reported kidney disease, diabetes, or hypertension. CKD was classified based on estimated glomerular filtration rate < 60 mL/min/1.73 m2 or urine-albumin-to-creatinine ratio of ≥ 30 mg/g. Participants collected stool and dietary recalls seasonally over a year. Gut microbiota was characterized using 16s rRNA and metagenomic sequencing.
Results
Ten participants had CKD (42%) with a median (interquartile range) estimated glomerular filtration rate of 49 (44, 54) mL/min/1.73 m2. By 16s rRNA sequencing, there was moderate to high intraclass correlation (ICC = 0.63) for seasonal alpha diversity (Shannon index) within individuals and modest differences by season (P < .01). ICC was lower with metagenomics, which has resolution at the species level (ICC = 0.26). There were no differences in alpha or beta diversity by CKD with either method. Among 79 genera, Frisingicoccus, Tuzzerella, Faecalitalea, and Lachnoclostridium had lower abundance in CKD, while Collinsella, Lachnospiraceae_ND3007, Veillonella, and Erysipelotrichaceae_UCG_003 were more abundant in CKD (each nominal P < .05) using 16s rRNA sequencing. Higher Collinsella and Veillonella and lower Lachnoclostridium in CKD were also identified by metagenomics. By metagenomics, Coprococcus catus and Bacteroides stercoris were more and less abundant in CKD, respectively, at false discovery rate corrected P = .02.
Conclusions
We identified candidate taxa in the gut microbiota associated with CKD. High ICC in individuals with modest seasonal impacts implies that follow-up studies may use less frequent sampling.
{"title":"Longitudinal Pilot Evaluation of the Gut Microbiota Comparing Patients With and Without Chronic Kidney Disease","authors":"Shirin Pourafshar PhD, MSCR, RDN , Binu Sharma MS , Jenifer Allen BA , Madeleine Hoang , Hannah Lee , Holly Dressman PhD , Crystal C. Tyson MD, MHS , Indika Mallawaarachchi MS , Pankaj Kumar PhD , Jennie Z. Ma PhD , Pao-Hwa Lin PhD , Julia J. Scialla MD, MHS","doi":"10.1053/j.jrn.2024.01.003","DOIUrl":"10.1053/j.jrn.2024.01.003","url":null,"abstract":"<div><h3>Objective</h3><p>The gut microbiota contributes to metabolic diseases, such as diabetes and hypertension, but is poorly characterized in chronic kidney disease (CKD).</p></div><div><h3>Design and Methods</h3><p>We enrolled 24 adults within household pairs, in which at least one member had self-reported kidney disease, diabetes, or hypertension. CKD was classified based on estimated glomerular filtration rate < 60 mL/min/1.73 m<sup>2</sup> or urine-albumin-to-creatinine ratio of ≥ 30 mg/g. Participants collected stool and dietary recalls seasonally over a year. Gut microbiota was characterized using 16s rRNA and metagenomic sequencing.</p></div><div><h3>Results</h3><p>Ten participants had CKD (42%) with a median (interquartile range) estimated glomerular filtration rate of 49 (44, 54) mL/min/1.73 m<sup>2</sup>. By 16s rRNA sequencing, there was moderate to high intraclass correlation (ICC = 0.63) for seasonal alpha diversity (Shannon index) within individuals and modest differences by season (<em>P</em> < .01). ICC was lower with metagenomics, which has resolution at the species level (ICC = 0.26). There were no differences in alpha or beta diversity by CKD with either method. Among 79 genera, <em>Frisingicoccus</em>, <em>Tuzzerella</em>, <em>Faecalitalea</em>, and <em>Lachnoclostridium</em> had lower abundance in CKD, while <em>Collinsella</em>, <em>Lachnospiraceae_ND3007</em>, <em>Veillonella</em>, and <em>Erysipelotrichaceae_UCG_003</em> were more abundant in CKD (each nominal <em>P</em> < .05) using 16s rRNA sequencing. Higher <em>Collinsella</em> and <em>Veillonella</em> and lower <em>Lachnoclostridium</em> in CKD were also identified by metagenomics. By metagenomics, <em>Coprococcus catus</em> and <em>Bacteroides stercoris</em> were more and less abundant in CKD, respectively, at false discovery rate corrected <em>P</em> = .02.</p></div><div><h3>Conclusions</h3><p>We identified candidate taxa in the gut microbiota associated with CKD. High ICC in individuals with modest seasonal impacts implies that follow-up studies may use less frequent sampling.</p></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"34 4","pages":"Pages 302-312"},"PeriodicalIF":3.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139576941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Niacin is reported to decrease phosphorus concentration in maintenance hemodialysis (MHD) patients. Egg white is one of the main substitutable proteins in MHD patients due to its low phosphorus content. Therefore, we aimed to evaluate the effects of combined egg white and niacin supplementation on dialysis patients' serum phosphorus and nutritional biomarkers.
Design and Methods
In this randomized controlled clinical trial, 98 patients on MHD were randomly allocated to four groups for 8 weeks: 24 g egg white (n = 25), 600 g niacin daily (n = 24), egg white combined with niacin (n = 24), and control (n = 24). Calcium, phosphorus, fibroblast growth factor-23, and other nutritional markers were assessed.
Results
There was a significant difference among the groups only in phosphorus at the end of the trial, which was significantly lower in the niacin group (4.38 + 0.812 mg/dL) than in both the egg white (5.07 + 0.49 mg/dL) and egg white with niacin supplementation (5.41 + 0.662 mg/dL) groups. In this regard, albumin increased in egg white and egg white with niacin supplementation, while albumin did not change significantly in the niacin group. Urea reduction ratio and Kt/V rose only in the egg-white group, while aspartate aminotransferase increased only in the niacin and control groups.
Conclusion
Niacin decreases serum phosphorus concentration more than egg-white protein or a combined intervention. Egg white protein supplementation has beneficial effects on some nutritional statuses other than phosphorus control without the side effects of niacin.
{"title":"Effect of Egg-White Protein Alone or Combined With Niacin on Nutritional Status, and Phosphorus Control in Maintenance Hemodialysis Patients: A Randomized Controlled Trial","authors":"Parisa Javadian MD , Niloofar Nematollahi MD , Ehsan Ghaedi MSc , Shahram Tahmasebian PhD , Ebrahim Saedi PhD","doi":"10.1053/j.jrn.2023.12.008","DOIUrl":"10.1053/j.jrn.2023.12.008","url":null,"abstract":"<div><h3>Objective</h3><p>Niacin is reported to decrease phosphorus concentration in maintenance hemodialysis (MHD) patients. Egg white is one of the main substitutable proteins in MHD patients due to its low phosphorus content. Therefore, we aimed to evaluate the effects of combined egg white and niacin supplementation on dialysis patients' serum phosphorus and nutritional biomarkers.</p></div><div><h3>Design and Methods</h3><p>In this randomized controlled clinical trial, 98 patients on MHD were randomly allocated to four groups for 8 weeks: 24 g egg white (n = 25), 600 g niacin daily (n = 24), egg white combined with niacin (n = 24), and control (n = 24). Calcium, phosphorus, fibroblast growth factor-23, and other nutritional markers were assessed.</p></div><div><h3>Results</h3><p>There was a significant difference among the groups only in phosphorus at the end of the trial, which was significantly lower in the niacin group (4.38 + 0.812 mg/dL) than in both the egg white (5.07 + 0.49 mg/dL) and egg white with niacin supplementation (5.41 + 0.662 mg/dL) groups. In this regard, albumin increased in egg white and egg white with niacin supplementation, while albumin did not change significantly in the niacin group. Urea reduction ratio and Kt/V rose only in the egg-white group, while aspartate aminotransferase increased only in the niacin and control groups.</p></div><div><h3>Conclusion</h3><p>Niacin decreases serum phosphorus concentration more than egg-white protein or a combined intervention. Egg white protein supplementation has beneficial effects on some nutritional statuses other than phosphorus control without the side effects of niacin.</p></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"34 4","pages":"Pages 350-358"},"PeriodicalIF":3.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To assess the consumption of ultra-processed foods (UPFs) in the immediate (2 months after transplantation) and late post-transplant (14 months after transplantation) periods among kidney transplant patients and to examine its correlation with nutritional quality and body composition.
Design and Methods
A cross-sectional analysis of 96 kidney transplant recipients divided into 2 groups: immediate post-transplant (n = 71) and late post-transplant (n = 25). Sociodemographic, anthropometric, and laboratory data were collected and grouped in a database. Food intake was evaluated by a validated food frequency questionnaire and foods were divided according to the NOVA classification system. The consumption of UPFs was calculated and statistical analyses were performed to evaluate its correlation with nutritional components and body composition.
Results
The consumption of UPFs was 649.4 [420.0-1061.72] kcal/day, accounting for 33.3 ± 11.9% of the total daily energy intake. The immediate post-transplant group showed higher total daily energy and UPFs intake compared to the late post-transplant group (P = .002 and P = .046, respectively), although the energy contribution of UPFs was similar between both groups. UPFs intake was positively correlated with higher percentages of total fat, trans fat, saturated, monounsaturated fat, polyunsaturated fat, starch, and sodium (P < .05 for all analyses). An inverse correlation was observed between UPFs consumption and the percentage of protein and carbohydrates in the food intake (P = .025 and P = .008, respectively). In the immediate post-transplant group, a higher intake of UPFs was correlated with lower muscle mass (r = −0.250, P = .037).
Conclusions
The findings of this study reveal a pattern of increased consumption of UPFs among kidney transplant patients in comparison to the national average. This higher intake of UPFs was correlated with lower nutritional quality during both periods. Moreover, a significant correlation was observed between UPFs consumption and adverse body composition parameters, specifically in the immediate post-transplant period.
{"title":"Ultra-Processed Food Consumption, Poorer Nutritional Quality, and Lower Muscle Mass in Immediate and Late Postkidney Transplant Periods","authors":"Beatriz Dorneles Ferreira da Costa BSc , Camila Correa PhD , Elis Forcellini Pedrollo PhD , Roberto Ceratti Manfro MD , Cristiane Bauermann Leitão PhD , Gabriela Corrêa Souza PhD","doi":"10.1053/j.jrn.2023.12.006","DOIUrl":"10.1053/j.jrn.2023.12.006","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the consumption of ultra-processed foods (UPFs) in the immediate (2 months after transplantation) and late post-transplant (14 months after transplantation) periods among kidney transplant patients and to examine its correlation with nutritional quality and body composition.</p></div><div><h3>Design and Methods</h3><p>A cross-sectional analysis of 96 kidney transplant recipients divided into 2 groups: immediate post-transplant (n = 71) and late post-transplant (n = 25). Sociodemographic, anthropometric, and laboratory data were collected and grouped in a database. Food intake was evaluated by a validated food frequency questionnaire and foods were divided according to the NOVA classification system. The consumption of UPFs was calculated and statistical analyses were performed to evaluate its correlation with nutritional components and body composition.</p></div><div><h3>Results</h3><p>The consumption of UPFs was 649.4 [420.0-1061.72] kcal/day, accounting for 33.3 ± 11.9% of the total daily energy intake. The immediate post-transplant group showed higher total daily energy and UPFs intake compared to the late post-transplant group (<em>P</em> = .002 and <em>P</em> = .046, respectively), although the energy contribution of UPFs was similar between both groups. UPFs intake was positively correlated with higher percentages of total fat, trans fat, saturated, monounsaturated fat, polyunsaturated fat, starch, and sodium (<em>P</em> < .05 for all analyses). An inverse correlation was observed between UPFs consumption and the percentage of protein and carbohydrates in the food intake (<em>P</em> = .025 and <em>P</em> = .008, respectively). In the immediate post-transplant group, a higher intake of UPFs was correlated with lower muscle mass (r = −0.250, <em>P</em> = .037).</p></div><div><h3>Conclusions</h3><p>The findings of this study reveal a pattern of increased consumption of UPFs among kidney transplant patients in comparison to the national average. This higher intake of UPFs was correlated with lower nutritional quality during both periods. Moreover, a significant correlation was observed between UPFs consumption and adverse body composition parameters, specifically in the immediate post-transplant period.</p></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"34 4","pages":"Pages 313-320"},"PeriodicalIF":3.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139643257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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