Journal of Renal Nutrition最新文献_第3页

The Association of Serum Bicarbonate With Psychological and Physical Health-Related Quality of Life in Patients Receiving Maintenance Hemodialysis: A Secondary Analysis of the Frequent Hemodialysis Network Daily Trial 接受维持性血液透析患者血清碳酸氢盐与心理和身体健康相关生活质量的关系：对频繁血液透析网络（FHN）每日试验的二次分析

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Renal Nutrition

Pub Date : 2026-01-01 DOI: 10.1053/j.jrn.2025.05.007

Katherine Scovner Ravi MD, MPH , Enass Elsayed MD , Glenn M. Chertow MD, MPH , Finnian R. Mc Causland MBBCh, MMSc

Introduction

Serum bicarbonate (S_BIC) is a surrogate for acid-base. Although higher and lower S_BIC concentrations are associated with mortality in patients receiving maintenance hemodialysis (HD), the association of S_BIC with patient-reported outcomes is unclear.

Methods

Using data from the Frequent Hemodialysis Network Daily Trial, we performed linear and repeated measures random effects regression to assess the association of pre-HD S_BIC with general well-being (feeling thermometer score), Beck Depression Inventory (BDI) score, and Physical Health Composite score.

Results

Among the 244 subjects included in this study, mean age was 50 ± 14 years, 39% were women, and 42% were Black. Compared with S_BIC 25–<28 mEq/L, S_BIC <22 mEq/L and S_BIC ≥28 mEq/L were associated with lower feeling thermometer scores (−3.4; 95% confidence interval [CI] –10.3, +3.5 and −4.4; 95% CI –12.2, +3.4, respectively); S_BIC levels ≥28 mEq/L were associated with higher BDI scores (4.3; 95% CI + 0.5, +8.1). Compared with S_BIC 25–<28 mEq/L in the adjusted repeated measures analysis, S_BIC <22 mEq/L and S_BIC ≥28 mEq/L were associated with lower feeling thermometer scores (−5.1; 95% CI –9.1, −1.1 and −3.7; 95% CI –8.2, +0.7, respectively); S_BIC levels ≥28 mEq/L were associated with higher BDI scores (1.5; 95% CI –0.0, +3.1). There was no association of S_BIC with Physical Health Composite score.

Conclusion

Higher and lower pre-HD S_BIC were associated with a lower sense of general well-being and higher S_BIC was associated with more pronounced depressive symptoms. Whether normalization of S_BIC could enhance the well-being of patients receiving maintenance dialysis is unclear.

简介：血清碳酸氢盐（SBIC）是酸碱的替代物。虽然SBIC浓度的高低与接受维持性血液透析（HD）患者的死亡率相关，但SBIC与患者报告的结果之间的关系尚不清楚。方法：使用来自频繁血液透析网络每日试验的数据，我们采用线性和重复测量随机效应回归来评估hd前SBIC与总体幸福感（感觉温度计评分）、贝克抑郁量表评分和身体健康综合评分的关系。结果：244例纳入研究的患者平均年龄为50±14岁，女性39%，黑人42%。与SBIC相比，BIC≥28 mEq/L与较低的感觉温度计评分相关（分别为-3.4；95%CI分别为-10.3,+3.5和-4.4；95%CI分别为-12.2,+3.4）；SBIC水平≥28 mEq/L与较高的贝克抑郁量表评分相关（4.3;95%CI +0.5, +8.1）。与SBIC相比，BIC≥28 mEq/L与较低的感觉温度计评分相关（分别为-5.1；95%CI分别为-9.1,-1.1和-3.7；95%CI分别为-8.2,+0.7）；SBIC水平≥28 mEq/L与较高的贝克抑郁量表评分相关（1.5;95%CI -0.0, +3.1）。SBIC与身体健康综合评分无相关性。结论：hd前期SBIC较高和较低与较低的总体幸福感相关，较高的SBIC与更明显的抑郁症状相关。SBIC的正常化是否能提高维持性透析患者的幸福感尚不清楚。

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引用次数: 0

Applying Integrative Analysis of Dietary Patterns to Understand Ramadan-Induced Nutritional Status Alterations in Hemodialysis Patients 应用饮食模式综合分析了解斋月引起的血液透析患者营养状况改变。

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Renal Nutrition

Pub Date : 2026-01-01 DOI: 10.1053/j.jrn.2025.08.004

Imliya Ibrahim BSc , Jun-Hao Lim MSc , Nurul Iman Hafizah Adanan MSc , Cordelia-Kheng-May Lim MSc , Geeta Appannah PhD , Wan Ahmad Hafiz Wan Md Adnan MD , Nor Fadhlina Zakaria MD, MMed , Christopher-Thiam-Seong Lim MBBch, MRCP, FAMS, FRCP , Rosnawati Yahya MBChB, MRCP, FRCP , Bayan Tashkandi PhD , Tilakavati Karupaiah PhD, APD , Zulfitri Azuan Mat Daud PhD, RD

Objective

The changes in dietary behaviors and food choices during Ramadan lead to significant nutritional status alterations in hemodialysis (HD) patients. Routine dietary assessment may not capture disruptions in food behaviors of Muslim HD patients during Ramadan. This study aimed to elucidate changes in nutritional status affected by Ramadan food choices using a dietary pattern (DP) approach.

Methods

This 6-week, multicenter, prospective longitudinal study included 102 Malaysian Muslim HD patients who observed fasting during Ramadan. Nutritional assessments, including anthropometry and biochemical parameters, were conducted at 2 timepoints: 2 weeks prior to Ramadan (V0) and during the fourth week of Ramadan (V1). DPs were derived from 3-day diet records collected at V1 using principal component analysis (PCA) and reduced rank regression (RRR). A general linear model with repeated measures was applied to evaluate the variations in Ramadan-induced nutritional status changes across tertiles within each DP. Further, the integrative analysis between the DPs identified the specific foods that contributed to these changes.

Results

PCA identified 4 DPs: Home-Foods_DP, Chicken-Meat_DP, Carbohydrate-based_DP, and Traditional_DP. Meanwhile, RRR yielded 1 DP, which is Quick-Foods_DP. Significant interactions between DPs and serum phosphate changes were observed in the Chicken-Meat_DP (P = .020) and Quick-Foods_DP (P = .004), where high adherence to either pattern was associated with increased serum phosphate during Ramadan. The Quick-Foods_DP showed a significant interaction with serum potassium (P < .001), where high adherence was linked to an increasing trend during Ramadan. Additionally, the Home-Foods_DP exhibited a significant interaction with serum albumin (P = .035), where low adherence was associated with a greater reduction during Ramadan.

Conclusion

Dietary pattern analysis reveals the synergistic effects of food-food interaction on Ramadan-induced nutritional alterations in HD patients, providing a foundation for evidence-based dietary guidance for Muslim HD patients during Ramadan.

目的：斋月期间饮食行为和食物选择的改变导致血液透析（HD）患者营养状况的显著改变。常规饮食评估可能无法捕捉穆斯林HD患者在斋月期间饮食行为的中断。本研究旨在利用饮食模式（DP）方法阐明斋月食物选择对营养状况的影响。方法：这项为期六周的多中心前瞻性纵向研究纳入了102名马来西亚穆斯林HD患者，他们在斋月期间禁食。营养评估，包括人体测量和生化参数，在两个时间点进行：斋月前两周（V0）和斋月第四周（V1）。采用主成分分析（PCA）和降秩回归（RRR）计算仔猪V1期3 d的日粮数据。采用一个具有重复测量的一般线性模型来评估每个DP内各三分卫在斋月期间营养状况变化的变化。此外，DPs之间的综合分析确定了导致这些变化的特定食物。结果：主成分分析确定了四种dp：家庭食品dp、鸡肉dp、碳水化合物dp和传统dp。与此同时，准备金率产生了一个DP，即快餐DP。在鸡肉dp （p=0.020）和快餐dp （p=0.004）中观察到dp与血清磷酸盐变化之间的显著相互作用，其中任何一种模式的高依从性与斋月期间血清磷酸盐增加有关。速食dp与血清钾有显著的相互作用(pDP与血清白蛋白有显著的相互作用（p=0.035），其中低依从性与斋月期间更大的减少有关。结论：饮食模式分析揭示了食物-食物相互作用对斋月期间HD患者营养改变的协同作用，为穆斯林HD患者斋月期间的循证饮食指导提供依据。

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引用次数: 0

Technological Devices for Nutritional Counseling in Patients With Diabetic Kidney Disease 糖尿病肾病患者营养咨询的技术设备。

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Renal Nutrition

Pub Date : 2025-11-01 DOI: 10.1053/j.jrn.2025.05.006

Fabiola Martín-del-Campo PhD , Andrea Arriaga-Verduzco MSc , Ari Cisneros-Hernández MSc , Norma García-Galindo MSc , Francisco Gerardo Yanowsky-Escatell PhD , Leonardo Pazarín-Villaseñor PhD , Jorge Andrade-Sierra PhD

Objectives

This study explored the access, use, and acceptance of technological devices for nutritional counseling in patients with diabetic kidney disease (DKD) in a low socioeconomic setting.

Methods

In this cross-sectional study, 80 adult patients with DKD from an underserved population, attending the nephrology service of a tertiary-care teaching hospital were included. All patients had a clinical, nutritional, and biochemical evaluation; a direct questionnaire was applied to evaluate access and use of technological devices for nutritional counseling as well as their acceptance (knowledge and perception about benefits, barriers, needs, and easy to use).

Results

Eighty-seven percent of patients had access to a smartphone, whereas 20% and 6% to a computer and tablet, respectively; 40% use technological devices for health/nutrition search. Knowledge (1 [1-2]) and barriers (1.4 [1-1.8]) scores were low; scores for benefits (3.7 [3-4]), needs (4.4 [3.7-5]), and easy to use (4.2 [3.7-4.5]) were high. Higher perceptions of the benefits, needs, and willingness to receive nutritional counseling via telemedicine and lower barriers perception were associated with higher easy to use score.

Conclusions

Despite advanced age and low educational level, patients had good access to smartphones and perceived their possible benefits and need for nutritional counseling. Regardless of low knowledge, perception of barriers was very low. Telemedicine via smartphones may be a good option to improve nutritional knowledge and skills of patients with DKD.

目的：本研究探讨低社会经济背景下糖尿病肾病（DKD）患者营养咨询技术设备的获取、使用和接受情况。方法：横断面研究；80名成年DKD患者来自服务不足的人群，在一家三级护理教学医院的肾病科就诊。所有患者均进行临床、营养和生化评价；采用了一份直接问卷来评估营养咨询技术设备的获取和使用情况及其接受程度（对益处、障碍、需求和使用方便的了解和认识）。结果：87%的患者有智能手机，20%和6%的患者分别有电脑和平板电脑；40%的人使用技术设备进行健康/营养搜索。知识[1(1-2)]和障碍[1.4(1-1.8)]得分较低；效益评分[3.7(3-4)]、需求评分[4.4(3.7-5)]、使用方便评分[4.2(3.7-4.5)]较高。对通过远程医疗接受营养咨询的益处、需求和意愿的较高认知，以及较低的认知障碍，与较高的易用性得分相关。结论：尽管患者年龄较大，受教育程度较低，但他们对智能手机有良好的了解，并意识到智能手机可能带来的好处和对营养咨询的需求。除了低知识外，对障碍的认知也很低。通过智能手机进行远程医疗可能是提高DKD患者营养知识和技能的一个很好的选择。

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引用次数: 0

The Relentless Challenge of Dietary Salt Restriction for Hypertension and Kidney Disease 饮食盐限制对高血压和肾脏疾病的持续挑战。

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Renal Nutrition

Pub Date : 2025-11-01 DOI: 10.1053/j.jrn.2025.10.001

Linda W. Moore PhD, RDN, Giacomo Garibotto MD

引用次数: 0

Higher Renal Net Acid, but Not Higher Phosphate Excretion During Growth Associates With Lower Adult Circulating Uromodulin “生长过程中较高的肾净酸，而不是较高的磷酸盐排泄与较低的成人循环尿调素有关”。

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Renal Nutrition

Pub Date : 2025-11-01 DOI: 10.1053/j.jrn.2024.12.002

Seyedeh-Masomeh Derakhshandeh-Rishehri PhD , Luciana Peixoto Franco MS , Hermann Kalhoff MD , Stefan A. Wudy MD , Thomas Remer PhD

Objectives

Uromodulin is the most abundant urinary protein in healthy subjects, which under physiological conditions protects against kidney stone formation. Acid-base imbalances, especially states with acidic urine, increase the risk for uric acid and oxalate stones, but lower it for phosphate (PO₄)-containing stones. Whether habitual high acid loads and high dietary phosphorus intake (P-In) themselves may influence plasma uromodulin concentrations in the long-term is not known.

Methods

We prospectively examined biomarker based on the associations of P-In and endogenous acid loads of 3-17-year-old healthy participants (n = 358) of the Dortmund Nutritional and Anthropometric Longitudinally Designed study (Dortmund, Germany), with their circulating uromodulin levels later in adulthood. Urinary (PO₄)excretion, net acid excretion (NAE), potential renal acid load (uPRAL), and pH were analyzed in 24-hour urine samples repeatedly collected during growth. Circulating uromodulin was analyzed in adult fasting blood samples. Individual means of age- and sex-stratified standard deviation scores of growth- and nutritional biomarker-related parameters were calculated. Multilinear regression models adjusted for anthropometric, renal, and blood parameters were conducted to examine the prospective relationships of preadulthood urinary biomarkers with adult circulating uromodulin.

Results

Uromodulin associated inversely with NAE (P_for-trend < .03) and positively with urinary pH (P_for-trend = .05; lowest pH-quintile vs. highest quintile: P = .03), but not significantly with uPRAL and (PO₄) excretion during growth.

Conclusions

The known increased urolithiasis risk associated with high endogenous acid production may be further augmented by a high NAE-related reduction of the stone-formation inhibitor uromodulin. Despite not observing a significant association with uPRAL, the potential of habitual low-PRAL diets to raise uromodulin needs to be further studied.

目的：尿调蛋白是健康人体内最丰富的尿蛋白，在生理条件下对肾结石的形成起保护作用。酸碱失衡，尤其是尿液呈酸性的状态，会增加尿酸和草酸结石的风险，但会降低含磷酸盐结石的风险。是否习惯性高酸负荷和高膳食磷摄入量（P-In）本身可能影响血浆尿调素浓度长期尚不清楚。方法：我们前瞻性地研究了DONALD研究（德国多特蒙德）中3-17岁健康参与者（n=358）基于生物标志物的P-In和内源性酸负荷与成年后循环尿调素水平的关系。在生长过程中反复收集24小时尿液样本，分析尿磷酸盐排泄量（PO4-Ex）、净酸排泄量（NAE）、潜在肾酸负荷（uPRAL）和pH。分析了成人空腹血液样本中的循环尿调素。计算生长和营养生物标志物相关参数的年龄和性别分层标准偏差得分的个体平均值。采用校正人体测量、肾脏和血液参数的多元线性回归模型来检验成年前尿液生物标志物与成人循环尿调素的潜在关系。结果：尿调素与NAE呈负相关(p - for-trend - for-trend=0.05；最低ph -五分位数与最高ph -五分位数（P=0.03），但与生长期间的uPRAL和PO4-Ex差异不显著。结论：已知的与高内源性酸产生相关的尿石症风险增加，可能会进一步增加与nae相关的结石形成抑制剂尿调蛋白的高度减少。尽管没有观察到与pral的显著关联，但习惯低pral饮食提高尿调蛋白的潜力需要进一步研究。

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引用次数: 0

The Effect of Low-grade Inflammation on Body Composition in Peritoneal Dialysis Patients 低度炎症对腹膜透析患者体成分的影响。

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Renal Nutrition

Pub Date : 2025-11-01 DOI: 10.1053/j.jrn.2025.06.005

Andrew Davenport MD

Objective

Kidney dialysis patients are at an increased risk of sarcopenia and mortality. Although there are many potential causes, the effect of chronic inflammation on changes in body composition in peritoneal dialysis (PD) over time was reviewed.

Methods

Changes in body composition were measured by multifrequency bioimpedance in PD outpatients attending routine clinic review with sustained normal or raised C reactive protein (CRP) concentrations, excluding patients with peritonitis, and other acute hospitalizations.

Results

Body composition was measured; median 12 (11-14) months apart in 427 PD outpatients (59.5% male, 37.2% diabetic), median dialysis vintage 12 months, 215 sustained normal CRP, and (≤5 mg/L) versus 212 sustained raised CRP (9 [6-19] mg/L). Body composition did not differ initially, but over time whereas there were no changes in fat mass, fat-free mass index remained stable in the normal CRP group (17.8 ± 2.3 vs 17.9 ± 2.4) but decreased in the raised CRP group (18.0 ± 2.6 vs 14.4 ± 2.6, P < .05), and over time serum albumin was lower in the raised CRP group (36.8 ± 4.7 vs 38.8 ± 4.0, P < .001). Estimated dietary protein intake declined over time in both groups but remained lower in the raised CRP group (0.83 ± 0.32 vs 0.87 ± 0.21 g/kg/day, P < .05). In a multivariable model, loss of lean body tissue was associated with persistently raised CRP (odds ratio 2.6, 95% confidence intervals 1.58-4.2, P < .001).

Conclusion

Sustained low-grade inflammation leads to a loss of lean body tissue in PD outpatients. Studies are required to determine whether treating the causes of, and reducing, low-grade inflammation results in prevention of lean tissue loss.

目的：肾透析患者发生肌肉减少症和死亡的风险增加。尽管有许多潜在的原因，慢性炎症对腹膜透析（PD）中身体成分随时间变化的影响进行了综述。方法：对C反应蛋白（CRP）浓度持续正常或升高的PD门诊患者（不包括腹膜炎和其他急性住院患者）进行常规临床复查，通过多频生物阻抗测量其体成分的变化。结果：测量体成分，427例PD门诊患者（59.5%为男性，37.2%为糖尿病患者）中位间隔12（11-14）个月，中位透析时间12个月；215例CRP维持正常（≤5mg /L）， 212例CRP升高（9 (6-19)mg/L）。身体组成最初没有差异，但随着时间的推移，脂肪量没有变化，无脂质量指数（FFMI）在正常CRP组保持稳定（17.8±2.3 vs 17.9±2.4），但在CRP升高组下降（18.0±2.6 vs 14.4±2.6）。结论：持续的低度炎症导致PD门诊患者瘦体组织的损失。需要进行研究来确定治疗病因和减少低度炎症是否能预防瘦组织的损失。

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引用次数: 0

Knowledge, Attitude, and Practice Toward Low-Salt Diets Among Patients With Chronic Kidney Disease and Their Spouses: A Cross-Sectional Study 慢性肾病患者及其配偶对低盐饮食的知识、态度和实践：一项横断面研究

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Renal Nutrition

Pub Date : 2025-11-01 DOI: 10.1053/j.jrn.2025.06.007

Yinhui Li MD, Baoling Liu MD, Liqian Dong MD, Heng Sang BD, Ni Kang BD

Objectives

This study aimed to assess the knowledge, attitude, and practice (KAP) of patients with chronic kidney disease (CKD) and their spouses toward low-salt diets.

Methods

This cross-sectional study enrolled patients with CKD and their spouses at the outpatient nephrology clinic of our hospital between September 2023 and February 2024.

Results

The study enrolled 443 patients and 499 spouses of patients. The mean KAP scores for patients were 13.64 ± 3.1, 35.19 ± 5.98, and 29.44 ± 7.58, respectively. Spouses of patients had mean scores of 14.39 ± 3.22, 31.66 ± 4.70, and 30.56 ± 6.52, respectively. Path analysis demonstrated that among patients, education, duration of CKD, and income had direct effects on knowledge. Knowledge, gender, marital status, duration of CKD, and residence had direct effects on attitude. Knowledge, attitude, education, CKD stage, employment, and type of medical insurance had direct effects on practice. For the spouses, duration of CKD had direct effect on knowledge; knowledge, residence, and education had direct effects on attitude; knowledge, attitude, residence, education, employment, CKD stage, and dialysis had direct effects on practice.

Conclusion

Both patients with CKD and their spouses demonstrated sufficient knowledge, positive attitude, and proactive practice toward low-salt diets. Clinicians should emphasize education and support programs targeting patients and their spouses to reinforce positive attitude and encourage sustained adherence to low-salt diets, particularly focusing on socioeconomic factors influencing KAP.

目的：本研究旨在评估慢性肾脏疾病（CKD）患者及其配偶对低盐饮食的认知、态度和实践（KAP）。方法：本横断面研究纳入了2023年9月至2024年2月在我院肾内科门诊就诊的CKD患者及其配偶。结果：研究纳入了443名患者和499名患者的配偶。患者KAP平均评分分别为13.64±3.1、35.19±5.98、29.44±7.58。患者配偶平均得分分别为14.39±3.22、31.66±4.70和30.56±6.52。通径分析表明，在患者中，教育程度、CKD病程和收入对知识有直接影响。知识、性别、婚姻状况、CKD病程、居住地对态度有直接影响。知识、态度、教育程度、CKD阶段、就业、医疗保险类型对实习有直接影响。对配偶而言，慢性肾病病程对认知有直接影响；知识、居住地和教育程度对态度有直接影响；知识、态度、居住、学历、就业、CKD分期、透析对实践有直接影响。结论：CKD患者及其配偶对低盐饮食具有足够的知识、积极的态度和积极的实践。临床医生应强调针对患者及其配偶的教育和支持计划，以加强积极的态度，并鼓励持续坚持低盐饮食，特别是关注影响知识、态度和实践的社会经济因素。

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引用次数: 0

The Association of Antiemetics Use With Incident Chronic Kidney Disease 止吐药与慢性肾脏疾病的关系

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Renal Nutrition

Pub Date : 2025-11-01 DOI: 10.1053/j.jrn.2025.06.004

Diana S. Kalantar BS , Rina Takahashi MD, PhD , Jenny I. Shen MD , Diana Tran MPH , Adnan Ismail BS , Erika Lopez Pena BS , Mayara Abichequer-Beer RD , Fridtjof Thomas PhD , Jun Ling Lu MD , Keiichi Sumida MD , Kamyar Kalantar-Zadeh MD, MPH, PhD , Csaba P. Kovesdy MD , Connie M. Rhee MD, MSc

Objectives

Gastrointestinal symptoms can significantly impact patients' nutritional status. Effective management using antiemetics is crucial for maintaining adequate nutrition. However, the effect of antiemetics on long-term renal function remains unclear. This study aimed to examine the association of antiemetics with the incident chronic kidney disease (CKD) in patients with normal renal function.

Methods

In a historical cohort study involving 323,970 US Veterans with normal estimated glomerular filtration rate, we identified 13,154 Veterans initiating antiemetics. The Cox proportional hazards model adjusted for demographics, major comorbidities, and laboratory measurements was used to estimate the relationship between antiemetics and the incident CKD, defined as estimated glomerular filtration rate <60 mL/min/1.73 m² on two occasions, separated by ≥ 90 days. Propensity score (PS) matching and PS overlap weighting were also performed.

Results

The mean age of nonusers and users of antiemetics was 64.1 ± 14.2 and 62.1 ± 12.9 years. Antiemetic users were more likely to be female, smokers, and had a higher prevalence of comorbidities. Antiemetic use was associated with an increased risk of incident CKD across various models: unmatched adjusted (hazard ratio [HR] 1.26; 95% confidence interval [CI] 1.22-1.31), PS matched (HR 1.22; 95% CI 1.17-1.28), and PS overlap weighting (HR 1.28; 95% CI 1.18-1.46).

Conclusions

Antiemetic use is associated with a higher risk of incident CKD in individuals without preexisting kidney disease. This association appears robust across different analytical models. While antiemetics are essential for managing gastrointestinal symptoms—potentially improving nutritional status—the results underscore the necessity for careful monitoring of renal function in patients prescribed antiemetics.

目的：胃肠道症状可显著影响患者的营养状况。使用止吐药的有效管理对于维持足够的营养至关重要。然而，止吐药对长期肾功能的影响尚不清楚。本研究旨在探讨止吐药与肾功能正常的慢性肾脏疾病（CKD）发生的关系。方法：在一项涉及323,970名肾小球滤过率（eGFR）正常的美国退伍军人的历史队列研究中，我们确定了13,154名退伍军人服用止吐药。采用Cox比例风险模型对人口统计学、主要合并症和实验室测量进行调整，以估计止吐药与CKD事件之间的关系，两次定义为eGFR 2，间隔≥90天。倾向得分（PS）匹配和PS重叠加权。结果：未使用止吐药和使用止吐药的平均年龄分别为64.1±14.2岁和62.1±12.9岁。止吐药使用者更有可能是女性、吸烟者，并且有更高的合并症患病率。在各种模型中，止吐药的使用与CKD发生风险增加相关：未匹配调整(风险比[HR] 1.26；95%可信区间[CI] 1.22-1.31)， PS匹配(HR 1.22；95% CI 1.17-1.28)， PS重叠加权(HR 1.28；95% ci 1.18-1.46)。结论：止吐药的使用与先前没有肾脏疾病的个体发生CKD的高风险相关。这种关联似乎在不同的分析模型中都很强大。虽然止吐药对控制胃肠道症状至关重要——可能改善营养状况——但结果强调了在服用止吐药的患者中仔细监测肾功能的必要性。

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引用次数: 0

Hyperphosphatemia in Patients on Hemodialysis May be Driven by the Consumption of Ultraprocessed Foods 血液透析患者的高磷血症可能是由食用超加工食品引起的。

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Renal Nutrition

Pub Date : 2025-11-01 DOI: 10.1053/j.jrn.2025.07.007

Andrea C. Sczip MSc , Jyana G. Morais PhD , Adaiane Calegari MSc , Tatiana S. Kruger , Jorgiane C. Oliveira , Natália K. Scatone MSc , Rafaela G. dos Santos , Fellype C. Barreto MD, PhD , Fabiana B. Nerbass PhD

Objective

We aimed to investigate the role of dietary diversity of unprocessed and minimally processed foods and the intake of ultraprocessed foods (UPFs), along with their respective phosphorus source subgroups, in hyperphosphatemia among patients on chronic hemodialysis.

Methods

This is a secondary analysis of a multicenter cross-sectional study conducted in seven dialysis units in Southern Brazil. Two validated questionnaires were used: a dietary diversity questionnaire to assess the intake of unprocessed and minimally processed foods, and a UPFs consumption questionnaire to evaluate the intake of UPFs. Dietary intake was assessed on 2 separate days—1 dialysis day and 1 nondialysis day. From these instruments, scores were calculated for overall dietary diversity, total UPFs consumption, and phosphorus sources subgroups.

Results

A total of 297 patients participated (age: 52.1 ± 14.1 years; 57.9% men; 42% with hyperphosphatemia). While unprocessed and minimally processed phosphorus sources were more commonly consumed, multivariate analysis revealed that UPFs, particularly those from animal-based sources, were independently associated with hyperphosphatemia. Each one-point increase in intake of UPFs scores corresponded to an increased likelihood of hyperphosphatemia: 25% for total UPF, 76% for animal-based UPFs, and 24% for other UPF sources.

Conclusion

Our findings indicate that although phosphorus sources from UPFs were consumed less frequently than those from unprocessed and minimally processed foods, consumption of UPFs—especially those from animal-based sources—was an independent determinant of hyperphosphatemia. These results highlight the need for dietary interventions that prioritize healthy food choices in the management of hyperphosphatemia.

目的：我们旨在研究未加工食品和最低加工食品的饮食多样性以及超加工食品（upf）的摄入量及其各自的磷源亚组在慢性血液透析（HD）患者高磷血症中的作用。方法：这是一项在巴西南部7个透析单位进行的多中心横断面研究的二次分析。使用了两份有效问卷：一份膳食多样性问卷用于评估未加工和最低加工食品的摄入量，一份UPFs消费问卷用于评估UPFs的摄入量。饮食摄入分别在透析日和非透析日进行评估。根据这些工具，计算总体膳食多样性、upf总消耗量和磷源亚组的得分。结果：共297例患者参与，年龄：52.1±14.1岁；男性57.9%;42%为高磷血症)。虽然未经加工和最低限度加工的磷源更常被消耗，但多变量分析显示，upf，特别是来自动物源的upf，与高磷血症独立相关。UPF摄入量每增加1分，高磷血症的可能性就会增加：总UPF为25%，动物性UPF为76%，其他UPF来源为24%。结论：我们的研究结果表明，尽管来自UPFs的磷源的消耗频率低于来自未加工和最低加工食品的磷源，但UPFs的消耗-特别是来自动物源的磷源-是高磷血症的独立决定因素。这些结果强调了在高磷血症管理中优先选择健康食物的饮食干预的必要性。

{"title":"Hyperphosphatemia in Patients on Hemodialysis May be Driven by the Consumption of Ultraprocessed Foods","authors":"Andrea C. Sczip MSc , Jyana G. Morais PhD , Adaiane Calegari MSc , Tatiana S. Kruger , Jorgiane C. Oliveira , Natália K. Scatone MSc , Rafaela G. dos Santos , Fellype C. Barreto MD, PhD , Fabiana B. Nerbass PhD","doi":"10.1053/j.jrn.2025.07.007","DOIUrl":"10.1053/j.jrn.2025.07.007","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to investigate the role of dietary diversity of unprocessed and minimally processed foods and the intake of ultraprocessed foods (UPFs), along with their respective phosphorus source subgroups, in hyperphosphatemia among patients on chronic hemodialysis.</div></div><div><h3>Methods</h3><div>This is a secondary analysis of a multicenter cross-sectional study conducted in seven dialysis units in Southern Brazil. Two validated questionnaires were used: a dietary diversity questionnaire to assess the intake of unprocessed and minimally processed foods, and a UPFs consumption questionnaire to evaluate the intake of UPFs. Dietary intake was assessed on 2 separate days—1 dialysis day and 1 nondialysis day. From these instruments, scores were calculated for overall dietary diversity, total UPFs consumption, and phosphorus sources subgroups.</div></div><div><h3>Results</h3><div>A total of 297 patients participated (age: 52.1 ± 14.1 years; 57.9% men; 42% with hyperphosphatemia). While unprocessed and minimally processed phosphorus sources were more commonly consumed, multivariate analysis revealed that UPFs, particularly those from animal-based sources, were independently associated with hyperphosphatemia. Each one-point increase in intake of UPFs scores corresponded to an increased likelihood of hyperphosphatemia: 25% for total UPF, 76% for animal-based UPFs, and 24% for other UPF sources.</div></div><div><h3>Conclusion</h3><div>Our findings indicate that although phosphorus sources from UPFs were consumed less frequently than those from unprocessed and minimally processed foods, consumption of UPFs—especially those from animal-based sources—was an independent determinant of hyperphosphatemia. These results highlight the need for dietary interventions that prioritize healthy food choices in the management of hyperphosphatemia.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 6","pages":"Pages 780-786"},"PeriodicalIF":3.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700947","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}

引用次数: 0

Development and Validation of a Prediction Model for Estimating 24-Hour Urinary Sodium Excretion Using Spot Urine Samples in Adult Patients 利用成年患者的定点尿样，开发并验证用于估算 24 小时尿钠排泄量的预测模型。

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Renal Nutrition

Pub Date : 2025-11-01 DOI: 10.1053/j.jrn.2024.09.004

Miriam Menacho-Roman BSc , Martin Fabregate-Fuente BSc , Laura Caja-Guayerbas BSc , Sergio Jiménez-Sánchez BSc , Javier Soto BSc , Ignacio Arribas-Gómez PhD, MD

Introduction

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 (24 h uNa) can be estimated from spot samples in adult patients who attend hospital clinics.

Design and 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 cutoff value of 130 mmol/24 h were performed, assessed by the C-statistic.

Results

The model was well calibrated (slope [95% confidence interval] 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 24 h uNa by NaRYC was 24.85 mmol/24 h [17.06-32.63]. The NaRYC had the highest values of Pearson coefficient (0.613 P < .0001), accuracy (the percentage of estimated 24 h uNa results within 30% deviation of measured 24 h uNa): 56.8%, and area under the receiver operating characteristic curve: 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% confidence interval 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.

尿钠排泄量的测量可提供有关个人钠平衡的宝贵信息，并有助于各种疾病的治疗。然而，24 小时尿样的采集可能会出现误差。定点尿钠（uNa）测量是估算尿钠排泄量的可靠方法，可替代 24 小时尿样采集：目的：评估能否通过采集医院门诊成年患者的定点尿样来估算其 24 小时尿钠排泄量（24uNa）：设计：方法：本医院开展了一项横断面研究，包括一个开发队列（284 名患者）和一个验证队列（229 名患者）。建立了一个多变量线性回归模型，并与以前的模型进行了比较。通过 C 统计量评估，对预设的 uNa 临界值 130 mmol/24h 进行了一致性分析，并比较了对每位患者进行正确分类的能力：结果：该模型校准良好（内部验证中的斜率[95%CI]为 0.965 [0.9960.965 [0.947-0.987]），显示出良好的区分度，在外部验证队列中也表现良好（斜率：0.811 [0.675-0.946]）。通过 NaRYC 测量的 24uNa 与估计的 24uNa 之间的平均偏差为 24.85 mmol/24h [17.06-32.63]。NaRYC 的皮尔逊系数（0.613 pC）最高：虽然结果的平均偏差是可以接受的，但在 95%CI 中观察到的变异性并不建议在单个受试者的基础上普遍使用定点尿代替 24 小时尿来估算尿液中 Na 的总排泄量。

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引用次数: 0