Journal of Renal Nutrition最新文献

Background & aims: Recent research has suggested that adherence to plant-based dietary index (PDI) may reduce the risk of type 2 diabetes and related complications like diabetic nephropathy (DN). Therefore, the aim of this study was to investigate the possible association of PDI with the odds of DN.

Methods: We enrolled 105 eligible women with DN and 105 controls without DN (30-65 years). A 147-item food frequency questionnaire was used to evaluate an overall PDI, healthy plant-based dietary index (hPDI), and unhealthful PDI. Biochemical variables and anthropometric measurements were assessed for all patients using predefined protocols.

Results: According to our final analyses, after controlling for potential confounders, participants with greater adherence to overall PDI (OR: 0.29; 95% CI: 0.15-0.56; P < .001) and hPDI (OR: 0.30; 95% CI: 0.15-0.56; P < .001) had 71% and 70% lower odds of DN compared to those with a low adherence, respectively. Conversely, subjects with a higher adherence to the unhealthful PDI had a positive association with increased odds of DN in the crude (OR = 5.00; 95% CI = 2.78-8.98; P < .001) and adjusted models (OR = 4.27; 95% CI = 2.24-8.14; P < .001), respectively.

Conclusion: The results of this study showed that greater adherence to overall PDI and hPDI was inversely associated with the odds of DN. However, further prospective studies are warranted to confirm these results.

Objective: To explore the relationship between dietary fiber (DF) intake and hyperkalemia in maintenance hemodialysis (MHD) patients.

Methods: A total of 110 MHD patients were included, including 67 males and 43 females. Patients were divided into normal serum potassium group (N) and a hyperkalemia group (H) according to the serum potassium level before dialysis. The daily diet was recorded by the 3-day dietary recording method. The daily dietary nutrient intake of patients was analyzed. Logistic regression was used to analyze the relationship between hyperkalemia and DF intake. A receiver operating characteristic curve was used to analyze the cutoff value of DF intake to prevent hyperkalemia.

Results: Of the 110 patients, 38 had hyperkalemia (serum potassium >5.5 mmol/L) before dialysis. There was no difference in sex, residual kidney function, body mass index, energy intake, fat intake, protein intake, calcium intake, sodium intake, phosphorus intake or the administration history of potassium-lowering drugs between the 2 groups (P > .05). Compared with the H group, patients in the N group had higher carbohydrate intake (315 ± 76 g/d vs. 279 ± 66 g/d, P = .016), dietary fiber intake (19 ± 5 g/d vs. 12 ± 8 g/d, P < .0001), and potassium intake (1,698 ± 392 mg/d vs. 1,533 ± 413 mg/d, P = .041), and more patients in group N used renin-angiotensin-aldosterone system inhibitors (52.78% vs. 23.68%, P = .003). However, the number of patients with constipation in group N was less than that in group H (20.83% vs. 42.11%, P = .018). Logistic regression analysis showed that DF intake was an independent protective factor for hyperkalemia [P < .0001, odds ratio = 0.766 (95% confidence intervals: 0.675-0.870)]. Receiver operating characteristic analysis showed that daily intake of DF greater than 15.33 g may be helpful to prevent hyperkalemia.

Conclusion: Insufficient dietary nutrient intake is prevalent in MHD patients, especially DF intake, which may be associated with hyperkalemia. Clinically, attention should be given to the dietary balance of MHD patients, especially DF intake.

Objective: Dietary interventions are the mainstay of chronic diseases prevention in general population, but the evidence to support such therapeutic approaches in patients with chronic kidney disease (CKD) is less robust. The objective of this study is to examine the association between dietary fiber intake and adverse cardiovascular and kidney outcomes and all-cause mortality in participants with CKD enrolled in the Chronic Renal Insufficiency Cohort study.

Design and methods: A total of 3791 Chronic Renal Insufficiency Cohort participants with self-reported dietary fiber intake were included in the analyses stratified by tertiles of dietary fiber at study baseline. Hazard ratios for occurrence of all-cause mortality, composite cardiovascular events and composite kidney events were calculated using Cox Proportional Hazards models adjusted for demographic, clinical, and laboratory characteristics, including levels of inflammatory markers, C-reactive protein and interleukin-6.

Results: Mean daily dietary fiber intake was 15.2 g/day. During a median (standard deviation) follow up of 14.6 (4.4) years, 1074 deaths from any cause occurred. In multivariable adjusted models, participants in the middle and low dietary fiber tertiles had a 19% (hazard ratio [95% CI]), 1.19 [1.02, 1.39]) and 11% (1.11 [0.95, 1.31]) greater risk of death respectively, compared to those in the highest fiber intake tertile. No statistically significant associations were observed between dietary fiber intake and adverse cardiovascular and kidney outcomes. Higher dietary fiber intake was not significantly associated with lower levels of C-reactive protein and interleukin-6.

Conclusion: A lower intake of dietary fiber was not associated with all-cause mortality in participants with CKD after adjustments for kidney function and inflammatory biomarkers. There was no significant association between dietary fiber intake and adverse kidney and cardiovascular outcomes. Future randomized intervention trials are needed to identify whether a high dietary fiber intake translates into improved clinical outcomes in CKD.

Objective: Dietary patterns are rapidly becoming a major focus of medical nutrition therapy in chronic kidney disease (CKD) and the analysis of dietary patterns has emerged as a practical approach to evaluate qualitative as well as quantitative aspects of overall diet. In an a-posteriori data-driven approach, dietary patterns are based on the actual food intake of the population evaluated. Investigation of dietary patterns in CKD is not well-described, and to our knowledge, has not been conducted in a UK-based cohort.

Methods: Adult participants with a diagnosed kidney condition (CKD 1-5 not requiring dialysis) were recruited into a multicenter observational cross-sectional study. Dietary intake was assessed using the European Prospective Investigation of Cancer in Norfolk Food Frequency Questionnaire. Logistic Principal Component Analysis was used to identify food group clusters. Differences between groups were assessed using univariate general linear modeling.

Results: In total, 696 patients were included. The mean age was 64.7 (±14.0) years, 61% of the cohort were male. Most participants were White British (89%). The mean estimated glomerular filtration rate was 36.6 (±20.9) mL/minute/1.73². We found differences in food group intake across stages (e.g., greater intake of nuts and seeds intake in CKD 1-2 versus CKD 4) and across sex (e.g., females had a higher intake of fruit and vegetables versus males). Comparison with the reference cohort revealed that, overall, the CKD cohort had reduced intakes of food stuffs such as cereals and cereal products, but higher intakes of groups such as meat and meat products. There were limited differences in micronutrients, although vitamin B2 and calcium were higher in earlier stages.

Conclusion: Overall, the findings from a novel a-posteriori approach underline the complex diversity of food patterns in CKD. The findings from our study may inform dieticians and other health-care providers about the need to consider treatment modalities and stages when giving dietary recommendations.

Background: This systematic review and meta-analysis investigated all prediction models for sarcopenia in Maintenance Hemodialysis (MHD) patients.

Methods: This study used the Systematic Reviews and Meta-Analysis statement (PRISMA) for systematic review.

Data sources: PubMed, Web of Science, Embase, Cochrane Library and Medline databases up to September 2023.

Data analysis: Risk of bias (ROB) was evaluated using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). Random effect models were calculated due to high heterogeneity identified.

Results: Fifteen models from twelve studies were analyzed. All studies had high ROB and three of them posed a high risk in terms of applicability. The pooled AUC, sensitivity, and specificity were 0.715, 0.583 and 0.656 respectively. The diagnostic criteria (P=0.0046), country (P=0.0046), and study design (P=0.0087) were significant sources of the heterogeneity. Analysing purely from the data perspective, grouping by diagnostic criterias, the AUC and specificity [(0.773, 95% CI 0.12-0.99, (0.652, 95% CI 0.641-0.664)] of the Asian Working Group for Sarcopenia (AWGS) group was lower than the European Working Group on Sarcopenia in Older People (EWGSOP) group [(0.859, 95% CI 0.12-1.00), (0.874, 95% CI 0.803-0.926)]. Grouping by styles of research, the AUC, sensitivity, and specificity in development group [(0.890, 95% CI 0.16-1.00), (0.751, 95% CI 0.697-0.800), (0.875, 95% CI 0.854-0.895)] were all higher than validation group [(0.715, 95% CI 0.09-0.98), (0.550, 95% CI 0.524-0.576), (0.617, 95% CI 0.604-0.629)].

Conclusions: Moving forward, there is a critical need to create low-ROB, high-applicability, and more accurate sarcopenia prediction models for MHD patients, customized for diverse global populations.

Because of increased risks of cardiovascular disease and death, patients with hyperphosphatemia receiving maintenance dialysis are advised to limit phosphorus consumption and are prescribed phosphate binders in an effort to better control serum phosphate concentrations. Because of large pill size, pill burden, and tolerability issues, phosphate binder adherence is relatively poor. On ingestion, phosphate is absorbed from the intestine via transcellular or paracellular transport. Data show that inhibiting sodium-hydrogen exchanger 3 modulates paracellular phosphate absorption (the predominant pathway in humans). Tenapanor is a first-in-class, minimally absorbed, phosphate absorption inhibitor that selectively inhibits sodium-hydrogen exchanger 3, with a mechanism distinct from, and complementary to, that of phosphate binders. In phase 3 and postregistrational studies, tenapanor conferred statistically significant and clinically meaningful reductions in serum phosphate in patients receiving maintenance dialysis with hyperphosphatemia. Here, we review the available preclinical and clinical data on the effects of tenapanor on controlling intestinal phosphate absorption.

Objective: An increase in proximal tubule fluid phosphate concentration is caused by increased serum fibroblast growth factor-23 (FGF23) levels, which resulted in renal tubular damage in a mouse model of chronic kidney disease (CKD). However, few human studies have supported this concept. This study aimed to explore the association among estimated proximal tubule fluid phosphate concentration (ePTFp), serum FGF23 levels, and renal tubular damage biomarkers in middle-aged and older populations with mild decline in renal function.

Methods: This cross-sectional study included 218 participants aged ≥45 with CKD stages G2-G4. Anthropometric measurements, blood tests, spot urine biomarkers, renal ultrasonography, cardiovascular assessment, smoking status, and medication usage were obtained in the morning in fasted states. The ePTFp was calculated using serum creatinine, urine phosphate, and creatinine concentrations. Urinary β2-microglobulin (β2-MG) and liver-type fatty acid-binding protein (L-FABP) levels were evaluated to assess renal tubular damage.

Results: PTFp, serum FGF23, urinary β2-MG, and urinary L-FABP levels increased with CKD stage progression (stages G2, G3, and G4). However, serum and urine phosphate concentrations were comparable across the CKD stages. Univariate analysis revealed a stronger correlation of ePTFp with serum FGF23, urinary β2-MG, and urinary L-FABP levels than with the corresponding serum and urine phosphate concentrations. Multivariate analyses demonstrated that increased ePTFp was independently associated with elevated serum FGF23 and urinary β2-MG levels, even after adjusting for potential covariates, including the estimated glomerular filtration rate and urinary albumin-to-creatinine ratio.

Conclusions: Our results are consistent with the concept in mouse model and suggest that increased ePTFp are associated with increased serum FGF23 levels and renal tubular damage during the early stages of CKD.

The contribution of potassium food additives to total dietary potassium intake is unknown. This poses challenges for individuals living with kidney disease who may need to monitor their potassium intake. Additionally, different countries have varying regulations regarding the reporting of dietary potassium content in foods. This article examines the potential of published food databases to assist clinicians in helping individuals with kidney disease manage their serum potassium levels. It uses the United States Department of Agriculture's Branded Food Products Database as an example. Evidence for potassium additive content in database entries, along with their bioavailability, is discussed, and best-practice recommendations are made based on current evidence. Clinical practice and future research priorities are suggested.

Objective: To describe the process of developing and implementing a novel approach to renal diet education by changing from a nutrient-based food list to a pictorial meal compilation approach through the skill steps: plan, select, cook, eat.

Design and methods: The skill-based teaching method accommodates low literacy levels and respects cultural values. This teaching style aligns the complex renal diet guidelines with family living. Each meal plan is based on a balanced diet and includes family preferences. Appropriate cooking methods and food swaps that match renal diet specifications are included. The accompanying Cook for Life cookbook demonstrates how to prepare the new kidney-friendly family meal. Recipes were supplied by a local Māori elder and his whānau and tested by the dietitian. The cookbook is provided to all patients receiving renal dietetic education. The teaching method has undergone several iterations to accommodate feedback from dietitians, nurses, doctors, and patients. This included patient engagement to develop the Storybook, a pictorial representation of typical meals consumed in the community with a corresponding food substitution to illustrate how to compile kidney-friendly meals.

Results: Analysis of feedback regarding this approach indicates high levels of acceptance and engagement with this new teaching style.

Conclusion: This practical skill-based dietary education teaching style appears to be a feasible, acceptable, culturally sensitive, and appropriate approach to dietary education for people who live with kidney disease. Patient engagement in the design of this approach supports effective learning and behavior change.

Introduction/aims/objective: Inadequate nutritional intake in haemodialysis (HD) patients increases the risk of muscle wasting, nutrient deficiencies, leading to an increased risk of additional morbidity and mortality. We aimed to assess nutritional intake on the dialysis day and nondialysis day (NDD) of patients established on HD.

Methods: We employed a 2-day dietary record, one on the day of dialysis and one on the NDD, and then determined nutritional intake using the Nutritics software. Muscle strength was assessed by hand grip strength, and the body composition was determined using multifrequency bioelectrical impedance recorded postdialysis.

Results: We recruited 51 established HD patients dialysing between May 2022 and July 2022, of mean age 60 ± 15 years, 52.9% male, and 51% diabetic. Only 25% achieved the calorie and protein intake recommended by Kidney Disease Outcomes Quality Initiative. Most patients had inadequate consumption of fiber (96%), calcium (86%), iron (80%), zinc (82%), selenium (92%), folate (82%), vitamin A (88%), and (100%) vitamin D. On the other hand, the great majority followed the restriction guidelines for potassium (96%), phosphorus (86%), and sodium (84%), respectively. However, consumption was greater for potassium (P = .007), phosphorus (P = .015), and zinc (P = .032) on NDDs versus dialysis days, but there was no difference in protein or calorie intake between days.

Conclusion: Our results suggest that many of our HD patients do not achieve the recommended nutritional targets. Patient compliance with restricting sodium, potassium, and phosphate limits protein and calorie intake. HD patients are at increased risk of sarcopenia, so failure to achieve dietary protein intake will further increase this risk.