Limited studies exist on prevalence of Protein energy wasting (PEW) in children with chronic kidney disease. The study aimed to determine the prevalence of PEW in children aged 2-18 years with CKD stage 2-5D, compare various diagnostic criteria and describe clinical characteristics of children with PEW.
Methods
A cross-sectional study (September 2023 to February 2024) conducted at the pediatric nephrology services of a tertiary-care center investigated children aged 2-18 years diagnosed with CKD stages 2-5D for PEW. Demographic, clinical, biochemical details and growth parameters were recorded at enrollment. The study employed three 3 PEW definitions: minimal, standard, and modified. Descriptive statistics were performed using STATA 14.0.
Results
The study enrolled 150 children (79.4% boys) in CKD 2-5D with a median (interquartile range) age of 10.6 (7,13.1) years. Congenital anomalies of kidney and urinary tract were the most common etiology in 104 (69.4%) children. The median estimated glomerular filtration rate at enrollment was 23.2 (12.7, 40) mL/min/1.73 m2. Seventy (46.7%) children satisfied minimal PEW definition, 20 (13.3%) children met standard PEW definition, and 40 (27.3%) satisfied pediatric tailored modified PEW definition. There was an increasing prevalence of modified PEW with advancing CKD stage (P =.04). Among individual parameters contributing to diagnosis of PEW, reduced muscle mass was a consistent finding, while serum albumin, short stature, and reduced body mass varied with CKD severity (P < .05). Children with modified PEW were more likely to be severely wasted and/or severely underweight. Infection-related hospitalization rate was significantly higher in children with PEW (P = .008).
Conclusion
The prevalence of PEW ranged from 13.3% to 46.7% depending on the definition used. Importantly, the prevalence increased with advancing stages of CKD. Age-appropriate criteria, like anthropometry, are crucial and highlight the need for tailored nutritional assessment in children.
{"title":"Assessment of Protein Energy Wasting in Children With Chronic Kidney Disease: A Cross-Sectional Study","authors":"Mohammed Kaif K. Mulla MBBS, Bobbity Deepthi MD Pediatrics, Madhileti Sravani MD Pediatrics, FPN, Sudarsan Krishnasamy MD Pediatrics, DM Pediatric Nephrology, Sriram Krishnamurthy MD Pediatrics, FIPNA","doi":"10.1053/j.jrn.2025.06.009","DOIUrl":"10.1053/j.jrn.2025.06.009","url":null,"abstract":"<div><h3>Objectives</h3><div>Limited studies exist on prevalence of Protein energy wasting (PEW) in children with chronic kidney disease. The study aimed to determine the prevalence of PEW in children aged 2-18 years with CKD stage 2-5D, compare various diagnostic criteria and describe clinical characteristics of children with PEW.</div></div><div><h3>Methods</h3><div>A cross-sectional study (September 2023 to February 2024) conducted at the pediatric nephrology services of a tertiary-care center investigated children aged 2-18 years diagnosed with CKD stages 2-5D for PEW. Demographic, clinical, biochemical details and growth parameters were recorded at enrollment. The study employed three 3 PEW definitions: minimal, standard, and modified. Descriptive statistics were performed using STATA 14.0.</div></div><div><h3>Results</h3><div>The study enrolled 150 children (79.4% boys) in CKD 2-5D with a median (interquartile range) age of 10.6 (7,13.1) years. Congenital anomalies of kidney and urinary tract were the most common etiology in 104 (69.4%) children. The median estimated glomerular filtration rate at enrollment was 23.2 (12.7, 40) mL/min/1.73 m<sup>2</sup>. Seventy (46.7%) children satisfied minimal PEW definition, 20 (13.3%) children met standard PEW definition, and 40 (27.3%) satisfied pediatric tailored modified PEW definition. There was an increasing prevalence of modified PEW with advancing CKD stage (<em>P</em> =.04). Among individual parameters contributing to diagnosis of PEW, reduced muscle mass was a consistent finding, while serum albumin, short stature, and reduced body mass varied with CKD severity (<em>P</em> < .05). Children with modified PEW were more likely to be severely wasted and/or severely underweight. Infection-related hospitalization rate was significantly higher in children with PEW (<em>P</em> = .008).</div></div><div><h3>Conclusion</h3><div>The prevalence of PEW ranged from 13.3% to 46.7% depending on the definition used. Importantly, the prevalence increased with advancing stages of CKD. Age-appropriate criteria, like anthropometry, are crucial and highlight the need for tailored nutritional assessment in children.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 6","pages":"Pages 718-725"},"PeriodicalIF":3.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556527","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 : 2025-11-01DOI: 10.1053/j.jrn.2025.07.006
Anum Akbar MBBS, PhD , Rebecca Drakowski PhD , Matthew VanOrmer PhD , Rebekah Rapoza BS , Taija Hahka MS , Colman Freel BS , Sathish Kumar Natarajan PhD , Melissa Thoene RD, PhD , Corrine Hanson RD, PhD , Ann Anderson-Berry MD, PhD , Teri Mauch MD, PhD
<div><h3>Objective</h3><div>Vitamin A (retinol) is essential for fetal organ development, with preclinical studies associating maternal vitamin A deficiency (VAD) with reduced nephron numbers, smaller kidneys, and higher chronic kidney disease risk later in life. However, similar findings in humans are limited, and no studies in Nebraska have examined maternal VAD's effect on fetal and infant kidney development, despite 10% of mothers being deficient at delivery. Additionally, the impact of provitamin A compounds (α-carotene, β-carotene, β-cryptoxanthin) on kidney size remains unexplored. This study addresses these gaps by analyzing maternal plasma retinol and provitamin A carotenoids' relationship with fetal and infant kidney sizes.</div></div><div><h3>Design and Methods</h3><div>An institutional review board–approved prospective cohort study enrolled 120 pregnant women in Nebraska prior to their anatomy scans (18-20 weeks of gestation). The high-performance liquid chromatography–tandem mass spectrometry evaluated the retinol and provitamin A carotenoid concentrations at 24-28 weeks of gestation (n = 79) and at delivery in maternal circulation (n = 79) and umbilical cord (n = 79). Ultrasounds were used to assess fetal kidney length, volume, and parenchymal thickness at 18-20 weeks and infant kidney measurements within 48-72 hours of birth. Spearman's correlation evaluated the relationship between maternal plasma levels and kidney sizes. Linear regression analysis was performed, adjusting for maternal hypertension, diabetes, and smoking status. A Kruskal–Wallis test was performed to examine kidney size differences across retinol adequate, insufficient, and deficient groups, and a <em>P</em> value of <0.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>Ten percent of mothers (n = 8) and 19% of mothers (n = 15) had VAD during 24-28 weeks of gestation and at delivery, respectively. Maternal retinol at 24-28 weeks or at delivery was not associated with fetal or infant kidney size, and fetal kidney size did not differ between maternal retinol groups. However, maternal α- and β-carotene at 24-28 gestational weeks were significantly positively associated with fetal kidney lengths (right (R) kidney length with α-carotene: β = 0.279, <em>P</em> = .022, left (L) kidney length with α-carotene: β = 0.475, <em>P</em> < .001, L kidney length with β-carotene: β = 0.255, <em>P</em> = .029). Cord retinol was not associated with infant kidney size, nor did infant kidney size differ between cord retinol groups. In contrast cord α-carotene was significantly positively associated with infant kidney lengths (R kidney length: β = 0.178, <em>P</em> = .029, L kidney length: β = 0.168, <em>P</em> = .040). Lastly, the change in maternal plasma retinol from gestation to delivery was not associated with the change in fetal kidney size from gestation to birth. On the other hand, the changes in maternal α-carotene and β-carotene were signi
{"title":"Relationship Between Maternal Plasma Retinol and Provitamin A Carotenoids With Fetal and Infant Kidney Development: A Comprehensive Analysis","authors":"Anum Akbar MBBS, PhD , Rebecca Drakowski PhD , Matthew VanOrmer PhD , Rebekah Rapoza BS , Taija Hahka MS , Colman Freel BS , Sathish Kumar Natarajan PhD , Melissa Thoene RD, PhD , Corrine Hanson RD, PhD , Ann Anderson-Berry MD, PhD , Teri Mauch MD, PhD","doi":"10.1053/j.jrn.2025.07.006","DOIUrl":"10.1053/j.jrn.2025.07.006","url":null,"abstract":"<div><h3>Objective</h3><div>Vitamin A (retinol) is essential for fetal organ development, with preclinical studies associating maternal vitamin A deficiency (VAD) with reduced nephron numbers, smaller kidneys, and higher chronic kidney disease risk later in life. However, similar findings in humans are limited, and no studies in Nebraska have examined maternal VAD's effect on fetal and infant kidney development, despite 10% of mothers being deficient at delivery. Additionally, the impact of provitamin A compounds (α-carotene, β-carotene, β-cryptoxanthin) on kidney size remains unexplored. This study addresses these gaps by analyzing maternal plasma retinol and provitamin A carotenoids' relationship with fetal and infant kidney sizes.</div></div><div><h3>Design and Methods</h3><div>An institutional review board–approved prospective cohort study enrolled 120 pregnant women in Nebraska prior to their anatomy scans (18-20 weeks of gestation). The high-performance liquid chromatography–tandem mass spectrometry evaluated the retinol and provitamin A carotenoid concentrations at 24-28 weeks of gestation (n = 79) and at delivery in maternal circulation (n = 79) and umbilical cord (n = 79). Ultrasounds were used to assess fetal kidney length, volume, and parenchymal thickness at 18-20 weeks and infant kidney measurements within 48-72 hours of birth. Spearman's correlation evaluated the relationship between maternal plasma levels and kidney sizes. Linear regression analysis was performed, adjusting for maternal hypertension, diabetes, and smoking status. A Kruskal–Wallis test was performed to examine kidney size differences across retinol adequate, insufficient, and deficient groups, and a <em>P</em> value of <0.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>Ten percent of mothers (n = 8) and 19% of mothers (n = 15) had VAD during 24-28 weeks of gestation and at delivery, respectively. Maternal retinol at 24-28 weeks or at delivery was not associated with fetal or infant kidney size, and fetal kidney size did not differ between maternal retinol groups. However, maternal α- and β-carotene at 24-28 gestational weeks were significantly positively associated with fetal kidney lengths (right (R) kidney length with α-carotene: β = 0.279, <em>P</em> = .022, left (L) kidney length with α-carotene: β = 0.475, <em>P</em> < .001, L kidney length with β-carotene: β = 0.255, <em>P</em> = .029). Cord retinol was not associated with infant kidney size, nor did infant kidney size differ between cord retinol groups. In contrast cord α-carotene was significantly positively associated with infant kidney lengths (R kidney length: β = 0.178, <em>P</em> = .029, L kidney length: β = 0.168, <em>P</em> = .040). Lastly, the change in maternal plasma retinol from gestation to delivery was not associated with the change in fetal kidney size from gestation to birth. On the other hand, the changes in maternal α-carotene and β-carotene were signi","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 6","pages":"Pages 708-717"},"PeriodicalIF":3.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700948","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 : 2025-11-01DOI: 10.1053/j.jrn.2024.07.005
Xiaonv Lin MSN , Weige Sun MSN , Jiejing Cheng MB , Yue Du MB , Bin Xu MD
Background
This systematic review and meta-analysis investigated all prediction models for sarcopenia in maintenance hemodialysis patients.
Methods
This study used the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement for systematic review. Data sources were 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. 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 area under the curve (AUC), sensitivity, and specificity were 0.715, 0.583 and 0.656, respectively. The diagnostic criteria (P = .0046), country (P = .0046), and study design (P = .0087) were significant sources of the heterogeneity. Analyzing purely from the data perspective, grouping by diagnostic criteria, 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 group was lower than the European Working Group on Sarcopenia in Older People group [(0.859, 95% CI 0.12-1.00) and (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), and (0.875, 95% CI 0.854-0.895)] were all higher than the validation group [(0.715, 95% CI 0.09-0.98), (0.550, 95% CI 0.524-0.576), and (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 maintenance hemodialysis patients customized for diverse global populations.
背景：本系统综述和荟萃分析调查了维持性血液透析（MHD）患者肌少症的所有预测模型：本研究采用系统综述与荟萃分析声明（PRISMA）进行系统综述：截至2023年9月的PubMed、Web of Science、Embase、Cochrane Library和Medline数据库：使用预测模型偏倚风险评估工具（PROBAST）评估偏倚风险（ROB）。由于发现的异质性较高，因此计算了随机效应模型：对 12 项研究的 15 个模型进行了分析。所有研究的 ROB 都很高，其中三项研究的适用性风险很高。汇总的AUC、灵敏度和特异性分别为0.715、0.583和0.656。诊断标准（P=0.0046）、国家（P=0.0046）和研究设计（P=0.0087）是异质性的重要来源。单纯从数据角度分析，按诊断标准分组，亚洲肌少症工作组（AWGS）组的AUC和特异性[（0.773，95% CI 0.12-0.99，（0.652，95% CI 0.641-0.664）]低于欧洲老年人肌少症工作组（EWGSOP）组[（0.859，95% CI 0.12-1.00），（0.874，95% CI 0.803-0.926）]。按研究风格分组，发展组的 AUC、灵敏度和特异性[（0.890，95% CI 0.16-1.00），（0.751，95% CI 0.697-0.800），（0.875，95% CI 0.854-0.895）]均高于验证组[（0.715，95% CI 0.09-0.98），（0.550，95% CI 0.524-0.576），（0.617，95% CI 0.604-0.629）]：展望未来，我们亟需为 MHD 患者创建低 ROB、高适用性和更准确的肌少症预测模型，并为全球不同人群量身定制。
{"title":"Prediction Models for Sarcopenia in Patients With Maintenance Hemodialysis: A Systematic Review and Meta-Analysis","authors":"Xiaonv Lin MSN , Weige Sun MSN , Jiejing Cheng MB , Yue Du MB , Bin Xu MD","doi":"10.1053/j.jrn.2024.07.005","DOIUrl":"10.1053/j.jrn.2024.07.005","url":null,"abstract":"<div><h3>Background</h3><div>This systematic review and meta-analysis investigated all prediction models for sarcopenia in maintenance hemodialysis patients.</div></div><div><h3>Methods</h3><div>This study used the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement for systematic review. Data sources were 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. Random-effect models were calculated due to high heterogeneity identified.</div></div><div><h3>Results</h3><div>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 area under the curve (AUC), sensitivity, and specificity were 0.715, 0.583 and 0.656, respectively. The diagnostic criteria (<em>P</em> = .0046), country (<em>P</em> = .0046), and study design (<em>P</em> = .0087) were significant sources of the heterogeneity. Analyzing purely from the data perspective, grouping by diagnostic criteria, the AUC, and specificity [(0.773, 95% <em>CI</em> 0.12-0.99, (0.652, 95% <em>CI</em> 0.641-0.664)] of the Asian Working Group for Sarcopenia group was lower than the European Working Group on Sarcopenia in Older People group [(0.859, 95% <em>CI</em> 0.12-1.00) and (0.874, 95% <em>CI</em> 0.803-0.926)]. Grouping by styles of research, the AUC, sensitivity, and specificity in development group [(0.890, 95% <em>CI</em> 0.16-1.00), (0.751, 95% <em>CI</em> 0.697-0.800), and (0.875, 95% <em>CI</em> 0.854-0.895)] were all higher than the validation group [(0.715, 95% <em>CI</em> 0.09-0.98), (0.550, 95% <em>CI</em> 0.524-0.576), and (0.617, 95% <em>CI</em> 0.604-0.629)].</div></div><div><h3>Conclusions</h3><div>Moving forward, there is a critical need to create low-ROB, high-applicability, and more accurate sarcopenia prediction models for maintenance hemodialysis patients customized for diverse global populations.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 6","pages":"Pages 764-779"},"PeriodicalIF":3.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602057","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}
It remains unclear whether dietary fiber intake improves kidney outcome. The objective of our study was to examine the association between dietary fiber intake and the risk of kidney failure among patients with proteinuric chronic kidney disease (CKD).
Methods
A total of 2,126 participants in the Chronic Kidney Disease-Japan Cohort study were included in the present study. Dietary fiber intake was assessed using a self-administered Dietary History Questionnaire. The outcome was the initiation of kidney replacement therapy (KRT). The inverse probability weighting–Cox proportional hazards model was used to assess the association between dietary fiber intake and kidney outcome.
Results
The mean (standard deviation) estimated glomerular filtration rate and urinary protein-to-creatinine (Cre) ratio were 28 (13) mL/min/1.73 m2 and 1.4 (1.9) g/gCre, respectively. The median (interquartile range) dietary fiber intake was 10.4 (7.6-14.1) g/day. Serum potassium levels were comparable across quartiles of dietary fiber intake. During the median follow-up of 5.2 years, 823 initiated KRT (7.03 per 100 person-years). Although the highest quartile of total fiber intake was associated with a 37% (95% confidence interval: 30-48%) lower hazard of KRT initiation than the lowest quartile, their association became almost null after inverse probability weighting.
Conclusion
Higher dietary fiber intake was not associated with a lower risk of kidney failure among patients with proteinuric CKD.
{"title":"Lack of Association Between Dietary Fiber Intake and Kidney Failure Among Patients With Chronic Kidney Disease: The Chronic Kidney Disease-Japan Cohort Study","authors":"Koki Hattori MD, PhD , Yusuke Sakaguchi MD, PhD , Yoshitaka Isaka MD, PhD , Takahiro Imaizumi MD, PhD , Shoichi Maruyama MD, PhD , Masafumi Fukagawa MD, PhD , CKD-JAC Investigators","doi":"10.1053/j.jrn.2025.06.003","DOIUrl":"10.1053/j.jrn.2025.06.003","url":null,"abstract":"<div><h3>Objective</h3><div>It remains unclear whether dietary fiber intake improves kidney outcome. The objective of our study was to examine the association between dietary fiber intake and the risk of kidney failure among patients with proteinuric chronic kidney disease (CKD).</div></div><div><h3>Methods</h3><div>A total of 2,126 participants in the Chronic Kidney Disease-Japan Cohort study were included in the present study. Dietary fiber intake was assessed using a self-administered Dietary History Questionnaire. The outcome was the initiation of kidney replacement therapy (KRT). The inverse probability weighting–Cox proportional hazards model was used to assess the association between dietary fiber intake and kidney outcome.</div></div><div><h3>Results</h3><div>The mean (standard deviation) estimated glomerular filtration rate and urinary protein-to-creatinine (Cre) ratio were 28 (13) mL/min/1.73 m<sup>2</sup> and 1.4 (1.9) g/gCre, respectively. The median (interquartile range) dietary fiber intake was 10.4 (7.6-14.1) g/day. Serum potassium levels were comparable across quartiles of dietary fiber intake. During the median follow-up of 5.2 years, 823 initiated KRT (7.03 per 100 person-years). Although the highest quartile of total fiber intake was associated with a 37% (95% confidence interval: 30-48%) lower hazard of KRT initiation than the lowest quartile, their association became almost null after inverse probability weighting.</div></div><div><h3>Conclusion</h3><div>Higher dietary fiber intake was not associated with a lower risk of kidney failure among patients with proteinuric CKD.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 6","pages":"Pages 741-748"},"PeriodicalIF":3.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532761","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 : 2025-09-01DOI: 10.1053/j.jrn.2025.01.008
Ahmed Elkalashy MD , Randall R. Rainwater BS , Umair Ali MD , Enas Elbahnasawy MD , Manisha Singh MD , Nithin Karakala MD
In end-stage kidney disease (ESKD), hyperphosphatemia occurs secondary to decreased renal elimination with continued intestinal absorption of dietary phosphate. Even in chronic kidney disease, glomerular filtration rate lower than 30 mL/min markedly decreases the filtration of inorganic phosphate and increases its serum level. Sevelamer, a noncalcium phosphate binder, is commonly used to control hyperphosphatemia. Available in 2 forms, sevelamer hydrochloride and sevelamer carbonate, it absorbs phosphate in the gastrointestinal tract and is known to have minimal adverse effects. These are limited to nausea, vomiting, flatulence, and metabolic acidosis, with infrequent significant adverse outcomes. We present a series of 2 patients with ESKD on sevelamer, with lower gastrointestinal bleeding and endoscopic findings of colonic mucosal injuries with histopathological findings of sevelamer crystals deposition.
Although reported in gastrology literature, nephrology reports show a paucity of discussion around this increasingly common adverse effect and the need for vigilance in ESKD.
{"title":"Gastrointestinal Mucosal Cell Injury Caused by Sevelamer Crystals: Case Series and Literature Review","authors":"Ahmed Elkalashy MD , Randall R. Rainwater BS , Umair Ali MD , Enas Elbahnasawy MD , Manisha Singh MD , Nithin Karakala MD","doi":"10.1053/j.jrn.2025.01.008","DOIUrl":"10.1053/j.jrn.2025.01.008","url":null,"abstract":"<div><div>In end-stage kidney disease (ESKD), hyperphosphatemia occurs secondary to decreased renal elimination with continued intestinal absorption of dietary phosphate. Even in chronic kidney disease, glomerular filtration rate lower than 30 mL/min markedly decreases the filtration of inorganic phosphate and increases its serum level. Sevelamer, a noncalcium phosphate binder, is commonly used to control hyperphosphatemia. Available in 2 forms, sevelamer hydrochloride and sevelamer carbonate, it absorbs phosphate in the gastrointestinal tract and is known to have minimal adverse effects. These are limited to nausea, vomiting, flatulence, and metabolic acidosis, with infrequent significant adverse outcomes. We present a series of 2 patients with ESKD on sevelamer, with lower gastrointestinal bleeding and endoscopic findings of colonic mucosal injuries with histopathological findings of sevelamer crystals deposition.</div><div>Although reported in gastrology literature, nephrology reports show a paucity of discussion around this increasingly common adverse effect and the need for vigilance in ESKD.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 628-635"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374700","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 : 2025-09-01DOI: 10.1053/j.jrn.2025.04.001
Takahiro Yajima MD, Maiko Arao MD
Objective
The relationship between myosteatosis and muscle quality in hemodialyzed patients remains unknown. This study aimed to investigate the relationship between computed tomography (CT)-based abdominal myosteatosis indicators and handgrip strength (HGS) in these patients.
Methods
This study enrolled 128 hemodialyzed patients who underwent CT, bioimpedance analysis (BIA), and HGS measurement. CT-based abdominal myosteatosis indicators were measured, including psoas muscle density (PMD), paraspinous muscle density (PSMD), and abdominal skeletal muscle density (ASMD), defined as the mean CT value of each muscle at the third lumbar vertebral level. The association between these indicators and HGS was analyzed, and the diagnostic abilities of these indicators to detect low muscle strength, as defined by HGS cutoff values (male, <28 kg; female, <18 kg), were investigated.
Results
The PMD, PSMD, and ASMD were independently correlated with HGS (β = 0.310, P = .0041; β = 0.210, P = .033; and β = 0.252, P = .011, respectively), but not with BIA-estimated skeletal muscle index. Sixty-two (48.4%) patients had low HGS. After adjusting for confounding factors, the adjusted C-statistics of PMD, PSMD, and ASMD for detecting low HGS were 0.845 (reference), 0.836 (P = .56), and 0.837 (P = .50), respectively. Moreover, an increase in the PMD alone was independently associated with a decrease in the risk of low HGS (adjusted odds ratio: 0.912 (95% confidence interval 0.841-0.982), P = .015).
Conclusions
CT-based abdominal myosteatosis indicators were independently associated with HGS, but not with BIA-estimated skeletal muscle index, and may aid in detecting clinically acceptable low HGS in hemodialyzed patients. The PMD may be the most recommended myosteatosis indicator for assessing muscle quality in this population.
{"title":"Computed Tomography-based Abdominal Myosteatosis Indicators and Handgrip Strength in Hemodialyzed Patients","authors":"Takahiro Yajima MD, Maiko Arao MD","doi":"10.1053/j.jrn.2025.04.001","DOIUrl":"10.1053/j.jrn.2025.04.001","url":null,"abstract":"<div><h3>Objective</h3><div>The relationship between myosteatosis and muscle quality in hemodialyzed patients remains unknown. This study aimed to investigate the relationship between computed tomography (CT)-based abdominal myosteatosis indicators and handgrip strength (HGS) in these patients.</div></div><div><h3>Methods</h3><div>This study enrolled 128 hemodialyzed patients who underwent CT, bioimpedance analysis (BIA), and HGS measurement. CT-based abdominal myosteatosis indicators were measured, including psoas muscle density (PMD), paraspinous muscle density (PSMD), and abdominal skeletal muscle density (ASMD), defined as the mean CT value of each muscle at the third lumbar vertebral level. The association between these indicators and HGS was analyzed, and the diagnostic abilities of these indicators to detect low muscle strength, as defined by HGS cutoff values (male, <28 kg; female, <18 kg), were investigated.</div></div><div><h3>Results</h3><div>The PMD, PSMD, and ASMD were independently correlated with HGS (β = 0.310, <em>P</em> = .0041; β = 0.210, <em>P</em> = .033; and β = 0.252, <em>P</em> = .011, respectively), but not with BIA-estimated skeletal muscle index. Sixty-two (48.4%) patients had low HGS. After adjusting for confounding factors, the adjusted C-statistics of PMD, PSMD, and ASMD for detecting low HGS were 0.845 (reference), 0.836 (<em>P</em> = .56), and 0.837 (<em>P</em> = .50), respectively. Moreover, an increase in the PMD alone was independently associated with a decrease in the risk of low HGS (adjusted odds ratio: 0.912 (95% confidence interval 0.841-0.982), <em>P</em> = .015).</div></div><div><h3>Conclusions</h3><div>CT-based abdominal myosteatosis indicators were independently associated with HGS, but not with BIA-estimated skeletal muscle index, and may aid in detecting clinically acceptable low HGS in hemodialyzed patients. The PMD may be the most recommended myosteatosis indicator for assessing muscle quality in this population.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 646-654"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025199","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 : 2025-09-01DOI: 10.1053/j.jrn.2025.07.005
Giacomo Garibotto MD, Lucia Macciò MD, PhD, Linda W. Moore PhD, RDN
{"title":"Physical Exercise in Patients With Chronic Kidney Disease: A Call to Action","authors":"Giacomo Garibotto MD, Lucia Macciò MD, PhD, Linda W. Moore PhD, RDN","doi":"10.1053/j.jrn.2025.07.005","DOIUrl":"10.1053/j.jrn.2025.07.005","url":null,"abstract":"","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 565-567"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683958","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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