Journal of Renal Nutrition最新文献

Objectives: Skeletal muscle loss and abnormal fat distribution are predictors of poor clinical outcomes in adults with chronic kidney disease (CKD). However, the relationship between body composition (muscle mass and adipose tissue) and prognosis in children with CKD has not been well elucidated.

Methods: The retrospective single-center study enrolled children with CKD and healthy group who underwent an abdominal computerized tomography examination and compared the body composition of the third lumbar spine (L3) between the 2 groups. We defined the primary outcome as hemodialysis, peritoneal dialysis, kidney transplantation, or death. Logistic regression analysis was applied to assess the connection between low skeletal muscle density (SMD) and clinical and demographic variables. Multivariate Cox regression analysis was used to evaluate the risk factors for progression to the primary outcome. Kaplan-Meier survival analysis was performed to compare the effect of different body composition on event-free survival rate.

Results: Thirty-two patients with CKD [estimated glomerular filtration rate: 14.89 (8.86, 29.88) (mL/min/1.73 m²)] and 66 heathy subjects [estimated glomerular filtration rate: 135.72 (121.70, 161.29) (mL/min/1.73 m²)] were recruited in our study. From the assessment of body composition assessed by computerized tomography, skeletal muscle area, SMD, and skeletal muscle index in the CKD group was lower than those in the healthy group (P < .05). On the other hand, visceral fat area and visceral fat index in the CKD group were significantly higher than those in the healthy group (P < .05). In logistic regression analysis, triglyceride (odds ratio: 8.635, 95% confidence interval (CI): 1.153-64.687) was independently associated with low SMD. After adjusting clinical data and body composition, high serum albumin (hazard ratio: 0.873, 95% CI: 0.798-0.955) and high SMD (hazard ratio: 0.895, 95% CI: 0.822-0.974) were protective factors for delaying renal failure. Based on the Kaplan-Meier analysis, only the group with low SMD had lower event-free survival in comparison to the reference group (P < .05).

Conclusions: These findings suggest that there is significant skeletal muscle loss and decrease in SMD in CKD children. Notably, low SMD is indicative of poor prognosis in CKD children.

Objectives: Higher serum magnesium concentrations have been linked to reduced risk of chronic kidney diseases (CKDs). However, the dose-response relationships between magnesium intake and CKD and kidney stones in the general population remain unknown. This study aimed to quantitatively assess the dose-response relationships between magnesium intake and CKD and kidney stones.

Methods: Adult participants (≥50 years) from the 2007-2018 National Health and Nutrition Examination Survey were included. Magnesium intake from diet and supplements were determined with structured dietary recalls. Patients with kidney stones were identified using a standard questionnaire. CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m². The nonlinear relationships were explored with restricted cubic splines. Stratified analyses by sex were conducted.

Results: The weighted prevalence of CKD and kidney stones was 12.16% and 13.13%, respectively. A nonlinear relationship between magnesium intake and CKD (P_{for nonlinearity}<.01) and kidney stones (P_{for nonlinearity} = .02) was found. There was an initial steep decrease in odds of CKD and kidney stones with increasing intakes of magnesium, and then a platform or weaker decrease in odds of CKD and kidney stones was observed beyond 350 mg/day of magnesium intake [odds ratio (95% confidence interval) for CKD: 0.60 (0.46-0.78), 0.77 (0.61-0.98) for kidney stones]. Higher magnesium intake was inversely associated with odds of CKD in both males and females, while the inverse association between higher magnesium intake and odds of kidney stones was only statistically significant in females.

Conclusions: Higher magnesium intake was nonlinearly associated with lower odds of kidney stones and CKD, and a threshold level of 350 mg/day of magnesium intake was observed in adults aged 50 years and older. These findings deserve to be confirmed by prospective cohort studies.

Objective: Low vitamin D status is associated with either low muscle mass or impaired muscle function in dialysis patients. However, there is no consensus on how best to correct hypovitaminosis D, defined as serum 25-hydroxyvitamin D level <30 ng/mL, in patients with end-stage kidney disease (ESKD). This study investigated the effect of different vitamin D supplementation regimens on sarcopenia outcomes in dialysis patients.

Methods: This was a prospective randomized controlled trial. ESKD patients treated with maintenance hemodialysis (HD) or peritoneal dialysis with low vitamin D status on a ratio of 1:1, were randomized to either receive oral ergocalciferol utilizing a severity-dependent treatment protocol for low vitamin D status suggested by the Kidney Disease Outcomes Quality Initiative as a control group or a fixed-dose regimen of 20,000 international units/week. The changes in muscle mass were measured by bioimpedance spectroscopy, muscle strength was assessed by a hand grip dynamometer, physical performance was determined by gait speed, and muscle-related biomarkers were examined.

Results: A total of 76 dialysis patients were randomized (HD = 43.4%). Baseline characteristics, including age, dialysis vintage, and muscle parameters were similar. After supplementation, the average serum 25-hydroxyvitamin D levels in the severity-dependent and fixed-dose groups were significantly elevated from 14.5 ± 7.3 to 27.2 ± 13.2 ng/mL, P < .001 and from 15.1 ± 6.4 to 28.8 ± 11.5 ng/mL, P < .001, respectively, and did not differ between groups at 6 months (P = .60). Despite comparable energy and protein intake, the mean bioimpedance spectroscopy-derived total body muscle mass normalized to height squared was significantly increased at 6 months in the fixed-dose group (14.5 ± 3.3 to 15.3 ± 3.0 kg/m², P = .03) compared with the severity-dependent protocol (13.5 ± 2.7 to 13.7 ± 2.9 kg/m², P = .58). In the subgroup analysis, muscle mass improvement was statistically elevated in peritoneal dialysis patients (P = .01) while unaltered among HD patients (P = .88) in the fixed-dose group. Muscle strength, gait speed, and serum insulin-like growth factor-1 level, as the mediators of muscle cell growth, were not different between the two groups at 6 months (P > .05). Neither hypercalcemia nor hyperphosphatemia was found throughout the study.

Conclusion: A fixed-dose ergocalciferol supplementation demonstrates similar performance in the correction of low vitamin D status but better muscle mass improvement than a severity-dependent protocol among ESKD patients. Regular dosing intervals of weekly vitamin D supplementation appear to be a promising treatment for sarcopenia among patients undergoing dialysis.

Objectives: Higher dietary acid load (DAL) has been linked to elevated incidence and progression of chronic kidney disease. However, the association between DAL and mortality in patients on maintenance hemodialysis (MHD) has not been evaluated.

Methods: We retrospectively analyzed baseline laboratory data, self-administered diet history questionnaire results, and 10-year mortality rates in 44 patients (26 men, 67.9 ± 10.4 years) on MHD who participated in a randomized, double-blind, crossover pilot trial of rice endosperm protein supplementation, which was conducted in 2013. DAL was estimated from nutrition intake using potential renal acid load (PRAL), and patients were divided into tertiles using this score.

Results: During the 10-year observation period, 19 patients (43%) died. A higher PRAL score was significantly associated with higher all-cause mortality. The multivariable-adjusted hazard ratio for all-cause mortality in the highest tertile of PRAL versus the lowest tertile was 3.88 (95% confidence interval [CI], 1.10-13.61). Multiple logistic regression analysis showed a significant association between higher PRAL and lower intake of green and yellow vegetables (odds ratio, 5.40; 95% CI, 1.37-21.26) and fruits (odds ratio, 4.76; 95% CI, 1.30-16.76).

Conclusions: Higher PRAL is positively associated with all-cause mortality, and these associations might be affected by a lower intake of fruits and vegetables in Japanese patients on MHD.