Patients' Preferences and Perceived Barriers and Facilitators to Achieving Nutrition-Related Health Outcomes in Chronic Kidney Disease: A Scoping Review.

Stressful Life Changes Affect Nutrition-Related Health Outcomes Among US Army Soldiers (P18-070-19)

Aim: In the Middle East where nutrition-related diseases continue to be on the rise, health literacy related research may provide meaningful insight to patient-provider communication, nutrition and general health behavior, to improve health outcomes. Yet, little is known about health literacy in the region. We provide insight into the current research on health literacy and nutrition-related outcomes in the region. Methods: English-language articles were identified using relevant keywords to search PubMed, Medline, Web of Science, and ProQuest Middle East & African. Inclusion criteria were quantitative and qualitative studies of any design focused on health literacy and nutrition-related health outcomes in the Middle East. We identified 22 unduplicated articles that met inclusion criteria.Results: To date, only three studies employ a validated health literacy measure to examine the relationship between health literacy and nutrition-related disease outcomes (e.g., diabetes, overweight, and obesity). However, the research findings from the three studies cannot be generalized to larger populations within each country. Participants were patients who regularly visited health care facilities. The limited samples may bias conclusions regarding health literacy and the influence on nutrition-related disease outcomes.Conclusions: Research is needed to understand health literacy and health literacy needs in Middle East countries, which are known for their racial and ethnic, and socio-economic diversity. Researchers can take advantage of the multitude of health literacy tools which have been validated and are readily available for use in diverse populations. Established health literacy measures provide greater benefit than developing brand new assessments when important information is urgently needed to address nutrition-related health outcomes.

The Effectiveness of App-Based Mobile Interventions on Nutrition Behaviors and Nutrition-Related Health Outcomes: A Systematic Review and Meta-Analysis

Moving Beyond Tools and Building Bridges: Lessons Learned From a CKD Decision Support in Primary Care

The food environment plays an important role in nutrition-related health outcomes. The influence of market settings on overall diet quality may be substantial where individuals regularly attend any given market. Salamanca Market (Hobart, Tasmania), and Carriageworks Market (Sydney, New South Wales; NSW) are two popular Saturday markets, attended regularly by locals. Salamanca Market provides a diverse range of edible (~30% of stalls) and non-edible (~70% of stalls) goods with a non-exclusive focus on ‘Tasmania’s own’ products. Carriageworks ‘Farmers Market’ features primarily edible products (~90% of stalls), requiring products to be grown/made/produced by the stallholder in NSW or Australian Capital Territory(1). While benefiting from tourism, these two markets are strongly attended by locals(2), therefore making an important contribution to health of individuals as a food environment experienced frequently and repeatedly. This study examined changes in food/beverage stall offerings at these markets over a 10- to 13-year period, as a reflection on the potential changes in weekly markets and hence food environments experienced across Australia. Stallholder information for Salamanca (summer stallholders 2011–12 to 2023–24) and Carriageworks (2015–2024 inclusive) markets were obtained from the respective official websites and analysed for stall categorisation. Current range of available products and categorisations were confirmed through in-person audits in January 2024. Descriptive statistics were used to summarise the findings. Over the study period, Salamanca Market food and beverage offerings grew by 21% to comprise 31.7% (89/291) of all stalls in 2024. This was driven by an increase in stalls offering primarily ‘discretionary’ foods/beverages: Take Away Food increased by 58% to 38% and Confectionary nearly doubled to 11% of food/beverage stalls. Stalls selling alcohol as their primary product increased from 13% to 64% of all beverage stalls over this time; vendors selling primarily whisky/spirits grew from 1 stall in 2012–13 to 9 stalls in 2023–24. This occurred simultaneously with a reduction in ‘core’ foods availability: Fruit and Vegetable stalls dropped from 24% to 10% and Dairy halved to 3% of food/beverage stalls. However, self-titled ‘farmers market’ Carriageworks demonstrated relative stability in stall composition over 10 years. Notable changes included reduction in number of Meat/Fish/Poultry/Alternatives stalls by 50%, and an almost halving of Condiments stalls, however other stall types (Fruit/Vegetables; Dairy) have remained relatively unchanged in number and proportion; almost two thirds of stalls primarily sold ‘core’ foods. In summary, stall composition at a market prizing a diversity of offerings demonstrated a transition to a poorer food environment, whereas stall composition at a ‘farmers market’ demonstrated less change and a ‘healthier’ composition of food/beverage offerings over 10–13 years. The food environment offered at ‘farmers markets’ is likely to be superior for healthful food purchasing and positive impacts on nutrition-related outcomes, compared to mixed-business markets.

Kidney failure: are we failing?

Chronic kidney disease (CKD) is a complex condition, where the decrease in kidney function is accompanied by numerous metabolic changes affecting virtually all the organ systems of the human body. Many of the biomarkers characteristic of the individually affected organ systems have been associated with adverse outcomes including higher mortality in advanced CKD, whereas in persons without CKD these biomarkers may have no bearing on survival. It is believed that the high mortality seen in CKD is a result of several abnormalities conspiring to induce or aggravate a heightened degree of cardiovascular morbidity and predisposition to wasting syndrome. Not all the biomarkers may, however, be causally responsible for the adverse outcomes associated with them. We review various biomarkers of protein-energy wasting, inflammation, oxidative stress, potassium disarrays, acid-base disorders, bone and mineral disorders, glycemic status, and anemia. Although all of these biomarkers have shown associations with worsened outcomes in CKD, markers of protein-energy wasting, especially serum albumin, remain the strongest predictor of survival in CKD patients, especially those undergoing maintenance dialysis treatment. We also review the putative pathophysiologic mechanisms behind these associations, and present potential therapeutic interventions that could result in remedies to improve poor clinical outcomes in CKD, pending the results of current and future controlled trials.

Introduction: Chronic kidney disease (CKD) is a global health concern, particularly among patients with type 2 diabetes mellitus (T2DM) and prediabetes, who are at high risk of cardiovascular disease (CVD). The Center for Integrated and Novel Approaches in Vascular-Metabolic Disease (CINEMA) program at University Hospitals Cleveland Medical Center aims to address these challenges through a multidisciplinary, patient-centered intervention. This study evaluates CKD prevalence, outcomes, and guideline-directed treatments within the CINEMA program. Methods: Patients with T2DM or prediabetes at high-risk for cardiovascular events, including those with established atherosclerotic CVD, elevated coronary artery calcium score ≥100, chronic heart failure, ischemic stroke, peripheral arterial disease, CKD (defined as eGFR<60mL/min/1.73m2 and/or by the presence of albuminuria, UACR ≥30 mg/g) and obesity with metabolic syndrome were included. Results: From May 2020 to September 2022, 454 patients were enrolled in the CINEMA program with 45% having a diagnosis of CKD. Among those with CKD, the median age was 64 years, 48% were women, and 47% were Black. 93% had T2DM, 82% had HTN, 52% had established coronary artery disease, and 39% had heart failure. Median eGFR was 49 mL/min/1.73m2 and median UACR was 42 mg/g. Over two-thirds of those with CKD were stage G3 or greater and 50% were stage A2 or greater. Persons with CKD were more likely to be older, Black, have diabetes and heart failure (p<0.05 for all). UACR screening increased ~8-fold with the CINEMA program. The CINEMA intervention was associated with statistically significant improvements in cardiometabolic risk factors with reductions in body weight (-3.49 lbs), BMI (-0.54 kg/m2), systolic blood pressure (-2.65 mmHg), Hb A1c (-0.63%), total cholesterol (-9.01 mg/dL) and LDL cholesterol (-8.29 mg/dL) with p<0.05 for all. No significant changes were seen in eGFR (p=0.58) or UACR (p=0.41). Notably, there was significant increase in prescription rates of SGLT2i (25% to 55%) and GLP-1RA (14% to 38%) in the CKD population from baseline to follow-up visit (p<0.05). Conclusions: The CINEMA program demonstrates effectiveness in improving ASCVD risk factors and shows promise in addressing CKD outcomes among high-risk patients with T2DM or prediabetes. Enhanced screening for CKD, proper risk stratification, and aggressive implementation of guideline directed medical therapies in patients with CKD can lead to improved outcomes.

Chronic kidney disease (CKD) is a global health concern, particularly among patients with type 2 diabetes mellitus (T2DM) and prediabetes who are at high risk of cardiovascular disease (CVD). The Center for Integrated and Novel Approaches in Vascular-Metabolic Disease (CINEMA) program aims to address these challenges through a multidisciplinary, patient-centered intervention. This study evaluates the CKD prevalence and outcomes in the CINEMA program, with a focus on risk for CVD and CKD progression and guideline-directed treatments. Patients with T2DM or prediabetes at high-risk for cardiovascular events, including those with established atherosclerotic CVD, elevated coronary artery calcium score ≥100, chronic heart failure, ischemic stroke, peripheral arterial disease, CKD (defined as eGFR<60mL/min/1.73 m and/or by the presence of urine-albumin creatinine ratio, UACR, ≥30 mg/g) and obesity with metabolic syndrome were included. From May 2020 to September 2022, 454 patients were enrolled in the CINEMA program with 45 % having a diagnosis of CKD. Among those with CKD, the median age was 64 years, 48 % were women, and 47 % were Black. 93 % had T2DM, 82 % had HTN, 52 % had established coronary artery disease, and 39 % had heart failure. Median eGFR was 49 mL/min/1.73 m and median UACR was 42 mg/g. Persons with CKD were more likely to be older, Black, have diabetes and heart failure (p < 0.05 for all). From August 2020 to June 2022, the CINEMA intervention was associated with statistically significant improvements in cardiometabolic risk factors with reductions in body weight (-3.49 lbs), BMI (-0.54 kg/m2), systolic blood pressure (-2.65 mmHg), Hb A1c (-0.63 %), total cholesterol (-9.01 mg/dL) and LDL cholesterol (-8.29 mg/dL), p < 0.05 for all. There was a trend toward lower UACR (p = 0.41) and no significant change in eGFR (p = 0.58). There was a significant increase in prescription rates of SGLT2i (25 % to 55 %) and GLP-1RA (14 % to 38 %) in the CKD population from baseline to follow-up (p < 0.05). In high-risk patients with T2DM or prediabetes and CKD, the CINEMA program is effective in improving cardiovascular risk factors and shows promise in addressing CKD outcomes. Enhanced screening for CKD, appropriate risk stratification, and aggressive implementation of guideline-directed medical therapies may lead to improved long-term outcomes.

BACKGROUND AND AIMS Sex-specific differences exist in the population prevalence of chronic kidney disease (CKD), progression rates and health outcomes. Recognition, diagnosis and monitoring are central processes in the management of patients with CKD, but it is unknown whether these processes differ between men and women. METHOD This is an observational cohort study of all adult individuals (n = 227 847) with at least one eGFR (from serum creatinine) &amp;lt;60 mL/min/1.73 m2 during outpatient routine care in Stockholm, Sweden, 2009–2017. Through logistic regression, we evaluated differences by sex in carrying an ICD-10 code for CKD and provision of recommended medications (renin–angiotensin system inhibitors [RASi] and statins) at inclusion. Through Cox regression, we evaluated potential sex differences in receiving a CKD diagnosis, referral to nephrology care and performance of laboratory monitoring (creatinine and albuminuria) in the next 18 months from inclusion. We also explored time-trends, comparing the above-mentioned nephrology care indicators among 70–80 000 unique eligible individuals per calendar year (in total 695 632 observations), thus allowing participants to contribute to different calendar year-cohorts. RESULTS We identified more women (55%) than men (45%) with probable CKD (eGFR &amp;lt; 60 mL/min/1.73 m2). Women were generally older than men (median 77 versus 74 years), but eGFR was similar between sexes (51 mL/min/1.73 m2). More men than women had diabetes or myocardial infarction, but there was similar prevalence of hypertension. At inclusion and compared with men, women had lower risk of carrying an ICD-10 code for CKD (odds ratio [OR]: 0.47, 95% CI: 0.45–0.49) and were less likely to receive RASi (OR: 0.55; 0.50–0.61, among patient with albuminuria A3) or statins (OR: 0.64; 0.63–0.66, among patients ≥ 50 years), despite the presence of clear indications. In subsequent time-to-event analyses, women were less likely to receive a CKD diagnosis (hazard ratio [HR]: 0.43; 0.42–0.45) and visit a nephrologist (HR: 0.46; 0.43–0.48) regardless of CKD severity, presence of albuminuria or criteria for referral. Women were also less likely to undergo monitoring of creatinine or albuminuria, even among participants with diabetes (HR: 0.75; 0.74–0.76) or hypertension (HR: 0.76; 0.75–0.78). Multivariable adjustment including comorbidities, eGFR and indication for referral showed some attenuation of the effect, but a sex difference remained. Although in absolute terms there has been a gradual improvement in all nephrology care indicators over time, the observed sex gap persisted throughout. CONCLUSION We found profound sex differences in the detection, recognition, monitoring and management (including referrals) of CKD in healthcare, also across high-risk groups and indications.

Definition and Classification of CKD: The Debate Should Be About Patient Prognosis—A Position Statement From KDOQI and KDIGO

Finerenone—A New Frontier in Renin-Angiotensin-Aldosterone System Inhibition in Diabetic Kidney Disease

Background/Aims: Abnormal serum potassium is associated with higher mortality in dialysis patients, but its impact on outcomes in predialysis chronic kidney disease (CKD) is less clear. Furthermore, blacks with normal kidney function have lower urinary potassium excretion, but it is unclear if such differences have a bearing on race-associated outcomes in CKD. Methods: We studied predialysis mortality and slopes of estimated glomerular filtration rate, eGFR) associated with serum potassium in 1,227 males with CKD. Mortality was examined in time-dependent Cox models, and slopes of eGFR in linear mixed effects models with adjustments for case mix and laboratory values. Results: Both hypo- and hyperkalemia were associated with mortality overall and in 933 white patients, but in 294 blacks hypokalemia was a stronger death predictor. Hypokalemia was associated with loss of kidney function independent of race: a 1 mEq/l lower potassium was associated with an adjusted difference in slopes of eGFR of -0.13 ml/min/1.73 m²/year (95% CI: -0.20 to -0.07), p < 0.001. Conclusion: Hypo- and hyperkalemia are associated with higher mortality in CKD patients. Blacks appear to better tolerate higher potassium than whites. Hypokalemia is associated with faster CKD progression independent of race. Hyperkalemia management may warrant race-specific consideration, and hypokalemia correction may slow CKD progression. This is a work of the US Government and is not subject to copyright protection in the USA. Foreign copyrights may apply. Published by S. Karger AG, Basel

Chronic kidney disease (CKD) has significant clinical and therapeutic implications. This study assessed CKD prevalence, risk factors, and long-term outcomes in patients with systemic lupus erythematosus (SLE), both with and without lupus nephritis (LN). This single-center, retrospective, medical records review study, conducted between 2014 and 2023, included adult patients with SLE. CKD was defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or albuminuria ≥ 30 mg/24 h in ≥ 2 consecutive tests, spaced ≥ 3 months apart. Statistical analyses included chi-square tests, t tests, multivariable regression, and Cox proportional hazards models. A total of 175 patients with SLE were included, with a mean follow-up of 18.3 (SD 14.7) years. Of these patients, 12 required kidney replacement therapy. CKD was diagnosed in 54.6% (89/163) of patients, including 15.7% with reduced eGFR only, 52.8% with albuminuria only, and 31.5% with both. LN was associated with a higher hazard ratio (HR) of 5.4 for CKD, and 46.1% of patients with CKD had no history of LN. CKD was associated with increased cardiovascular morbidity and hospitalization rates for SLE exacerbations and infections. Cox analyses identified LN as the strongest predictor of CKD, with age and lower eGFR at diagnosis identified as other predictors. CKD was an important predictor of mortality among patients with SLE, in both univariate and multivariable analyses (19.1% vs 1.4%, P < 0.001). CKD is highly prevalent in SLE, including in patients without prior LN. CKD is associated with increased morbidity and mortality. This study emphasizes the clinical relevance of CKD diagnosis and management in patients with SLE.

Too Many for Too Few: Finding Appropriate Nephrology Referrals for Patients With CKD That Optimize Outcomes