Kidney Disease Stage Research Articles

Enhancing diagnostic outcomes in kidney genetic disorders: the KidGen national kidney genomics study protocol

BackgroundGenetic kidney disease (GKD) significantly affects the community and is responsible for a notable portion of adult kidney disease cases and about half of cases in paediatric patients. It substantially impacts the quality of life and life expectancy for affected children and adults across all stages of kidney disease. Precise genetic diagnosis in GKD promises to improve patient outcomes, provide access to targeted treatments, and reduce the disease burden for individuals, families, and healthcare systems. Genetic investigations are increasingly used in nephrology practice; however, many patients who undergo testing still lack a definitive diagnosis.MethodsThe KidGen National Kidney Genomics Study aims to increase diagnostic yield for those with suspected monogenic kidney disease without a diagnosis after standard diagnostic genetic testing. The program will seek to enrol up to 200 families from KidGen Collaborative kidney genetics clinics across Australia who have yet to receive conclusive diagnoses despite prior testing. Participants will undergo a personalised pathway of research genomic investigations. These include re-analysing existing data and/or undergoing advanced genomic testing methods, including short and long-read whole-genome sequencing, RNA sequencing, and functional genomics strategies using mouse modelling or kidney organoids.DiscussionThe KidGen National Kidney Genomics Study is a coordinated, multidisciplinary extension of previous research projects that aims to assess the diagnostic yield of advanced genomic approaches. The study's evidence will drive changes to current diagnostic pathways, including identifying which chronic kidney disease patients are most likely to benefit from a more comprehensive genomic approach to diagnosis.

The Challenge of Fractures in Patients With Chronic Kidney Disease.

People with chronic kidney disease (CKD) are at increased risk of fractures in comparison to the non-CKD population, and fractures are associated with high mortality and worsening quality of life. However, the approach for evaluation of bone disease and fracture risk in CKD is different from the approach in the general population. The authors conducted a literature review of PubMed to include studies on pathophysiology of CKD mineral bone disorder, fracture risk assessment, and therapeutic options in the setting of CKD. The higher risk observed in the CKD population is related to the complex interplay of changes in bone turnover (T), mineralization (M), and volume (V), along with other risk factors accumulated as glomerular filtration rate declines. The diagnosis of the type of renal osteodystrophy is not based only on assessment of bone density and traditional risk factors for osteoporosis. There are limitations of currently available fracture risk tools in the CKD population. Treatment choice should take into consideration the 3 components of the TMV classification along with the stage of kidney disease and comorbidities, but the assessment of these components has not been well established. Current data are limited on efficacy and safety of treatments for fracture prevention in CKD. As new medications for the treatment of osteoporosis become available, there is an urgency to establish more clear guidelines for the diagnosis, fracture risk stratification, and treatment of bone disease in CKD.

Knowledge and competence of primary healthcare physicians in the management of diabetes-related chronic kidney disease.

Diabetes mellitus (DM) is a primary cause of chronic kidney disease (CKD), a significant and growing global health issue. Primary healthcare physicians (PHPs) are crucial in detecting, managing, and preventing CKD, but many lack the necessary knowledge and skills to effectively diagnose and manage the disease. This study assessed the knowledge and competence of PHPs in managing diabetes-related CKD. This cross-sectional study was conducted among all Primary Healthcare Physicians (PHPs) working at Primary Healthcare Center (PHC) in King Abdulaziz Medical City of the National Guard, Jeddah, Saudi Arabia. An online questionnaire was sent to all PHPs and data were collected from January 2024 to February 2024. Data analysis performed utilizing RStudio (version 4.3.1). Categorical variables were expressed as frequencies and percentages, whereas mean and standard deviations were computed for continuous variables. Kruskal-Wallis rank sum test was used to determine differences in confidence scores across various demographic and occupational characteristics. A multivariable linear regression analysis was performed to identify factors related to confidence. Of 141 PHPs, 122 filled online questionnaire yielding a response rate of 86.5%. responded. The majority (90.2%) were 18-45 years of age, 68.0% were qualified as family physicians, 38.0% belonged to the specialized poly clinic, and 54.9% had less than 5 years of experience. PHPs showed a varied levels of confidence and knowledge. While 76.2% were confident about the stages of kidney disease and 65.6% acknowledged the importance of the urine albumin-creatinine ratio (uACR) test, 58.1% were uncertain of interpreting uACR results and CKD diagnostic criteria. More than 60.0% were uncertain of the treatment steps postdiagnosis and prediction of CKD prognosis. Age, qualification, specialization in family medicine, and clinic affiliation were significantly related to confidence levels. The study underscores notable gaps in PHPs' knowledge and confidence concerning CKD screening, diagnosis, and management. Continuous education and targeted interventions are essential for the improvement of PHPs' competence and patient outcomes in the management of CKD.

The effect of synbiotic supplementation on plasma levels of advanced glycation end products and cardiovascular risk factors in hemodialysis patients: A double-blind clinical trial.

There is increasing evidence supporting the relationship between imbalance of gut microbiota and development of chronic kidney and cardiovascular diseases. This study aimed to investigate the effect of synbiotic supplementation on plasma levels of advanced glycation end products (AGEs) and cardiovascular risk factors in hemodialysis (HD) patients. In this randomized, double-blind, placebo-controlled clinical trial, 36 HD patients were randomly allocated into two groups to receive two synbiotic supplements (n = 19) or placebo (n = 17) daily for 12 weeks. Levels of AGEs, fibrinogen, hemoglobin A1c (HbA1c), and other measures were assessed at the beginning and end of the study. The data were analyzed using independent t-tests, paired t-tests, and analysis of covariance (ANCOVA). At the end of the study, the plasma levels of AGEs increased significantly in both the synbiotic (p < .001) and control (p = .001) groups, but the difference between the groups was not significant (p = .272). Plasma levels of fibrinogen decreased specifically within the synbiotic group (p = .007), and a statistically significant disparity between the groups persisted at the study's conclusion (p = .016). The mean levels of blood urea nitrogen (BUN) decreased (p < .05) in both groups, but there was no difference between the two groups at the end of the study (p = .116). No significant differences were observed in other measured biomarkers. Synbiotic supplementation improved plasma fibrinogen and BUN levels in HD patients, but did not significantly improve AGEs and HbA1c. Further investigations are needed to investigate the effect of probiotics on AGEs in HD patients at different stages of kidney disease.

Knowledge and Competence Regarding the Management of Chronic Kidney Disease among Family Medicine Professionals in the Eastern Province of Saudi Arabia: A Cross-Sectional Study.

Diabetes is a significant risk factor for chronic kidney disease (CKD) and a primary cause of global morbidity and mortality, resulting in significant costs to healthcare systems. The management of diabetic CKD in the primary care setting remains an ongoing challenge despite the current best practices in the quality of care. This study evaluated family medicine physicians' knowledge and confidence regarding managing CKD in the Eastern Province of Saudi Arabia. A self-administered online questionnaire was distributed to physicians through various social media sites and email lists. The largest number of participants reported a full confidence in knowing kidney disease stages, blood pressure targets and the importance of urine albumin-creatinine ratio testing. Overall, 71.8% of physicians reported a high confidence level, followed by 23.9% reporting average and 4.2% reporting low confidence. Being younger and working at PHC were identified as significant predictors of increased confidence. Although most of the physicians reported a high confidence in managing CKD patients, the need for improvement was evident. Age and workplace institutions were the greater contributors to physicians' confidence. Continuous education among healthcare practitioners is crucial to updating knowledge and providing optimum quality of care among this group of patients.

MicroRNA and renal fibrosis in autosomal dominant polycystic kidney disease: a longitudinal study.

Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary kidney disorder that may progress to kidney failure, accounting for 5-10% of all patients with end-stage kidney disease (ESKD). Clinical data, as well as molecular genetics and advanced imaging techniques have provided surrogate prognostic biomarkers to predict rapid decline in kidney function, nonetheless enhanced tools for assessing prognosis for ADPKD are stillneeded. The aim of this study was to analyze specific microRNAs involved in the pathogenesis of ADPKD and in the development of renal fibrosis, evaluating their potential role as predictors of renal function loss. We evaluated kidney function by estimated glomerular filtration rate (eGFR) in 32 ADPKD patients in different stages of kidney disease at T0 and after a 24-month follow up (T1). Patients were divided into two groups: Rapid disease progression ([RP], n 15) and Non-rapid disease progression ([NRP], n 17), according to the Mayo Clinic classification criteria. At T0, ADPKD patients underwent plasma sampling for quantitative analysis of h-miR-17-5p, h-miR-21-5p and h-miR-199a-5p microRNA expression, using the quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) method and a 3T magnetic resonance imaging (MRI), using an advanced MRI imaging protocol, for the quantification of total kidney volume (TKV), total perfusion volume (TPV) and total fibrotic volume (TFV). The expression of h-miR17-5p was higher (p < 0.05) in ADPKD patients with rapid disease progression. h-miR-17-5p, h-miR-21-5p and h-mir-199-5p showed a positive and significant correlation with the eGFR slope (mL/min/1.73 m2/year) (p < 0.05) but not with the eGFR at both T0 and T1. Both total fibrotic volume (cm3) and height-adjusted total fibrotic volume (cm3/m) were positively and significantly correlated to h-miR 21-5p and h-miR 199-5p (p < 0.05), but not to total kidney volume (cm3) and height-adjusted total kidney volume (cm3/m). The microRNAs we studied were associated with fibrosis and renal damage, suggesting their possible role as biomarkers able to identify ADPKD patients at high risk of disease progression regardless of the degree of kidney function, and therefore suitable for medical therapy, and may help uncovering new molecular mechanisms underlying cystogenesis.

Comparison of Dietary Patterns and Daily Food Intake Across Kidney Disease Stages in England: An A-Posteriori Cluster Analysis

ObjectiveDietary patterns are rapidly becoming a major focus of medical nutrition therapy in 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 are not well described, and, to our knowledge, have not been conducted in a UK-based cohort. MethodsAdult participants with a diagnosed kidney condition (CKD 1-5 not requiring dialysis) were recruited into a multi-centre observational cross-sectional study. Dietary intake was assessed using the European Prospective Investigation of Cancer in Norfolk Food Frequency Questionnaire. Logistic Principal Components Analysis was used to identify food group clusters. Differences between groups were assessed using univariate general linear modelling. ResultsIn 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 eGFR was 36.6 (±20.9) ml/min/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. ConclusionOverall, 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 healthcare providers about the need to consider treatment modalities and stages when giving dietary recommendations.

Investigating clinical pharmacokinetics of brivaracetam by using a pharmacokinetic modeling approach

The development of technology and the processing speed of computing machines have facilitated the evaluation of advanced pharmacokinetic (PK) models, making modeling processes simple and faster. The present model aims to analyze the PK of brivaracetam (BRV) in healthy and diseased populations. A comprehensive literature review was conducted to incorporate the BRV plasma concentration data and its input parameters into PK-Sim software, leading to the creation of intravenous (IV) and oral models for both populations. The developed physiologically based pharmacokinetic (PBPK) model of BRV was then assessed using the visual predictive checks, mean observed/predicted ratios (Robs/pre), and average fold error for PK parameters including the maximum systemic concentration (Cmax), the area under the curve at time 0 to t (AUC0–∞), and drug clearance (CL). The PBPK model of BRV demonstrated that mean Robs/pre ratios of the PK parameters remained within the acceptable limits when assessed against a twofold error margin. Furthermore, model predictions were carried out to assess how AUC0–∞ is affected following the administration of BRV in individuals with varying degrees of liver cirrhosis, ranging from different child–pugh (CP) scores like A, B, and C. Moreover, dose adjustments were recommended by considering the variations in Cmax and CL in various kidney disease stages (mild to severe).

#2232 Personalized kidney replacement therapy in critically ill patients: unity makes strength!

Abstract Background and Aims The complexity of the critically ill patient with kidney disease has increased in recent years. A holistic and multidisciplinary approach is, therefore, necessary in order to provide the best therapeutic guidance. Multiple modalities of kidney replacement therapies (KRT) are available in this setting, namely continuous kidney replacement therapies (CKRTs) and hybrid therapies, also such as sustained low-efficiency dialysis (SLED) and slow continuous ultrafiltration (SCUF). These techniques can be used in conjunction with other extracorporeal clearance therapies such as plasmapheresis (PF), and immunoadsorption (IA). Their prescription must be individualized according to the characteristics of each patient. In our hospital all KRT and extracorporeal techniques used are reviewed daily by a nephrologist. This study aims to describe the 20-year experience of our centre in individualized KRT prescription in intensive care. Methods A retrospective cohort, single centre study was conducted. We reviewed adult patients (age ≥18 years) admitted in all the ICUs of our hospital centre between January 2002 and December 2022, who required a KRT. We aimed to describe demographic data, different stages of kidney disease [AKI, AKI in CKD, chronic hemodialysis (HD), peritoneal dialysis (PD), kidney transplant (KT), rapidly progressive kidney failure (RPKF), other causes], the KRT used and the main outcomes. Results During the study period, 1578 patients who required a KRT were admitted to the ICU. Median age was 65 (IQR: 45-81) years old and 59.9% were male. Among these patients 715 (45.3%) had AKI, 380 (24.1%) were in HD, 315 (20%) had AKI in CKD, 130 (8.2%) had a KT and 31 (2%) were in PD. Four patients had RPKF and 3 patients had other causes for KRT, such as hyperammonemia and sodium valproate poisoning. The main KRT performed were: SLED—1365 (86.5%) patients; continuous venovenous hemodiafiltration (cvvHDF)—120 (7.6%) patients; SLED + cvvHDF—66 (4.2%). Other KRT executed were SLED + PF (11 patients), continuous venovenous hemofiltration (cvvHF) (8 patients) and SCUF (2 patients). Among all patients mortality rate was 42.3%, 33% had renal recovery and 7.4% started chronic HD. In AKI group the median age was 64 (IQR: 48-80) years and 56.3% were male. 576 (80.7%) performed SLED, 91 (12.7%) did cvvHDF and 36 (5.0%). Mortality rate was of 52.1%, renal recovery 45% and 2.9% started chronic HD. Conclusion Our ICU multidisciplinary approach model with a critical care nephrology specialists team translates into a large amount of accumulated experience with SLED. Our results are comparable to centres that predominantly use CKRTs. The range of different techniques used reflects the fact that KRT has become a complex treatment for critically ill patients, which allows for the prescription to be precisely tailored to the different daily clinical needs.

25(OH)D level and vascular lesion scores in kidney histopathology as risk-stratification tool for predicting renal progression in people with type 2 diabetes

AimTo evaluate the potential of the combined individual vascular histopathological lesion and serum 25-hydroxy vitamin D [25(OH)D] level as predictors of outcomes in patients with diabetes and chronic kidney disease. MethodsA total of 190 patients with type 2 diabetes and kidney disease stages 1–4 were retrospectively included. Kaplan-Meier analysis and the log-rank test were performed to assess renal survival differences. And the time-dependent receiver operating characteristic analyses were used to characterize the predictive accuracy. Hazard ratios for vascular lesion scores and 25(OH)D levels with renal outcomes were estimated using Cox proportional hazards regression models with follow-up time. ResultsOver a median follow-up of 23.78 (12.61, 37.14) months, 71 patients (37.4 %) experienced the renal outcomes. Enrolled patients with more severe vascular lesions had worse kidney function, heavier proteinuria, lower serum 25(OH)D levels, and higher prevalence of composite kidney outcomes. Baseline serum 25(OH)D was a significant independent risk factor for vascular lesion scores. The effect of serum 25(OH)D level on kidney prognosis was more pronounced in males and those with more exacerbated vascular lesions (score 2). The severity of vascular lesions and serum 25(OH)D levels were associated with unfavorable kidney outcomes. Accordingly, further time-dependent receiver operating characteristic curves confirmed that combined 25(OH)D level and vascular lesion score had a stable and reliable performance in renal outcomes prediction at short and long-term follow-up times. Conclusions25(OH)D level and vascular lesion scores in kidney histopathology could serve as a useful risk-stratification tool for predicting renal progression in patients with type 2 diabetes.

Long-Term Effects of Dietary Modifications on Renal Outcomes in Diabetes: A Meta-Analysis

This meta-analysis investigated the long-term efficacy of dietary modifications on renal outcomes in individuals with diabetes. We systematically reviewed six studies, focusing on the impact of specific dietary components, including protein and salt intake and the use of nutraceuticals such as ketoacids, across global settings, including Poland, Nigeria, Taiwan, Italy, Austria, and Japan. The studies varied in design, ranging from observational to randomized controlled trials. The sample sizes and study durations ranged from 28 to 6,213 participants and 28 days to 5 years. Our analysis revealed that dietary protein restriction generally stabilized and improved renal function. However, the response to protein restriction varied, suggesting the need for personalized dietary management strategies. Furthermore, reducing salt intake was consistently beneficial, aligning with its known effects on lowering blood pressure and reducing proteinuria. Nutraceuticals, especially ketoacids, showed their potential as supplements for renal diet management. These findings supported the integration of nutraceuticals into dietary plans to enhance renal outcomes without compromising nutritional status. Thus, our meta-analysis demonstrated the importance of tailored dietary interventions in managing renal outcomes in individuals with diabetes and suggested that personalized nutrition, which considers individual dietary needs and kidney disease stage, should be a fundamental component of comprehensive CKD management.

Social and psychological problems experienced by people with chronic diseases in Algeria

The chronic diseases constitute pathological social phenomena as they have an impact on the organic construction for individuals; They make their roles and functions in the society regress and weak due to the results made by these diseases on their social, psychological, and economic lives as well. They make several problems which lead to struggles be it the patient with himself or with people surrounding him. Amongst the most known and dangerous diseases is kidney failure which is included at the last stage of kidney disease; The kidney completely loses its function and work leading by this to dialysis with medical equipments and apparatus. Undoubtedly, the patient, at the time of being acquainted with the disease, is exposed to psychological trauma such as: not accepting and not adapting to the disease. Following by social problems by time owed to the fact that the patient will not play his ordinary role whether inside the family or outside it leading him accordingly to pressures preventing him from adapting to the social reality. Therefore, we pose the following question: What are the major psychological and social problems that patients with kidney failure are suffering from?

Postoperative factors associated with psychological well-being of living kidney donors: results of a retrospective and qualitative study.

Kidney transplantation from a living donor is the treatment of choice for end- stage kidney disease. Psychological implications of living kidney donation are of great importance, both during preliminary psychiatric assessment and post-donation follow-up. The identification of risk factors worsening the psychological well-being of living kidney donors (LKDs), before and after donation, remains challenging in terms of research. At the University Hospitals of Geneva (HUG), our clinical observations and practice compelled us to establish post-donation follow-ups for LKDs at 6 months and 1 year. Pre-and post-donation sociodemographic, physical, psychological, and psychiatric data was collected from the medical records of 115 LKDs who underwent a complete physical and psychological evaluation during the period 2011-2018. We tested for any potential association between the variables under study. A qualitative and retrospective analysis of this data highlighted the impact of postoperative factors, such as pain, fatigue, recipient-donor relationship, and fulfillment of donors' expectations, on the post-donation psychological well-being of LKDs. With regard to these findings, regular post-donation follow-ups, optimal care of postoperative pain and fatigue, as well as a solid therapeutic alliance with LKDs remain key points for clinicians involved in the dynamic process of living kidney donation.

Systemic biomarkers of microvascular alterations in type 1 diabetes associated neuropathy and nephropathy - A prospective long-term follow-up study

IntroductionThis study aimed to investigate circulating biomarkers associated with the risk of developing diabetic peripheral neuropathy (DPN) and nephropathy in type 1 diabetes (T1D). Materials and methodsPatients with childhood-onset T1D (n = 49, age 38.3 ± 3.8 yrs.) followed prospectively were evaluated after 30 years of diabetes duration. DPN was defined as an abnormality in nerve conduction tests. Matrix metalloproteinase-9 (MMP-9) and its tissue inhibitor TIMP-1, neutrophil gelatinase-associated lipocalin-2 (NGAL), soluble P-selectin (sP-selectin), estimated GFR (eGFR), micro/macroalbuminuria and routine biochemistry were assessed. For comparison, control subjects were included (n = 30, age 37.9 ± 5.5 yrs.). ResultsIn all, twenty-five patients (51 %) were diagnosed with DPN, and nine patients (18 %) had nephropathy (five microalbuminuria and four macroalbuminuria). Patients with DPN had higher levels of TIMP-1 (p = 0.036) and sP-selectin (p = 0.005) than controls. Patients with DPN also displayed higher levels of TIMP-1 compared to patients without DPN (p = 0.035). Patients with macroalbuminuria had kidney disease stage 3 with lower eGFR, higher levels of TIMP-1 (p = 0.038), and NGAL (p = 0.002). In all patients, we found only weak negative correlations between eGFR and TIMP-1 (rho = −0.304, p = 0.040) and NGAL (rho = −0.277, p = 0.062, ns), respectively. MMP-9 was higher in patients with microalbuminuria (p = 0.021) compared with normoalbuminuric patients. ConclusionsOur findings indicate that TIMP-1 and MMP-9, as well as sP-selectin and NGAL, are involved in microvascular complications in T1D. Monitoring and targeting these biomarkers may be a potential strategy for treating diabetic nephropathy and neuropathy.

Sodium-glucose co-transporter 2 inhibitor add-on therapy for metformin delays diabetic retinopathy progression in diabetes patients: a population-based cohort study

To investigate how sodium-glucose co-transporter 2 inhibitors (SGLT2is) add-on therapy for metformin affects diabetic retinopathy (DR) progression in patients with type 2 diabetes mellitus (T2DM). This nationwide population-based study conducted from January 1, 2016, to December 31, 2018 involved 3,432,911 adults with T2DM in Taiwan. To adjust for potential confounders, data on sex, age, income, comorbidities, diabetes complication severity index score, staging of kidney disease, anti-diabetic medications, and index year were included. The outcome was DR progression, determined by procedure codes or the addition of ICD-9-CM or ICD-10-CM codes to the medical records of the patients during the study. Sensitivity analyses were performed to validate the findings. The adjusted hazard ratio (aHR) of DR progression was 0.89 for the SGLT2is add-on group, relative to the control group [95% confidence interval (CI) 0.81–0.99, P = 0.026]. The Kaplan–Meier curve of the cumulative incidence rate showed that the cumulative incidence of DR progression was considerably decreased in the SGLT2is cohort (log-rank P = 0.0261). The use of SGLT2is for less than 1 year and 1–2 years were associated with a significant increase in the risk of DR progression (aHR 1.56 and 1.88, respectively); however, the risk markedly reduced if the SGLT2is regimen was used for more than 2 years (aHR 0.41, 95% Cl 0.35–0.48; P < 0.001). The serial sensitivity analysis showed consistent findings. The aHR of DR progression was 0.82 for the SGLT2is cohort relative to the non-SGLT2is cohort based on the fundoscopy or indirect ophthalmoscopy findings within 1 year before the outcome date (95% Cl 0.71–0.95; P = 0.009). Co-administration of metformin and SGLT2is may reduce the risk of DR progression. Short-term use of SGLT2is may markedly increase the risk of DR, whereas prolonged use SGLT2is may significantly decrease it.

Insulin Resistance and Insulin Handling in Chronic Kidney Disease.

Insulin regulates energy metabolism involving multiple organ systems. Insulin resistance (IR) occurs when organs exhibit reduced insulin sensitivity, leading to difficulties in maintaining glucose homeostasis. IR ensures decades prior to development of overt diabetes and can cause silent metabolic derangements. IR is typically seen very early in the course of chronic kidney disease (CKD) and is evident even when the estimated glomerular filtration rate (eGFR) is within the normal range and IR persists at various stages of kidney disease. In this article, we will discuss insulin handling by the kidneys, mechanisms responsible for IR in CKD, measurements and management of IR in patients with CKD, and recent type 2 diabetic trials with implications for improved cardiovascular outcomes in CKD. © 2023 American Physiological Society. Compr Physiol 13:5069-5076, 2023.

Actual dietary intake versus dietary recommendation among patients with chronic kidney disease!-an observational study

Background: As diet is an important component of chronic kidney disease management. It is important to understand the actual dietary intake of these patients and see if they are able to meet their respective recommended dietary allowance (RDA), failing which they are predisposed to malnutrition. Hence the study was carried out to assess the actual dietary intake of the subjects with chronic kidney disease to understand the gap between recommendation and actual intake. Aim of this study was to assess the dietary intake of patients with chronic kidney disease. Methods: Patients with chronic kidney disease in stages 3 and 4 were recruited based on the inclusion criteria and the information on demographics, medical history, subjective data and seven-day dietary recall were obtained. The quantitative and qualitative estimation of the seven-day dietary intake was computed using “Dietcal” software. Results: Anorexia was observed among 54% of the study participants. The mean calorie, protein and carbohydrate intake was 959.69±166.49 Kcals, 27.94±5.36 g and 160.5±26.7 g respectively while mean intake of sodium, potassium and phosphorous were 88.65±42.88 mg, 944.5±188.69 mg and 560.77±127.64 mg respectively. Conclusions: The actual dietary intake was lesser than the recommended intake as influenced by anorexia, dysguesia, early satiety and dietary restrictions. Poor nutrient intake per se is the primary influential factor in the onset of malnutrition. Hence, it is important to adopt customized approach rather than generalized nutrient restrictions imposed upon these patients.

Daño renal oculto en pacientes diabéticos.

Introduction: Up to 40% of patients with type 2 Diabetes mellitus (T2DM) develop diabetic nephropathy (DN). This variable proportion depends on several intrinsic factors of the population. The study's objective was to describe the renal functional stage of patients with T2DM and to demonstrate the incidence of occult kidney damage in patients admitted to a provincial reference center for patients with T2DM in Holguín, Cuba. Methods: The present observational, cross-sectional, and prospective study was conducted at the Provincial Diabetic Center in Holguín from March 2019 to March 2021. Cases of patients with T2DM were included. The variables were demographic and clinical (Albuminuria, hyperglycemia, hypertension, proteinuria, hypercholesterolemia, hypertriglyceridemia, hyperuricemia, and fundus). The sample was probabilistic, consisting of 377 cases. Descriptive statistics were used. Results: 537 patients with T2DM were analyzed, including 341 women (63.5%). Patients &gt; 60 years old were 259 (48.2%). The time of diagnosis of T2DM was &lt;1 year in 270 cases (50.3%). 74 cases (13.8%) were patients with already established DN. Patients with obesity and overweight were 74.9%. The presence of albuminuria in grades A2 and A3 was 21.2% (CI95 17.8-24.7%). 60% of cases presented hypertriglyceridemia. High blood pressure occurred in 75.6%. In 79 cases (14.7%), there was diabetic retinopathy. CKD-EPI stage 2 had 254 cases, or 47.3%. Conclusion: Most patients with T2DM (82.1%) have chronic kidney disease in stages 2 to 5. Over half (60%) present Hypertriglyceridemia, obesity, and high blood pressure.

#2954 DAPAGLIFLOZIN IN IGA NEPHROPATHY: EARLY EXPERIENCE FROM A SINGLE CENTER IN CENTRAL INDIA

Abstract Background and Aims IgA nephropathy (IgAN), a common glomerulopathy, may progress to end- stage kidney disease despite use of optimum treatment with immunosuppressants and renin- angiotensin aldosterone system antagonist. Recently, dapagliflozin (DAPA) has been shown to reduce the progression of kidney function decline in IgAN. The beneficial effects in kidney function could be because of reduction in the intraglomerular pressure. To assess the kidney function in terms of change in estimated glomerular filtration rate (eGFR) and urinary protein creatinine ratio (UPCR) with use of DAPA in patients with IgAN. Method We retrospectively collected the data of IgAN patients from our electronic database. Demographic, renal function parameters and biopsy findings were collected and compared in patients who received immunosuppression only (group I) and those who received DAPA in addition to immunosuppression (group II). Results We identified a total of 150 patients with IgAN from our database. Among these, 59 (39.3%) were managed conservatively whereas 91 (60.7%) were receiving immunosuppressive (steroid+/- mycophenolate mofetil) treatments. Among these, 67 (73.6%) received immunosuppression treatment alone (group I) whereas 24 (26.4%) patients received DAPA along with immunosuppression (group II). The mean age was 34.8±10.7 years and 36.7±9.4 years in groups I and II respectively. Proportion of males was 68.7% and 70.8% in two groups. At baseline, the renal function parameters such as serum creatinine, eGFR and UPCR as well as MEST-C scores were comparable in both the groups (p&amp;gt;0.05 for all three parameters). After a median follow-up of 4.9 months (IQR25-75: 1.6 to 13.4 months) in the group I, the improvement in eGFR (P = .065) and reduction in UPCR (P = .778) did not reach statistical significance. After a median follow-up of 3.9 months (IQR25-75: 1.1 to 12.3 months) in the groups II, there was non-significant improvement in the eGFR but the reduction in the UPCR was significant (median 2.6 [IQR25-75: 13 to 3.8] to 1.9 [IQR25-75: 0.7 to 2.6], P = .041). Conclusion Our initial experience in patients of IgA nephropathy suggests that the addition of DAPA to existing immunosuppressive treatment is useful in reducing the UPCR in short-term.

#2947 COMPARISON OF TRACE ELEMENT CONCENTRATIONS IN PREDIALYSIS, HEMODIALYSIS AND PERITONEAL DIALYSIS PATIENTS

Abstract Background and Aims Regulation of many trace elements (TE) is critically dependent on kidney functions. Dialysis modality, duration of dialysis, equipment, purity of water and nutrition also impacts TE balance. There are inadequate data on comparison of TE in patients with different stages of kidney disease. We aimed to compare TE levels in a restricted geographical area across a wide range of glomerular filtration rate (GFR) including end stage kidney disease. We assumed that this kind of design might be beneficial for understanding TE balance and impact of dialysis. Method Hemodialysis (HD), peritoneal dialysis (PD) and chronic kidney disease (CKD) patients with reduced GFR were included in this cross-sectional study. A sample of plasma was analyzed by inductively coupled plasma mass spectrometry (ICP-MS) (Thermo Scientific™ iCAP Q ICP-MS, USA). Sensitivity was on the order of ppb (µg/L). A control group (CG) with glomerular filtration rate ≥ 90 ml/min were used for comparison of plasma levels of TE. Results Results of TE are presented in the Table 1. Significant number of both patients and controls lack a valid TE measurement because of the concentrations below limit of the detection (LoD). Copper, in CKD patients, is negatively correlated with hospitalization within the last six months (r= - 0,315, p= 0.005). Conclusion Our data suggest that TE levels except Zn and Mn deviate from that of CG in a statistically significant manner in renal patients. Existing data on TE in renal patients are inconsistent and there is some confusion. Similarly, our results are consistent with some data and conflicting with others. In future studies, this confusion could be eliminated by evaluating each trace element separately and minimizing methodological problems. (This study is realized with support of Cumhuriyet University CUBAP)