Non-dialysis Chronic Kidney Disease Research Articles

Integrating the new pharmacological standard of care with traditional nutritional interventions in non-dialysis CKD.

Chronic kidney disease (CKD) is widely recognized as a leading and growing contributor to global morbidity and mortality worldwide. Nutritional therapy is the basic treatment for metabolic control, and may contribute to nephroprotection; however, the absence of solid evidence on slowing CKD progression together with poor adherence to dietary prescription limit de facto itsefficacy and prevent itsmore widespread use. Sodium-glucose transport protein 2 inhibitors (SGLT2is) are now considered the new standard of care in CKD; in addition, novel potassium binders, glucagon-like peptide-1 receptor antagonists (GLP1-RAs) and nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) show either direct (SGLT2i, GLP1-RA, nsMRA) or indirect (potassium binders that enable the optimal use of renin-angiotensin-aldosterone system inhibitors) nephroprotective effects. These drugs could potentially lead to a more permissive diet, thereby allowing the patient to reap the benefits of this approach. In particular, SGLT2is, and to a lesser extent also GLP1-RAs and nsMRAsin patients with diabetic kidney disease, can counterbalance hyperfiltration as well as the higher protein intake often recorded in obese patients; on the other hand, potassium binders can facilitate following plant-based diets, which are considered healthy because of the high content of essential micronutrients such as antioxidant vitamins, minerals, alkalies, and fibers. In this review paper, we discuss the current pharmacological paradigm shift that places a new, broader standard of care in light of its interaction with nutritional therapy in order to optimize the global approach to patients with CKDnotondialysis.

Health Literacy in Non-dialyzed Chronic Kidney Disease Patients: A Cross-Sectional Study

Objective: To explore the current status and influencing factors of health literacy in non-dialyzed chronic kidney disease (CKD) patients, and to provide a basis for developing more comprehensive and effective interventions. Methods: 206 CKD patients hospitalized or followed up in outpatient clinics in the Department of Nephrology of a tertiary hospital in Baoding City were conveniently selected from June to August 2024. General information questionnaire, Health Literacy Scale for Chronic Disease Patients, Perceived Social Support Scale, and Positive Psychological Questionnaire were used to conduct the survey. Results: The health literacy score of non-dialyzed CKD patients was (91.04±15.17); The results of multiple linear regression analysis showed that the number of comorbidities, education level, per capita monthly household income, family support, and optimism were the influencing factors of health literacy in CKD patients. Conclusion: The health literacy of non-dialyzed CKD patients is low, and healthcare professionals should develop scientific and reasonable intervention programs based on their influencing factors in order to enhance the health literacy and delay disease progression.

Does gut microbiota dysbiosis impact the metabolic alterations of hydrogen sulfide and lanthionine in patients with chronic kidney disease?

BackgroundChronic Kidney Disease (CKD) is characterized by a methionine-related metabolic disorder involving reduced plasma levels of hydrogen sulfide (H2S) and increased lanthionine. The gut microbiota influences methionine metabolism, potentially impacting sulfur metabolite dysfunctions in CKD. We evaluated whether gut microbiota dysbiosis contributes to H2S and lanthionine metabolic alterations in CKD.MethodsThe gut microbiota of 88 CKD patients (non-dialysis, hemodialysis, and transplant patients) and 26 healthy controls were profiled using 16 S-amplicon sequencing. H2S and lanthionine concentrations were measured in serum and fecal samples using the methylene blue method and LC-MS/MS, respectively.ResultsThe CKD population exhibited a tenfold increase in serum lanthionine associated with kidney dysfunction. Despite lanthionine retention, hemodialysis and transplant patients had significantly lower serum H2S than healthy controls. Fecal H2S levels were not altered or related to bloodstream H2S concentrations. Conversely, fecal lanthionine was significantly increased in CKD compared to healthy controls and associated with kidney dysfunction. Microbiota composition varied among CKD groups and healthy controls, with the greatest dissimilarity observed between hemodialysis and transplant patients. Changes relative to the healthy group included uneven Ruminococcus gnavus distribution (higher in transplant patients and lower in non-dialysis CKD patients), reduced abundance of the short-chain fatty acid-producing bacteria Alistipes indistinctus and Coprococcus eutactus among transplant patients, and depleted Streptococcus salivarius in non-dialysis CKD patients. A higher abundance of Methanobrevibacter smithii, Christensenella minuta, and Negativibacillus massiliensis differentiated hemodialysis patients from controls. No correlation was found between differentially abundant species and the metabolic profile that could account for the H2S and lanthionine alterations observed.ConclusionsThe metabolic deregulation of H2S and lanthionine observed in the study was not associated with alterations in the gut microbiota composition in CKD patients. Further research on microbial sulfur pathways may provide a better understanding of the role of gut microbiota in maintaining H2S and lanthionine homeostasis.

Patient-reported mental health problems and clinical outcomes in adults with non-dialysis chronic kidney disease.

Mental health affects well-being and physical health. Among adults with chronic kidney disease (CKD), mental health (MH) problems are common and can induce adverse clinical outcomes. We examined the association between patient-reported MH problems and clinical outcomes in adults with non-dialysis CKD. This prospective observational study included 1,879 participants from the KNOW-CKD (KoreaN Cohort Study for Outcomes in Patients With CKD). Patients-reported MH problems were determined using four indicators of the Korea National Health and Nutrition Examination Survey questionnaire. We described the cross-sectional differences in health-related quality of life according to MH problems. We prospectively evaluated the hazard ratio (HR) of all-cause death and end-stage kidney disease (ESKD) according to the MH problems for a median follow-up of 6.4 years. The participants (mean age 53 years; 61.6% male) had patient-reported MH problems of inadequate sleep duration (17.4%), subjective distress (27.3%), depressive symptoms (13.2%), and suicidal ideation (16.8%). In the fully adjusted Cox proportional model, poor MH (≥2 problems) was associated with a high risk of ESKD (HR, 1.46; 95% confidence interval [CI], 1.18-1.08) and death (HR, 1.55; 95% CI, 1.04-2.32) compared with good MH. Furthermore, the single indicator of suicidal ideation was associated with a high risk of ESKD (HR, 1.37; 95% CI, 1.11-1.69) and death (HR, 1.98; 95% CI, 1.34-2.92). Patient-reported MH problems are common in adults with CKD. Poor MH and only suicidal ideation are associated with a high risk of ESKD and early death. Age and sex modify the association between poor MH and adverse clinical outcomes in non-dialysis CKD.

Impact of Home-Based Rehabilitation on Renal Prognosis in Patients with Chronic Kidney Disease.

The increasing prevalence of chronic kidney disease (CKD) requires effective preventive measures, particularly due to an aging population. This study aimed to assess the effectiveness of home visit rehabilitation in preventing renal function decline among patients with CKD. In this retrospective study, patients with non-dialysis CKD undergoing home visit rehabilitation were compared with those receiving outpatient care at the Nippon Medical School Hospital between August 2017 and August 2023. Patients' backgrounds were matched using propensity scores derived from a logistic regression model. The primary endpoint was the annual change in the estimated glomerular filtration rate (eGFR), and the secondary endpoint was the annual change in blood parameters (Δblood urea nitrogen, Δcreatinine, Δtotal protein, Δalbumin, ΔC-reactive protein, Δhemoglobin, and Δhematocrit). Furthermore, the incidence of clinical outcomes, including mortality, hospitalization rate, and dialysis initiation rate, were analyzed within the additional 1-year observation period. Overall, 128 patients (64 matched pairs) were analyzed. After a mean follow-up period of 12.7 ± 4.6 months, there was no significant difference in the eGFR between both groups (40.1 ± 13.7 vs. 37.8 ± 13.8 mL/min/1.73 m2, p = 0.36), but the annual decline in eGFR (%/year) was significantly lower in the rehabilitation group (-1.1 ± 29.8% vs. -11.8 ± 27.7%/year, p = 0.037). The annual change in the level of each blood test parameter and clinical outcomes were not significantly different between the two groups. Home-based rehabilitation interventions may mitigate the progression of renal impairment in patients with CKD.

Effects of supportive hemodialysis on the management of a pregnant woman with advanced chronic kidney disease: a case report and literature review

BackgroundPregnancy in women with chronic kidney disease (CKD) is associated with an increased risk of adverse maternal and fetal outcomes, including worsening renal function, hypertension, proteinuria, preeclampsia, preterm delivery, stillbirth, and intrauterine growth restriction. Some pregnant women with CKD may require dialysis after conception. Clinical guidelines provide recommendations for optimal hemodialysis prescription in pregnant women undergoing maintenance hemodialysis for end-stage kidney disease. However, the timing of initiation and optimal doses of hemodialysis for pregnant women with non-dialysis advanced CKD remain uncertain.Case presentationWe describe the case of a 29-year-old woman with a history of CKD for at least 2 years. She was referred to our department with a serum creatinine level of 2.48 mg/dL and an estimated glomerular filtration rate of 20 mL/min/1.73 m2. Because she was found to be pregnant at the initial visit, she was referred to the Department of Obstetrics. At 23 weeks’ gestation, she was admitted due to threatened premature delivery and urinary tract infection, which were managed with ritodrine hydrochloride and antibiotics. Owing to maternal weight loss and asymmetrical fetal growth restriction, daily protein intake was increased from 40 g/day to 60–80 g/day. Additionally, supportive hemodialysis (three times per week) was initiated at 26 weeks’ gestation, and the pre-dialysis blood urea nitrogen (BUN) level was consistently maintained < 40 mg/dL. Consequently, the patient’s weight increased, and fetal growth recovered. Because her blood pressure increased particularly during and after dialysis sessions, dialysis was discontinued at 32 weeks’ gestation. Urinary protein increased to a nephrotic level, and blood pressure was poorly controlled by medication, suggesting the onset of preeclampsia. Thus, a cesarean section was performed at 33 weeks’ gestation, and she delivered a male baby weighing 1449 g. Following childbirth, the patient did not require hemodialysis.ConclusionsSupportive hemodialysis during pregnancy in women with advanced CKD can increase maternal protein intake without elevating BUN levels, leading to improved fetal growth.

Association between health-related hope and distress from restrictions in chronic kidney disease and dialysis

BackgroundIn chronic kidney disease (CKD), the durability of patient adherence to fluid and dietary restrictions may depend on the degree to which they have hope that they will enjoy life. Previous cross-sectional studies have shown that higher hope was associated with lower distress from fluid and dietary restrictions and better adherence in the short term. In this study, we aimed to examine the long-term relationship of hope with distress from fluid and dietary restrictions.MethodsThis prospective observational cohort study included 444 patients with CKD undergoing dialysis in one of five Japanese nephrology centers. Hope as a predictor was measured using an 18-item health-related hope scale. Outcomes were two-item measures of distress from fluid and dietary intake restrictions using the Japanese version of the Kidney Disease Quality of Life Short Form, Version 1.3 (higher scores indicate lower levels of distress). Multivariate linear mixed models were used to estimate the association of baseline health-related hope with distress from fluid and dietary restrictions at baseline and follow-up.ResultsThe mean age of the participants was 67 years, and 31.1% of them were females. In total, 124, 98, and 222 had non-dialysis CKD, peritoneal dialysis, and hemodialysis, respectively. Higher levels of baseline health-related hope were associated with lower levels of distress from fluid restriction after one year (per 10-point increase, 2.6 points (95% confidence interval, 1.0 to 4.1)); whereas the baseline score was not associated with the distress from fluid restriction at 2 years. Similarly, higher levels of baseline health-related hope were associated with lower levels of distress from dietary restriction after one year (per 10-point increase, 2.0 points (95% confidence interval, 0.3 to 3.6)); whereas the baseline score was not associated with the distress from dietary restriction at 2 years.ConclusionsHealth-related hope, regardless of depression, can potentially mitigate long-term distress from fluid and dietary restrictions in patients with a wide range of CKD severities.Trial registrationUMIN000054710.

Real-world fracture risk, osteoporosis treatment status, and mortality of Japanese non-dialysis patients with chronic kidney disease stages G3-5.

Few studies have investigated fracture risk and mortality in a Japanese chronic kidney disease (CKD) stages G3-5 population using a large-scale clinical database. This retrospective cohort study extracted data from 1 April 2008 to 30 April 2023. A single age-sex-matched control without CKD was matched with each non-dialysis CKD (estimated glomerular filtration rate < 60mL/min/1.73m2) patient. The incidences of all and hip fractures and all-cause mortality after the index date were calculated. Among 76,598 (38,299 per group) individuals matched, the incidence of all fractures did not differ between the CKD and control groups (5.7% vs 5.8%; hazard ratio [HR] 1.022 [95% confidence interval CI 0.952-1.098], P = 0.542). The CKD group had higher risk of hip fracture than the control group (incidence of hip fracture, 1.7% vs 1.3%; HR 1.415 [95% CI 1.234-1.622], P < 0.001). Multivariable regression analysis showed an increased risk for hip fracture in the CKD vs control groups, and a greater difference in this risk was observed with younger age. Osteoporosis treatment and bone mineral density (BMD) measurements were 10.0% and 5.3% in the CKD group and 4.4% and 4.4% in the control group, respectively. Mortality was also higher in the CKD group (HR 1.413 [95% CI 1.330-1.501], P < 0.001). Japanese patients with CKD had higher risk of hip fracture than those without. Treatment and BMD measurement for fracture are insufficient in Japanese patients with CKD, and more adequate management of fracture risk is needed.

Screening for Peripheral Vascular Disease: The Role of Ankle-Brachial Index (ABI) and Estimated Glomerular Filtration Rate (eGFR) Changes in Chronic Kidney Disease.

Background Chronic kidney disease (CKD) is a significant public health issue worldwide, closely linked with cardiovascular events such as atherosclerosis, peripheral arterial disease (PAD), stroke, coronary artery disease (CAD), and heart failure. The ankle-brachial index (ABI) is a simple tool that compares blood pressure in the ankle and arm, helping to detect PAD and assess the risk of cardiovascular events. An increased ABI signifies an increased risk of cardiovascular disease (CVD), whereas a diminished ABI correlates with angiographically verified atherosclerosis along with heightened death rates. Recent research indicates a U-shaped relationship between ABI and mortality, underscoring the necessity for early detection and action to mitigate potential consequences. Aim This study aimed to correlate ABI changes with estimated glomerular filtration rate (eGFR) changes in CKD patients to screen for the development of peripheral vascular disease. Materials and methods This prospective cross-sectional study was conducted in the outpatient department of a tertiary care hospital in India, focusing on patients diagnosed with CKD admitted to the general medicine department. The inclusion criteria were CKD patients with an eGFR less than 60 ml/min/1.73 m², accompanied by indicators of renal damage such as albuminuria, reduced kidney size on ultrasound, abnormal urinary sediment, or biopsy-proven kidney disease. Patients with peripheral vascular disease, with end-stage renal disease (on dialysis), with limb amputations, with hemodynamic instability, or who declined participation were excluded. eGFR was calculated using the Modification of Diet in Renal Disease (MDRD) equation, and the ABI was measured at baseline, three months, and six months. ABI values below 0.9 indicated peripheral vascular disease, and the study aimed to correlate changes in ABI with eGFR to assess vascular disease development in non-dialyzed CKD patients. Results By the end of the third month, a positive correlation was observed between ABI and eGFR (r=0.259), which persisted at the end of the sixth month (r=0.245). Conclusion The study concludes that a direct relationship exists between decreasing eGFR and ABI, which increases susceptibility to PAD and CVD. A low ABI is linked to an accelerated decline in eGFR, indicating that systemic atherosclerosis predicts kidney function deterioration.

Identification of serum biomarkers for chronic kidney disease using serum metabolomics

This study aimed to identify biomarkers for chronic kidney disease (CKD) by studying serum metabolomics. Serum samples were collected from 194 non-dialysis CKD patients and 317 healthy controls (HC). Using ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS), untargeted metabolomics analysis was conducted. A random forest model was developed and validated in separate sets of HC and CKD patients. The serum metabolomic profiles of patients with chronic kidney disease (CKD) exhibited significant differences compared to healthy controls (HC). A total of 314 metabolites were identified as significantly different, with 179 being upregulated and 135 being downregulated in CKD patients. KEGG enrichment analysis revealed several key pathways, including arginine biosynthesis, phenylalanine metabolism, linoleic acid metabolism, and purine metabolism. The diagnostic efficacy of the classifier was high, with an area under the curve of 1 in the training and validation sets and 0.9435 in the cross-validation set. This study provides comprehensive insights into serum metabolism in non-dialysis CKD patients, highlighting the potential involvement of abnormal biological metabolism in CKD pathogenesis. Exploring metabolites may offer new possibilities for the management of CKD.

Physical Activity Elements and Adverse Outcomes in Patients with Chronic Kidney Disease in Guangdong (PEAKING) project: protocol for a prospective cohort study

IntroductionPhysical inactivity is prevalent and associated with adverse outcomes among patients with chronic kidney disease (CKD). Most previous studies have relied on subjective questionnaires to assess levels of physical activity...

Efficacy and safety analysis of sodium zirconium cyclosilicate and calcium polystyrene sulfonate on rapid reduction of potassium in moderate to severe hyperkalemia patients with chronic kidney disease without dialysis.

Hyperkalemia is a common complication of chronic kidney disease (CKD). This study aims to investigate the efficacy and safety of sodium zirconium cyclosilicate and calcium polystyrene sulfonate in reducing potassium in patients with acute and severe hyperkalemia in CKD who are not undergoing dialysis. A retrospective real-world study was conducted among 73 patients with non-dialysis chronic kidney disease who were hospitalized in the First Affiliated Hospital of Chengdu Medical College from June 2020 to June 2022. 33 patients treated with sodium zirconium cyclosilicate were categorized as SZC group, and the other 40 patients treated with calcium polystyrene sulfonate were categorized as CPS group. Serum potassium, serum sodium, magnesium, calcium, and phosphorus levels were examined. Adverse reactions were recorded during medication. Significantly decreased serum potassium was observed in both groups, whereas the potassium reduction was higher in the SZC group than in the CPS group at 2, 4, 24, and 48 hours after medication while there was no statistically significant difference in the serum potassium level between the two groups at 72 hours. For those people whose initial potassium exceeded 6 mmol/L, the potassium reduction was more obvious in the SZC group than in the CPS group at 2 and 4 hours after medication. The control rate of hyperkalemia in the SZC group was significantly higher than in the CPS group at 4, 24, and 48 hours. No distinct change was observed in serum sodium, calcium, magnesium, and phosphorus before and 72 hours after medication. No severe adverse reactions occurred. Sodium zirconium cyclosilicate has a more obvious effect on reducing potassium particularly for those patients with moderate to severe hyperkalemia who need rapid potassium reduction.

The Effect of Herbal Medicine for Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Objectives: This study aimed to evaluate the effect of herbal medicine on patients with non-dialysis chronic kidney disease (CKD).Methods: Articles published from 2011 to February 17, 2024 were searched via PubMed, EMBASE, Cochrane Library, CNKI, CiNii, KISS, RISS, and OASIS. The quality of included articles was evaluated using a risk-of-bias tool. Meta-analyses considered the effects of herbal medicines on the total effective rate, renal function estimates (GFR, SCr, BUN, 24h-Upro), and other indicators (e.g., uric acid, hemoglobin, and bone density-related indicators).Results: A total of 13 RCTs were included in this study. The treatment group showed a significantly higher total effective rate (RR: 1.47, 95% CI: 1.33-1.62, P&lt;0.00001) and GFR (MD: 9.28, 95% CI: 6.52-12.04, P&lt;0.00001), together with improvements in other renal function indicators, except for 24h-Upro (p=0.05). There were no significant differences in uric acid, hemoglobin, and bone density-related indicators. Adverse events were minimal in both groups.Conclusion: For non-dialysis CKD, this study supports the effectiveness of nine herbal medicines, either alone or in combination with Western medicines. However, even the meta-analyses provide insufficient evidence to conclusively guarantee the safety and efficacy of all types of herbal medicines in treating CKD. Therefore, additional well-designed studies are necessary to enhance the clinical application of herbal medicines in CKD.

The Impact of Uric Acid-Lowering Therapy on the Progression of Non-dialysis Chronic Kidney Disease: A Prospective Cohort Study.

Background Hyperuricemia treatment can positively influence the progression of chronic kidney disease (CKD). This study aimed to evaluate the impact of uric acid-lowering therapy on the progression of CKD after three months. Materials and methods A prospective cohort study was conducted on 126 patients with non-dialysis CKD in Can Tho Central General Hospital, Vietnam, from December 2018 to December 2019. Adopting a questionnaire survey method to collect information, including demographic characteristics, body mass index (BMI), personal history, previous medical history, diet, and use of drugs with the potential to affect the uric acid levels in the blood. Participants also underwent necessary tests, such as serum uric acid, serum creatinine, and blood lipids. Data were analyzed using SPSS software version 26.0(IBM Corp., Armonk, NY). Results The prevalence of hyperuricemia in patients with non-dialysis CKD was 77.8%, and the average serum uric acid was 494.21 ± 131.57 µmol/L. Patients with a high-purine diet were about 18.85 times as likely to have hyperuricemia as those with a low-purine diet (p < 0.001, OR = 18.85, 95%CI: 4.233-83.938). BMI, stages of CKD, and hypertension were associated with the hyperuricemia rate (p < 0.05). After three months of treatment, 46.2% of patients achieved the serum uric acid target, and the patient group combined allopurinol with changing diet had a higher rate than the patient group changing diet only (p = 0.02). There was a moderate inverse correlation between the difference in serum uric acid and the difference in estimated glomerular filtration rate (eGFR) after treatment (r = -0.5, p = 0.001). Conclusions The effective management of hyperuricemia by combining nonpharmacological (changing diet) and/or pharmacological (allopurinol) therapies may meaningfully improve the glomerular filtration rate in non-dialysis CKD patients with hyperuricemia.

Oral Liposomal Iron Versus Injectable Iron Sucrose for Anemia Treatment in Non-dialysis Chronic Kidney Disease Patients: A Non-inferiority Study.

Introduction Anemia is a prevalent and persistent complication in chronic kidney disease (CKD), particularly in advanced stages, contributing to the deterioration of renal function and diminishing patients' quality of life. Iron supplementation constitutes a cornerstone of anemia management in this population. Among various iron formulations, liposomal iron has emerged as a promising option due to its enhanced efficacy in replenishing iron reserves and improved tolerability. Objective This study aims to assess the comparative effects of intravenous and liposomal oral iron on hemoglobin levels in non-dialysis CKD patients. Additionally, it seeks to evaluate the rate of hemoglobin correction, iron reserve status during treatment, and therapeutic tolerance to these interventions. Materials and methods A randomized controlled trial enrolled CKD patients (stages 3-5, not on dialysis) with iron deficiency anemia (hemoglobin ≤ 12 g/dL, ferritin ≤ 100 ng/mL, transferrin saturation ≤ 25%). Participants were allocated to receive either daily oral liposomal iron (Group OS) at a dosage of 30 mg or intravenous iron-hydroxide sucrose complex weekly (Group IV) for three months. Follow-up extended through the treatment phase and two months post-withdrawal. Results Thirty-one CKD patients were randomized into two groups: 14 received intravenous iron (IV group) and 17 received oral iron (OS group). After excluding four patients, the final cohort comprised 27 individuals (IV group: n=13, OS group: n=14). Both iron treatments resulted in progressive hemoglobin increases, with the IV group showing a mean increase of 14.65% (p=0.049) compared to 4.78% (p=0.003) in the OS group. Secondary analysis revealed significant increases in ferritin levels (p<0.001) and transferrin saturation (TSAT) levels (p=0.031) in the IV group. Post-treatment follow-up demonstrated stable hemoglobin levels in the OS group and a consistent increase in ferritin levels in the IV group. Adverse reactions predominantly included hypotension in the IV group (4 (30.7%)) and constipation in the OS group (4 (28.4%)). Discussion and conclusion Anemia remains a significant challenge in CKD patients. Our study compares oral liposomal iron to injectable iron for anemia treatment, aiming to minimize hospitalizations for iron infusion, preserve venous capital, and mitigate potential harmful side effects. We found oral liposomal iron to be a safe and effective option for correcting anemia in non-dialysis CKD patients, albeit with lower efficacy in replenishing iron stores compared to IV iron. Comparative analysis with similar studies supports the non-inferiority of oral liposomal iron, although IV iron retains superiority in replenishing iron reserves.

Nutritional assessment and medical dietary therapy for management of obesity in patients with non-dialysis chronic kidney disease: a practical guide for endocrinologist, nutritionists and nephrologists. A consensus statement from the Italian society of endocrinology (SIE), working group of the club nutrition-hormones and metabolism; the Italian society of nutraceuticals (SINut), club ketodiets and nutraceuticals "KetoNut-SINut"; and the Italian society of nephrology

Chronic kidney disease (CKD) is a serious health concern with an estimated prevalence of about 13.4% worldwide. It is cause and consequence of various comorbidities, including cardiovascular diseases. In parallel, common pathological conditions closely related to ageing and unhealthy dietary habits increase the risk of CKD development and progression, including type 2 diabetes and obesity. Among these, obesity is either independent risk factor for new onset kidney disease or accelerates the rate of decline of kidney function by multiple mechanisms. Therefore, the role of diets aimed at attaining weight loss in patients with obesity is clearly essential to prevent CKD as to slow disease progression. Various dietary approaches have been licensed for the medical dietary therapy in CKD, including low-protein diet and Mediterranean diet. Interestingly, emerging evidence also support the use of low-carbohydrate/ketogenic diet (LCD/KD) in these patients. More specifically, LCD/KDs may efficiently promote weight loss, improve metabolic parameters, and reduce inflammation and oxidative stress, resulting in a dietary strategy that act globally in managing collateral conditions that are directly and indirectly related to the kidney function. This consensus statement from the Italian Society of Endocrinology (SIE), working group of the Club Nutrition - Hormones and Metabolism; the Italian Society of Nutraceuticals (SINut), Club Ketodiets and Nutraceuticals "KetoNut-SINut"; and the Italian Society of Nephrology (SIN) is intended to be a guide for Endocrinologist, Nutritionists and Nephrologist who deal with the management of patients with obesity with non-dialysis CKD providing a practical guidance on assessing nutritional status and prescribing the optimal diet in order to best manage obesity to prevent CKD and its progression to dialysis.

GPCRs overexpression and impaired fMLP-induced functions in neutrophils from chronic kidney disease patients.

G-protein coupled receptors (GPCRs) expressed on neutrophils regulate their mobilization from the bone marrow into the blood, their half-live in the circulation, and their pro- and anti-inflammatory activities during inflammation. Chronic kidney disease (CKD) is associated with systemic inflammatory responses, and neutrophilia is a hallmark of CKD onset and progression. Nonetheless, the role of neutrophils in CKD is currently unclear. Blood and renal tissue were collected from non-dialysis CKD (grade 3 - 5) patients to evaluate GPCR neutrophil expressions and functions in CKD development. CKD patients presented a higher blood neutrophil-to-lymphocyte ratio (NLR), which was inversely correlated with the glomerular filtration rate (eGFR). A higher frequency of neutrophils expressing the senescent GPCR receptor (CXCR4) and activation markers (CD18+CD11b+CD62L+) was detected in CKD patients. Moreover, CKD neutrophils expressed higher amounts of GPCR formyl peptide receptors (FPR) 1 and 2, known as neutrophil pro- and anti-inflammatory receptors, respectively. Cytoskeletal organization, migration, and production of reactive oxygen species (ROS) by CKD neutrophils were impaired in response to the FPR1 agonist (fMLP), despite the higher expression of FPR1. In addition, CKD neutrophils presented enhanced intracellular, but reduced membrane expression of the protein Annexin A1 (AnxA1), and an impaired ability to secrete it into the extracellular compartment. Secreted and phosphorylated AnxA1 is a recognized ligand of FPR2, pivotal in anti-inflammatory and efferocytosis effects. CKD renal tissue presented a low number of neutrophils, which were AnxA1+. Together, these data highlight that CKD neutrophils overexpress GPCRs, which may contribute to an unbalanced aging process in the circulation, migration into inflamed tissues, and efferocytosis.

Estimated Glomerular Filtration Rate and Sleep Quality in Stage 3-5 Non-Dialysis Chronic Kidney Disease Patients: Is There a Correlation?

Background: Chronic kidney disease (CKD) is a growing health issue that significantly affects patients' quality of life. CKD patients are prone to sleep disturbances, which can lead to chronic fatigue and a decrease in their quality of life. The Pittsburgh Sleep Quality Index (PSQI) is a parameter that can be used to assess the sleep quality of CKD patients. Objective: This study aims to determine the relationship between estimated glomerular filtration rate (eGFR) and sleep quality in non-dialysis CKD patients. Methods: The research design is an observational analytic study with a cross-sectional approach. The research subjects were stage 3-5 non-dialysis CKD patients aged 18 to 60 years at Prof. Dr. R. D. Kandou Hospital Manado from March to May 2022. The sleep quality of CKD patients was assessed using the PSQI score. Data analysis was performed with a significance level of p &lt; 0.05. Results: A total of 30 patients with stage 3-5 non-dialysis CKD were found. They consisted of 20 males and 10 females, aged 38-59 years, with an average of 59.80 ± 9.86 years. In the normality test using Shapiro-Wilk, the patient samples were not normally distributed (p = .000). For statistical analysis using the Spearman test, a negative correlation was found between eGFR and PSQI scores (r = -0.554), which was statistically significant (p = 0.002). Conclusion: This study found a significant relationship between eGFR and PSQI scores, which shows that a decrease in eGFR worsens the sleep quality of non-dialysis CKD patients.

Low LCAT activity is linked to acute decompensated heart failure and mortality in patients with CKD

Chronic kidney disease (CKD) is often associated with decreased activity of lecithin-cholesterol acyltransferase (LCAT), an enzyme essential for HDL maturation. This reduction in LCAT activity may potentially contribute to an increased risk of cardiovascular mortality in patients with CKD. The objective of this study was to investigate the association between LCAT activity in patients with CKD and the risk of adverse outcomes. We measured serum LCAT activity and characterized lipoprotein profiles using nuclear magnetic resonance spectroscopy in 453 non-dialysis CKD patients from the CARE FOR HOMe study. LCAT activity correlated directly with smaller HDL particle size, a type of HDL potentially linked to greater cardiovascular protection. Over a mean follow-up of 5.0 ± 2.2 years, baseline LCAT activity was inversely associated with risk of death (standardized HR 0.62, 95% CI 0.50–0.76; P < 0.001) and acute decompensated heart failure (ADHF) (standardized HR 0.67, 95% CI 0.52–0.85; P = 0.001). These associations remained significant even after adjusting for other risk factors. Interestingly, LCAT activity was not associated with the incidence of atherosclerotic cardiovascular events or kidney function decline during the follow-up. To conclude, our findings demonstrate that low LCAT activity is independently associated with all-cause mortality and ADHF in patients with CKD, and is directly linked to smaller, potentially more protective HDL subclasses.

Evaluating the risk of new-onset glaucoma in chronic kidney disease patients: a nationwide cohort study

BackgroundA better understanding of the association between chronic kidney disease (CKD) and glaucoma is required to optimize clinical outcomes. Therefore, this study aimed to investigate the association of chronic kidney disease (CKD) with new diagnoses of glaucoma over time from January 2009 to December 2019.MethodThis retrospective propensity-matched cohort study utilizing Taiwanese electronic health records examined the incidence of newly diagnosed glaucoma in patients with and without chronic kidney disease (CKD). The exposure variable was the diagnosis of CKD, identified through diagnostic codes. The primary outcome was the incidence of new-onset glaucoma. Subgroup analyses on glaucoma risk included age, gender, comorbidities, glaucoma subtypes, and dialysis status. Statistical analyses included Kaplan–Meier analysis, Cox proportional hazards models, and Poisson regression models, with the associated hazard ratios and confidence intervals reported.ResultsSeven hundred twenty-three thousand two hundred sixteen patients with CKD (42.3% female; mean [SD] age at index, 66.3 [15.6] years) and 723,216 patients without CKD (42.3% female; mean [SD] age at index, 66.3 [15.7]) were recruited. We showed a significantly increased risk of glaucoma irrespective of subtypes in CKD patients compared to those without CKD (HR: 1.29 [CI: 1.26–1.32], p < 0.001). Kaplan–Meier curves revealed a significantly increased glaucoma risk in both the dialytic subtype and non-dialytic CKD patients when compared to their non-CKD counterparts (p < 0.001). We also showed that all genders (aHR 1.17 [CI: 1.13–1.21] for females vs. aHR 1.39 [CI:1.35–1.43] for males), all ages (< = 49: aHR 1.49 [CI: 1.37–1.62]; 50–59: aHR 1.48 [CI: 1.40–1.56]; 60–69: aHR 1.30 [CI: 1.25–1.6]; 70–79: aHR 1.21 [CI: 1.17–1.26]; > 80: aHR 1.29 [CI: 1.21–1.37]); all income brackets and all urbanization status were associated with significantly increased risk of glaucoma from among the CKD cohort when compared to their respective non-CKD cohort (p < 0.001).ConclusionsOur cohort study spanning 12 years showed an elevated glaucoma risk following a CKD diagnosis compared to a frequency-matched non-CKD cohort. Our findings have relevance for the clinical practice of at-risk CKD patients.Trial registrationDue to the retrospective nature of the study, no registration was necessary.