Status In Chronic Kidney Disease Patients Research Articles

#2368 GHRH levels and AhR expression in CKD patients before and after kidney transplantation

Abstract Background and Aims Chronic kidney disease (CKD) is an irreversible decline in renal function where kidney transplantation (KT) is the optimal therapeutic intervention. We aim to investigate the role and activation of the uremic toxin receptor aryl hydrocarbon receptor (AhR) in the microvasculature, particularly its implication in the blood-brain barrier impairment. We will also explore the potential role of growth hormone-releasing hormone (GHRH) as a biomarker reflecting the resolution of uremia-induced inflammation, early vascular ageing (EVA) phenotype, and potential enhancement in central nervous system (CNS) function post-KT. Method Resistance arteries from KT patients and non-CKD controls were isolated and expression of AhR was analysed by immunohistochemistry. The study used plasma samples from 60 KT patients, and levels of GHRH were measured at baseline and two years after transplantation using ELISA. Results Following KT, our initial findings indicate a decrease in levels of DBP, Lp(a), creatinine, homocysteine, phosphate, and troponin T among KT patients. Conversely, there was an increase in albumin, HBA1c, calcium and NfL post-transplantation. The expression of AhR in the resistance arteries of KT patients (2.6%) was notably lower compared to non-CKD controls (9.7%). Plasma concentrations of GHRH were significantly higher (p < 0.0001) in CKD-5 patients two years post-KT (2.94 ng/mL, IQR 2.60-3.43) compared to baseline (2.32 mg/L, IQR 1.84-3.24). This elevated trend in GHRH levels post-KT was observed in both sexes, with males (p < 0.0001) and females (p 0.0084) showing higher levels—males (3.0 ng/mL, IQR 2.6-3.5) and females (2.8 ng/mL, IQR 2.4-3.5)—compared to baseline level of males (2.4 ng/mL, IQR 1.8-3.2) and females (2.2 ng/mL, 1.9-3.3). No significant difference in GHRH levels was observed when assessing extreme EVA phenotypes based on the presence or absence of calcification or fibrosis. Conclusion Contrary to our initial expectation, the preliminary results indicate a downregulation in AhR expression within resistance vessels of CKD patients, implying modifications in AhR signaling within the uremic environment. The observed alteration in GHRH levels presents a promising avenue for further investigation focusing on its possible application as a biomarker for assessing CNS status in CKD patients undergoing KT. Prospective clinical application could involve the administration of GHRH agonists as a protective measure against cognitive impairment, considering its deficiency in CKD. Such supplementation holds promise to prevent further cognitive morbidity. The modulation in the levels of this hormone has the potential to significantly influence the treatment trajectory of CKD patients and enhance clinical outcomes.

The hidden and complex relationship between dietary phosphorus and malnutrition in hemodialysis patients with chronic kidney disease.

Chronic kidney disease (CKD) has always been a complicated global challenge, ranking as the 12th leading cause of death worldwide. Hemodialysis, being one of the most opted renal replacement therapies (RRTs) for patients with end-stage renal disease (ESRD), still possesses some limitations in preventing complications, such as malnutrition and mineral bone disease (CKD-MBD). While efforts have focused on controlling CKD-MBD parameters like calcium and phosphate, less attention has been given to dietary interventions. Moreover, the adoption of low-phosphorus diets for hemodialysis patients is very complex due to potential conflicts with the guideline-recommended high-protein dietary approach. This study sought to investigate the relationship between dietary phosphorus intake and nutritional status in CKD patients undergoing regular hemodialysis. This non-randomized cross-sectional study comprising 88 patients was conducted at the Hemodialysis Unit, RSUD Dr. Soetomo, Surabaya, East Java, using a three-day dietary record in March 2022. Relationships between variables were analyzed using Spearman and ANOVA tests. No significant positive association was found between dietary calcium with corrected calcium levels (p = 0.988; rs = -0.002) and between dietary phosphorus with plasma phosphate levels (p = 0.082; rs = 0.187). However, Spearman's analysis revealed a weak but positive correlation between dietary phosphorus and nutritional status (p = 0.022; rs = 0.215*). Our study highlights a positive relationship between dietary phosphorus and nutritional status among hemodialysis patients, offering insights into potential strategies for optimizing patient care and outcomes.

A Retrospective Study on Vitamin D Status and Its Association With Cardiometabolic Risk Factors Among Children With Chronic Kidney Disease at King Abdulaziz University Hospital.

Vitamin D deficiency is a significant global health issue. It is prevalent in chronic kidney disease (CKD) patients, which is an important cause of death among children. Many studies have found a link between low vitamin D status in CKD patients and cardiovascular disease (CVD) risk factors. However, there are no data on this relationship in children with CKD in Saudi Arabia. We aimed to demonstrate this association among children with CKD admitted to the King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. Data were collected between June and August 2020 from a convenience sample of pediatric patients. In total, 153 pediatric patients with CKD stages 2-5 were admitted to the KAUH between 2010 and 2019, and 67.3% had CKD stage 5. Approximately 4.6% and 10.5% of the participants were overweight or obese, respectively. Patients who fell into the lower 25-hydroxyvitamin D (25[OH]D) tertile were older, had higher body mass index (BMI) values, and had higher blood pressure than those in the upper two tertiles; however, these differences were not statistically significant. There was a significant inverse association of 25(OH)D levels with BMI, blood pressure, and serum creatinine levels. The results of this retrospective study suggest that patients with CKD and lower vitamin D levels have a higher BMI and blood pressure and are therefore at higher risk of developing CVD. Future prospective studies with a larger sample size are needed to confirm these findings. Randomized clinical trials are also needed to investigate the effect of sufficient vitamin D status on reducing CVD in patients with CKD.

Thyroid Dysfunction and Chronic Kidney Disease: A Study Among the Northeastern Population of India.

Chronic kidney disease (CKD) is a multifaceted non-communicable disease characterized by a progressive decline in kidney function ultimately requiring renal replacement therapy (RRT) in most patients. Due to the high cost and availability of a limited number of donors, the majority of patients dependon dialysis and conservative management. Thyroid hormones are indispensable for the growth, development, and homeostasis of our body. The kidney plays an important role in the metabolism, degradation, and excretion of thyroid hormones. Various studies have revealed significant dysfunction in thyroid hormone status in CKD patients, but the results are inconsistent. To evaluate and compare the thyroid hormone status in CKD patients with healthy controls along with a comparison of thyroid hormones in CKD patients on regular hemodialysis with those on conservative management. The present cross-sectional study involved 100 subjectsof both sexes between 40 and 70 years of age, out of which 50 were patients of stage 5 CKDwith no previous history of any thyroid disorders, while 50 apparently healthy subjects served as control. Of the CKD patients,52% were on regular hemodialysis while 48% were receiving conservative care. The participants were investigated for various biochemical parameters like blood urea, serum creatinine, total triiodothyronine (TT3), total thyroxine (TT4), and thyroid stimulating hormone (TSH). The estimated glomerular filtration rate (eGFR) was calculated using a modification of diet in renal disease (MDRD) 4 variable formula. The thyroid profiles were also compared between patients of CKD receiving conservative management and those on maintenance hemodialysis. Of the total sample, 35 (70%) were male and 15 (30%) were female in each of the case and control groups. The mean ageof CKD patients and the control group was 55.32 ± 9.62 years and 54.48 ± 9.63 years, respectively. TT3 was reduced in all50 CKD patients. TT4 was normal in 31 (62%), reduced in 18 (36%), and high in one (2%) case. TSH was high in 38 (76%) cases, while reduced in one (2%) and normal in 11 (22%) cases. The mean blood level of TT3 and TT4 showed a statistically significant reduction (P < 0.0001 for each), while the TSH level showed a significant increase with a p-value of 0.0002 in CKD patients compared to controls. The mean blood urea and serum creatinine levels were statistically increased in cases than in controls (P < 0.0001). The thyroid hormone status revealed a significant difference between CKD patients on maintenance hemodialysis compared to those on conservative care with a p-value of 0.0005 for TT3, 0.0006 for TT4, and 0.0055 for TSH. Patients with CKD were at risk of thyroid hypofunction irrespective of their mode of treatment. This study highlights the clinically relevant interactions between renal and thyroid function, which may be helpful to clinicians for optimal diagnosis and management of CKD patients.

Central obesity as assessed by conicity index and a-body shape index associates with cardiovascular risk factors and mortality in kidney failure patients.

Anthropometric indices of central obesity, waist circumference (WC), conicity index (CI), and a-body shape index (ABSI), are prognostic indicators of cardiovascular (CV) risk. The association of CI and ABSI with other CV risk indices, markers of nutritional status and inflammation, and clinical outcomes in chronic kidney disease (CKD) stage 5 (CKD5) patients was investigated. In a cross-sectional study with longitudinal follow up of 203 clinically stable patients with CKD5 (median age 56 years; 68% males, 17% diabetics, 22% with CV disease, and 39% malnourished), we investigated CI and ABSI and their associations with atherogenic index of plasma (AIP), Framingham CV risk score (FRS), Agatston scoring of coronary artery calcium (CAC) and aortic valve calcium (AVC), handgrip strength (HGS), high sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6). CV events (CVE) and all-cause mortality during up to 10-years follow up were analyzed by multivariate survival analysis of restricted mean survival time (RMST). Chronic kidney disease patients with middle and highest CI and ABSI tertiles (indicating greater abdominal fat deposition), compared to those with the lowest CI and ABSI tertiles, tended to be older, more often men and diabetic, had significantly higher levels of hsCRP, IL-6, AIP, FRS, CAC and AVC scores. CI and ABSI were positively correlated with CAC, FRS, AIP, hsCRP and IL-6. Both CI and ABSI were negatively correlated with HGS. In age-weighted survival analysis, higher CI and ABSI were associated with higher risk of CVE (Wald test = 4.92, p = 0.027; Wald test = 4.95, p = 0.026, respectively) and all-cause mortality (Wald test = 5.24, p = 0.022; Wald test = 5.19, p = 0.023, respectively). In RMST analysis, low vs. high and middle tertiles of CI and ABSI associated with prolonged CVE-free time and death-free time, and these differences between groups increased over time. Abdominal fat deposit indices, CI and ABSI, predicted CV outcomes and all-cause mortality, and were significantly associated with the inflammatory status in CKD patients.

Prevalence and Associates of Frailty Status in Different Stages of Chronic Kidney Disease: A Cross-Sectional Study.

Frailty is a state of homeostenosis associated with adverse outcomes. Chronic kidney disease (CKD) increases considerably by aging and shares the common risk factors with frailty. We aimed to examine the prevalence and independent associates of frailty status in CKD patients. In this single-centre, cross-sectional study, we used the five-item Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight (FRAIL) scale to evaluate frailty. A binary logistic regression analysis model including the parameters found to have relationship with frailty in univariate analyses was used to detect independent associates of frailty status. Odds ratio (OR) and 95% confidence interval (CI) were given. Study included 148 patients aged 18-80. Sixty (60) patients were end stage renal disease (ESRD) patients on maintenance hemodialysis (HD) (at least for 3 months) and 88 were stage 3-4 CKD patients. Thirty-seven (37) patients (42%) were eGFR G3a, 31 patients (35.3%) were eGFR G3b and 20 patients (22.7%) were eGFR G4 in stage 3-4 CKD patients. Demographics, etiology of CKD, comorbidities, regular drugs, dialysis-related and laboratory data were recorded. FRAIL scale was scored as follows; 0=robust, 1-2=prefrail, and ≥3= frail. The frailty status was compared between frail+prefrail group vs robust (non-frail) group. The prevalences of prefrailty and frailty were 68.3% and 3.3% in HD group and 53.4% and zero in stage 3-4 CKD group, respectively (p = 0.025). In the multivariate logistic regression analysis, being in HD group (OR=3.87, 95% CI= 1.06-14.19, p=0.04), older age (OR=1.09, 95% CI= 1.04-1.13) and female sex (OR=9.13, 95%CI= 2.82-29.46) were independent risk factors for frailty (p<0.001, for both). Prefrailty and frailty are quite common among HD and CKD stage 3-4 patients. Being an HD patient is an independent risk factor for non-robust (frail or prefrail) status. Our findings point out a remarkably high prevalence of frailty severity (prefrailty/frailty) phenotype among patients with advanced CKD stages.

Serum Neutrophil Gelatinase-Associated Lipocalin and Iron Status in Predialysis Chronic Kidney Disease at Zagazig University

Background: The burden of chronic kidney disease (CKD) is substantial. Anemia is a common feature of CKD. Objective: The aim was to predict about iron status by serum neutrophil gelatinase-associated lipocalin (NGAL) levels and role of serum NGAL as biomarker of iron deficiency in CKD patients. Patients and Methods: A prospective, case-control comparative study that was conducted at Nephrology Outpatient Clinic and Internal Medicine Department, Zagazig University Hospitals. Seventy two participants were divided into two groups: Group I included 36 participants with no chronic kidney disease and group II that included 36 chronic kidney disease patients. Laboratory investigations included iron parameters and serum NGAL levels were measured Results: S. Iron, TIBC, S. Ferritin and calculated T. sat” were statistically analyzed and showed that there was a statistical significant difference between the two studied groups. NGAL level was higher in CKD group than in the non-CKD group. A significant positive correlation between serum NGAL and T sat & serum ferritin and there was a significant negative correlation between NGAL and eGFR, HB and serum iron. Conclusion: Patients had significantly higher NGAL levels when compared to controls and this means that it had an important role in iron metabolism in those patients. There was statistically significant direct correlation between serum NGAL levels and serum ferritin levels and T. sat and inverse correlation with iron. Serum NGAL could be a good biomarker for iron status in CKD patients but not better than the ordinary used methods “serum ferritin and T. sat”.

Association of Zinc Deficiency with Development of CVD Events in Patients with CKD.

Deficiency of the micronutrient zinc is common in patients with chronic kidney disease (CKD). The aim of this review is to summarize evidence presented in literature for consolidation of current knowledge regarding zinc status in CKD patients, including those undergoing hemodialysis. Zinc deficiency is known to be associated with various risk factors for cardiovascular disease (CVD), such as increased blood pressure, dyslipidemia, type 2 diabetes mellitus, inflammation, and oxidative stress. Zinc may protect against phosphate-induced arterial calcification by suppressing activation of nuclear factor kappa light chain enhancer of activated B. Serum zinc levels have been shown to be positively correlated with T50 (shorter T50 indicates higher calcification propensity) in patients with type 2 diabetes mellitus as well as those with CKD. Additionally, higher intake of dietary zinc was associated with a lower risk of severe abdominal aortic calcification. In hemodialysis patients, the beneficial effects of zinc supplementation in relation to serum zinc and oxidative stress levels was demonstrated in a meta-analysis of 15 randomized controlled trials. Thus, evidence presented supports important roles of zinc regarding antioxidative stress and suppression of calcification and indicates that zinc intake/supplementation may help to ameliorate CVD risk factors in CKD patients.

Is dual-energy absorptiometry accurate in the assessment of bone status of patients with chronic kidney disease?

It remains unclear whether dual-energy absorptiometry (DXA) is appropriate for the assessment of bone status in patients with chronic kidney disease (CKD), a disease that impacts bone health. The aims of this study were to compare DXA and central quantitative computed tomography (cQCT) and to evaluate bone status in patients with pre-dialysis CKD. This retrospective study included 363 healthy control subjects whose bone mineral density (BMD) was evaluated with DXA and 117 CKD patients whose BMD was evaluated using both cQCT and DXA. Diagnostic discordance was assessed between the lumbar spine (LS) and femur neck (FN) from DXA or between two modalities. The trabecular bone score (TBS) was extracted from DXA images. The volume of abdominal aortic calcification (AAC) was calculated using CT images from cQCT. Using LS DXA T-score, osteoporosis was less common in the CKD group than in controls. Patients with normal LS BMD using DXA were reclassified into osteopenia or osteoporosis using cQCT in CKD patients. Among discordant subjects between FN and LS in DXA, a higher BMD of LS was more common in CKD patients than in controls. CKD patients had lower TBS than controls despite having the same diagnosis using DXA. AAC volume negatively correlated with BMD from cQCT and with TBS but not with BMD from DXA. TBS and cQCT could accurately assess bone status in CKD patients since DXA may overestimate LS BMD, likely due to an increased AAC volume.

Obesity and Other Nutrition Related Abnormalities in Pre-Dialysis Chronic Kidney Disease (CKD) Participants.

Chronic kidney disease (CKD) is increasing in sub-Saharan Africa. Undernutrition has been prevalent amongst end stage CKD patients, with limited data on the prevalence of obesity. The aim of this study was to assess the nutritional status of CKD patients using various methods sensitive to over and under-nutrition. Stage 3 to 5 CKD patients (glomerular filtration rate (GFR) < 60 mL/min/1.73 m2) attending a pre-dialysis clinic in Cape Town, were enrolled. Exclusion criteria included infectious and autoimmune conditions. Sociodemographic, clinical and biochemical data were collected, and anthropometric measurements were performed. Dietary intake was measured with a quantified food frequency questionnaire (FFQ). Statistical Package for the Social Sciences (SPSS) version 26 was used for statistical analysis. Seventy participants, with mean age of 41.8 ± 11.8 years, 52.9% females and 47.1% males were enrolled. Participants enrolled mainly had stage 5 kidney failure. Thirty percent were overweight (21) and 25 (36%) were obese, 22 (60%) of females were overweight and obese, while 13 (39.4%) of males were predominantly normal weight. Abdominal obesity was found in 42 (60%) of participants, mainly in females. Undernutrition prevalence was low at 3%. Dietary assessment showed a high sugar and protein intake. There was a high prevalence of overweight, obesity and abdominal obesity in CKD stage 35 patients, with unhealthy dietary intake and other nutritional abnormalities.

&lt;p&gt;Protein-Energy Wasting and Associated Factors Among Chronic Kidney Disease Patients at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia&lt;/p&gt;

BackgroundProtein-energy wasting is a major issue in patients with chronic kidney disease (CKD), adversely affecting morbidity, mortality, functional activity, and quality of life. Assessment of nutritional status in CKD patients is important to ensure patient’s normal protein stores and avoid metabolic complications. However, in Ethiopia, there were very few studies done to assess the prevalence of protein-energy wasting (PEW) and its associated factors among CKD patients.ObjectiveTo assess protein-energy wasting and associated factors among chronic kidney disease patients at adult OPD St. Paulo’s Hospital Millennium Medical College, Addis Ababa Ethiopia.Materials and MethodsAn institution-based cross-sectional study was conducted from March to April 2019. Data were collected using a structured interviewer-administered questionnaire and anthropometric measurements, and laboratory data were collected from patient files. Data were entered into Epi-data version 3.1 and analyzed using SPSS version 20. Both bivariate and multiple logistic regression analyses were performed to identify associated factors. P values <0.05 were considered to declare statistical significance.ResultsIn this study, 274 respondents were interviewed with a response rate of 100%. The prevalence of protein-energy wasting in CKD patients was 23.4%. Chronic kidney disease patients at age ≥65 years were seven times more likely to have protein-energy wasting as compared to patients aged 18–34 years [AOR=7.0, 95% (CI: 2.4, 20.5)]. Patients who had a history of anorexia were 5.2 times more likely to have protein-energy wasting as compared to those who had no history of anorexia [(AOR=5.2, 95% (CI: 2.7, 10.3)] and were significantly associated with the risk of having CKD.ConclusionThe prevalence of protein-energy wasting among CKD patients was high and associated with age, physical activity, history of anorexia, and CKD stages. Interventions that address nutritional problems and lifestyle factors in CKD patients need to be implemented together with medical treatment.

Dietary acid load in children with chronic kidney disease.

Western diet is characterized by a high acid load that could generate various degrees of metabolic acidosis, of which at least the stronger forms are known to contribute to the progression of chronic kidney disease (CKD). The aim of this study was to estimate the potential renal acid load (PRAL) and acid base status in CKD patients attended at the Children's Hospital J.M. de los Ríos in Caracas, Venezuela from April 2015 to February 2016. Twenty-seven children with CKD were included. Diet composition was evaluated by a food frequency questionnaire and a 24-h intake reminder. PRAL was calculated by the Remer and Manz method. Laboratory tests included serum creatinine, electrolytes and venous gases. Protein intake was above recommendations in 21 patients (78.6%). Average vegetable and fruit intake was 0.4 and 1.5 servings per day, respectively. Mean PRAL was 16 ± 10.7 mEq/day. PRAL correlated positively with energy (p = 0.005), protein (p = 0.001) and fat intake (p = 0.0001), daily servings of dairy (p = 0.04) meat (p = 0.001) and cereals (0.001) and negatively with vegetable intake (p = 0.04). Serum pH and bicarbonate were 7.3 ± 0.08 and 20.46 ± 4.5 mEq/L, respectively. Twenty-one patients (80.7%) with metabolic acidosis were treated with sodium bicarbonate. Dietary pattern of Venezuelan children with CKD may constitute a risk factor for the progression of the disease by promoting metabolic acidosis via unfavorable dietary acid loads. PRAL should be assessed as a valuable guide for nutritional counseling in children with CKD.

Limitations of serum albumin level as a marker of nutritional status in hemodialysis patients

Introduction. Albumin is widely used to evaluate nutritional status. However, its usage on patients with chronic kidney disease (CKD) remains controversial. This study was conducted to determine whether serum albumin levels can be used indicator of nutritional status in end-stage CKD patients undergoing routine hemodialysis.Methods. This cross-sectional study included 535 subjects who underwent hemodialysis twice per week in 2017 from three hospitals in Jakarta, Indonesia. Data were collected from the medical records of the subjects and analysed using descriptive statistics and mean comparisons of independent samples.Results. Based on body mass index as a marker of nutritional status, the majority (85.9%) of subjects were not underweight. Almost an equal proportion of underweight subjects had normal serum albumin (15.1%) compared with hypoalbuminemia (14.4%). Hypoalbuminemia was found in 29.7% and 28.6% of non-underweight and underweight subjects, respectively. Moreover, there was no significant difference in serum albumin levels between underweight and non-underweight patients (p = 0.886, Mann-Whitney test).Conclusions. Our data do not support a role for serum albumin level as a marker for nutritional status in CKD patients.

Chronic sodium bicarbonate may promote metabolic dysregulation in a rodent model of CKD

Chronic kidney disease (CKD) has no cure, and few treatment options targeted at slowing the decline in glomerular filtration rate (GFR). Several small clinical trials have indicated that oral sodium bicarbonate (NaHCO3) targets and slows the decline in GFR in CKD. The reported beneficial effects of NaHCO3 in this setting have led to its now common use clinically. It’s known however, that chronic alkali ingestion can promote potassium (K+) wasting, and that K+ depletion has been linked with metabolic dysregulation. Further, CKD patients who are supplemented chronically with oral NaHCO3 display significantly decreased plasma K+ levels relative to control treated counterparts, although these decreases in plasma K+ remain within normal range. No study has investigated the metabolic impacts of chronic NaHCO3 treatment and K+ wasting in CKD. To this end, we tested the hypothesis that in the setting of high tubular flow, chronic NaHCO3 ingestion would promote K+ wasting and metabolic dysfunction. In order to test our hypothesis, 9 male, 8 wk old Sprague Dawley (SD) rats underwent a 2/3 nephrectomy (Nx) and telemetry implantation. The 2/3 Nx is a model of reduced renal mass that has increased single nephron GFR in the absence of metabolic acidosis, similar to most human patients with CKD. Following 4 weeks of recovery, animals were given either 0.1M NaHCO3 (Bicarb, n=3), 0.1M NaCl (Vehicle, n=3) or 0.2M NH4Cl‐NaHCO3 (AC/B, n=3) in the drinking water for 12 weeks. Following 9 weeks of drinking water treatment, we observed a significantly higher hemoglobin A1c in our bicarb treated group compared to vehicle and AC/B treated groups (Bicarb 4.6 ± 0.1 vs Veh 4.2 ± 0.3 vs AC/B 4.2 ± 0.2; One‐way ANOVA, p=0.05). Following another 3 weeks of drinking water treatment, we performed blood gas measurements to assess plasma K+. In contrast to our hypothesis we observed the highest levels of plasma K+ in our bicarb treated animals compared to our vehicle or AC/B groups (Bicarb 5.18 ± 0.28 vs Veh 4.48 ± 0.66 vs AC/B 4.5 ± 0.21; One‐way ANOVA, p=0.16). Our data show that oral NaHCO3 could worsen blood glucose control in the setting of high tubular flow. Additionally, plasma K+ may not be a reliable measure for assessment of K+ status in CKD patients supplemented with NaHCO3. As the majority of K+ is stored intracellularly, further studies characterizing the effect of chronic alkali ingestion on total body K+ are warranted to assess the impact of NaHCO3 on K+ depletion in this patient population.Support or Funding InformationNIH PO1H134604 and DK099548

Rapid weight loss with dietary salt restriction in hospitalized patients with chronic kidney disease

Dietary salt restriction is essential for managing fluid retention in patients with chronic kidney disease (CKD). In this retrospective cohort study, we investigated weight loss from the perspective of fluid status in CKD patients during a 7-day hospitalization period while consuming a low-salt diet (5 g/day). Among 311 patients, the median weight loss (interquartile range, maximum) was 0.7 (0.0–1.4, 4.7) kg on Day 4 and 1.0 (0.3–1.7, 5.9) kg on Day 7. Patients were classified into quartiles based on pre-hospital urinary salt excretion (quartile [Q] 1, 1.2–5.7; Q2, 5.8–8.4; Q3, 8.5–11.3; Q4, 11.4–29.2 g/day). Weight loss was significantly greater in Q3 and Q4 than in Q1. The body mass index (BMI) and urinary salt excretion in the first 24 hours after admission were independently associated with rapid weight loss on Day 4 by multivariate logistic regression analysis. In conclusion, CKD patients with a high salt intake or high BMI exhibit rapid weight loss within a few days of consuming a low-salt diet. Dietary salt restriction is effective for reducing proteinuria in these patients, but long-term observation is needed to confirm the sustained effects.

Prevalence and Severity of Anemia in CKD patients

Background:Anemia is one of the well-recognized and significant complications of chronic kidney disease (CKD) which manifests noteworthy association with the progression of CKD, the inevitable necessity for blood transfusion, prolonged hospitalization. This study aimed to conduct a comprehensive study as regards the prevalence of anemia and its association with laboratory parameters in CKD patients. Methods:The Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation was applied to calculate the estimated glomerular filtration rate (eGFR) and the patients with hemoglobin (Hb) level < 13.0 g/dL in case of males and that < 12.0 g/dL in females was defined as anemic. The patients were stratified according to their Hb level into four different categories: Hb 12 g/dL. Results:Demographic status of CKD patients: Male/Female = 106/123 (M/F% = 46.28/53.71) with mean age 54.94 ± 17.98 and 55.13 ± 14.27, respectively. Out of 229 CKD patients, 157 (69%) were anemic, and 72 (31%) patients were non-anemic. The mean eGFR of anemic and non-anemic CKD patients was 10.14 ±13.57 and35.74 ± 30.36 with a significance level (P<0.001). Anemia was more prevalent in females’ (36%) than males’ patients (32%). The Prevalence for Hb < 12 g/dL for male and female patients was 55.29% and 79.25%, respectively, while that < 11 g/dL for male and female was found to be 39.03% and 63.21%. Conclusion:The prevalence of anemia in CKD population is notable and correlates with the progression of CKD

Probiotic supplementation and reducing infiammation in hemodialysis patients: A systematic review

Background: Chronic kidney disease (CKD) is a growing health problem worldwide. Uremic toxin buildup caused by protein bacterial metabolites such as indoleamines, urea, and indoxyl sulfate contribute to dysbiosis in the gut microbiome in hemodialysis patients, which contributes to a pro-infiammatory environment. Aims: This systematic review of the literature considers the confiicting evidence on probiotic supplementation and infiammatory status in CKD patients receiving hemodialysis. Methods: PubMed, EBSCO, and Google Scholar were all used to search for control/clinical trials demonstrating the effects of probiotic supplementation on these protein bacterial metabolites and C-reactive protein (CRP) levels. Results: Four of the five studies observed no significant findings in the reduction of infiammatory status in this population. One study demonstrated a significant reduction in CRP levels after 3 months of probiotic supplementation. Many articles varied between using single and multiple strains of bacteria which contributed to limitations to the studies. There was limited supporting evidence to suggest that probiotic supplementation could reduce infiammatory status in hemodialysis patients. Conclusions: Based on the findings, more research is needed before any conclusive recommendations can be made on whether probiotic supplementation would be beneficial for patients receiving hemodialysis treatments.

Study of oxidant and anti-oxidant status in patients with chronic kidney disease

Background: Chronic kidney disease (CKD) is associated with oxidative stress (OS), which occurs even in early stages of CKD and was shown to further contribute to progression of renal dysfunction and increased cardiovascular risk in CKD patients. Majority of studies have evaluated OS in CKD patients using limited biomarkers. Present study aimed at comprehensive evaluation of oxidant and antioxidant status in CKD patients. Methods: 120 patients diagnosed with CKD who were classified into three groups of 40 each [group-1 (CKD stage1 and 2), group-2 (CKD stage3 and 4) and group-3 (CKD stage 5] based on eGFR and 30 healthy controls were recruited. Malondialdehyde (MDA), protein carbonyls (PC), ferric reducing ability of plasma (FRAP), protein thiols, superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase were measured in all subjects. FRAP was corrected for uric acid (FRAP_UA) and MDA/FRAP_UA ratio was calculated. Score for oxidative stress (SOS) was calculated using the oxidant antioxidant parameters studied. Results: MDA, PC, MDA/FRAP_UA, FRAP and SOS were higher whereas protein thiols, SOD, GPx and catalase were lower in CKD patients than controls. Further, MDA, PC and FRAP and SOS increased progressively and protein thiols, SOD and catalase decreased progressively with increasing renal dysfunction. MDA, PC, FRAP and SOS showed positive correlation with creatinine and negative correlation with eGFR, whereas protein thiols, SOD, and catalase showed positive association with eGFR and negative correlation with creatinine. Conclusions: CKD patients are prone for oxidant injury which increases progressively with worsening renal dysfunction and is associated with degree of renal impairment. Score for oxidative stress helps in comprehensive assessment of oxidative stress in CKD patients.

Markers of iron status in chronic kidney disease.

Anemia is one of the main comorbidities related to chronic kidney disease (CKD). Until the advent of erythropoiesis stimulating agents (ESA), endogenous erythropoietin deficiency has been thought to be the main culprit of anemia in CKD patients. The use of ESAs has shed new light on the physiology of CKD anemia, where iron homeostasis plays an increasingly important role. Disorders of iron homeostasis occurring in CKD turn the anemia management in those patients into a complex multifactorial therapeutic task, where ESA and Iron dose must be properly balanced to achieve the desired outcome without exposing the patients to the risk of serious adverse events. This review covers diagnostic markers traditionally used for quantifying iron status in CKD patients, such as serum ferritin and transferrin saturation, new ones, such as reticulocyte hemoglobin content and percent hypochromic red cells (HRC), as well as experimental ones, such as hepcidin and soluble transferrin receptor (sTfR). Each marker is presented in terms of their diagnostic performance, followed by biological and analytical variability data. Advantages and disadvantages of each marker are briefly discussed. Although serum ferritin and transferrin saturation are easily available, they exhibit large biological variability and require caution when used for diagnosing iron status in CKD patients. Reticulocyte hemoglobin content and the percentage of HRC are more powerful, but their widespread use is hampered by the issue of sample stability in storage. sTfR and hepcidin show promise, but require further investigation as well as the development of standardized, low-cost assay platforms.

Nutritional Risk Screening in patients with chronic kidney disease.

Knowledge concerning nutritional status of patients with chronic kidney disease (CKD) is limited. Nutritional Risk Screening-2002 (NRS-2002) has been used to evaluate the nutritional aspects of patients according to the recommendation of European Society for Clinical Nutrition and Metabolism. Here we aim to assess the prevalence and characteristics of nutritional risk in CKD patients by using NRS-2002. NRS-2002 scores of 292 CDK patients were recorded in first 24 hours subsequent to their admission to hospital. All patients have never been on dialysis. BMI, weight and various biochemical parameters were also characterized for these patients. Possible correlations between these parameters and NRS-2002 score were investigated. The overall prevalence of nutritional risk was 44.9% (53.6% in CKD stage 4-5 patients and 38.3% in stage 1-3 patients). Statistically significant differences were found in serum Albumin, Haemoglobin B, and lymphocyte counts between patients with or without increased nutritional risk. Under the situation that attending physicians were completely unaware of NRS-2002 scores, only 35.1% of the patients at risk received nutritional support. The nutritional risk status was associated with CKD stages but independent from primary diagnosis type. More attention should be paid to the nutritional status in CKD patients (including early stage patients). We recommended using NRS-2002 for nutritional risk assessment among non-dialysis CKD patients in routine clinical practice.