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Nutrients and Renal Function

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A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (16 May 2018) | Viewed by 101505

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Special Issue Editors

Prof. Dr. Enrico Fiaccadori

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Guest Editor

Acute and Chronic Renal Failure Unit, Department of Clinical and Experimental Medicine, University of Parma - Parma (Italy)
Interests: Clinical Nephrology; Hemodialysis; Dialysis, Nutrition in CKD, Nutrition in AKI

Prof. Dr. Loreto Gesualdo

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Guest Editor

Nephrology Dialysis and Transplantation, University of Bari – Bari (Italy)
Interests: Immunology of renal disease, renal fibrosis, immunotherapy, regenerative and translational medicine, microbioma in CKD, diabetic kidney disease

Special Issue Information

Dear Colleagues,

Chronic kidney disease (CKD) is a major global health issue, since 6–10% of the adult population is diagnosed with the syndrome in most of the recent epidemiologic studies. The Western diet is rich in sugar, fat and sodium and poor in fibers. Despite the fact that the indirect effects of these nutrients on renal function are well known, their influence on nutritional and metabolic disorders, such as obesity, diabetes and hypertension, requires further investigation regarding their direct effects on renal function. Different sources of macronutrients have different effects on metabolism; however, the literature regarding the protective or harmful effect of different types of lipids, carbohydrates or proteins on renal function is scarce. In addition, the production of uremic toxins by gut microbiota, known to increase cardiovascular risk and to accelerate the progression of CKD, could also play a role in the reduction of renal function in otherwise healthy subjects. Other nutritional and non-nutritional substances present or added in food, such as nutraceuticals, active metabolites, additives and preservatives can also have potential protective or harmful effects on renal function. On this topic, you are invited to submit proposals for manuscripts that fit the objectives and the topics of this Special Issue.

The objective of this proposed Special Issue on “Renal Epidemiology and Nutrients” is to publish selected papers detailing specific aspects of nutrition that could play a role in renal function decline, both in normal subjects and in patients with CKD. Particularly, papers (reviews and/or clinical or experimental studies) dealing with the role of specific nutrients and non-nutritional substances present in food on renal function, and also contributions addressing their indirect effects on the kidney through metabolic disorders, will be included.

Prof. Dr. Enrico Fiaccadori
Prof Loreto Gesualdo
Guest Editors

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Keywords

Protein
Fibers
Fatty acids
Chronic kidney disease
Uremic toxins
Nutraceuticals
Fructose
Dietary Sodium
Dietary potassium
Dietary phosphorus

Published Papers (13 papers)

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Research

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17 pages, 3348 KiB

Open AccessArticle

Chrysin Inhibits Advanced Glycation End Products-Induced Kidney Fibrosis in Renal Mesangial Cells and Diabetic Kidneys

by Eun-Jung Lee, Min-Kyung Kang, Dong Yeon Kim, Yun-Ho Kim, Hyeongjoo Oh and Young-Hee Kang

Nutrients 2018, 10(7), 882; https://doi.org/10.3390/nu10070882 - 09 Jul 2018

Cited by 35 | Viewed by 5700

Abstract

Advanced glycation end products (AGEs) play a causative role in the development of diabetic nephropathy via induction of matrix protein deposition in kidneys. This study investigated inhibitory effects of chrysin, present in bee propolis and herbs, on glomerulosclerosis in db/db mice and AGEs-exposed renal mesangial cells. The in vivo study explored the demoting effects of 10 mg/kg chrysin on glomerular fibrosis in a type 2 diabetic model. Oral supplementation of chrysin inhibited the collagen fiber accumulation and α-smooth muscle actin (α-SMA) induction in periodic acid schiff-positive renal tissues of db/db mice. Moreover, treating db/db mice with chrysin diminished the level of AGEs increased in diabetic glomeruli. The in vitro study employed human mesangial cells exposed to 100 μg/mL AGE-BSA for 72 h in the presence of 1–20 μM chrysin. Glucose increased mesangial AGE production via induction of receptor for AGEs. Chrysin suppressed the induction of collagens, α-SMA, fibroblast-specific protein-1 and matrix metalloproteinases enhanced by AGE-bovine serum albumin. Furthermore, chrysin blunted transforming growth factor-β1 induction and Smad 2/3 activation in AGEs-exposed mesangial cells. These results demonstrate that chrysin attenuated accumulation of myofibroblast-like cells and matrix proteins in AGEs-laden diabetic glomeruli. Therefore, chrysin may be a potential renoprotective agent targeting glucose-mediated AGEs-associated glomerulosclerosis and fibrosis. Full article

(This article belongs to the Special Issue Nutrients and Renal Function)

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13 pages, 1763 KiB

Open AccessArticle

Microgreens Production with Low Potassium Content for Patients with Impaired Kidney Function

by Massimiliano Renna, Maria Castellino, Beniamino Leoni, Vito Michele Paradiso and Pietro Santamaria

Nutrients 2018, 10(6), 675; https://doi.org/10.3390/nu10060675 - 26 May 2018

Cited by 42 | Viewed by 8117

Abstract

Chronic kidney disease represents a global problem together with other so-called ‘lifestyle-related diseases’. Unlike the healthy population, for the patients with impaired kidney function, it is of course prudent to recommend a restriction of high-potassium foods. Thus, it is suggested to limit the consumption of vegetables, because they generally contain high concentrations of potassium. At the same time, a lower consumption of vegetables reduces the intake of healthy compounds such as vitamins, fibers, and antioxidants, which also reduces the vegetables’ potential benefit in chronic kidney disease patients. Microgreens are an emerging class of specialty crop that represent a nutritious and refined food. In this study, for the first time, some chicory (local variety ‘Molfetta’ and cultivar ‘Italico a costa rossa’) and lettuce (cultivar ‘Bionda da taglio’) genotypes were grown using a hydroponic system with different potassium (K) levels (0, 29.1, 58.4, and 117 mg L⁻¹) in order to produce microgreens with a low potassium content. The crop performances, cations content, proximate composition, and antioxidant activity were analyzed. Independent of the genotype, the K content in the microgreens was successfully reduced using a nutrient solution (NS), without K or with 29.1 mg K L⁻¹, which supplied between 103 and 129 mg of K 100 g⁻¹ FW (about 7.7–8.6% of the K daily intake that was recommended for the patients that were affected by chronic kidney disease). Whereas, 100 g of microgreens that were grown by using an NS with 58.4 or 117 mg K L⁻¹ supply between 225 and 250 mg of K (about 15.8–16.5% of the K daily intake recommended for patients affected by chronic kidney disease). No differences were observed in terms of the shoot height, dry matter, proximate composition, and visual quality. A slightly lower yield was observed using an NS with a K concentration <58.4 mg L⁻¹. These results suggest that by using an NS without K or with low K concentrations, it is possible to obtain a useful reduction of K in microgreens, without negatively affecting the quality. Unlike conventional vegetables, the microgreens that were produced in the present study could reduce the potassium intake in patients with impaired kidney function who were accustomed to eating vegetable-based dishes. Full article

(This article belongs to the Special Issue Nutrients and Renal Function)

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11 pages, 550 KiB

Open AccessArticle

Dietary Sodium and Other Nutrient Intakes among Patients Undergoing Hemodialysis in New Zealand

by Zhengxiu Xie, Rachael McLean and Mark Marshall

Nutrients 2018, 10(4), 502; https://doi.org/10.3390/nu10040502 - 18 Apr 2018

Cited by 10 | Viewed by 4695

Abstract

This study describes baseline intakes of sodium and other nutrients in a multi-ethnic sample of hemodialysis patients in New Zealand participating in the SoLID Trial between May/2013 to May/2016. Baseline 3-day weighed food record collections were analyzed using Foodworks 8 Professional food composition database, supplemented by other sources of nutrient information. Intakes of dietary sodium and other nutrients were compared with relevant guidelines and clinical recommendations. Eighty-five participants completed a 3-day weighed food record. The mean (SD) sodium intake was 2502 (957) mg/day at and more than half of the participants exceeded recommended intake levels. Sodium intake was positively associated with energy intake. Only 5% of participants met the recommended calorie density; nine percent of participants ate the recommended minimum of 1.2 g/kg of protein per day; 68% of participants were consuming inadequate fiber at baseline. A high proportion of dialysis patients in SoLID Trial did not meet current renal-specific dietary recommendations. The data show excess sodium intake. It is also evident that there was poor adherence to dietary guidelines for a range of other nutrients. A total diet approach is needed to lower sodium intake and improve total diet quality among hemodialysis patients in New Zealand. Full article

(This article belongs to the Special Issue Nutrients and Renal Function)

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8 pages, 648 KiB

Open AccessArticle

The Impact of Abdominal Fat Levels on All-Cause Mortality Risk in Patients Undergoing Hemodialysis

by Takahiro Yajima, Kumiko Yajima, Hiroshi Takahashi and Keigo Yasuda

Nutrients 2018, 10(4), 480; https://doi.org/10.3390/nu10040480 - 12 Apr 2018

Cited by 21 | Viewed by 4218

Abstract

Although an increased body mass index is associated with lower mortality in patients undergoing hemodialysis (HD), known as the “obesity paradox,” the relationship of abdominal fat levels with all-cause mortality has rarely been studied. We investigated the impact of computed-tomography-measured abdominal fat levels (visceral fat area (VFA) and subcutaneous fat area (SFA)) on all-cause mortality in this population. A total of 201 patients undergoing HD were enrolled and cross-classified by VFA and SFA levels according to each cutoff point, VFA of 78.7 cm² and SFA of 93.2 cm², based on the receiver operator characteristic (ROC) curve as following; group 1 (G1): lower VFA and lower SFA, G2: higher VFA and lower SFA, G3: lower VFA and higher SFA, G4: higher VFA and higher SFA. During a median follow-up of 4.3 years, 67 patients died. Kaplan–Meier analysis revealed 10-year survival rates of 29.0%, 50.0%, 62.6%, and 72.4% in G1, G2, G3, and G4 (p < 0.0001), respectively. The adjusted hazard ratio was 0.30 (95% confidence interval [CI] 0.05–1.09, p = 0.070) for G2 vs. G1, 0.37 (95% CI 0.18–0.76, p = 0.0065) for G3 vs. G1, and 0.21 (95% CI 0.07–0.62, p = 0.0035) for G4 vs. G1, respectively. In conclusion, combined SFA and VFA levels were negatively associated with risks for all-cause mortality in patients undergoing HD. These results are a manifestation of the “obesity paradox.” Full article

(This article belongs to the Special Issue Nutrients and Renal Function)

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11 pages, 1542 KiB

Open AccessArticle

Effects of Cholesterol Levels on Mortality in Patients with Long-Term Peritoneal Dialysis Based on Residual Renal Function

by Yen-Chung Lin, Yi-Chun Lin, Chiung-Chi Peng, Kuan-Chou Chen, Hsi-Hsien Chen, Te-Chao Fang, Shian-Ying Sung and Mai-Szu Wu

Nutrients 2018, 10(3), 300; https://doi.org/10.3390/nu10030300 - 03 Mar 2018

Cited by 13 | Viewed by 4321

Abstract

The effect of dyslipidemia on peritoneal dialysis (PD) patients based on the presence of residual renal function (RRF; renal creatinine clearance >2 mL/min/1.73 m²) is unknown. Data from the Taiwan Renal Registry Data System between 2005 and 2012 were analyzed to estimate the association between dyslipidemia and mortality in PD patients. Long-term PD patients (n = 8032) were divided into groups with (RRF; n = 2691, 33.5%) and without RRF (non-RRF; n = 5341, 66.5%). The primary outcome was three-year mortality, and multivariate Cox regression was used for survival analysis. After stratifying the total cholesterol (TC) level between the first and third years, the hazard ratio for mortality was estimated. In the non-RRF group, TC < 120 mg/dL was associated with independently increased risk of mortality. In the RRF group, low TC was not independently correlated with increased mortality, but TC > 285 mg/dL was associated with increased risk. PD patients with higher level of TC (>200 mg/dL) in both first and third years of dialysis had significantly lower risk of mortality. In this nationwide cohort study, PD patients without RRF who had low TC level had the highest mortality, in contrast to those with RRF. Malnutrition in long-term PD patients without RRF is an important issue to be monitored. Full article

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15 pages, 1066 KiB

Open AccessArticle

Dietary Approach to Recurrent or Chronic Hyperkalaemia in Patients with Decreased Kidney Function

by Adamasco Cupisti, Csaba P. Kovesdy, Claudia D’Alessandro and Kamyar Kalantar-Zadeh

Nutrients 2018, 10(3), 261; https://doi.org/10.3390/nu10030261 - 25 Feb 2018

Cited by 123 | Viewed by 15594

Abstract

Whereas the adequate intake of potassium is relatively high in healthy adults, i.e., 4.7 g per day, a dietary potassium restriction of usually less than 3 g per day is recommended in the management of patients with reduced kidney function, especially those who tend to develop hyperkalaemia including patients who are treated with angiotensin pathway modulators. Most potassium-rich foods are considered heart-healthy nutrients with high fibre, high anti-oxidant vitamins and high alkali content such as fresh fruits and vegetables; hence, the main challenge of dietary potassium management is to maintain high fibre intake and a low net fixed-acid load, because constipation and metabolic acidosis are per se major risk factors for hyperkalaemia. To achieve a careful reduction of dietary potassium load without a decrease in alkali or fibre intake, we recommend the implementation of certain pragmatic dietary interventions as follows: Improving knowledge and education about the type of foods with excess potassium (per serving or per unit of weight); identifying foods that are needed for healthy nutrition in renal patients; classification of foods based on their potassium content normalized per unit of dietary fibre; education about the use of cooking procedures (such as boiling) in order to achieve effective potassium reduction before eating; and attention to hidden sources of potassium, in particular additives in preserved foods and low-sodium salt substitutes. The present paper aims to review dietary potassium handling and gives information about practical approaches to limit potassium load in chronic kidney disease patients at risk of hyperkalaemia. Full article

(This article belongs to the Special Issue Nutrients and Renal Function)

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15 pages, 1580 KiB

Open AccessArticle

Markers of Iron Status Are Associated with Risk of Hyperuricemia among Chinese Adults: Nationwide Population-Based Study

by Xiangping Li, Tingchao He, Kai Yu, Qian Lu, Rashad Alkasir, Guifang Guo and Yong Xue

Nutrients 2018, 10(2), 191; https://doi.org/10.3390/nu10020191 - 09 Feb 2018

Cited by 29 | Viewed by 4941

Abstract

Background: Elevated serum uric acid (SUA) involved in iron metabolism, has been increasingly recognized as a risk factor for gout and cardiovascular diseases. The objective of this study was to examine the associations between markers of iron status with risk of hyperuricemia (HU) in Chinese adult population. Methods: Data were extracted from the 2009 wave of the China Health and Nutrition Survey, consisting of 7946 apparently healthy adults. Serum ferritin (SF), transferrin, soluble transferrin receptors (sTfR), hemoglobin (Hb), high-sensitivity C-reactive protein (hs-CRP), and SUA were measured. Diet was assessed with three consecutive 24 h recalls. Demographic characteristics, smoking status, alcohol consumption, and physical activities were investigated using a structured questionnaire. Multilevel mixed-effects models were constructed to estimate the associations of SF, transferrin, sTfR, and Hb with SUA and the risk of HU. Results: The crude prevalence of HU was 16.1%. SF, transferrin, and Hb levels were positively associated with SUA and the risk of HU after adjustment for cluster effects and potential confounders (all p-trend < 0.05). Compared with participants in the lowest quartile of SF, those in the highest quartile had significantly higher SUA concentrations (β = 0.899 mg/dL, 95% confidence interval (CI): 0.788, 1.010; p < 0.001) and higher risk of HU (odds ratio (OR) = 3.086, 95% CI: 2.450, 3.888; p < 0.001). Participants with the highest quartile of transferrin had significantly higher SUA concentrations (β = 0.488 mg/dL, 95% CI: 0.389, 0.587; p < 0.001) and higher risk of HU (OR: 1.900; 95% CI: 1.579, 2.286; p < 0.001) when compared with those with the lowest quartile. In male participants, those in the highest quartile of Hb had significantly higher risk of HU when compared to the reference group (OR: 1.401, 95% CI: 1.104, 1.777; p < 0.01); however, this association was not found in female participants (OR: 1.093; 95% CI: 0.821, 1.455; p = 0.544). Conclusion: SF, transferrin, and Hb levels were positively associated with the risk of HU, and additional studies are needed to confirm the findings, as well as to elucidate their underlying mechanisms. Full article

(This article belongs to the Special Issue Nutrients and Renal Function)

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13 pages, 1165 KiB

Open AccessArticle

Malnutrition, Inflammation, Atherosclerosis Syndrome (MIA) and Diet Recommendations among End-Stage Renal Disease Patients Treated with Maintenance Hemodialysis

by Małgorzata Maraj, Beata Kuśnierz-Cabala, Paulina Dumnicka, Agnieszka Gala-Błądzińska, Katarzyna Gawlik, Dorota Pawlica-Gosiewska, Anna Ząbek-Adamska, Małgorzata Mazur-Laskowska, Piotr Ceranowicz and Marek Kuźniewski

Nutrients 2018, 10(1), 69; https://doi.org/10.3390/nu10010069 - 11 Jan 2018

Cited by 73 | Viewed by 8882

Abstract

Malnutrition-inflammation-atherosclerosis syndrome is one of the causes of increased mortality in chronic kidney disease (CKD). The aim of the study was to assess the inflammation and nutritional status of patients in end-stage kidney disease treated with maintenance hemodialysis. The study included a group of 98 hemodialyzed patients with stage 5 CKD (38 women and 60 men). Albumin, prealbumin (PRE), and C-reactive protein (CRP) were measured in serum samples collected before mid-week dialysis. Fruit and vegetables frequency intakes were assessed with a questionnaire. CRP was above the reference limit of 5 mg/L in 53% of patients. Moreover, the Glasgow Prognostic Score (GPS) indicated the co-occurrence of inflammation and protein calorie malnutrition in 11% of patients, and the presence of either inflammation or malnutrition in 25%. The questionnaire revealed that hemodialyzed patients frequently exclude fruit and vegetables from their diets. Nearly 43% of the interviewed patients declared frequently eating vegetables, and 35% declared frequently eating fruit, a few times per week or less. The most frequently selected fruit and vegetables had a low antioxidant capacity. The strict dietary restrictions in CKD are difficult to fulfill, and if strictly followed, may lead to protein-calorie malnutrition. Full article

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23 pages, 1153 KiB

Open AccessReview

Nutrients, Nutraceuticals, and Xenobiotics Affecting Renal Health

by Carmela Cosola, Alice Sabatino, Ighli Di Bari, Enrico Fiaccadori and Loreto Gesualdo

Nutrients 2018, 10(7), 808; https://doi.org/10.3390/nu10070808 - 23 Jun 2018

Cited by 23 | Viewed by 8299

Abstract

Chronic kidney disease (CKD) affects 8–16% of the population worldwide. In developed countries, the most important risk factors for CKD are diabetes, hypertension, and obesity, calling into question the importance of educating and acting on lifestyles and nutrition. A balanced diet and supplementation can indeed support the maintenance of a general health status, including preservation of renal function, and can help to manage and curb the main risk factors for renal damage. While the concept of protein and salt restriction in nephrology is historically acknowledged, the role of some nutrients in renal health and the importance of nutrition as a preventative measure for renal care are less known. In this narrative review, we provide an overview of the demonstrated and potential actions of some selected nutrients, nutraceuticals, and xenobiotics on renal health and function. The direct and indirect effects of fiber, protein, fatty acids, curcumin, steviol glycosides, green tea, coffee, nitrates, nitrites, and alcohol on kidney health are reviewed here. In view of functional and personalized nutrition, understanding the renal and systemic effects of dietary components is essential since many chronic conditions, including CKD, are related to systemic dysfunctions such as chronic low-grade inflammation. Full article

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15 pages, 1309 KiB

Open AccessReview

Dietary Salt Restriction in Chronic Kidney Disease: A Meta-Analysis of Randomized Clinical Trials

by Carlo Garofalo, Silvio Borrelli, Michele Provenzano, Toni De Stefano, Carlo Vita, Paolo Chiodini, Roberto Minutolo, Luca De Nicola and Giuseppe Conte

Nutrients 2018, 10(6), 732; https://doi.org/10.3390/nu10060732 - 06 Jun 2018

Cited by 105 | Viewed by 9324

Abstract

Background. A clear evidence on the benefits of reducing salt in people with chronic kidney disease (CKD) is still lacking. Salt restriction in CKD may allow better control of blood pressure (BP) as shown in a previous systematic review while the effect on proteinuria reduction remains poorly investigated. Methods. We performed a meta-analysis of randomized controlled trials (RCTs) evaluating the effects of low versus high salt intake in adult patients with non-dialysis CKD on change in BP, proteinuria and albuminuria. Results. Eleven RCTs were selected and included information about 738 CKD patients (Stage 1–4); urinary sodium excretion was 104 mEq/day (95%CI, 76–131) and 179 mEq/day (95%CI, 165–193) in low- and high-sodium intake subgroups, respectively, with a mean difference of −80 mEq/day (95%CI from −107 to −53; p <0.001). Overall, mean differences in clinic and ambulatory systolic BP were −4.9 mmHg (95%CI from −6.8 to −3.1, p <0.001) and −5.9 mmHg (95%CI from −9.5 to −2.3, p <0.001), respectively, while clinic and ambulatory diastolic BP were −2.3 mmHg (95%CI from −3.5 to −1.2, p <0.001) and −3.0 mmHg (95%CI from −4.3 to −1.7; p <0.001), respectively. Mean differences in proteinuria and albuminuria were −0.39 g/day (95%CI from −0.55 to −0.22, p <0.001) and −0.05 g/day (95%CI from −0.09 to −0.01, p = 0.013). Conclusion. Moderate salt restriction significantly reduces BP and proteinuria/albuminuria in patients with CKD (Stage 1–4). Full article

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11 pages, 714 KiB

Open AccessReview

A Low-Protein Diet for Diabetic Kidney Disease: Its Effect and Molecular Mechanism, an Approach from Animal Studies

by Munehiro Kitada, Yoshio Ogura, Itaru Monno and Daisuke Koya

Nutrients 2018, 10(5), 544; https://doi.org/10.3390/nu10050544 - 27 Apr 2018

Cited by 40 | Viewed by 9566

Abstract

A low-protein diet (LPD) can be expected to retard renal function decline in advanced stages of chronic kidney disease (CKD), including diabetic kidney disease (DKD), and is recommended in a clinical setting. Regarding the molecular mechanisms of an LPD against DKD, previous animal studies have shown that an LPD exerts reno-protection through mainly the improvement of glomerular hyperfiltration/hypertension due to the reduction of intraglomerular pressure. On the other hand, we have demonstrated that an LPD, particularly a very-LPD (VLPD), improved tubulo-interstitial damage, inflammation and fibrosis, through the restoration of autophagy via the reduction of a mammalian target of rapamycin complex 1 (mTORC1) activity in type 2 diabetes and obesity animal models. Thus, based on animal studies, a VLPD may show a more beneficial effect against advanced DKD. Previous clinical reports have also shown that a VLPD, not a moderate LPD, slows the progression of renal dysfunction in patients with chronic glomerular nephritis. However, there is insufficient clinical data regarding the beneficial effects of a VLPD against DKD. Additionally, the patients with CKD, including DKD, are a high-risk group for malnutrition, such as protein–energy wasting (PEW), sarcopenia, and frailty. Therefore, an LPD, including a VLPD, should be prescribed to patients when the benefits of an LPD outweigh the risks, upon consideration of adherence, age, and nutritional status. As the future predicts, the development of a VLPD replacement therapy without malnutrition may be expected for reno-protection against the advanced stages of DKD, through the regulation of mTORC1 activity and adequate autophagy induction. However, further studies to elucidate detailed mechanisms by which a VLPD exerts reno-protection are necessary. Full article

(This article belongs to the Special Issue Nutrients and Renal Function)

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19 pages, 8335 KiB

Open AccessReview

Efficacy of Nutritional Interventions on Inflammatory Markers in Haemodialysis Patients: A Systematic Review and Limited Meta-Analysis

by Ban-Hock Khor, Sreelakshmi Sankara Narayanan, Sharmela Sahathevan, Abdul Halim Abdul Gafor, Zulfitri Azuan Mat Daud, Pramod Khosla, Alice Sabatino, Enrico Fiaccadori, Karuthan Chinna and Tilakavati Karupaiah

Nutrients 2018, 10(4), 397; https://doi.org/10.3390/nu10040397 - 23 Mar 2018

Cited by 30 | Viewed by 7558

Abstract

Low-grade chronic inflammation is prevalent in patients undergoing haemodialysis (HD) treatment and is linked to the development of premature atherosclerosis and mortality. The non-pharmacological approach to treat inflammation in HD patients through nutritional intervention is well cited. We aimed to assess the efficacy of different nutritional interventions at improving inflammatory outcomes in HD patients, based on markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumour necrosis factor-α (TNF-α). We searched PubMed, Cochrane Library, and Embase for randomized controlled trials (RCT) published before June 2017. Inclusion criteria included RCTs on adult patients on maintenance HD treatment with duration of nutritional interventions for a minimum 4 weeks. Risk of bias was assessed using the Jadad score. In total, 46 RCTs experimenting different nutritional interventions were included in the review and categorized into polyphenols rich foods, omega-3 fatty acids, antioxidants, vitamin D, fibres, and probiotics. Meta-analyses indicated significant reduction in CRP levels by omega-3 fatty acids (Random model effect: −0.667 mg/L, p < 0.001) and vitamin E (fixed model effect: −0.257 mg/L, p = 0.005). Evidence for other groups of nutritional interventions was inconclusive. In conclusion, our meta-analysis provided evidence that omega-3 fatty acids and vitamin E could improve inflammatory outcomes in HD patients. Full article

(This article belongs to the Special Issue Nutrients and Renal Function)

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23 pages, 641 KiB

Open AccessReview

The Relationship between Maternal Nutrition during Pregnancy and Offspring Kidney Structure and Function in Humans: A Systematic Review

by Yu Qi Lee, Clare E. Collins, Adrienne Gordon, Kym M. Rae and Kirsty G. Pringle

Nutrients 2018, 10(2), 241; https://doi.org/10.3390/nu10020241 - 21 Feb 2018

Cited by 26 | Viewed by 9241

Abstract

The intrauterine environment is critical for fetal growth and organ development. Evidence from animal models indicates that the developing kidney is vulnerable to suboptimal maternal nutrition and changes in health status. However, evidence from human studies are yet to be synthesised. Therefore, the aim of the current study was to systematically review current research on the relationship between maternal nutrition during pregnancy and offspring kidney structure and function in humans. A search of five databases identified 9501 articles, of which three experimental and seven observational studies met the inclusion criteria. Nutrients reviewed to date included vitamin A (n = 3), folate and vitamin B12 (n = 2), iron (n = 1), vitamin D (n = 1), total energy (n = 2) and protein (n = 1). Seven studies were assessed as being of “positive” and three of “neutral” quality. A variety of populations were studied, with limited studies investigating maternal nutrition during pregnancy, while measurements of offspring kidney outcomes were diverse across studies. There was a lack of consistency in the timing of follow-up for offspring kidney structure and/or function assessments, thus limiting comparability between studies. Deficiencies in maternal folate, vitamin A, and total energy during pregnancy were associated with detrimental impacts on kidney structure and function, measured by kidney volume, proteinuria, eGFR_cystC and mean creatinine clearance in the offspring. Additional experimental and longitudinal prospective studies are warranted to confirm this relationship, especially in Indigenous populations where the risk of renal disease is greater. Full article

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