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Nutrients
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Nutritional Problems of Children and Adults in Chronic Kidney Disease
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Nutritional Problems of Children and Adults in Chronic Kidney Disease

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutritional Epidemiology".

Deadline for manuscript submissions: closed (15 September 2023) | Viewed by 28465

Special Issue Editors

Prof. Dr. Małgorzata Szczuko

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Guest Editor
Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland
Interests: nutrition; inflammation; metabolism; diabetes; microbiome; short-chain fatty acids; vitamins
Special Issues, Collections and Topics in MDPI journals
Dr. Karolina Kędzierska-Kapuza

E-Mail Website
Guest Editor
Department of Gastroenterological Surgery and Transplantology, Centre of Postgraduate Medical Education, Marymoncka St. 99/103, 01-813 Warsaw, Poland
Interests: chronic kidney disease; dialysis; transplantation; diabetes; vitamins; liver; pancreas
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The main cause of chronic kidney disease (CKD) and End-Stage Renal Disease (ESRD) is obesity, hypertension, and diabetes in adults. That is why CKD is called a civilization disease.

The topic of chronic kidney disease nutrition depends on the stage of the patient’s disease and nutritional status.

The slow, irreversible, and progressive deterioration of kidney function, characterized by a reduction in glomerular filtration rate, brings with it many challenges for both adult and pediatric patients.

Increased protein catabolism and protein malnutrition are common symptoms in patients.

The etiology includes, but is not limited to, metabolic acidosis, intestinal dysbiosis; systemic inflammation with activation of the complement, endothelin-1 axis, and renin-angiotensin-aldosterone; resistance to anabolic hormones; increase in energy expenditure; and accumulation of uremic toxins. Moreover, it cannot be determined whether the low levels of thyroid hormones in CKD patients are an adaptation that reduces energy expenditure and minimizes protein catabolism, or the abnormal adaptation involved in the wasting syndrome.

Therefore, diet therapy is focused on: inhibiting kidney damage, preventing malnutrition, reducing the severity of metabolic disorders. An interesting issue is the introduction of a vegetarian diet in the nutrition of CKD patients. A vegetarian diet supplemented with ketoanalogues appears to be more beneficial in patients with more advanced CKD.

However, in the case of children, the topic is even more complicated.

Metabolic disorders include growth hormone (GH) and insulin-like growth factor I (IGF-I), electrolyte disturbances, alteration of bone and mineral (calcium and phosphate) metabolism, leading to osteodystrophy.

Moreover, metabolic acidosis, uremia, anemia, inflammation, as well as hyperparathyroidism and hypogonadism, are problems that occur in the same patient. Nutritional deficiencies, vitamin D, vitamin B12 and folate, recurrent vomiting, appetite disorders, and progressive anorexia are tasks for a well-qualified dietitian. At the same time, there is little evidence and interventions in this group of patients, which makes patient care inadequate. Therefore, the purpose of this Special Issue is to discuss various solutions and help CKD patients.

Dr. Małgorzata Szczuko
Dr. Karolina Kędzierska-Kapuza
Guest Editors

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Keywords

  • chronic kidney disease
  • children
  • malnutrition
  • ketoanalogues
  • parenteral nutrition
  • vegetarian diet
  • metabolic disorders
  • osteodystrophy

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Published Papers (6 papers)

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Research

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12 pages, 3379 KiB  
Article
Glyoxylic Acid, an α-Keto Acid Metabolite Derived from Glycine, Promotes Myogenesis in C2C12 Cells
by Toshio Norikura, Yutaro Sasaki, Akiko Kojima-Yuasa and Atsushi Kon
Nutrients 2023, 15(7), 1763; https://doi.org/10.3390/nu15071763 - 4 Apr 2023
Cited by 4 | Viewed by 2381
Abstract
α-Keto acids may help prevent malnutrition in patients with chronic kidney disease (CKD), who consume protein-restricted diets, because they serve as amino acid sources without producing nitrogenous waste compounds. However, the physiological roles of α-keto acids, especially those derived from non-essential amino acids, [...] Read more.
α-Keto acids may help prevent malnutrition in patients with chronic kidney disease (CKD), who consume protein-restricted diets, because they serve as amino acid sources without producing nitrogenous waste compounds. However, the physiological roles of α-keto acids, especially those derived from non-essential amino acids, remain unclear. In this study, we examined the effect of glyoxylic acid (GA), an α-keto acid metabolite derived from glycine, on myogenesis in C2C12 cells. Differentiation and mitochondrial biogenesis were used as myogenesis indicators. Treatment with GA for 6 d resulted in an increase in the expression of differentiation markers (myosin heavy chain II and myogenic regulatory factors), mitochondrial biogenesis, and intracellular amounts of amino acids (glycine, serine, and alanine) and their metabolites (citric acid and succinic acid). In addition, GA treatment suppressed the 2.5-µM dexamethasone (Dex)-induced increase in mRNA levels of ubiquitin ligases (Trim63 and Fbxo32), muscle atrophy markers. These results indicate that GA promotes myogenesis, suppresses Dex-induced muscle atrophy, and is metabolized to amino acids in muscle cells. Although further in vivo experiments are needed, GA may be a beneficial nutrient for ameliorating the loss of muscle mass, strength, and function in patients with CKD on a strict dietary protein restriction. Full article
(This article belongs to the Special Issue Nutritional Problems of Children and Adults in Chronic Kidney Disease)
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15 pages, 1695 KiB  
Article
Effect of Diet and Supplementation on Serum Vitamin C Concentration and Antioxidant Activity in Dialysis Patients
by Anna Bogacka, Anna Sobczak-Czynsz, Edyta Balejko, Angelika Heberlej and Kazimierz Ciechanowski
Nutrients 2023, 15(1), 78; https://doi.org/10.3390/nu15010078 - 24 Dec 2022
Cited by 4 | Viewed by 2730
Abstract
Loss of vitamin C, especially in conjunction with an inadequate supply, can lead to decreased plasma concentrations of vitamin C. This in turn can lead to overt or subclinical deficiency. The present study aimed to evaluate the effects of diet and supplementation on [...] Read more.
Loss of vitamin C, especially in conjunction with an inadequate supply, can lead to decreased plasma concentrations of vitamin C. This in turn can lead to overt or subclinical deficiency. The present study aimed to evaluate the effects of diet and supplementation on vitamin C concentrations and serum antioxidant activity (FRAP) in hemodialysis (HD) patients. Sixty-eight HD patients participated in the study. In all of them, the diet was initially determined, and they were divided into five groups according to the diet and supplementation used. Group 1 received an unchanged diet, considered by them to be optimal; in group 2, the standard diet used in HD patients was introduced; in group 3, a standard diet enriched with natural antioxidants was employed; in group 4, a standard diet as in group 2 was used, but enriched with supplements (vitamin C, vitamin E, Se, and Zn). In contrast, group 5 consisted of HD patients with coexisting diabetes. Vitamin C serum levels were determined by high-performance liquid chromatography HPLC and antioxidant activity by The Ferric Reducing Ability of Plasma FRAP. The study shows that a well-chosen diet can slow the build-up of malnutrition and increase antioxidant activity as measured by the FRAP method in the blood of hemodialysis patients. Vitamin C supplementation can improve antioxidant status in hemodialysis patients. * The results presented in this paper complement our study, which assessed the effect of diet on the activity of erythrocyte antioxidant enzymes: Catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px), but also on the concentrations of non-enzymatic antioxidants (tocopherols, carotenoids, and vitamin C) in hemodialysis patients. In the study, plasma malondialdehyde (MDA) concentrations were assessed as an indicator of oxidative damage. Full article
(This article belongs to the Special Issue Nutritional Problems of Children and Adults in Chronic Kidney Disease)
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16 pages, 893 KiB  
Article
Adherence to Caloric and Protein Recommendations in Older Hemodialysis Patients: A Multicenter Study
by Sylwia Czaja-Stolc, Ewelina Puchalska-Reglińska, Sylwia Małgorzewicz, Marta Potrykus, Małgorzata Kaczkan, Aneta Kałużna, Zbigniew Heleniak and Alicja Dębska-Ślizień
Nutrients 2022, 14(19), 4160; https://doi.org/10.3390/nu14194160 - 7 Oct 2022
Cited by 3 | Viewed by 2362
Abstract
Hemodialysis (HD) patients are characterized by malnutrition, which adversely affects their survival. The development of malnutrition is influenced, among other factors, by improper diet and the advanced age of patients. The study aimed to assess the nutritional status and adherence to dietary recommendations [...] Read more.
Hemodialysis (HD) patients are characterized by malnutrition, which adversely affects their survival. The development of malnutrition is influenced, among other factors, by improper diet and the advanced age of patients. The study aimed to assess the nutritional status and adherence to dietary recommendations among older patients. The multicenter study included 179 stable HD patients. The nutritional status was assessed by a 7-point Subjective Global Assessment (SGA). Anthropometry and body composition was analyzed. The diet was assessed based on the 3-day food diary and the Food Frequency Questionnaire with 6 answers (FFQ-6). Blood laboratory tests were performed. Based on the 7-point SGA, malnutrition was diagnosed in 38.5% of HD patients. The decreased content of the muscle tissue (LTI < 14 kg/m2) was observed in 70.4% of the examined patients and the decreased concentration of s-albumin was observed in 44.1% of patients. Older patients had significantly lower LTI. 26% of patients consumed less than 25 kcal/kg body weight and less than 0.8 g protein/kg body weight. Older patients’ diets contained significantly fewer calories. There were significant differences between nutrient intake on a weekday with dialysis, a weekday without dialysis, and a weekend day without dialysis. The lowest intake of nutrients was observed on the day of dialysis. Nutritional education and the determination of whether food is permitted during hemodialysis are necessary to improve patients’ nutrition. Full article
(This article belongs to the Special Issue Nutritional Problems of Children and Adults in Chronic Kidney Disease)
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Review

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18 pages, 848 KiB  
Review
Does Vitamin Supplementation Play a Role in Chronic Kidney Disease?
by Aleksandra Beata Juszczak, Maciej Kupczak and Tomasz Konecki
Nutrients 2023, 15(13), 2847; https://doi.org/10.3390/nu15132847 - 23 Jun 2023
Cited by 11 | Viewed by 5341
Abstract
Although the role of vitamins in the human body is proven, guidelines for patients with chronic kidney disease (CKD) remain unclear. This narrative review summarizes the findings of 98 studies of CKD and the effects of vitamin D, B, C, A, E, and [...] Read more.
Although the role of vitamins in the human body is proven, guidelines for patients with chronic kidney disease (CKD) remain unclear. This narrative review summarizes the findings of 98 studies of CKD and the effects of vitamin D, B, C, A, E, and K supplementation on patients on dialysis for CKD, with the aim of summarizing the existing guidelines. The findings are promising, showing the potential effectiveness of vitamin supplementation with, for example, vitamins B, D, or C. However, recommendations are still ambiguous, especially in the case of vitamins A and K, due to the potential toxicity associated with higher doses for patients. Continued research is needed to rigorously evaluate the effectiveness and carefully consider the potential risks of some vitamin supplementation for patients with CKD. Full article
(This article belongs to the Special Issue Nutritional Problems of Children and Adults in Chronic Kidney Disease)
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15 pages, 774 KiB  
Review
Diet and Physical Activity in Adult Dominant Polycystic Kidney Disease: A Review of the Literature
by Irene Capelli, Sarah Lerario, Valeria Aiello, Michele Provenzano, Roberta Di Costanzo, Andrea Squadrani, Anna Vella, Valentina Vicennati, Carolina Poli, Gaetano La Manna and Olga Baraldi
Nutrients 2023, 15(11), 2621; https://doi.org/10.3390/nu15112621 - 3 Jun 2023
Cited by 7 | Viewed by 6442
Abstract
Autosomal polycystic kidney disease is the most common inherited kidney disease determining 5% of all end-stage kidney disease. The only therapy approved for this condition is Tolvaptan, which, with its aquaretic effect, has a strong effect on patients’ daily life. Recently, the literature [...] Read more.
Autosomal polycystic kidney disease is the most common inherited kidney disease determining 5% of all end-stage kidney disease. The only therapy approved for this condition is Tolvaptan, which, with its aquaretic effect, has a strong effect on patients’ daily life. Recently, the literature has been enriched with new works that analyze possible non-pharmacological therapeutic strategies to slow cysts’ enlargement and chronic kidney disease progression. Among them, dietary schemes reducing carbohydrate intake and inducing ketoses have been demonstrated to have efficacy in several pre-clinical and clinical studies. A ketogenic diet, calorie restriction, intermittent fasting, and time-restricted feeding can reduce aerobic glycolysis and inhibit the mTOR pathway, producing a reduction in cyst cell proliferation, a reduction in kidney volume, and helping to preserve kidney function. ADPKD’s burden of disease has an impact on patients’ quality of life, and the possibility to play sports or carry out physical exercise can help people in everyday life. The multisystemic character of the disease, especially cardiovascular involvement, needs to be carefully evaluated to establish the quality and quantity of physical activity that patients can safely carry out. Full article
(This article belongs to the Special Issue Nutritional Problems of Children and Adults in Chronic Kidney Disease)
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Other

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19 pages, 2362 KiB  
Systematic Review
Demand for Water-Soluble Vitamins in a Group of Patients with CKD versus Interventions and Supplementation—A Systematic Review
by Karolina Kędzierska-Kapuza, Urszula Szczuko, Hanna Stolińska, Dimitra Rafailia Bakaloudi, Waldemar Wierzba and Małgorzata Szczuko
Nutrients 2023, 15(4), 860; https://doi.org/10.3390/nu15040860 - 8 Feb 2023
Cited by 8 | Viewed by 7492
Abstract
Background: Increasingly, chronic kidney disease (CKD) is becoming an inevitable consequence of obesity, metabolic syndrome, and diabetes. As the disease progresses, and through dialysis, the need for and loss of water-soluble vitamins both increase. This review article looks at the benefits and possible [...] Read more.
Background: Increasingly, chronic kidney disease (CKD) is becoming an inevitable consequence of obesity, metabolic syndrome, and diabetes. As the disease progresses, and through dialysis, the need for and loss of water-soluble vitamins both increase. This review article looks at the benefits and possible risks of supplementing these vitamins with the treatment of CKD. Methods: Data in the PubMed and Embase databases were analyzed. The keywords “chronic kidney disease”, in various combinations, are associated with thiamin, riboflavin, pyridoxine, pantothenic acid, folates, niacin, cobalamin, and vitamin C. This review focuses on the possible use of water-soluble vitamin supplementation to improve pharmacological responses and the overall clinical condition of patients. Results: The mechanism of supportive supplementation is based on reducing oxidative stress, covering the increased demand and losses resulting from the treatment method. In the initial period of failure (G2-G3a), it does not require intervention, but later, especially in the case of inadequate nutrition, the inclusion of supplementation with folate and cobalamin may bring benefits. Such supplementation seems to be a necessity in patients with stage G4 or G5 (uremia). Conversely, the inclusion of additional B6 supplementation to reduce CV risk may be considered. At stage 3b and beyond (stages 4–5), the inclusion of niacin at a dose of 400–1000 mg, depending on the patient’s tolerance, is required to lower the phosphate level. The inclusion of supplementation with thiamine and other water-soluble vitamins, especially in peritoneal dialysis and hemodialysis patients, is necessary for reducing dialysis losses. Allowing hemodialysis patients to take low doses of oral vitamin C effectively reduces erythropoietin dose requirements and improves anemia in functional iron-deficient patients. However, it should be considered that doses of B vitamins that are several times higher than the recommended dietary allowance of consumption may exacerbate left ventricular diastolic dysfunction in CKD patients. Conclusions: Taking into account the research conducted so far, it seems that the use of vitamin supplementation in CKD patients may have a positive impact on the treatment process and maintaining a disease-free condition. Full article
(This article belongs to the Special Issue Nutritional Problems of Children and Adults in Chronic Kidney Disease)
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