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Relevant Nutritional, Biochemical and Molecular Disorders in CKD
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Relevant Nutritional, Biochemical and Molecular Disorders in CKD

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

Deadline for manuscript submissions: closed (20 October 2022) | Viewed by 45906

Special Issue Editors

Prof. Dr. Jorge B. Cannata-Andía

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Guest Editor
1. Bone and Mineral Research Unit, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), RICORS2040 (Kidney Disease)-ISCIII, Avda. Roma, sn., 33011 Oviedo, Spain
2. Department of Medicine, Universidad de Oviedo, 33011 Oviedo, Spain
Interests: toxicology of aluminium; bone and mineral metabolism disorders in the general population and in chronic kidney disease; vascular calcification; bone demineralisation; ageing
Dr. Sara Panizo

E-Mail Website
Guest Editor
Unidad de Gestión Clínica de Metabolismo Óseo, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Retic REDinREN-ISCIII, Universidad de Oviedo, 33003 Oviedo, España
Interests: bone metabolism; vascular metabolism; chronic inflammatory diseases
Special Issues, Collections and Topics in MDPI journals
Dr. Cristina Alonso-Montes

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Guest Editor
Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Retic REDinREN-ISCIII, Avda. Roma, sn., 33011 Oviedo, Spain
Interests: bone metabolism; vascular metabolism; chronic inflammatory diseases
Special Issues, Collections and Topics in MDPI journals
Dr. Natalia Carrillo-López

E-Mail Website
Guest Editor
1. Metabolismo Óseo, Vascular y Enfermedades Inflamatorias Crónicas, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
2. Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS2040, Kidney Disease), 28040 Madrid, Spain
Interests: calcification; chronic kidney disease-mineral and bone disorder; blood vessel calcification; chronic renal failure; fibrosis in CKD
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Chronic kidney disease (CKD) has become one of the main public health problems because of demographic aging. Worldwide, an estimated 500 million adults suffer from CKD. Early stages of CKD are associated with a significant increase in cardiovascular morbidity. 

The requirement and metabolism of nutrients, vitamins, and essential and non-essential elements varies during the different stages of CKD; in some of them the deficit is the rule, while in others excess is the main problem leading to clinical, biochemical and molecular abnormalities. Understanding the applicable nutritional principles and avoiding overweight, malnutrition, as well as bone and cardiovascular disorder remain critical issues in CKD.

Several aspects of great relevance in CKD will be included in this Special Issue of Nutrients, starting with the importance of the nutritional support in children with CKD and the overall benefits of working with a dietitian. Critical aspects in current CKD management, such as the dietary patterns in relationship with potassium, magnesium, vitamin D, and antioxidants, will be discussed.

Metabolic and vascular disorders, inflammation, regulation by miRNAs, the microbiota, intestinal hormones, short chain fatty acids, molecules derived from adipose tissue, bariatric surgery, the association with the bone and vascular axis, malnutrition, inflammation and atherosclerosis (MIA) syndrome, the impact of malnutrition on cognitive impairment, the relationship between serum albumin levels and mortality, and the role of diabetes and kidney transplantation in bone and vessel health will be discussed. The topics will be addressed keeping a translational perspective.

Prof. Dr. Jorge B. Cannata-Andía
Dr. Sara Panizo
Dr. Cristina Alonso-Montes
Dr. Natalia Carrillo-López
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • CKD and uremia
  • nutrition
  • gut hormones
  • microbiota
  • nutritional supplements
  • inflammation and nutrition
  • obesity
  • bariatric surgery and obesity
  • antioxidants and vitamin D
  • vascular calcification and arterial stiffness
  • miRNAs and CKD
  • diabetes and CKD
  • CKD and transplantation

Published Papers (15 papers)

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13 pages, 1848 KiB  
Article
Phosphorus May Induce Phenotypic Transdifferentiation of Vascular Smooth Muscle Cells through the Reduction of microRNA-145
by Sara Fernández-Villabrille, Beatriz Martín-Carro, Julia Martín-Vírgala, Cristina Alonso-Montes, Alejandra Fernández-Fernández, Carlos Martínez-Salgado, José L. Fernández-Martín, Manuel Naves-Díaz, Jorge B. Cannata-Andía, Natalia Carrillo-López and Sara Panizo
Nutrients 2023, 15(13), 2918; https://doi.org/10.3390/nu15132918 - 27 Jun 2023
Cited by 1 | Viewed by 1102
Abstract
Phosphorus is a vital element for life found in most foods as a natural component, but it is also one of the most used preservatives added during food processing. High serum phosphorus contributes to develop vascular calcification in chronic kidney disease; however, it [...] Read more.
Phosphorus is a vital element for life found in most foods as a natural component, but it is also one of the most used preservatives added during food processing. High serum phosphorus contributes to develop vascular calcification in chronic kidney disease; however, it is not clear its effect in a population without kidney damage. The objective of this in vivo and in vitro study was to investigate the effect of high phosphorus exposure on the aortic and serum levels of miR-145 and its effect on vascular smooth muscle cell (VSMCs) changes towards less contractile phenotypes. The study was performed in aortas and serum from rats fed standard and high-phosphorus diets, and in VSMCs exposed to different concentrations of phosphorus. In addition, miR-145 silencing and overexpression experiments were carried out. In vivo results showed that in rats with normal renal function fed a high P diet, a significant increase in serum phosphorus was observed which was associated to a significant decrease in the aortic α-actin expression which paralleled the decrease in aortic and serum miR-145 levels, with no changes in the osteogenic markers. In vitro results using VSMCs corroborated the in vivo findings. High phosphorus first reduced miR-145, and afterwards α-actin expression. The miR-145 overexpression significantly increased α-actin expression and partially prevented the increase in calcium content. These results suggest that miR-145 could be an early biomarker of vascular calcification, which could give information about the initiation of the transdifferentiation process in VSMCs. Full article
(This article belongs to the Special Issue Relevant Nutritional, Biochemical and Molecular Disorders in CKD)
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12 pages, 2801 KiB  
Article
Effects of a Losartan-Antioxidant Hybrid (GGN1231) on Vascular and Cardiac Health in an Experimental Model of Chronic Renal Failure
by Laura Martínez-Arias, Sara Fernández-Villabrille, Cristina Alonso-Montes, Gonzalo García-Navazo, María P. Ruíz-Torres, Ramón Alajarín, Julio Alvarez-Builla, Elena Gutiérrez-Calabres, Juan José Vaquero-López, Natalia Carrillo-López, Diego Rodríguez-Puyol, Jorge B. Cannata-Andía, Sara Panizo and Manuel Naves-Díaz
Nutrients 2023, 15(8), 1820; https://doi.org/10.3390/nu15081820 - 10 Apr 2023
Viewed by 1899
Abstract
Drugs providing antihypertensive and protective cardiovascular actions are of clinical interest in controlling cardiovascular events and slowing the progression of kidney disease. We studied the effect of a hybrid compound, GGN1231 (derived from losartan in which a powerful antioxidant was attached), on the [...] Read more.
Drugs providing antihypertensive and protective cardiovascular actions are of clinical interest in controlling cardiovascular events and slowing the progression of kidney disease. We studied the effect of a hybrid compound, GGN1231 (derived from losartan in which a powerful antioxidant was attached), on the prevention of cardiovascular damage, cardiac hypertrophy, and fibrosis in a rat model of severe chronic renal failure (CRF). CRF by a 7/8 nephrectomy was carried out in male Wistar rats fed with a diet rich in phosphorous (0.9%) and normal calcium (0.6%) for a period of 12 weeks until sacrifice. In week 8, rats were randomized in five groups receiving different drugs including dihydrocaffeic acid as antioxidant (Aox), losartan (Los), dihydrocaffeic acid+losartan (Aox+Los) and GGN1231 as follows: Group 1 (CRF+vehicle group), Group 2 (CRF+Aox group), Group 3 (CRF+Los group), Group 4 (CRF+Aox+Los group), and Group 5 (CRF+GGN1231 group). Group 5, the CRF+GGN1231 group, displayed reduced proteinuria, aortic TNF-α, blood pressure, LV wall thickness, diameter of the cardiomyocytes, ATR1, cardiac TNF-α and fibrosis, cardiac collagen I, and TGF-β1 expression. A non-significant 20% reduction in the mortality was also observed. This study showed the possible advantages of GGN1231, which could help in the management of cardiovascular and inflammatory processes. Further research is needed to confirm and even expand the positive aspects of this compound. Full article
(This article belongs to the Special Issue Relevant Nutritional, Biochemical and Molecular Disorders in CKD)
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19 pages, 3285 KiB  
Article
Serum and Urinary Soluble α-Klotho as Markers of Kidney and Vascular Impairment
by Julia Martín-Vírgala, Sara Fernández-Villabrille, Beatriz Martín-Carro, Isaac Tamargo-Gómez, Juan F. Navarro-González, Carmen Mora-Fernández, Laura Calleros, Elena Astudillo-Cortés, Noelia Avello-Llano, Guillermo Mariño, Adriana S. Dusso, Cristina Alonso-Montes, Sara Panizo, Jorge B. Cannata-Andía, Manuel Naves-Díaz and Natalia Carrillo-López
Nutrients 2023, 15(6), 1470; https://doi.org/10.3390/nu15061470 - 18 Mar 2023
Cited by 5 | Viewed by 2374
Abstract
This study was designed to investigate the controversy on the potential role of sKlotho as an early biomarker in Chronic Kidney Disease–Mineral Bone Disorder (CKD-MBD), to assess whether sKlotho is a reliable marker of kidney α-Klotho, to deepen the effects of sKlotho on [...] Read more.
This study was designed to investigate the controversy on the potential role of sKlotho as an early biomarker in Chronic Kidney Disease–Mineral Bone Disorder (CKD-MBD), to assess whether sKlotho is a reliable marker of kidney α-Klotho, to deepen the effects of sKlotho on vascular smooth muscle cells (VSMCs) osteogenic differentiation and to evaluate the role of autophagy in this process. Experimental studies were conducted in CKD mice fed a normal phosphorus (CKD+NP) or high phosphorus (CKD+HP) diet for 14 weeks. The patients’ study was performed in CKD stages 2–5 and in vitro studies which used VSMCs exposed to non-calcifying medium or calcifying medium with or without sKlotho. The CKD experimental model showed that the CKD+HP group reached the highest serum PTH, P and FGF23 levels, but the lowest serum and urinary sKlotho levels. In addition, a positive correlation between serum sKlotho and kidney α-Klotho was found. CKD mice showed aortic osteogenic differentiation, together with increased autophagy. The human CKD study showed that the decline in serum sKlotho is previous to the rise in FGF23. In addition, both serum sKlotho and FGF23 levels correlated with kidney function. Finally, in VSMCs, the addition of sKlotho prevented osteogenic differentiation and induced autophagy. It can be concluded that serum sKlotho was the earliest CKD-MBD biomarker, a reliable indicator of kidney α-Klotho and that might protect against osteogenic differentiation by increasing autophagy. Nevertheless, further studies are needed to investigate the mechanisms of this possible protective effect. Full article
(This article belongs to the Special Issue Relevant Nutritional, Biochemical and Molecular Disorders in CKD)
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11 pages, 828 KiB  
Article
Estimation of Glomerular Filtration Rate in Obese Patients: Utility of a New Equation
by Pehuén Fernández, María Laura Nores, Walter Douthat, Javier de Arteaga, Pablo Luján, Mario Campazzo, Jorge de La Fuente and Carlos Chiurchiu
Nutrients 2023, 15(5), 1233; https://doi.org/10.3390/nu15051233 - 28 Feb 2023
Viewed by 2121
Abstract
There is no consensus on the best equation to estimate glomerular filtration rate (eGFR) in obese patients (OP). Objective: to evaluate the performance of the current equations and the new Argentinian Equation (“AE”) to estimate GFR in OP. Two validation samples were used: [...] Read more.
There is no consensus on the best equation to estimate glomerular filtration rate (eGFR) in obese patients (OP). Objective: to evaluate the performance of the current equations and the new Argentinian Equation (“AE”) to estimate GFR in OP. Two validation samples were used: internal (IVS, using 10-fold cross-validation) and temporary (TVS). OP whose GFR was measured (mGFR) with clearance of iothalamate between 2007/2017 (IVS, n = 189) and 2018/2019 (TVS, n = 26) were included. To evaluate the performance of the equations we used: bias (difference between eGFR and mGFR), P30 (percentage of estimates within ±30% of mGFR), Pearson’s correlation (r) and percentage of correct classification (%CC) according to the stages of CKD. The median age was 50 years. Sixty percent had grade I obesity (G1-Ob), 25.1% G2-Ob and 14.9% G3-Ob, with a wide range in mGFR (5.6–173.1 mL/min/1.73 m2). In the IVS, AE obtained a higher P30 (85.2%), r (0.86) and %CC (74.4%), with lower bias (−0.4 mL/min/1.73 m2). In the TVS, AE obtained a higher P30 (88.5%), r (0.89) and %CC (84.6%). The performance of all equations was reduced in G3-Ob, but AE was the only one that obtained a P30 > 80% in all degrees. AE obtained better overall performance to estimate GFR in OP and could be useful in this population. Conclusions from this study may not be generalizable to all populations of obese patients since they were derived from a study in a single center with a very specific ethnic mixed population. Full article
(This article belongs to the Special Issue Relevant Nutritional, Biochemical and Molecular Disorders in CKD)
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14 pages, 1174 KiB  
Article
Association between Cognitive Impairment and Malnutrition in Hemodialysis Patients: Two Sides of the Same Coin
by Silverio Rotondi, Lida Tartaglione, Marzia Pasquali, Maria Josè Ceravolo, Anna Paola Mitterhofer, Annalisa Noce, Monica Tavilla, Silvia Lai, Francesca Tinti, Maria Luisa Muci, Alessio Farcomeni and Sandro Mazzaferro
Nutrients 2023, 15(4), 813; https://doi.org/10.3390/nu15040813 - 4 Feb 2023
Cited by 4 | Viewed by 2206
Abstract
Cognitive impairment and malnutrition are prevalent in patients on hemodialysis (HD), and they negatively affect the outcomes of HD patients. Evidence suggests that cognitive impairment and malnutrition may be associated, but clinical studies to assess this association in HD patients are lacking. The [...] Read more.
Cognitive impairment and malnutrition are prevalent in patients on hemodialysis (HD), and they negatively affect the outcomes of HD patients. Evidence suggests that cognitive impairment and malnutrition may be associated, but clinical studies to assess this association in HD patients are lacking. The aim of this study was to evaluate the association between cognitive impairment evaluated by the Montreal Cognitive Assessment (MoCA) score and nutritional status evaluated by the malnutrition inflammation score (MIS) in HD patients. We enrolled 84 HD patients (44 males and 40 females; age: 75.8 years (63.5–82.7); HD vintage: 46.0 months (22.1–66.9)). The MISs identified 34 patients (40%) as malnourished; the MoCa scores identified 67 patients (80%) with mild cognitive impairment (MCI). Malnourished patients had a higher prevalence of MCI compared to well-nourished patients (85% vs. 70%; p = 0.014). MoCa score and MIS were negatively correlated (rho:−0.317; p < 0.01). Our data showed a high prevalence of MCI and malnutrition in HD patients. Low MoCA scores characterized patients with high MISs, and malnutrition was a risk factor for MCI. In conclusion, it is plausible that MCI and malnutrition are linked by common sociodemographic, clinical, and biochemical risk factors rather than by a pathophysiological mechanism. Full article
(This article belongs to the Special Issue Relevant Nutritional, Biochemical and Molecular Disorders in CKD)
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14 pages, 1471 KiB  
Article
Osteocytic Sclerostin Expression as an Indicator of Altered Bone Turnover
by Yentl Huybrechts, Pieter Evenepoel, Mathias Haarhaus, Etienne Cavalier, Geert Dams, Wim Van Hul, Patrick C. D’Haese and Anja Verhulst
Nutrients 2023, 15(3), 598; https://doi.org/10.3390/nu15030598 - 23 Jan 2023
Cited by 1 | Viewed by 1674
Abstract
Renal osteodystrophy (ROD) is a complex and serious complication of chronic kidney disease (CKD), a major global health problem caused by loss of renal function. Currently, the gold standard to accurately diagnose ROD is based on quantitative histomorphometric analysis of trabecular bone. Although [...] Read more.
Renal osteodystrophy (ROD) is a complex and serious complication of chronic kidney disease (CKD), a major global health problem caused by loss of renal function. Currently, the gold standard to accurately diagnose ROD is based on quantitative histomorphometric analysis of trabecular bone. Although this analysis encompasses the evaluation of osteoblast and osteoclast number/activity, tfigurehe interest in osteocytes remains almost nihil. Nevertheless, this cell type is evidenced to perform a key role in bone turnover, particularly through its production of various bone proteins, such as sclerostin. In this study, we aim to investigate, in the context of ROD, to which extent an association exists between bone turnover and the abundance of osteocytes and osteocytic sclerostin expression in both the trabecular and cortical bone compartments. Additionally, the effect of parathyroid hormone (PTH) on bone sclerostin expression was examined in parathyroidectomized rats. Our results indicate that PTH exerts a direct inhibitory function on sclerostin, which in turn negatively affects bone turnover and mineralization. Moreover, this study emphasizes the functional differences between cortical and trabecular bone, as the number of (sclerostin-positive) osteocytes is dependent on the respective bone compartment. Finally, we evaluated the potential of sclerostin as a marker for CKD and found that the diagnostic performance of circulating sclerostin is limited and that changes in skeletal sclerostin expression occur more rapidly and more pronounced. The inclusion of osteocytic sclerostin expression and cortical bone analysis could be relevant when performing bone histomorphometric analysis for diagnostic purposes and to unravel pathological mechanisms of bone disease. Full article
(This article belongs to the Special Issue Relevant Nutritional, Biochemical and Molecular Disorders in CKD)
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14 pages, 1556 KiB  
Article
Nutritional Assessment and Support in Children with Chronic Kidney Disease: The Benefits of Working with a Registered Dietitian
by Marta Suárez-González, Flor Ángel Ordoñez-Álvarez, Helena Gil-Peña, Sara Carnicero-Ramos, Lucía Hernández-Peláez, Sonia García-Fernández and Fernando Santos-Rodríguez
Nutrients 2023, 15(3), 528; https://doi.org/10.3390/nu15030528 - 19 Jan 2023
Viewed by 2567
Abstract
Background: An unbalanced dietary pattern, characterized by high animal protein content: may worsen metabolic control, accelerate renal deterioration and consequently aggravate the stage of the chronic kidney disease (CKD) in pediatric patients with this condition. Aim: to assess the effect of a registered [...] Read more.
Background: An unbalanced dietary pattern, characterized by high animal protein content: may worsen metabolic control, accelerate renal deterioration and consequently aggravate the stage of the chronic kidney disease (CKD) in pediatric patients with this condition. Aim: to assess the effect of a registered dietitian (RD) intervention on the CKD children’s eating habits. Methods: Anthropometric and dietetic parameters, obtained at baseline and 12 months after implementing healthy eating and nutrition education sessions, were compared in 16 patients (50% girls) of 8.1 (1–15) years. On each occasion, anthropometry, 3-day food records and a food consumption frequency questionnaire were carried out. The corresponding relative intake of macro- and micronutrients was contrasted with the current advice by the European Food Safety Authority (EFSA) and with consumption data obtained using the Spanish dietary guidelines. Student’s paired t-test, Wilcoxon test and Mc Nemar test were used. Results: At Baseline 6% were overweight, 69% were of normal weight and 25% were underweight. Their diets were imbalanced in macronutrient composition. Following nutritional education and dietary intervention 63%, 75% and 56% met the Dietary Reference Values requirements for fats, carbohydrates and fiber, respectively, but not significantly. CKD children decreased protein intake (p < 0.001), increased dietary fiber intake at the expense of plant-based foods consumption (p < 0.001) and a corresponding reduction in meat, dairy and processed food intake was noticed. There were no changes in the medical treatment followed or in the progression of the stages. Conclusions: RD-led nutrition intervention focused on good dieting is a compelling helpful therapeutic tool to improve diet quality in pediatric CKD patients. Full article
(This article belongs to the Special Issue Relevant Nutritional, Biochemical and Molecular Disorders in CKD)
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15 pages, 1812 KiB  
Article
Adipose and Plasma microRNAs miR-221 and 222 Associate with Obesity, Insulin Resistance, and New Onset Diabetes after Peritoneal Dialysis
by Gordon Chun Kau Chan, Win Hlaing Than, Bonnie Ching Ha Kwan, Ka Bik Lai, Ronald Cheong Kin Chan, Jeremy Yuen Chun Teoh, Jack Kit Chung Ng, Kai Ming Chow, Phyllis Mei Shan Cheng, Man Ching Law, Chi Bon Leung, Philip Kam Tao Li and Cheuk Chun Szeto
Nutrients 2022, 14(22), 4889; https://doi.org/10.3390/nu14224889 - 18 Nov 2022
Cited by 3 | Viewed by 1776
Abstract
Background: The correlation between microRNA, obesity, and glycemic intolerance in patients on peritoneal dialysis (PD) is unknown. We aimed to measure the adipose and plasma miR-221 and -222 levels, and to evaluate their association with adiposity, glucose intolerance, and new onset diabetes mellitus [...] Read more.
Background: The correlation between microRNA, obesity, and glycemic intolerance in patients on peritoneal dialysis (PD) is unknown. We aimed to measure the adipose and plasma miR-221 and -222 levels, and to evaluate their association with adiposity, glucose intolerance, and new onset diabetes mellitus (NODM) after the commencement of PD. Methods: We prospectively recruited incident adult PD patients. miR-221 and -222 were measured from adipose tissue and plasma obtained during PD catheter insertion. These patients were followed for 24 months, and the outcomes were changes in adiposity, insulin resistance, and NODM after PD. Results: One hundred and sixty-five patients were recruited. Patients with pre-existing DM had higher adipose miR-221 (1.1 ± 1.2 vs. 0.7 ± 0.9-fold, p = 0.02) and -222 (1.9 ± 2.0 vs. 1.2 ± 1.3-fold, p = 0.01). High adipose miR-221 and -222 levels were associated with a greater increase in waist circumference (miR-221: beta 1.82, 95% CI 0.57–3.07, p = 0.005; miR-222: beta 1.35, 95% CI 0.08–2.63, p = 0.038), Homeostatic Model Assessment for Insulin Resistance (HOMA) index (miR-221: beta 8.16, 95% CI 2.80–13.53, p = 0.003; miR-222: beta 6.59, 95% CI 1.13–12.05, p = 0.018), and insulin requirements (miR-221: beta 0.05, 95% CI 0.006–0.09, p = 0.02; miR-222: beta 0.06, 95% CI 0.02–0.11, p = 0.002) after PD. The plasma miR-222 level predicted the onset of NODM (OR 8.25, 95% CI 1.35–50.5, p = 0.02). Conclusion: miR-221 and -222 are associated with the progression of obesity, insulin resistance, and NODM after PD. Full article
(This article belongs to the Special Issue Relevant Nutritional, Biochemical and Molecular Disorders in CKD)
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12 pages, 603 KiB  
Article
Sex Difference in the Associations among Hyperuricemia with New-Onset Chronic Kidney Disease in a Large Taiwanese Population Follow-Up Study
by Jui-Hsin Chen, Chun-Chi Tsai, Yi-Hsueh Liu, Pei-Yu Wu, Jiun-Chi Huang, Tung-Ling Chung, Ho-Ming Su and Szu-Chia Chen
Nutrients 2022, 14(18), 3832; https://doi.org/10.3390/nu14183832 - 16 Sep 2022
Cited by 8 | Viewed by 1695
Abstract
The global prevalence and incidence of chronic kidney disease (CKD) continue to increase. Whether hyperuricemia is an independent risk factor for renal progression and whether there are sex differences in the relationships between serum uric acid (UA) and a decline in renal function [...] Read more.
The global prevalence and incidence of chronic kidney disease (CKD) continue to increase. Whether hyperuricemia is an independent risk factor for renal progression and whether there are sex differences in the relationships between serum uric acid (UA) and a decline in renal function are unclear. Therefore, in this longitudinal study, we aimed to explore these relationships in a large cohort of around 27,000 Taiwanese participants in the Taiwan Biobank (TWB), and also to identify serum UA cutoff levels in men and women to predict new-onset CKD. A total of 26,942 participants with a median 4 years of complete follow-up data were enrolled from the TWB. We excluded those with CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) at baseline (n = 297), and the remaining 26,645 participants (males: 9356; females: 17,289) were analyzed. The participants who developed CKD during follow-up were defined as having incident new-onset CKD, and those with a serum UA level >7 mg/dL in males and >6 mg/dL in females were classified as having hyperuricemia. After multivariable analysis, hyperuricemia (odds ratio [OR], 2.541; 95% confidence interval [CI], 1.970–3.276; p < 0.001) was significantly associated with new-onset CKD. Furthermore, in the male participants (n = 9356), hyperuricemia (OR, 1.989; 95% CI, 1.440–2.747; p < 0.001), and quartile 4 of UA (vs. quartile 1; OR, 2.279; 95% CI, 1.464–3.547; p < 0.001) were significantly associated with new-onset CKD, while in the female participants (n = 17,289), hyperuricemia (OR, 3.813; 95% CI, 2.500–5.815; p < 0.001), quartile 3 of UA (vs. quartile 1; OR, 3.741; 95% CI, 1.250–11.915; p = 0.018), and quartile 4 of UA (vs. quartile 1; OR, 12.114; 95% CI, 14.278–34.305; p < 0.001) were significantly associated with new-onset CKD. There were significant interactions between hyperuricemia and sex (p = 0.024), and quartiles of serum UA and sex (p = 0.010) on new-onset CKD. Hyperuricemia was associated with new-onset CKD in the enrolled participants, and the interactions between hyperuricemia and sex were statistically significant. Hyperuricemia was more strongly associated with new-onset CKD in the women than in the men. Full article
(This article belongs to the Special Issue Relevant Nutritional, Biochemical and Molecular Disorders in CKD)
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15 pages, 3652 KiB  
Article
The Increase in FGF23 Induced by Calcium Is Partially Dependent on Vitamin D Signaling
by Sandra Rayego-Mateos, Nuria Doladé, Alicia García-Carrasco, Juan Miguel Diaz-Tocados, Merce Ibarz and Jose Manuel Valdivielso
Nutrients 2022, 14(13), 2576; https://doi.org/10.3390/nu14132576 - 22 Jun 2022
Cited by 4 | Viewed by 2056
Abstract
Background: Increased FGF23 levels are an early pathological feature in chronic kidney disease (CKD), causing increased cardiovascular risk. The regulation of FGF23 expression is complex and not completely understood. Thus, Ca2+ has been shown to induce an increase in FGF23 expression, but [...] Read more.
Background: Increased FGF23 levels are an early pathological feature in chronic kidney disease (CKD), causing increased cardiovascular risk. The regulation of FGF23 expression is complex and not completely understood. Thus, Ca2+ has been shown to induce an increase in FGF23 expression, but whether that increase is mediated by simultaneous changes in parathyroid hormone (PTH) and/or vitamin D is not fully known. Methods: Osteoblast-like cells (OLCs) from vitamin D receptor (VDR)+/+ and VDR−/− mice were incubated with Ca2+ for 18 h. Experimental hypercalcemia was induced by calcium gluconate injection in thyro-parathyroidectomized (T-PTX) VDR +/+ and VDR−/− mice with constant PTH infusion. Results: Inorganic Ca2+ induced an increase in FGF23 gene and protein expression in osteoblast-like cells (OLCs), but the increase was blunted in cells lacking VDR. In T-PTX VDR +/+ and VDR−/− mice with constant PTH levels, hypercalcemia induced an increase in FGF23 levels, but to a lower extent in animals lacking VDR. Similar results were observed in FGF23 expression in bone. Renal and bone 1α-hydroxylase expression was also modulated. Conclusions: Our study demonstrates that Ca2+ can increase FGF23 levels independently of vitamin D and PTH, but part of the physiological increase in FGF23 induced by Ca2+ is mediated by vitamin D signaling. Full article
(This article belongs to the Special Issue Relevant Nutritional, Biochemical and Molecular Disorders in CKD)
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10 pages, 478 KiB  
Article
Potassium Intake—(Un)Expected Non-Predictor of Higher Serum Potassium Levels in Hemodialysis DASH Diet Consumers
by Cristina Garagarza, Ana Valente, Cristina Caetano, Inês Ramos, Joana Sebastião, Mariana Pinto, Telma Oliveira, Aníbal Ferreira and Catarina Sousa Guerreiro
Nutrients 2022, 14(10), 2071; https://doi.org/10.3390/nu14102071 - 15 May 2022
Cited by 5 | Viewed by 2616
Abstract
As high serum potassium levels can lead to adverse outcomes in hemodialysis (HD) patients, dietary potassium is frequently restricted in these patients. However, recent studies have questioned whether dietary potassium really affects serum potassium levels. The dietary approaches to stop hypertension (DASH) diet [...] Read more.
As high serum potassium levels can lead to adverse outcomes in hemodialysis (HD) patients, dietary potassium is frequently restricted in these patients. However, recent studies have questioned whether dietary potassium really affects serum potassium levels. The dietary approaches to stop hypertension (DASH) diet is considered a healthy dietary pattern that has been related to lower risk of developing end-stage kidney disease. The aim of this study was to analyze the association between a dietary pattern with high content of potassium-rich foods and serum potassium levels in HD patients. This was an observational, cross-sectional, multicenter study with 582 HD patients from 37 dialysis centers. Clinical and biochemical data were registered. Dietary intake was obtained using the Food Frequency Questionnaire. Adherence to the DASH dietary pattern was obtained from Fung’s DASH index. All statistical tests were performed using SPSS 26.0 software. A p-value lower than 0.05 was considered statistically significant. Patients’ mean age was 67.8 ± 17.7 years and median HD vintage was 65 (43–104) months. Mean serum potassium was 5.3 ± 0.67 mEq/L, dietary potassium intake was 2465 ± 1005 mg/day and mean Fung´s Dash Index was 23.9 ± 3.9. Compared to the lower adherence to the DASH dietary pattern, patients with a higher adherence to the DASH dietary pattern were older (p < 0.001); presented lower serum potassium (p = 0.021), serum sodium (p = 0.028), total fat intake (p = 0.001) and sodium intake (p < 0.001); and had higher carbohydrate intake (p < 0.001), fiber intake (p < 0.001), potassium intake (p < 0.001), phosphorus intake (p < 0.001) and body mass index (p = 0.002). A higher adherence to this dietary pattern was a predictor of lower serum potassium levels (p = 0.004), even in the adjusted model (p = 0.016). Following the DASH dietary pattern, which is rich in potassium, is not associated with increased serum potassium levels in HD patients. Furthermore, a higher adherence to the DASH dietary pattern predicts lower serum potassium levels. Therefore, generalized dietary potassium restrictions may not be adequate, at least for those with a DASH diet plan. Full article
(This article belongs to the Special Issue Relevant Nutritional, Biochemical and Molecular Disorders in CKD)
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Review

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19 pages, 624 KiB  
Review
Magnesium Administration in Chronic Kidney Disease
by Emma A. Vermeulen and Marc G. Vervloet
Nutrients 2023, 15(3), 547; https://doi.org/10.3390/nu15030547 - 20 Jan 2023
Cited by 4 | Viewed by 9243
Abstract
Awareness of the clinical relevance of magnesium in medicine has increased over the last years, especially for people with chronic kidney disease (CKD), due to magnesium’s role in vascular calcification and mineral metabolism. The inverse association between serum magnesium and clinically relevant, adverse [...] Read more.
Awareness of the clinical relevance of magnesium in medicine has increased over the last years, especially for people with chronic kidney disease (CKD), due to magnesium’s role in vascular calcification and mineral metabolism. The inverse association between serum magnesium and clinically relevant, adverse outcomes is well-established in people with CKD. Subsequent intervention studies have focused on the effect of magnesium administration, mainly in relation to cardiovascular diseases, mineral bone metabolism, and other metabolic parameters. The most commonly used routes of magnesium administration are orally and by increasing dialysate magnesium. Several oral magnesium formulations are available and the daily dosage of elemental magnesium varies highly between studies, causing considerable heterogeneity. Although data are still limited, several clinical studies demonstrated that magnesium administration could improve parameters of vascular function and calcification and mineral metabolism in people with CKD. Current clinical research has shown that magnesium administration in people with CKD is safe, without concerns for severe hypermagnesemia or negative interference with bone metabolism. It should be noted that there are several ongoing magnesium intervention studies that will contribute to the increasing knowledge on the potential of magnesium administration in people with CKD. Full article
(This article belongs to the Special Issue Relevant Nutritional, Biochemical and Molecular Disorders in CKD)
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27 pages, 1858 KiB  
Review
Bone Disease in Chronic Kidney Disease and Kidney Transplant
by Ezequiel Bellorin-Font, Eudocia Rojas and Kevin J. Martin
Nutrients 2023, 15(1), 167; https://doi.org/10.3390/nu15010167 - 29 Dec 2022
Cited by 9 | Viewed by 4989
Abstract
Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) comprises alterations in calcium, phosphorus, parathyroid hormone (PTH), Vitamin D, and fibroblast growth factor-23 (FGF-23) metabolism, abnormalities in bone turnover, mineralization, volume, linear growth or strength, and vascular calcification leading to an increase in bone fractures [...] Read more.
Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) comprises alterations in calcium, phosphorus, parathyroid hormone (PTH), Vitamin D, and fibroblast growth factor-23 (FGF-23) metabolism, abnormalities in bone turnover, mineralization, volume, linear growth or strength, and vascular calcification leading to an increase in bone fractures and vascular disease, which ultimately result in high morbidity and mortality. The bone component of CKD-MBD, referred to as renal osteodystrophy, starts early during the course of CKD as a result of the effects of progressive reduction in kidney function which modify the tight interaction between mineral, hormonal, and other biochemical mediators of cell function that ultimately lead to bone disease. In addition, other factors, such as osteoporosis not apparently dependent on the typical pathophysiologic abnormalities resulting from altered kidney function, may accompany the different varieties of renal osteodystrophy leading to an increment in the risk of bone fracture. After kidney transplantation, these bone alterations and others directly associated or not with changes in kidney function may persist, progress or transform into a different entity due to new pathogenetic mechanisms. With time, these alterations may improve or worsen depending to a large extent on the restoration of kidney function and correction of the metabolic abnormalities developed during the course of CKD. In this paper, we review the bone lesions that occur during both CKD progression and after kidney transplant and analyze the factors involved in their pathogenesis as a means to raise awareness of their complexity and interrelationship. Full article
(This article belongs to the Special Issue Relevant Nutritional, Biochemical and Molecular Disorders in CKD)
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10 pages, 475 KiB  
Review
Evolving Concepts on Inflammatory Biomarkers and Malnutrition in Chronic Kidney Disease
by Fredzzia Graterol Torres, María Molina, Jordi Soler-Majoral, Gregorio Romero-González, Néstor Rodríguez Chitiva, Maribel Troya-Saborido, Guillem Socias Rullan, Elena Burgos, Javier Paúl Martínez, Marina Urrutia Jou, Carles Cañameras, Josep Riera Sadurní, Anna Vila and Jordi Bover
Nutrients 2022, 14(20), 4297; https://doi.org/10.3390/nu14204297 - 14 Oct 2022
Cited by 31 | Viewed by 4608
Abstract
While patient care, kidney replacement therapy, and transplantation techniques for chronic kidney disease (CKD) have continued to progress, the incidence of malnutrition disorders in CKD appears to have remained unchanged over time. However, there is now a better understanding of the underlying pathophysiology [...] Read more.
While patient care, kidney replacement therapy, and transplantation techniques for chronic kidney disease (CKD) have continued to progress, the incidence of malnutrition disorders in CKD appears to have remained unchanged over time. However, there is now a better understanding of the underlying pathophysiology according to the disease background, disease stage, and the treatment received. In CKD patients, the increased production of proinflammatory cytokines and oxidative stress lead to a proinflammatory milieu that is at least partially responsible for the increased morbidity and mortality in this patient population. New insights into the pathogenic role of innate immunity and the proinflammatory cytokine profile, characterized, for instance, by higher levels of IL-6 and TNF-α, explain some of the clinical and laboratory abnormalities observed in these patients. In this article, we will explore currently available nutritional–inflammatory biomarkers in distinct CKD populations (hemodialysis, peritoneal dialysis, transplantation) with a view to evaluating their efficacy as predictors of malnutrition and their involvement in the common proinflammatory process. Although there is a direct relationship between inflammatory-nutritional status, signs and symptoms [e.g., protein-energy wasting (PEW), anorexia], and comorbidities (e.g., atheromatosis, atherosclerosis), we are in need of clearly standardized markers for nutritional-inflammatory assessment to improve their performance and design appropriate bidirectional interventions. Full article
(This article belongs to the Special Issue Relevant Nutritional, Biochemical and Molecular Disorders in CKD)
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12 pages, 635 KiB  
Review
Novel Insights in the Physiopathology and Management of Obesity-Related Kidney Disease
by Justo Sandino, Marina Martín-Taboada, Gema Medina-Gómez, Rocío Vila-Bedmar and Enrique Morales
Nutrients 2022, 14(19), 3937; https://doi.org/10.3390/nu14193937 - 22 Sep 2022
Cited by 9 | Viewed by 3699
Abstract
Obesity is recognized as an independent risk factor for the development of kidney disease, which has led to the designation of obesity-related glomerulopathy (ORG). Common renal features observed in this condition include glomerular hypertrophy, glomerulosclerosis, haemodynamic changes and glomerular filtration barrier defects. Additionally, [...] Read more.
Obesity is recognized as an independent risk factor for the development of kidney disease, which has led to the designation of obesity-related glomerulopathy (ORG). Common renal features observed in this condition include glomerular hypertrophy, glomerulosclerosis, haemodynamic changes and glomerular filtration barrier defects. Additionally, and although less studied, obesity-related kidney disease also involves alterations in renal tubules, including tubule hypertrophy, lipid deposition and tubulointerstitial fibrosis. Although not completely understood, the harmful effects of obesity on the kidney may be mediated by different mechanisms, with alterations in adipose tissue probably playing an important role. An increase in visceral adipose tissue has classically been associated with the development of kidney damage, however, recent studies point to adipose tissue surrounding the kidney, and specifically to the fat within the renal sinus, as potentially involved in the development of ORG. In addition, new strategies for the treatment of patients with obesity-related kidney disease are focusing on the management of obesity. In this regard, some non-invasive options, such as glucagon-like peptide-1 (GLP-1) receptor agonists or sodium–glucose cotransporter-2 (SGLT2) inhibitors, are being considered for application in the clinic, not only for patients with diabetic kidney disease but as a novel pharmacological strategy for patients with ORG. In addition, bariatric surgery stands as one of the most effective options, not only for weight loss but also for the improvement of kidney outcomes in obese patients with chronic kidney disease. Full article
(This article belongs to the Special Issue Relevant Nutritional, Biochemical and Molecular Disorders in CKD)
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