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Keywords = non-dialysis-dependent CKD

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26 pages, 3043 KiB  
Review
Dos and Don’ts in Kidney Nutrition: Practical Considerations of a Panel of Experts on Protein Restriction and Plant-Based Diets for Patients Living with Chronic Kidney Disease
by Massimo Torreggiani, Carla Maria Avesani, Barbara Contzen, Adamasco Cupisti, Sylwia Czaja-Stolc, Claudia D’Alessandro, Liliana Garneata, Abril Gutiérrez, Françoise Lippi, Carmen Antonia Mocanu, Alice Sabatino and Giorgina Barbara Piccoli
Nutrients 2025, 17(12), 2002; https://doi.org/10.3390/nu17122002 - 14 Jun 2025
Viewed by 767
Abstract
Dietary management is a pillar of chronic kidney disease (CKD) treatment. While some rules are the same as dietary prescriptions for the general population and those suffering from other chronic diseases (energy intake, salt intake, avoidance of ultra-processed food and limited intake of [...] Read more.
Dietary management is a pillar of chronic kidney disease (CKD) treatment. While some rules are the same as dietary prescriptions for the general population and those suffering from other chronic diseases (energy intake, salt intake, avoidance of ultra-processed food and limited intake of animal fats), in non-dialysis-dependent patients living with CKD, the specific focus is on protein intake. Low-protein diets (LPDs) and supplemented very low protein diets (sVLPDs) have been successfully employed to decrease the symptoms of people living with non-dialysis-dependent CKD, delay the progression of the disease and retard the need for dialysis. Randomized clinical trials have yielded conflicting results on efficacy, resulting in conflicting guidelines. Concerns about the risk of malnutrition (specifically when the main source of proteins is plant-derived), electrolyte imbalances, and energy intake, and the idea that adherence is difficult, jeopardize the use and wide application of LPDs and sVLPDs. That dietary management focuses mainly on nutrients while dietary quality occupies second place is also an erroneous concept that requires discussion. In September 2023, a group of experts composed of nephrologists and dieticians gathered in Frankfurt, Germany, to try to reconcile the different guideline indications and address most of the common doubts of final dispatchers to increase the prescription of “renal diets” and improve people living with CKD’s adherence to them. Full article
(This article belongs to the Special Issue Reducing the Burden of Chronic Diseases Through Plant-Based Diets)
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15 pages, 1064 KiB  
Review
Plant-Dominant Low-Protein Diets: A Promising Dietary Strategy for Mitigating Disease Progression in People with Chronic Kidney Disease—A Comprehensive Review
by Jun-Ya Kaimori, Yusuke Sakaguchi, Tatsufumi Oka and Yoshitaka Isaka
Nutrients 2025, 17(4), 643; https://doi.org/10.3390/nu17040643 - 11 Feb 2025
Viewed by 2041
Abstract
Chronic kidney disease (CKD) is a global health crisis affecting over 10% of the population, with mortality rates increasing significantly. Current management strategies, including expensive medications and renal replacement therapies, highlight the need for cost-effective, conservative approaches. This review examines the evidence for [...] Read more.
Chronic kidney disease (CKD) is a global health crisis affecting over 10% of the population, with mortality rates increasing significantly. Current management strategies, including expensive medications and renal replacement therapies, highlight the need for cost-effective, conservative approaches. This review examines the evidence for plant-dominant low-protein diets (PLADO) in managing non-dialysis-dependent CKD. Existing guidelines for protein restriction in CKD vary considerably, with inconsistencies and a lack of personalization noted in the KDOQI and KDIGO recommendations. While traditional low-protein diet trials show limited success due to poor adherence and marginal benefits, PLADO offers a potentially more sustainable alternative. PLADO’s advantages include improved nutrient density, reduced dietary acid load, anti-inflammatory effects, and beneficial modulation of the gut microbiome, potentially reducing uremic toxins and improving cardiovascular health. However, challenges remain, including adherence issues, potential nutrient deficiencies, and potassium management. Although observational studies show promise, further large-scale randomized controlled trials are necessary to validate PLADO’s efficacy and establish optimal dietary composition. A personalized, multidisciplinary approach is essential for successful implementation and monitoring to maximize PLADO’s benefits in improving outcomes for individuals with NDD-CKD. Full article
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22 pages, 1904 KiB  
Article
Efficacy and Safety of Roxadustat in Patients with CKD: Pooled Analysis by Baseline Inflammation Status
by Gabriel Choukroun, Frank Strutz, Alexander Harkavyi, Vicki Santos, Alina Jiletcovici and Lucia Del Vecchio
J. Clin. Med. 2025, 14(2), 303; https://doi.org/10.3390/jcm14020303 - 7 Jan 2025
Viewed by 1299
Abstract
Background/Objectives: Inflammation may contribute to hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) and is often present in patients with chronic kidney disease (CKD). Roxadustat is approved in multiple countries for the treatment of anemia of CKD. This pooled analysis evaluated the efficacy and safety [...] Read more.
Background/Objectives: Inflammation may contribute to hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) and is often present in patients with chronic kidney disease (CKD). Roxadustat is approved in multiple countries for the treatment of anemia of CKD. This pooled analysis evaluated the efficacy and safety of roxadustat in patients with dialysis-dependent (DD) or non-dialysis-dependent (NDD) CKD by inflammation status. Methods: Data from five studies comparing roxadustat versus ESAs were pooled by patient populations in this analysis (NDD: DOLOMITES; DD: ROCKIES, SIERRAS, HIMALAYAS, PYRENEES). The mean change from baseline in hemoglobin levels to Weeks 28–52 and mean weekly dose of roxadustat or ESA at Week 24 were assessed by baseline inflammation levels (determined by high-sensitivity C-reactive protein [hsCRP] levels, divided into quintiles). Safety data were summarized descriptively. Results: In total, 613 patients with NDD CKD (roxadustat n = 320; ESA n = 293) and 4072 patients with DD CKD (roxadustat n = 2022; ESA n = 2050) were evaluated. Roxadustat increased hemoglobin levels in a manner similar to ESAs, independent of baseline inflammation status. In both the NDD and DD populations, roxadustat doses did not increase at Week 24 in patients with higher hsCRP levels at baseline. Patients with high baseline hsCRP levels required greater ESA doses at Week 24 compared with patients who had lower baseline hsCRP levels in both patient populations. The incidence rates of treatment-emergent adverse events were generally comparable with those of roxadustat and ESA across hsCRP quintiles in both the NDD and DD populations. Conclusions: Roxadustat addresses the multiple causes of anemia of CKD, regardless of inflammatory status, without requiring dose increases. Full article
(This article belongs to the Section Nephrology & Urology)
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14 pages, 1381 KiB  
Article
Association of Handgrip Strength and Nutritional Status in Non-Dialysis-Dependent Chronic Kidney Disease Patients: Results from the KNOW-CKD Study
by Minsang Kim, Yeong-Won Park, Dha Woon Im, Yujin Jeong, Hyo Jin Noh, Soo Jin Yang, Eunjeong Kang, Hyunjin Ryu, Jayoun Kim, Ja-Ryong Koo, Ki Ryang Na, Eun Young Seong and Kook-Hwan Oh
Nutrients 2024, 16(15), 2442; https://doi.org/10.3390/nu16152442 - 26 Jul 2024
Cited by 2 | Viewed by 1987
Abstract
Handgrip strength (HGS) is suggested as an indirect assessment of nutritional status in chronic kidney disease (CKD) patients, but evidence is limited for non-dialysis-dependent CKD (NDD-CKD) patients. This cross-sectional study included 404 patients from the Phase II KoreaN Cohort Study for Outcome in [...] Read more.
Handgrip strength (HGS) is suggested as an indirect assessment of nutritional status in chronic kidney disease (CKD) patients, but evidence is limited for non-dialysis-dependent CKD (NDD-CKD) patients. This cross-sectional study included 404 patients from the Phase II KoreaN Cohort Study for Outcome in Patients With CKD. HGS, measured twice in each hand, was the exposure, and malnutrition status was defined by a malnutrition–inflammation score (MIS) of 6 or higher. A logistic regression analysis adjusted for age, sex, diabetes mellitus (DM), hypertension, CKD stages, smoking, overhydration, education, and income status was used to assess malnutrition risk. The predictability of HGS for malnutrition was evaluated using the area under the curve (AUC). Patients with lower HGS were older, had a higher prevalence of DM, and lower estimated glomerular filtration rate. Higher HGS was significantly associated with lower malnutrition risk after adjustment (per 1 standard deviation increase, adjusted odds ratio, 0.47 [0.30–0.75]). Subgroup analyses showed no significant interaction between HGS and malnutrition risk across age, sex, DM, and CKD stage. HGS showed fair predictability for malnutrition in men (AUC 0.64 [0.46–0.83]) and women (AUC 0.71 [0.55–0.86]). In conclusion, HGS is a useful diagnostic indicator of malnutrition in NDD-CKD patients. Full article
(This article belongs to the Special Issue Nutritional Therapies in Clinical Practice, Management and Care)
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25 pages, 1325 KiB  
Review
Care of Adults with Advanced Chronic Kidney Disease
by Sanjivani Shrestha, Kanza Haq, Divyanshu Malhotra and Dipal M. Patel
J. Clin. Med. 2024, 13(15), 4378; https://doi.org/10.3390/jcm13154378 - 26 Jul 2024
Viewed by 3046
Abstract
Chronic kidney disease (CKD) impacts over 10% of the global population. Adults with CKD face significant morbidity and mortality. As kidney disease progresses, the risk of adverse outcomes increases. Here, we present an overview of strategies to care for adults with advanced CKD [...] Read more.
Chronic kidney disease (CKD) impacts over 10% of the global population. Adults with CKD face significant morbidity and mortality. As kidney disease progresses, the risk of adverse outcomes increases. Here, we present an overview of strategies to care for adults with advanced CKD (stage 4–5 CKD, not receiving kidney replacement therapy). We aim to guide clinicians through several aspects of CKD care, ranging from recommended laboratory assessments to interdisciplinary support for patients as they plan for kidney replacement therapy (dialysis, transplantation, or conservative management). We incorporate considerations of health equity and person-centered care, empowering clinicians to deliver high-quality care to people with CKD. Full article
(This article belongs to the Special Issue Renal Failure: Treatment Advances and Future Directions)
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10 pages, 884 KiB  
Article
Efficacy and Safety of Oral Supplementation with Liposomal Iron in Non-Dialysis Chronic Kidney Disease Patients with Iron Deficiency
by Davide Cesarano, Silvio Borrelli, Giorgia Campilongo, Annarita D’Ambra, Federica Papadia, Carlo Garofalo, Antonia De Marco, Federica Marzano, Chiara Ruotolo, Loreto Gesualdo, Pietro Cirillo and Roberto Minutolo
Nutrients 2024, 16(9), 1255; https://doi.org/10.3390/nu16091255 - 24 Apr 2024
Cited by 4 | Viewed by 3542
Abstract
Introduction. Iron deficiency is common in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD). Oral iron supplementation is recommended in these patients, but it is associated with a higher incidence of gastrointestinal adverse reactions. Liposomal iron therapy has been proposed as a new iron [...] Read more.
Introduction. Iron deficiency is common in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD). Oral iron supplementation is recommended in these patients, but it is associated with a higher incidence of gastrointestinal adverse reactions. Liposomal iron therapy has been proposed as a new iron formulation, improving iron bioavailability with less side effects; however, few data are available in patients with NDD-CKD. Methods. We designed a single-arm pilot study to evaluate the efficacy of liposomal iron administered for six months in correcting iron deficiency (defined as serum ferritin < 100 ng/mL and/or transferrin saturation < 20%) in patients with NDD-CKD stages 1–5. The primary endpoints were the achievement of serum ferritin ≥ 100 ng/mL and transferrin saturation ≥ 20%. Secondary outcomes were hemoglobin (Hb) changes and the safety of liposomal iron. Results. The efficacy population included 34/38 patients, who completed at least one visit after baseline. Liposomal iron increased the achievement of transferrin saturation targets from 11.8% at baseline to 50.0% at month 6 (p = 0.002), while no significant correction of serum ferritin (p = 0.214) and Hb was found (p = 0.465). When patients were stratified by anemia (Hb < 12 g/dL in women and Hb < 13 g/dL in men), a significant improvement of transferrin saturation was observed only in anemic patients (from 13.3 ± 5.8% to 20.2 ± 8.1%, p = 0.012). Hb values slightly increased at month 6 only in anemic patients (+0.60 g/dL, 95%CI −0.27 to +1.48), but not in those without anemia (+0.08 g/dL, 95%CI −0.73 to +0.88). In patients taking at least one dose of liposomal iron (safety population, n = 38), the study drug was discontinued in eight patients due to death (n = 2), a switch to intravenous iron (n = 2), and the occurrence of side effects (n = 4). Conclusions. The use of liposomal iron in patients with NDD-CKD is associated with a partial correction of transferrin saturation, with no significant effect on iron storage and Hb levels. Full article
(This article belongs to the Section Micronutrients and Human Health)
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16 pages, 1479 KiB  
Article
Uremic Toxins and Inflammation: Metabolic Pathways Affected in Non-Dialysis-Dependent Stage 5 Chronic Kidney Disease
by María Peris-Fernández, Marta Roca-Marugán, Julià L. Amengual, Ángel Balaguer-Timor, Iris Viejo-Boyano, Amparo Soldevila-Orient, Ramon Devesa-Such, Pilar Sánchez-Pérez and Julio Hernández-Jaras
Biomedicines 2024, 12(3), 607; https://doi.org/10.3390/biomedicines12030607 - 7 Mar 2024
Cited by 8 | Viewed by 2935
Abstract
Chronic kidney disease (CKD) affects approximately 12% of the global population, posing a significant health threat. Inflammation plays a crucial role in the uremic phenotype of non-dialysis-dependent (NDD) stage 5 CKD, contributing to elevated cardiovascular and overall mortality in affected individuals. This study [...] Read more.
Chronic kidney disease (CKD) affects approximately 12% of the global population, posing a significant health threat. Inflammation plays a crucial role in the uremic phenotype of non-dialysis-dependent (NDD) stage 5 CKD, contributing to elevated cardiovascular and overall mortality in affected individuals. This study aimed to explore novel metabolic pathways in this population using semi-targeted metabolomics, which allowed us to quantify numerous metabolites with known identities before data acquisition through an in-house polar compound library. In a prospective observational design with 50 patients, blood samples collected before the initial hemodialysis session underwent liquid chromatography and high-resolution mass spectrometer analysis. Univariate (Mann–Whitney test) and multivariate (logistic regression with LASSO regularization) methods identified metabolomic variables associated with inflammation. Notably, adenosine-5′-phosphosulfate (APS), dimethylglycine, pyruvate, lactate, and 2-ketobutyric acid exhibited significant differences in the presence of inflammation. Cholic acid, homogentisic acid, and 2-phenylpropionic acid displayed opposing patterns. Multivariate analysis indicated increased inflammation risk with certain metabolites (N-Butyrylglycine, dimethylglycine, 2-Oxoisopentanoic acid, and pyruvate), while others (homogentisic acid, 2-Phenylpropionic acid, and 2-Methylglutaric acid) suggested decreased probability. These findings unveil potential inflammation-associated biomarkers related to defective mitochondrial fatty acid beta oxidation and branched-chain amino acid breakdown in NDD stage 5 CKD, shedding light on cellular energy production and offering insights for further clinical validation. Full article
(This article belongs to the Special Issue Metabolomics Technology and Bioinformatics for Precision Medicine)
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10 pages, 1942 KiB  
Article
Home Haemoglobin Monitoring for the Titration of Erythropoietin-Stimulating Agents in Chronic Kidney Disease: A Pragmatic Pilot Trial
by Richard Bodington, Madeline Lok and Sunil Bhandari
Diagnostics 2024, 14(2), 232; https://doi.org/10.3390/diagnostics14020232 - 22 Jan 2024
Viewed by 1657
Abstract
Background. No trials of POCT device pathways have been published in the field of anaemia of CKD. We describe the results of a year of use of a novel POCT device with its associated eHealth pathway in the home monitoring of ESA therapy, [...] Read more.
Background. No trials of POCT device pathways have been published in the field of anaemia of CKD. We describe the results of a year of use of a novel POCT device with its associated eHealth pathway in the home monitoring of ESA therapy, with the aim of evaluating device performance and pathway feasibility. Methods: We used a POCT device designed for home self-testing, able to measure Hb from a drop of capillary blood (Luma, Entia, UK). Results were shared with HCPs via an associated mobile application. The pilot ran from August 2020 to March 2022 in a single UK renal centre. All adult non-dialysis-dependent-CKD patients on ESAs were eligible for inclusion. Participants were mailed the device and trained remotely. Participants were encouraged to self-test twice weekly for up to 1 year, with data collected on a pragmatic basis. Lab and Luma’s results were compared. Results: Seventeen participants returned comparable datasets (underwent ≥ 4 lab Hb measurements and self-tested for >5 months) with a mean testing frequency of 1.6 tests/wk. 1062 Luma and 113 lab Hb results were analysed. The coefficient of variation (CV) for raw results was 8.3% with a bias of −2.0% and SD 8.5. The percentage of Luma results differing by >10% lab results was 30.9%, dropping to 17.7% using an 8-point-moving-average. Participants stated they preferred Luma to traditional ESA monitoring and recommended the pathway to others. Conclusion: One year of home self-testing with Luma yielded comparable device utility to other POCT haematology analysers derived via HCP testing. Innovative pilot trials such as this form the basis for new empowering and home-based models of care required and desired by patients and HCPs. Full article
(This article belongs to the Special Issue 21st Century Point-of-Care, Near-Patient and Critical Care Testing)
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12 pages, 500 KiB  
Article
Sevelamer Use and Mortality in People with Chronic Kidney Disease Stages 4 and 5 Not on Dialysis
by Pablo Molina, Mariola D. Molina, Juan J. Carrero, Verónica Escudero, Javier Torralba, Cristina Castro-Alonso, Sandra Beltrán, Belén Vizcaíno, Mercedes González-Moya, Julia Kanter, Asunción Sancho-Calabuig, Jordi Bover and José L. Górriz
J. Clin. Med. 2023, 12(24), 7631; https://doi.org/10.3390/jcm12247631 - 12 Dec 2023
Cited by 1 | Viewed by 2054
Abstract
Rationale and objective: Data suggest that non-calcium-based binders, and specifically sevelamer, may lead to lower rates of death when compared with calcium-based binders in end-stage renal disease (ESRD) patients. However, the association between sevelamer use and mortality for those with non-dialysis-dependent chronic kidney [...] Read more.
Rationale and objective: Data suggest that non-calcium-based binders, and specifically sevelamer, may lead to lower rates of death when compared with calcium-based binders in end-stage renal disease (ESRD) patients. However, the association between sevelamer use and mortality for those with non-dialysis-dependent chronic kidney disease (NDD-CKD) patients has been uncertain. Study design: Our research is presented in a prospective cohort study. Setting and participants: A total of 966 participants with NDD-CKD stages 4–5 were enrolled in the PECERA study from 12 centers in Spain. Exposure: The participants were treated with sevelamer. Outcome: This study yielded all-cause and cardiovascular mortality outcomes. Analytical approach: We conducted an association analysis between mortality and sevelamer use with time-dependent Cox proportional hazards models. Results: After a median follow-up of 29 months (IQR: 13–36 months), death occurred in 181 participants (19%), with cardiovascular (n = 95, 53%) being the leading cause of death. In a multivariable model, the adjusted hazard ratios (HRs) for patients under sevelamer treatment were 0.44 (95% CI, 0.22 to 0.88) and 0.37 (95% CI, 0.18 to 0.75) for all-cause and cardiovascular mortality, respectively, compared with those of untreated patients. Limitations: Some limitations include potential confusion via indication bias; causal statements about these associations cannot be made due to the observational nature of this study. Conclusions: In this prospective NDD-CKD cohort study, the administration of sevelamer was independently associated with lower all-cause and cardiovascular mortality, suggesting that non-calcium-based phosphate binders might be the first-line therapy for phosphate lowering in this population. Further interventional studies clarifying the risks and benefits of phosphate binders in NDD-CKD are warranted. Full article
(This article belongs to the Section Nephrology & Urology)
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10 pages, 594 KiB  
Review
Loop Diuretics and Sarcopenia: A Potential Association
by Nikolaos D. Karakousis and Petros N. Georgakopoulos
Muscles 2023, 2(4), 317-326; https://doi.org/10.3390/muscles2040024 - 22 Sep 2023
Viewed by 2399
Abstract
Background: Loop diuretics (LDs) are used to treat various health conditions including heart failure (HF), liver cirrhosis, and chronic kidney disease (CKD). Sarcopenia is a skeletal muscle health issue related to the depletion and decrease of muscle mass and strength, leading to adverse [...] Read more.
Background: Loop diuretics (LDs) are used to treat various health conditions including heart failure (HF), liver cirrhosis, and chronic kidney disease (CKD). Sarcopenia is a skeletal muscle health issue related to the depletion and decrease of muscle mass and strength, leading to adverse outcomes including frailty syndrome, functional decline, falls, hospitalizations, augmented length of hospital stay, and increased morbidity and mortality. Methods: This study investigated the probable association between LD use and sarcopenia via conducting a non-systematic review of the existing literature. Results: In subjects with non-dialysis-dependent chronic kidney disease (NDD-CKD), an augmented risk of sarcopenia is significantly associated with LD use. Interestingly, in patients with HF treated with LDs, thigh and arm circumferences were significantly small, which is indicative of skeletal muscle wasting. Additionally, in anorexic subjects who are more likely to be on diuretic medication, suffering also from cachexia, a higher prevalence of sarcopenia was demonstrated. In cirrhotic subjects, the treatment dosage of LDs was inversely correlated with the skeletal muscle area per year (ΔSMA). Nevertheless, in subjects with liver cirrhosis treated with LDs, who were divided into those with and those without muscle cramps, the presence of sarcopenia was similar. Conclusions: Further investigation is imperative to validate potential interplay between LDs and sarcopenia. Full article
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10 pages, 286 KiB  
Article
Novel Assessment of Viscoelastic Skeletal Muscle Properties in Chronic Kidney Disease: Association with Physical Functioning
by Thomas J. Wilkinson, Ellie F. Gore, Luke A. Baker and Alice C. Smith
Physiologia 2023, 3(3), 451-460; https://doi.org/10.3390/physiologia3030032 - 14 Sep 2023
Cited by 1 | Viewed by 1829
Abstract
Chronic kidney disease (CKD) is characterised by poor physical function. Mechanical muscle properties such as tone, elasticity, and stiffness influence the functional state of the muscle. Measuring these muscle mechanical properties is difficult and data on CKD are sparse. Using a novel myotonometer [...] Read more.
Chronic kidney disease (CKD) is characterised by poor physical function. Mechanical muscle properties such as tone, elasticity, and stiffness influence the functional state of the muscle. Measuring these muscle mechanical properties is difficult and data on CKD are sparse. Using a novel myotonometer device, the aims of this study were to compare the viscoelastic muscle properties in CKD patients with previously reported data and to explore the association with muscle function. Non-dialysis-dependent CKD participants were recruited into a cross-sectional study conducted between 2018 and 2020. Muscle properties (tone, stiffness, elasticity) were assessed using a myotonometer (MyotonPRO). Muscle function was assessed using physical performance tests (sit-to-stand 5 and 60, timed up and go, short physical performance battery, gait speed, incremental shuttle walk, postural sway). General linear regression models were used to explore the association between muscle properties and physical function. Thirty-nine participants were included (age 64.2 (SD: 10.4) years; 51% male; eGFR 40.9 (SD: 20.0) mL/min/1.73 m2). Participants with CKD had reduced muscle tone, stiffness, and elasticity compared to previously reported studies. Muscle tone (B = −0.567, p = 0.003) and muscle stiffness (B = −0.368, p = 0.071) were greater in males than females. Increased BMI was associated with lower muscle tone (B = −0.528, p = 0.002) and muscle stiffness (B = −0.577, p = 0.002). No meaningful nor consistent associations were found between these properties and measures of muscle function and physical performance. In conclusion, using a novel handheld myotonometer, this study found that CKD patients exhibit a reduction in muscle tone, stiffness, and elasticity. In a passive state, these viscoelastic muscle properties showed no consistent associations with physical performance. Full article
(This article belongs to the Special Issue Exercise Physiology and Biochemistry)
9 pages, 313 KiB  
Article
Resistin: A Potential Indicator of Aortic Stiffness in Non-Dialysis Chronic Kidney Disease Patients
by Chiu-Huang Kuo, Min-Shuo Chen, Chih-Hsien Wang, Yu-Hsien Lai, Yu-Li Lin and Bang-Gee Hsu
Medicina 2023, 59(9), 1652; https://doi.org/10.3390/medicina59091652 - 13 Sep 2023
Cited by 2 | Viewed by 1821
Abstract
Background and Objectives: In the progression and development of atherosclerosis, resistin plays a significant role. Chronic kidney disease (CKD), frequently associated with atherosclerosis, exhibits a marked increase in morbidity and mortality rates. This study set out to explore the association between aortic [...] Read more.
Background and Objectives: In the progression and development of atherosclerosis, resistin plays a significant role. Chronic kidney disease (CKD), frequently associated with atherosclerosis, exhibits a marked increase in morbidity and mortality rates. This study set out to explore the association between aortic stiffness and serum levels of resistin in non-dialysis-dependent CKD patients ranging from stages 3 to 5. Materials and Methods: We collected fasting blood samples from 240 CKD patients across stages 3 to 5. The concentration of resistin in serum was determined using a commercially available enzyme immunoassay kit. Those patients who exhibited a carotid–femoral pulse wave velocity (cfPWV) greater than 10 m/s were identified as the aortic stiffness group. Results: Out of the 240 CKD patients, 88 (36.7%) were classified within the aortic stiffness group. This group demonstrated higher incidences of diabetes, advanced age, increased body weight, body mass index, body fat mass, systolic and diastolic blood pressure, fasting glucose, and serum resistin levels. Multivariate logistic regression analysis highlighted resistin, diabetes, and body weight as independent predictors of aortic stiffness. Additionally, body fat mass, logarithmically transformed cfPWV (log-cfPWV) values and log-triglyceride levels were independent predictors of log-resistin levels by multivariate stepwise linear regression analysis. Conclusions: In CKD patients from stages 3 to 5, a positive correlation exists between elevated serum resistin levels and cfPWV values, identifying resistin as a potential predictor of aortic stiffness. Full article
(This article belongs to the Special Issue Chronic Kidney Disease and Cardiovascular Disease)
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12 pages, 871 KiB  
Article
Comparing Left Ventricular Diastolic Function between Peritoneal Dialysis and Non-Dialysis Patients with Stage 5 Chronic Kidney Disease: A Propensity Score-Matched Analysis
by Byoung-Geun Han, Jae Hee Seol, Sooyeon Choi, Donghui Shin, Jae-Seok Kim and Yong Hyuk Kim
J. Clin. Med. 2023, 12(15), 5092; https://doi.org/10.3390/jcm12155092 - 3 Aug 2023
Cited by 1 | Viewed by 1564
Abstract
Patients with chronic kidney disease (CKD) have a high incidence of left ventricular diastolic dysfunction (LVDD), which increases the risk of heart failure and mortality. We assessed fluid overload as an independent risk factor for LVDD in patients with decreased kidney function and [...] Read more.
Patients with chronic kidney disease (CKD) have a high incidence of left ventricular diastolic dysfunction (LVDD), which increases the risk of heart failure and mortality. We assessed fluid overload as an independent risk factor for LVDD in patients with decreased kidney function and compared its impact on the E/e′ ratio as a parameter for assessing left ventricular diastolic functions between patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and those with non-dialysis CKD stage 5 (CKD5) using propensity score matching (PSM). After PSM, 222 patients (CAPD, n = 111; CKD5, n = 111) were included. Fluid balance was assessed using bio-impedance spectroscopy and LVDD was determined by echocardiography based on an E/e′ ratio of >15. The CKD5 group had a significantly higher E/e′ ratio (p = 0.002), while fluid overload (OH/ECW) did not differ significantly between the groups. In the CAPD group, there were no significant differences in OH/ECW between patients with and without LVDD (p = 0.517). However, in the CKD5 group, patients with LVDD showed a significantly higher OH/ECW (p = 0.001). In a regression analysis investigating factors associated with the E/e′ ratio, OH/ECW was not significantly associated with the E/e′ ratio in the CAPD group (p = 0.087), but in the CKD5 group, it was independently correlated (p = 0.047). The factors closely associated with LVDD varied depending on dialysis dependence. While fluid overload independently influenced LVDD in non-dialysis patients, it was not statistically significant in patients with CAPD. Early assessment and management of volume status are crucial in addressing LVDD in patients with advanced-stage CKD. Full article
(This article belongs to the Section Nephrology & Urology)
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16 pages, 1049 KiB  
Article
The Moderating Role of Health Variables on the Association between Physical Exercise and Quality of Life in Patients with End-Stage Renal Disease
by Víctor Martínez-Majolero, Belén Urosa, Sonsoles Hernández-Sánchez and David Arroyo
Healthcare 2023, 11(15), 2148; https://doi.org/10.3390/healthcare11152148 - 27 Jul 2023
Cited by 1 | Viewed by 1795
Abstract
Scientific evidence demonstrates the positive impact that physical exercise has on the quality of life (QOL) of patients with chronic kidney disease (CKD). However, no study has proposed a model investigating the effect physical exercise has on the QOL of end-stage renal disease [...] Read more.
Scientific evidence demonstrates the positive impact that physical exercise has on the quality of life (QOL) of patients with chronic kidney disease (CKD). However, no study has proposed a model investigating the effect physical exercise has on the QOL of end-stage renal disease (ESRD) patients, considering the most frequent associated diseases (diabetes/hypertension). The objectives were (1) to explore the relationship between physical exercise and the QOL of adults with ESRD, and (2) to examine the moderating and/or mediating role of relevant patient variables. This non-interventional study utilized an ex post facto retrospective data analysis design with a sample of 310 patients with ESRD through two validated questionnaires. The dependent variables were the QOL scale (KDQOL-SF), and the physical function dimension (EFFISICA). The independent variables were the regular practice of intense physical activity (DEPINTE) and the daily time (in hours) the patient is in a sedentary attitude (TiParado). The moderating variables were the clinical situation and associated diseases. The mediator variable used was the body mass index. Bivariate and multiple regression analyses were conducted. Findings suggest implementing intense physical activity in transplant recipients and programmes to avoid sedentary lifestyles in dialysis patients have a positive effect in the QOL of ESRD patients. Full article
(This article belongs to the Special Issue Exercise Physiology and Its Performance in Health and Disease)
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13 pages, 496 KiB  
Review
Iron Parameters in Patients Treated with Roxadustat for Anemia of Chronic Kidney Disease
by Tomas Ganz, Francesco Locatelli, Mustafa Arici, Tadao Akizawa and Michael Reusch
J. Clin. Med. 2023, 12(13), 4217; https://doi.org/10.3390/jcm12134217 - 22 Jun 2023
Cited by 12 | Viewed by 3364
Abstract
Roxadustat is a novel agent with a distinct mechanism of action compared to erythropoiesis-stimulating agents (ESAs) and a potentially different combination of effects on iron parameters. This narrative review describes the effects of roxadustat on iron parameters and on hemoglobin levels in the [...] Read more.
Roxadustat is a novel agent with a distinct mechanism of action compared to erythropoiesis-stimulating agents (ESAs) and a potentially different combination of effects on iron parameters. This narrative review describes the effects of roxadustat on iron parameters and on hemoglobin levels in the context of iron supplementation in patients with anemia of non-dialysis-dependent (NDD) or dialysis-dependent (DD) chronic kidney disease (CKD). Roxadustat use was associated with a greater reduction in serum ferritin levels than seen with ESAs and an increase in serum iron levels compared to a decrease with ESAs. Decreases in transferrin saturation in patients treated with roxadustat were relatively small and, in the case of patients with NDD CKD, not observed by Week 52. These changes reflect the concomitant increases in both serum iron and total iron-binding capacity. Compared to placebo and an ESA, roxadustat improved iron availability and increased erythropoiesis while requiring less intravenous iron use. Hepcidin levels generally decreased in patients who received roxadustat compared to baseline values in all CKD populations; these decreases appear to be more robust with roxadustat than with an ESA or placebo. The mechanisms behind the effects of roxadustat and ESAs on iron availability and stores and erythropoiesis appear to differ and should be considered holistically when treating anemia of CKD. Full article
(This article belongs to the Special Issue Novelty in the Management of Progression and Complications of CKD)
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