Category Archives: Nutrition
Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: reconciling low protein intake with nutritional therapy.
Hemodialysis.com Author Interview:
Csaba P. Kovesdy MD FASN.
The Fred Hatch Professor of Medicine
Director, Clinical Outcomes and Clinical Trials Program in Nephrology
University of Tennessee Health Science Center
Chief of Nephrology
Division of Nephrology, Memphis VA Medical Center
Comments from Dr. Kovesdy:
Protein energy wasting (PEW) is common in patients with CKD: according to some studies as many as 20-25% of patients with non-dialysis dependent CKD have PEW. PEW is associated with significantly higher mortality, it is thus important to consider what interventions might be used to prevent it from developing, and to treat it once it has occurred. The reason for the development and worsening of PEW as CKD advances are very complex, and include various mechanisms that induce either decreased nutrient intake, or increased catabolism, or both. Interventions against PEW can thus target any, or several of these mechanisms. The practical implementation of such interventions is, however, hampered by a lack of clinical trials providing definitive answers about their efficacy and safety towards improving hard clinical end points.
Marie Benz, MD on Google+Central Body Fat Distribution Associates with Unfavorable Renal Hemodynamics Independent of Body Mass Index
Hemodialysis.com eInterview: Dr. Arjan J. Kwakernaak
Department of Medicine, Division of Nephrology
University Medical Center Groningen
PO Box 30001, NL-9700 RB
Groningen, The Netherlands
Hemodialysis.com: What was the rationale for the study?
Dr. Kwakernaak: Body fat distribution is a well-established risk factor for long-term kidney damage. The mechanisms underlying this increased renal risk in association with a central body fat distribution is often attributed to associated conditions, such as overall weight excess, hypertension, and diabetes. We suspected that body fat distribution might also exert an adverse effect on renal hemodynamics, independent from these factors. We therefore investigated whether a central body fat distribution was associated with an altered renal hemodynamic profile, independent of overall weight excess.
Association between Younger Age When First Overweight and Increased Risk for CKD
Dr. Richard Silverwood BSc MSc PhD
Department of Medical Statistics.
The London School of Hygiene & Tropical Medicine
Hemodialysis.com: What are the main findings of the study?
Dr. Silverwood: In a prospective cohort representative of the general United Kingdom population we found overweight beginning early in adulthood (by age 26 or 36 years) to be strongly associated with reduced kidney function at age 60-64. Diabetes and hypertension were both moderate mediators of the age at overweight-kidney function association.
Increased visceral adiposity is associated with coronary artery calcification in male patients with chronic kidney disease
Hemodialysis.com Authors’ Interview:
Cristianne Aoqui
Maria Eugenia F Canziani
Professora-afiliada Disciplina de Nefrologia
Universidade Federal de São Paulo – UNIFESP
Rua Pedro de Toledo 282, São Paulo, CEP 04039-000
Hemodialysis.com: What are the main findings of the study?
Answer: Our study addressed whether visceral obesity is associated with coronary artery calcification in male patients with chronic kidney disease (CKD). We confirmed this association, which had not yet been described for patients with CKD. Moreover, the association was independent of important features to be considered in this population, such as diabetes and level of ionized calcium.
Adherence to a Healthy Lifestyle and All-Cause Mortality in CKD
Hemodialysis.com Author Interview with
Ana C. Ricardo, MD, MPH
Assistant Professor of Medicine, University of Illinois at Chicago
Department of Medicine, Section of Nephrology
Hemodialysis.com: What are the main findings of the study?
Dr. Ricardo: We conducted a study to evaluate the association of four lifestyle factors (healthy diet, regular physical activity, body mass index and abstinence from smoking) with all-cause mortality among participants in the Third National Health and Nutrition Examination Survey, 1988-1994 (NHANES III) with chronic kidney disease (CKD).
Phosphorus and risk of renal failure in subjects with normal renal function
Hemodialysis.com Author Interview: John J. Sim, MD
Area Research Chair
Director of Continuing Medical Education
Division of Nephrology and Hypertension
Kaiser Permanente Los Angeles Medical Center
Los Angeles, CA 90027
Hemodialysis.com: What are the main findings of the study?
Dr. Sim: This study on individuals with no significant kidney disease and relatively intact kidney function (eGFR>/=60ml/ml) demonstrated that higher serum phosphorus levels were association with greater risk for developing end stage renal disease (ESRD). Every 0.5mg/dl increase in serum phosphorus was associated with 40% increase risk for ESRD. Additionally, every 0.5mg/dl higher level of phosphorus increased the risk of death by 9% during the 11 year observation period.
Importance of Understanding Phosphate Binding Capacity of Sevelamer and Lanthanum in Relation to Dietary Protein and Phosphate Intake in Chronic Hemodialysis Patients
Hemodialysis.com Interview with: William F. Finn, MD
Professor of Medicine (Ret)
University of North Carolina
School of Medicine
Hemodialysis.com: What are the main findings of the study?
Dr. Finn: Published reports were examined that detailed changes in the urinary excretion of phosphorus that followed the administration of various doses of either sevelamer hydrochloride/carbonate (SHC) or lanthanum carbonate (LC).
From these data, dose-response curves were developed.
These data demonstrated that the relative binding capacity of each agent decreased as doses was increased. That is, the respective dose-response curves are non-linear. At the upper limits of the clinically recommended doses, the phosphorus binding capacities plateau. This has important implications for the management of hyperphosphatemia in dialysis patients for it places an upper limit on the amount of phosphorus that can be bound. On the basis of these dose-response curves, it would require 18.4 g of SHC or 4.6 g of LC to bind 350 mg of phosphorus. This helps to explain the persistent hyperphosphatemia among many patients whose required dietary protein intake exceeds the ability to maintain phosphorus intake at or below 1000 mg per day.
A Self-Management Approach to Developing a Potassium Education Tool
Rachel Linzon, Josie Caruso-Ditta, Marla McKerracher, York Region Chronic Kidney Disease Program – Mackenzie Health, Richmond Hill, Ontario, Canada.
The development of the Potassium Education Tool was a continuous quality improvement program initiative.
Objective:
To incorporate a self-management approach in developing a potassium education tool (PET) to improve patient’s ability to self-manage the potassium in their diet and improve serum potassium levels.
Method:
In order to evaluate our original PET for potassium, 81 participants receiving hemodialysis responded to a pre-test survey of open and closed-ended questions. These questions addressed ease of understanding, usefulness and readability.
The responses from the closed-ended questions provided limited insight. It was the participant’s comments that provided the direction for the creation of a new PET. Participants requested that the information is:
- Alphabetized
- Less cluttered
- Larger font size
- More cultural food choices
- Specific quantities listed
- Increased variety in fruits and vegetables
