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Dietary Habits, Vitamin and Mineral Supplementations in Patients with Chronic Kidney Disease (CKD)

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

Deadline for manuscript submissions: closed (31 January 2019) | Viewed by 116984

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Special Issue Editor

Prof. Dr. Piergiorgio Messa

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Guest Editor

1. Unit of Nephrology, Università degli Studi di Milano, Via Commenda 15, 20122 Milano, Italy
2. Nephrology, Dialysis and Renal Transplant Unit—Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Via Commenda 15, 20122 Milano, Italy
Interests: transplantation; mineral and electrolyte metabolism; CKD

Special Issue Information

Dear Colleagues,

Patients with chronic kidney diseases (CKD) are particularly exposed to malnutrition not only due to the frequent involvement of the gastrointestinal tract in the course of CKD, but also to the spontaneous or doctor-recommended modifications of their dietary habits and to the adverse effects of the large series of drugs usually prescribed.

This nutritional derangement can involve particularly vitamins and other micronutrients, whose altered availability has been put in relationship not only with the consequences strictly related to the well known classical effects of these compounds, but also with some relevant clinical complications commonly observed in CKD patients. Furthermore, such nutritional modifications might be directly or indirectly related with some change in the quantitative and/or qualitative composition of the intestinal microbiota.

In this special issue of Nutrients, some experts in these fields will deal with some of the most critical conditions related to the altered dietary habits and availability of some of the most relevant vitamins and micronutrients in CKD patients.

Prof. Piergiorgio Messa
Guest Editor

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Published Papers (14 papers)

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Editorial

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4 pages, 186 KiB

Open AccessEditorial

Dietary Habits, Vitamin and Mineral Supplements in Patients with Chronic Kidney Disease (CKD)

by Piergiorgio Messa

Nutrients 2020, 12(12), 3817; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12123817 - 14 Dec 2020

Cited by 3 | Viewed by 2060

Abstract

Chronic kidney disease (CKD) is frequently complicated with a malnutrition status, due to the presence of gastrointestinal symptoms and/or to dietary and multi pharmacological prescriptions which are almost universally present in such patients [...] Full article

(This article belongs to the Special Issue Dietary Habits, Vitamin and Mineral Supplementations in Patients with Chronic Kidney Disease (CKD))

Research

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20 pages, 3978 KiB

Open AccessFeature PaperArticle

Moderate Protein Restriction in Advanced CKD: A Feasible Option in An Elderly, High-Comorbidity Population. A Stepwise Multiple-Choice System Approach

by Antioco Fois, Antoine Chatrenet, Emanuela Cataldo, Francoise Lippi, Ana Kaniassi, Jerome Vigreux, Ludivine Froger, Elena Mongilardi, Irene Capizzi, Marilisa Biolcati, Elisabetta Versino and Giorgina Barbara Piccoli

Nutrients 2019, 11(1), 36; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11010036 - 24 Dec 2018

Cited by 23 | Viewed by 7103

Abstract

Background: Protein restriction may retard the need for renal replacement therapy; compliance is considered a barrier, especially in elderly patients. Methods: A feasibility study was conducted in a newly organized unit for advanced kidney disease; three diet options were offered: normalization of protein intake (0.8 g/kg/day of protein); moderate protein restriction (0.6 g/kg/day of protein) with a “traditional” mixed protein diet or with a “plant-based” diet supplemented with ketoacids. Patients with protein energy wasting (PEW), short life expectancy or who refused were excluded. Compliance was estimated by Maroni-Mitch formula and food diary. Results: In November 2017–July 2018, 131 patients started the program: median age 74 years (min–max 24-101), Charlson Index (CCI): 8 (min-max: 2–14); eGFR 24 mL/min (4–68); 50.4% were diabetic, BMI was ≥ 30 kg/m² in 40.4%. Normalization was the first step in 75 patients (57%, age 78 (24–101), CCI 8 (2–12), eGFR 24 mL/min (8–68)); moderately protein-restricted traditional diets were chosen by 24 (18%, age 74 (44–91), CCI 8 (4–14), eGFR 22 mL/min (5–40)), plant-based diets by 22 (17%, age 70 (34–89), CCI 6.5 (2–12), eGFR 15 mL/min (5–46)) (p < 0.001). Protein restriction was not undertaken in 10 patients with short life expectancy. In patients with ≥ 3 months of follow-up, median reduction of protein intake was from 1.2 to 0.8 g/kg/day (p < 0.001); nutritional parameters remained stable; albumin increased from 3.5 to 3.6 g/dL (p = 0.037); good compliance was found in 74%, regardless of diets. Over 1067 patient-months of follow-up, 9 patients died (CCI 10 (6–12)), 7 started dialysis (5 incremental). Conclusion: Protein restriction is feasible by an individualized, stepwise approach in an overall elderly, high-comorbidity population with a baseline high-protein diet and is compatible with stable nutritional status. Full article

(This article belongs to the Special Issue Dietary Habits, Vitamin and Mineral Supplementations in Patients with Chronic Kidney Disease (CKD))

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13 pages, 1003 KiB

Open AccessArticle

Prevalence and Correlates of Sarcopenia among Elderly CKD Outpatients on Tertiary Care

by Claudia D’Alessandro, Giorgina Barbara Piccoli, Massimiliano Barsotti, Serena Tassi, Domenico Giannese, Riccardo Morganti and Adamasco Cupisti

Nutrients 2018, 10(12), 1951; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10121951 - 10 Dec 2018

Cited by 26 | Viewed by 5341

Abstract

Background: Sarcopenia is a widespread concern in chronic kidney disease (CKD) as well in elderly patients and is one of the main reasons why low-protein diets for this population are controversial. The aim of this study was to assess the prevalence and correlates of sarcopenia among elderly male patients affected by CKD followed up in an outpatient nephrology clinic, where moderate protein restriction (0.6–0.8 g/Kg/day) is routinely recommended to patients in CKD stage 3b-5 not on dialysis. Methods: This observational study included 80 clinically-stable male out-patients aged >60, affected by stage 3b-4 CKD. Forty patients aged ≥75 (older seniors) were compared to the other forty patients aged 60–74 (younger seniors). All patients underwent a comprehensive nutritional and functional assessment. Results: Older seniors showed lower serum albumin, hand-grip strength, body mass index (BMI), skeletal muscle mass, and resting energy expenditure. Protein intake was significantly lower in older seniors whereas energy intake was similar. Average daily physical activity was lower in the older seniors than in the younger ones. Sarcopenia was more prevalent in older than in younger seniors. Among older seniors, sarcopenic and non-sarcopenic ones differed in age and performance on the Six-Minute Walk test, whereas the estimated glomerular filtration rate (eGFR), biochemistry, dietary protein, and energy intakes were similar. Conclusions: Older senior CKD male patients have lower muscle mass, muscle strength, and physical capacity and activity levels, with a higher prevalence of sarcopenia than younger patients. This occurs at the same residual renal function and metabolic profile and protein intake. Energy intake was at the target in both subgroups. In this CKD cohort, sarcopenia was associated with age and physical capacity, but not with eGFR or dietary intakes. Full article

(This article belongs to the Special Issue Dietary Habits, Vitamin and Mineral Supplementations in Patients with Chronic Kidney Disease (CKD))

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13 pages, 1013 KiB

Open AccessArticle

Does a Supplemental Low-Protein Diet Decrease Mortality and Adverse Events After Commencing Dialysis? A Nationwide Cohort Study

by Chieh-Li Yen, Kun-Hua Tu, Ming-Shyan Lin, Su-Wei Chang, Pei-Chun Fan, Ching-Chung Hsiao, Chao-Yu Chen, Hsiang-Hao Hsu, Ya-Chun Tian and Chih-Hsiang Chang

Nutrients 2018, 10(8), 1035; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10081035 - 08 Aug 2018

Cited by 15 | Viewed by 4684

Abstract

Background: A beneficial effect of a ketoanalogue-supplemented low-protein diet (sLPD) in postponing dialysis has been demonstrated in numerous previous studies. However, evidence regarding its effect on long-term survival is limited. Our study assessed the long-term outcomes of patients on an sLPD after commencing dialysis. Methods: This retrospective study examined patients with new-onset end-stage renal disease with permanent dialysis between 2001 and 2013, extracted from Taiwan’s National Health Insurance Research Database. Patients who received more than 3 months of sLPD treatment in the year preceding the start of dialysis were extracted. The outcomes studied were all-cause mortality, infection rate, and major cardiac and cerebrovascular events (MACCEs). Results: After propensity score matching, the sLPD group (n = 2607) showed a lower risk of all-cause mortality (23.1% vs. 27.6%, hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.70–0.84), MACCEs (19.2% vs. 21.5%, HR 0.86, 95% CI 0.78–0.94), and infection-related death (9.9% vs. 12.5%, HR 0.76, 95% CI 0.67–0.87) than the non-sLPD group did. Conclusion: We found that sLPD treatment might be safe without long-term negative consequences after dialysis treatment. Full article

(This article belongs to the Special Issue Dietary Habits, Vitamin and Mineral Supplementations in Patients with Chronic Kidney Disease (CKD))

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Review

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14 pages, 552 KiB

Open AccessReview

Native Hypovitaminosis D in CKD Patients: From Experimental Evidence to Clinical Practice

by Carlo Alfieri, Oksana Ruzhytska, Simone Vettoretti, Lara Caldiroli, Mario Cozzolino and Piergiorgio Messa

Nutrients 2019, 11(8), 1918; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11081918 - 15 Aug 2019

Cited by 16 | Viewed by 3976

Abstract

Native hypovitaminosis D (n-hVITD) is frequently found from the early stages of chronic kidney disease (CKD) and its prevalence increases with CKD progression. Even if the implications of n-hVITD in chronic kidney disease-mineral bone disorder (CKD-MBD) have been extensively characterized in the literature, there is a lot of debate nowadays about the so called “unconventional effects” of native vitamin D (25(OH)VitD) supplementation in CKD patients. In this review, highlights of the dimension of the problem of n-hVITD in CKD stages 2–5 ND patients will be presented. In addition, it will focus on the “unconventional effects” of 25(OH)VitD supplementation, the clinical impact of n-hVITD and the most significant interventional studies regarding 25(OH)VitD supplementation in CKD stages 2–5 ND. Full article

(This article belongs to the Special Issue Dietary Habits, Vitamin and Mineral Supplementations in Patients with Chronic Kidney Disease (CKD))

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21 pages, 1210 KiB

Open AccessReview

Lipid Accumulation and Chronic Kidney Disease

by Zhibo Gai, Tianqi Wang, Michele Visentin, Gerd A. Kullak-Ublick, Xianjun Fu and Zhenguo Wang

Nutrients 2019, 11(4), 722; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11040722 - 28 Mar 2019

Cited by 204 | Viewed by 14651

Abstract

Obesity and hyperlipidemia are the most prevalent independent risk factors of chronic kidney disease (CKD), suggesting that lipid accumulation in the renal parenchyma is detrimental to renal function. Non-esterified fatty acids (also known as free fatty acids, FFA) are especially harmful to the kidneys. A concerted, increased FFA uptake due to high fat diets, overexpression of fatty acid uptake systems such as the CD36 scavenger receptor and the fatty acid transport proteins, and a reduced β-oxidation rate underlie the intracellular lipid accumulation in non-adipose tissues. FFAs in excess can damage podocytes, proximal tubular epithelial cells and the tubulointerstitial tissue through various mechanisms, in particular by boosting the production of reactive oxygen species (ROS) and lipid peroxidation, promoting mitochondrial damage and tissue inflammation, which result in glomerular and tubular lesions. Not all lipids are bad for the kidneys: polyunsaturated fatty acids (PUFA) such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) seem to help lag the progression of chronic kidney disease (CKD). Lifestyle interventions, especially dietary adjustments, and lipid-lowering drugs can contribute to improve the clinical outcome of patients with CKD. Full article

(This article belongs to the Special Issue Dietary Habits, Vitamin and Mineral Supplementations in Patients with Chronic Kidney Disease (CKD))

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23 pages, 819 KiB

Open AccessFeature PaperReview

Dietary Components That May Influence the Disturbed Gut Microbiota in Chronic Kidney Disease

by Denise Mafra, Natália Borges, Livia Alvarenga, Marta Esgalhado, Ludmila Cardozo, Bengt Lindholm and Peter Stenvinkel

Nutrients 2019, 11(3), 496; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11030496 - 27 Feb 2019

Cited by 112 | Viewed by 17047

Abstract

Gut microbiota imbalance is common in patients with chronic kidney disease (CKD) and associates with factors such as increased circulating levels of gut-derived uremic toxins, inflammation, and oxidative stress, which are linked to cardiovascular disease and increased morbimortality. Different nutritional strategies have been proposed to modulate gut microbiota, and could potentially be used to reduce dysbiosis in CKD. Nutrients like proteins, fibers, probiotics, and synbiotics are important determinants of the composition of gut microbiota and specific bioactive compounds such as polyphenols present in nuts, berries. and fruits, and curcumin, may also play a key role in this regard. However, so far, there are few studies on dietary components influencing the gut microbiota in CKD, and it is therefore not possible to conclude which nutrients should be prioritized in the diet of patients with CKD. In this review, we discuss some nutrients, diet patterns and bioactive compounds that may be involved in the modulation of gut microbiota in CKD and provide the background and rationale for studies exploring whether nutritional interventions with these dietary components could be used to alleviate the gut dysbiosis in patients with CKD. Full article

(This article belongs to the Special Issue Dietary Habits, Vitamin and Mineral Supplementations in Patients with Chronic Kidney Disease (CKD))

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22 pages, 1670 KiB

Open AccessReview

Magnesium: A Magic Bullet for Cardiovascular Disease in Chronic Kidney Disease?

by Nicoline H. J. Leenders and Marc G. Vervloet

Nutrients 2019, 11(2), 455; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11020455 - 22 Feb 2019

Cited by 42 | Viewed by 9242

Abstract

Magnesium is essential for many physiological functions in the human body. Its homeostasis involves dietary intake, absorption, uptake and release from bone, swifts between the intra- and extracellular compartment, and renal excretion. Renal excretion is mainly responsible for regulation of magnesium balance. In chronic kidney disease (CKD), for a long time the general policy has been limiting magnesium intake. However, this may not be appropriate for many patients. The reference ranges for magnesium are not necessarily optimal concentrations, and risks for insufficient magnesium intake exist in patients with CKD. In recent years, many observational studies have shown that higher (in the high range of “normal” or slightly above) magnesium concentrations are associated with better survival in CKD cohorts. This review gives an overview of epidemiological associations between magnesium and overall and cardiovascular survival in patients with CKD. In addition, potential mechanisms explaining the protective role of magnesium in clinical cardiovascular outcomes are described by reviewing evidence from in vitro studies, animal studies, and human intervention studies with non-clinical endpoints. This includes the role of magnesium in cardiac arrhythmia, heart failure, arterial calcification, and endothelial dysfunction. Possible future implications will be addressed, which will need prospective clinical trials with relevant clinical endpoints before these can be adopted in clinical practice. Full article

(This article belongs to the Special Issue Dietary Habits, Vitamin and Mineral Supplementations in Patients with Chronic Kidney Disease (CKD))

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20 pages, 842 KiB

Open AccessReview

Folic Acid and Vitamin B12 Administration in CKD, Why Not?

by Irene Capelli, Giuseppe Cianciolo, Lorenzo Gasperoni, Fulvia Zappulo, Francesco Tondolo, Maria Cappuccilli and Gaetano La Manna

Nutrients 2019, 11(2), 383; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11020383 - 13 Feb 2019

Cited by 78 | Viewed by 14832

Abstract

Patients affected by chronic kidney disease (CKD) or end-stage renal disease (ESRD) experience a huge cardiovascular risk and cardiovascular events represent the leading causes of death. Since traditional risk factors cannot fully explain such increased cardiovascular risk, interest in non-traditional risk factors, such as hyperhomocysteinemia and folic acid and vitamin B12 metabolism impairment, is growing. Although elevated homocysteine blood levels are often seen in patients with CKD and ESRD, whether hyperhomocysteinemia represents a reliable cardiovascular and mortality risk marker or a therapeutic target in this population is still unclear. In addition, folic acid and vitamin B12 could not only be mere cofactors in the homocysteine metabolism; they may have a direct action in determining tissue damage and cardiovascular risk. The purpose of this review was to highlight homocysteine, folic acid and vitamin B12 metabolism impairment in CKD and ESRD and to summarize available evidences on hyperhomocysteinemia, folic acid and vitamin B12 as cardiovascular risk markers, therapeutic target and risk factors for CKD progression. Full article

(This article belongs to the Special Issue Dietary Habits, Vitamin and Mineral Supplementations in Patients with Chronic Kidney Disease (CKD))

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9 pages, 1350 KiB

Open AccessReview

Dietary Protein, Kidney Function and Mortality: Review of the Evidence from Epidemiological Studies

by Giancarlo Bilancio, Pierpaolo Cavallo, Carolina Ciacci and Massimo Cirillo

Nutrients 2019, 11(1), 196; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11010196 - 18 Jan 2019

Cited by 14 | Viewed by 9870

Abstract

The World Health Organization recommends a minimum requirement of 0.8 g/day protein/kg ideal weight. Low protein diets are used against kidney failure progression. Efficacy and safety of these diets are uncertain. This paper reviews epidemiological studies about associations of protein intake with kidney function decline and mortality. Three studies investigated these associations; two reported data on mortality. Protein intake averaged >60 g/day and 1.2 g/day/kg ideal weight. An association of baseline protein intake with long-term kidney function decline was absent in the general population and/or persons with normal kidney function but was significantly positive in persons with below-normal kidney function. Independent of kidney function and other confounders, a J-curve relationship was found between baseline protein intake and mortality due to ≈35% mortality excess for non-cardiovascular disease in the lowest quintile of protein intake, a quintile where protein intake averaged <0.8 g/day/kg ideal weight. Altogether, epidemiological evidence suggests that, in patients with reduced kidney function, protein intakes of ≈0.8 g/d/kg ideal weight could limit kidney function decline without adding non-renal risks. Long-term lower protein intake could increase mortality. In most patients, an intake of ≈0.8 g/day/kg would represent a substantial reduction of habitual intake considering that average intake is largely higher. Full article

(This article belongs to the Special Issue Dietary Habits, Vitamin and Mineral Supplementations in Patients with Chronic Kidney Disease (CKD))

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11 pages, 282 KiB

Open AccessReview

Vitamin K in Chronic Kidney Disease

by Mario Cozzolino, Michela Mangano, Andrea Galassi, Paola Ciceri, Piergiorgio Messa and Sagar Nigwekar

Nutrients 2019, 11(1), 168; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11010168 - 14 Jan 2019

Cited by 48 | Viewed by 8589

Abstract

Vitamin K is a composite term referring to a group of fat-soluble vitamins that function as a cofactor for the enzyme γ-glutamyl carboxylase (GGCX), which activates a number of vitamin K-dependent proteins (VKDPs) involved in haemostasis and vascular and bone health. Accumulating evidence demonstrates that chronic kidney disease (CKD) patients suffer from subclinical vitamin K deficiency, suggesting that this represents a population at risk for the biological consequences of poor vitamin K status. This deficiency might be caused by exhaustion of vitamin K due to its high requirements by vitamin K-dependent proteins to inhibit calcification. Full article

(This article belongs to the Special Issue Dietary Habits, Vitamin and Mineral Supplementations in Patients with Chronic Kidney Disease (CKD))

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19 pages, 1318 KiB

Open AccessReview

The Emerging Role of Nutritional Vitamin D in Secondary Hyperparathyroidism in CKD

by Chien-Lin Lu, Dong-Feng Yeih, Yi-Chou Hou, Guey-Mei Jow, Zong-Yu Li, Wen-Chih Liu, Cai-Mei Zheng, Yuh-Feng Lin, Jia-Fwu Shyu, Remy Chen, Chung-Yu Huang and Kuo-Cheng Lu

Nutrients 2018, 10(12), 1890; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10121890 - 03 Dec 2018

Cited by 23 | Viewed by 8008

Abstract

In chronic kidney disease (CKD), hyperphosphatemia induces fibroblast growth factor-23 (FGF-23) expression that disturbs renal 1,25-dihydroxy vitamin D (1,25D) synthesis; thereby increasing parathyroid hormone (PTH) production. FGF-23 acts on the parathyroid gland (PTG) to increase 1α-hydroxylase activity and results in increase intra-gland 1,25D production that attenuates PTH secretion efficiently if sufficient 25D are available. Interesting, calcimimetics can further increase PTG 1α-hydroxylase activity that emphasizes the demand for nutritional vitamin D (NVD) under high PTH status. In addition, the changes in hydroxylase enzyme activity highlight the greater parathyroid 25-hydroxyvitmain D (25D) requirement in secondary hyperparathyroidism (SHPT); the higher proportion of oxyphil cells as hyperplastic parathyroid progression; lower cytosolic vitamin D binding protein (DBP) content in the oxyphil cell; and calcitriol promote vitamin D degradation are all possible reasons supports nutritional vitamin D (NVD; e.g., Cholecalciferol) supplement is crucial in SHPT. Clinically, NVD can effectively restore serum 25D concentration and prevent the further increase in PTH level. Therefore, NVD might have the benefit of alleviating the development of SHPT in early CKD and further lowering PTH in moderate to severe SHPT in dialysis patients. Full article

(This article belongs to the Special Issue Dietary Habits, Vitamin and Mineral Supplementations in Patients with Chronic Kidney Disease (CKD))

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12 pages, 1247 KiB

Open AccessFeature PaperReview

Energy-Dense Diets and Mineral Metabolism in the Context of Chronic Kidney Disease–Metabolic Bone Disease (CKD-MBD)

by Mariano Rodriguez and Escolastico Aguilera-Tejero

Nutrients 2018, 10(12), 1840; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10121840 - 01 Dec 2018

Cited by 5 | Viewed by 4287

Abstract

The aim of this paper is to review current knowledge about the interactions of energy-dense diets and mineral metabolism in the context of chronic kidney disease–metabolic bone disease (CKD-MBD). Energy dense-diets promote obesity and type II diabetes, two well-known causes of CKD. Conversely, these diets may help to prevent weight loss, which is associated with increased mortality in advanced CKD patients. Recent evidence indicates that, in addition to its nephrotoxic potential, energy-dense food promotes changes in mineral metabolism that are clearly detrimental in the context of CKD-MBD, such as phosphorus (P) retention, increased concentrations of fibroblast growth factor 23, decreased levels of renal klotho, and reduction in circulating concentrations of calcitriol. Moreover, in uremic animals, a high fat diet induces oxidative stress that potentiates high P-induced vascular calcification, and these extraskeletal calcifications can be ameliorated by oral supplementation of vitamin E. In conclusion, although energy-dense foods may have a role in preventing undernutrition and weight loss in a small section of the CKD population, in general, they should be discouraged in patients with renal disease, due to their impact on P load and oxidative stress. Full article

(This article belongs to the Special Issue Dietary Habits, Vitamin and Mineral Supplementations in Patients with Chronic Kidney Disease (CKD))

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25 pages, 1835 KiB

Open AccessReview

Biotic Supplements for Renal Patients: A Systematic Review and Meta-Analysis

by Anna Pisano, Graziella D’Arrigo, Giuseppe Coppolino and Davide Bolignano

Nutrients 2018, 10(9), 1224; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10091224 - 04 Sep 2018

Cited by 28 | Viewed by 6265

Abstract

Intestinal dysbiosis is highly pervasive among chronic kidney disease (CKD) patients and may play a key role in disease progression and complications. We performed a systematic review and meta-analysis to evaluate effects of biotic supplements on a large series of outcomes in renal patients. Ovid-MEDLINE, PubMed and CENTRAL databases were searched for randomized controlled trials (RCTs) comparing any biotic (pre-, pro- or synbiotics) to standard therapy or placebo. Primary endpoints were change in renal function and cardiovascular events; secondary endpoints were change in proteinuria/albuminuria, inflammation, uremic toxins, quality of life and nutritional status. Seventeen eligible studies (701 participants) were reviewed. Biotics treatment did not modify estimated glomerular filtration rate (eGFR) (mean difference (MD) 0.34 mL/min/1.73 m²; 95% CI −0.19, 0.86), serum creatinine (MD −0.13 mg/dL; 95% confidence interval (CI) −0.32, 0.07), C-reactive protein (MD 0.75 mg/dL; 95% CI −1.54, 3.03) and urea (standardized MD (SMD) −0.02; 95% CI −0.25, 0.20) as compared to control. Outcome data on the other endpoints of interest were lacking, sparse or in an unsuitable format to be analyzed collectively. According to the currently available evidence, there is no conclusive rationale for recommending biotic supplements for improving outcomes in renal patients. Large-scale, well-designed and adequately powered studies focusing on hard rather than surrogate outcomes are still awaited. Full article

(This article belongs to the Special Issue Dietary Habits, Vitamin and Mineral Supplementations in Patients with Chronic Kidney Disease (CKD))

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