Kidney and Dialysis

Editorial

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22 pages, 1878 KiB

Open AccessEditorial

Renal Nutrition—Where It Has Been and Where It Is Going

by Joel D. Kopple and Maryam Ekramzadeh

Kidney Dial. 2022, 2(4), 512-533; https://doi.org/10.3390/kidneydial2040046 - 11 Oct 2022

Viewed by 3730

Abstract

This paper is a synopsis of an invited lecture entitled, The Future of Renal Nutrition, that was presented at the Japanese Society of Dialysis Therapy, July 2022. The purpose of this presentation is to suggest some of the advances in the field of [...] Read more.

This paper is a synopsis of an invited lecture entitled, The Future of Renal Nutrition, that was presented at the Japanese Society of Dialysis Therapy, July 2022. The purpose of this presentation is to suggest some of the advances in the field of renal nutrition that the authors think are likely to occur during the next several years. There will be continued development of methods for precisely diagnosing and classifying protein-energy wasting and developing methods to treat this disorder. Why weight loss commonly occurs when the GFR decreases to about 30–35 mL/min/1.73 m² and why substantial weight loss (>5%/year) is associated with increased mortality will be investigated. Clinical consequences of the interactions between gut microbiota, nutrient intake and other environmental influences will continue to be examined. The clinical value of diets high in fruits and vegetables or other plants for chronic kidney disease (CKD) patients will continue to be studied. Our knowledge of how different diets and medicines affect intestinal absorption, metabolism and excretion of nutrients will expand. Precision medicine will be extended to precision nutrition. There will be more focus on the effects of nutritional disorders and dietary treatment on the emotional status and quality of life of people with kidney disease and their families. Nutritional centers that provide centralized nutritional assessment and dietary counselling for CKD patients may develop in more urban centers. More clinical trials will be conducted to test whether nutritional management improves clinical outcomes in people with kidney disease. It is hoped that the foregoing comments will encourage more research on these topics. Full article

(This article belongs to the Special Issue Seeking out SDGs in Dialysis Medicine—Selected Articles from the JSDT Conference, Yokohama 2022)

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5 pages, 415 KiB

Open AccessEditorial

Green Nephrology

by Raymond Vanholder

Kidney Dial. 2022, 2(3), 454-458; https://doi.org/10.3390/kidneydial2030041 - 5 Aug 2022

Cited by 3 | Viewed by 4114

Abstract

The greenhouse effect of carbon dioxide, nitrous oxide, and methane release resulted in an exponential rise of land temperatures over the last decades [...] Full article

(This article belongs to the Special Issue Seeking out SDGs in Dialysis Medicine—Selected Articles from the JSDT Conference, Yokohama 2022)

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2 pages, 146 KiB

Open AccessEditorial

Seeking out SDGs in Dialysis Medicine—Selected Articles from the JSDT Conference, Yokohama 2022

by Ken Tsuchiya

Kidney Dial. 2022, 2(2), 296-297; https://doi.org/10.3390/kidneydial2020028 - 2 Jun 2022

Viewed by 1460

Abstract

The 67th Annual Meeting of the Japanese Society for Dialysis Therapy (JSDT) was held in Yokohama City from 1 to3 July, 2022 [...] Full article

(This article belongs to the Special Issue Seeking out SDGs in Dialysis Medicine—Selected Articles from the JSDT Conference, Yokohama 2022)

Review

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23 pages, 1237 KiB

Open AccessReview

Trace Elements and Their Management in Dialysis Patients—Pathophysiology and Clinical Manifestations

by Shu Wakino

Kidney Dial. 2023, 3(3), 274-296; https://doi.org/10.3390/kidneydial3030025 - 21 Aug 2023

Cited by 2 | Viewed by 4087

Abstract

Recently, as the number of elderly dialysis patients has been increasing, complications associated with low nutritional status such as infectious disease have had a strong influence on the prognosis of dialysis patients. Nutritional disorders are caused by the inadequate intake of the three [...] Read more.

Recently, as the number of elderly dialysis patients has been increasing, complications associated with low nutritional status such as infectious disease have had a strong influence on the prognosis of dialysis patients. Nutritional disorders are caused by the inadequate intake of the three major nutrients—proteins, fats, and carbohydrates—as well as vitamin and mineral deficiencies. Minerals are composed of various elements, including small-amount elements and trace elements, which are present in the human body in very small quantities lower than that of iron. In dialysis and predialysis patients, zinc, manganese, and selenium are the three major elements that are significantly depleted as compared to normal subjects; these deficiencies are sometimes symptomatic. Zinc deficiency is manifest as anemia, taste abnormality, and delayed wound healing, while selenium deficiency is associated with impaired cardiac function and immunocompromised condition. Zinc has multiple functions, since various enzymes, including DNA polymerase and RNA polymerase, need zinc as a cofactor, while selenium is a component of selenoproteins, including glutathione peroxidase and thioredoxin reductases, which are major antioxidative stress enzymes. These elements can only be supplemented exogenously and contribute to the sustainable QOL of dialysis patients. On the other hand, as regards other trace elements, including copper, chromium, manganese, lead, arsenic, etc., the association of their deficiency or intoxication with various involvements of dialysis patients were investigated, although all investigations were performed in cross-sectional studies or observational studies. Therefore, the supplementation of these elements is inconclusive, given the scarcity of other intervention studies. More conclusive studies are endorsed for the establishment of proper supplementation strategies. Full article

(This article belongs to the Special Issue Seeking out SDGs in Dialysis Medicine—Selected Articles from the JSDT Conference, Yokohama 2022)

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10 pages, 843 KiB

Open AccessReview

Chronic Kidney Disease—Mineral and Bone Disorder (CKD-MBD), from Bench to Bedside

by Kosaku Nitta, Norio Hanafusa, Kenichi Akiyama, Yuki Kawaguchi and Ken Tsuchiya

Kidney Dial. 2023, 3(1), 46-55; https://doi.org/10.3390/kidneydial3010004 - 4 Jan 2023

Cited by 2 | Viewed by 7557

Abstract

Chronic kidney disease—mineral and bone disorder (CKD-MBD) is a systemic disorder that increases the risk of morbidity and mortality in dialysis patients. CKD-MBD is highly prevalent in dialysis patients, and appropriate treatment is important for improving their outcomes. Inorganic phosphate, fibroblast growth factor [...] Read more.

Chronic kidney disease—mineral and bone disorder (CKD-MBD) is a systemic disorder that increases the risk of morbidity and mortality in dialysis patients. CKD-MBD is highly prevalent in dialysis patients, and appropriate treatment is important for improving their outcomes. Inorganic phosphate, fibroblast growth factor 23, parathyroid hormone, and calciprotein particles are markers for critical components and effectors of CKD-MBD, and higher circulating levels of these markers are linked to cardiovascular diseases. In this short review, we focus on the pathogenesis and management of CKD-MBD in CKD patients, especially those on dialysis therapy, and discuss the prospects for improving the management in CKD patients, including those on dialysis. Full article

(This article belongs to the Special Issue Seeking out SDGs in Dialysis Medicine—Selected Articles from the JSDT Conference, Yokohama 2022)

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23 pages, 751 KiB

Open AccessReview

Multifaceted Nutritional Disorders in Elderly Patients Undergoing Dialysis

by Katsuhito Mori, Masafumi Kurajoh, Masaaki Inaba and Masanori Emoto

Kidney Dial. 2023, 3(1), 1-23; https://doi.org/10.3390/kidneydial3010001 - 22 Dec 2022

Cited by 1 | Viewed by 2922

Abstract

Advances in medicine have resulted in increased longevity, which has consequently led to unexpected geriatric syndromes, such as frailty and sarcopenia. Patients with end-stage kidney disease, especially those receiving dialysis treatment, often show characteristic reductions in body protein and energy storage, termed protein [...] Read more.

Advances in medicine have resulted in increased longevity, which has consequently led to unexpected geriatric syndromes, such as frailty and sarcopenia. Patients with end-stage kidney disease, especially those receiving dialysis treatment, often show characteristic reductions in body protein and energy storage, termed protein energy wasting (PEW). Therefore, maintenance of nutritional condition has a key role in defending against both geriatric syndromes and PEW, which share several components in elderly individuals undergoing hemodialysis. To counteract the development of an undesirable condition, nutritional evaluation is indispensable. In addition to simple measurements of body mass index, and serum albumin and creatinine, a composite nutritional assessment including a malnutrition inflammation score is useful, although subjective elements are included and a well-trained examiner is required. On the other hand, the geriatric nutritional risk index and nutritional risk index for Japanese hemodialysis patients (NRI-JH) are objective tools, and easy to use in clinical settings. Undernutrition is closely related to infectious events and the results of an infection are often serious in elderly patients, even those with survival, with large medical costs incurred. Together with appropriate nutritional evaluation, it is necessary to clarify the underlying relationship of PEW with infection for improvement of prognosis in affected elderly individuals. Full article

(This article belongs to the Special Issue Seeking out SDGs in Dialysis Medicine—Selected Articles from the JSDT Conference, Yokohama 2022)

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11 pages, 1576 KiB

Open AccessReview

Renal Rehabilitation—Its Theory and Clinical Application to Patients Undergoing Daily Dialysis Therapy

by Ryota Matsuzawa and Daisuke Kakita

Kidney Dial. 2022, 2(4), 565-575; https://doi.org/10.3390/kidneydial2040051 - 3 Nov 2022

Cited by 1 | Viewed by 4984

Abstract

An aging population and the prevalence of lifestyle-related ailments have led to a worldwide increase in the rate of chronic kidney disease requiring renal replacement therapy. The mean age of people requiring dialysis has been rising, and Japanese patients are aging more rapidly [...] Read more.

An aging population and the prevalence of lifestyle-related ailments have led to a worldwide increase in the rate of chronic kidney disease requiring renal replacement therapy. The mean age of people requiring dialysis has been rising, and Japanese patients are aging more rapidly than those in the United States and Europe. Compared to people with normal kidney function, those undergoing hemodialysis are at increased risk of sarcopenia or frailty and serious health problems that limit access to kidney transplantation and lead to adverse health outcomes such as functional dependence, hospitalization, and death in patients on dialysis treatment. The Japanese Society of Renal Rehabilitation, established in 2011, published a clinical practice guideline for renal rehabilitation in 2019. Although the concept has become widely known among kidney health providers in recent years, efforts have still not focused on routine clinical care for patients with chronic kidney disease. In this review, the theory and clinical application of renal rehabilitation for patients undergoing daily hemodialysis were investigated. Full article

(This article belongs to the Special Issue Seeking out SDGs in Dialysis Medicine—Selected Articles from the JSDT Conference, Yokohama 2022)

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17 pages, 2071 KiB

Open AccessReview

Toward Revision of the ‘Best Practice for Diabetic Patients on Hemodialysis 2012’

by Masanori Abe, Tomomi Matsuoka, Shunsuke Kawamoto, Kota Miyasato and Hiroki Kobayashi

Kidney Dial. 2022, 2(4), 495-511; https://doi.org/10.3390/kidneydial2040045 - 4 Oct 2022

Cited by 4 | Viewed by 4965

Abstract

Diabetic nephropathy is the leading cause of dialysis therapy worldwide. The number of diabetes patients on dialysis in clinical settings has been increasing in Japan. In 2013, the Japanese Society for Dialysis Therapy (JSDT) published the “Best Practice for Diabetic Patients on Hemodialysis [...] Read more.

Diabetic nephropathy is the leading cause of dialysis therapy worldwide. The number of diabetes patients on dialysis in clinical settings has been increasing in Japan. In 2013, the Japanese Society for Dialysis Therapy (JSDT) published the “Best Practice for Diabetic Patients on Hemodialysis 2012”. While glycated hemoglobin (HbA1c) is used mainly as a glycemic control index for dialysis patients overseas, Japan is the first country in the world to use glycated albumin (GA) for assessment. According to a survey conducted by the JSDT in 2018, the number of facilities measuring only HbA1c has decreased compared with 2013, while the number of facilities measuring GA or both has significantly increased. Ten years have passed since the publication of the first edition of the guidelines, and several clinical studies regarding the GA value and mortality of dialysis patients have been reported. In addition, novel antidiabetic agents have appeared, and continuous glucose monitoring of dialysis patients has been adopted. On the other hand, Japanese dialysis patients are rapidly aging, and the proportion of patients with malnutrition is increasing. Therefore, there is great variation among diabetes patients on dialysis with respect to their backgrounds and characteristics. This review covers the indices and targets of glycemic control, the treatment of hyperglycemia, and diet recommendations for dialysis patients with diabetes. Full article

(This article belongs to the Special Issue Seeking out SDGs in Dialysis Medicine—Selected Articles from the JSDT Conference, Yokohama 2022)

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11 pages, 718 KiB

Open AccessPerspective

How Can We Improve the Appetite of Older Patients on Dialysis in Japan?

by Yukie Kitajima

Kidney Dial. 2024, 4(2), 105-115; https://doi.org/10.3390/kidneydial4020008 - 8 May 2024

Viewed by 1647

Abstract

It is necessary to ensure adequate energy and protein intake in dialysis patients. However, in addition to the decline in dietary intake in older dialysis patients due to aging, the rate of anorexia is high in dialysis patients, which increases the risk of [...] Read more.

It is necessary to ensure adequate energy and protein intake in dialysis patients. However, in addition to the decline in dietary intake in older dialysis patients due to aging, the rate of anorexia is high in dialysis patients, which increases the risk of protein–energy wasting (PEW), sarcopenia, and frailty. There are many causes of anorexia in dialysis patients, including older dialysis patients, and approaches to improve the appetite of such patients have been reported; however, there has been no established approach to improve appetite adequately. Therefore, a key practical goal is to identify anorexia early and implement timely interventions before weight loss occurs. Appetite assessment tools and weight loss assessments are helpful for the screening and early identification of anorectic signs. Nutritional interventions include reducing dietary restrictions, using oral nutritional supplements, and intradialytic parenteral nutrition, as well as replenishing energy, protein, and zinc to prevent the development of nutritional disorders among older dialysis patients. Appetite assessments, early intervention, and dietary and nutritional counseling are key to improving appetite in these patients. The aging rate of dialysis patients in Japan is unprecedented globally, and I believe that this is a situation that will eventually occur in other countries as well. I discuss the factors that contribute to anorexia, especially in older dialysis patients, and Japan’s efforts to address this problem, such as the relaxation of dietary restrictions and the use of oral nutritional supplements. Full article

(This article belongs to the Special Issue Seeking out SDGs in Dialysis Medicine—Selected Articles from the JSDT Conference, Yokohama 2022)

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11 pages, 3710 KiB

Open AccessPerspective

Non-Ischemic Myocardial Fibrosis in End-Stage Kidney Disease Patients: A New Perspective

by Kenji Nakata and Nobuhiko Joki

Kidney Dial. 2023, 3(3), 311-321; https://doi.org/10.3390/kidneydial3030027 - 6 Sep 2023

Viewed by 1773

Abstract

Cardiovascular medicine, especially for ischemic heart disease, has evolved and advanced over the past two decades, leading to substantially improved outcomes for patients, even those with chronic kidney disease. However, the prognosis for patients with end-stage kidney disease (ESKD) has not improved so [...] Read more.

Cardiovascular medicine, especially for ischemic heart disease, has evolved and advanced over the past two decades, leading to substantially improved outcomes for patients, even those with chronic kidney disease. However, the prognosis for patients with end-stage kidney disease (ESKD) has not improved so greatly. Recent studies have reported that myocardial fibrosis in chronic kidney disease patients is characterized by patchy and interstitial patterns. Areas of fibrosis have been located in the perivascular space, and severe fibrotic lesions appear to spread into myocardial fiber bundles in the form of pericellular fibrosis. These findings are fully consistent with known characteristics of reactive fibrosis. In hemodialysis patients, a greater extent of myocardial fibrosis is closely associated with a poorer prognosis. In this review, we focus on non-ischemic cardiomyopathy, especially reactive myocardial fibrosis, in ESKD patients. Full article

(This article belongs to the Special Issue Seeking out SDGs in Dialysis Medicine—Selected Articles from the JSDT Conference, Yokohama 2022)

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