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The Importance of Diet Control in Patients with Polycystic Kidney Disease

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

Deadline for manuscript submissions: closed (5 November 2024) | Viewed by 10412

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Department of Nephrology, Dialysis, and Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
Interests: advanced glycation end-products (AGE); chronic kidney disease (CKD); soluble receptor for age (sRAGE); cleaved RAGE (cRAGE); endogenous secretory RAGE (esRAGE); vitamin D; sars-cov-2 infection; kidney transplantation
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Special Issue Information

Dear Colleagues,

Autosomal dominant polycystic kidney disease (ADPKD) is the first genetic cause of end-stage renal disease (ESRD). Notwithstanding the relevant recent advances in the pharmacological approach to this disease, most ADPKD patients still progress toward ESRD, requiring chronic replacement therapies. The role of dietary intervention, either for the control of the disease progression and/or the development of the frequently associated clinical complications (primarily, cardiovascular and metabolic diseases) in ADPKD patients, has been the object of very few controlled studies, which furthermore gave contradictory results. Consequently, many questions on a number of very critical issues still remain unanswered. Beyond those related to the role of salt, protein, and phosphate dietary restriction (problems shared with most other chronic renal diseases), uncertainties still remain about the role, if any, of water intake, diet caloric intake, the type of diet proteins, the dietary acidic load, vitamin and mineral supplementations, and the content of specific dietary components (caffeine, resveratrol, curcumin, etc).

Furthermore, the problems related to malnutritional conditions that often occur in ADPKD patients should not be disregarded, particularly in the most advanced stages, due to the huge increase in the mass of the kidneys and, sometimes, of the liver, which can negatively impact on the gastrointestinal functions, deserving specific and complicate dietary approaches.

This shortage of information is particularly critical in light of the consideration that ADPKD, despite being a genetic disease and therefore already present and diagnosable since birth, manifests itself clinically in most cases only after the fourth decade of life. So, there would be a great deal of room for the use of therapeutic interventions which, if effective and implemented early, could have a considerable impact on the progression of the disease. Obviously, dietary interventions, if proven effective, would have undoubted advantages in terms of safety and cost as compared to pharmacological ones.

On this background, we decided to start with an Special Issue of Nutrients specifically directed at collecting any type of contribution (controlled interventional and/or observational studies; systematic reviews and/or metanalyses; case series; experimental studies; narrative reviews) dealing with one or more of the above-listed topics or any additional problem related to the dietary approach in ADPKD patients, at any stage of their disease.

We decided first to invite scholars who have well-recognized scientific experience in this field, but we will be delighted to receive contributions from any other scientist who is willing to share her/his results with the scientific community.

I am very excited and looking forward to receiving suggestions and contributions from you all.

Prof. Dr. Piergiorgio Messa
Guest Editor

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Keywords

  • autosomal dominant polycystic kidney disease (ADPKD)
  • diet
  • dietary habit
  • dietary supplements
  • diet composition
  • water intake
  • malnutrition
  • obesity and ADPKD
  • renal disease progression in ADPKD.

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Published Papers (2 papers)

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Review

30 pages, 1570 KiB  
Review
Trigger Warning: How Modern Diet, Lifestyle, and Environment Pull the Trigger on Autosomal Dominant Polycystic Kidney Disease Progression
by Melina Messing, Jacob A. Torres, Nickolas Holznecht and Thomas Weimbs
Nutrients 2024, 16(19), 3281; https://doi.org/10.3390/nu16193281 - 27 Sep 2024
Cited by 1 | Viewed by 5727
Abstract
Understanding chronic kidney disease (CKD) through the lens of evolutionary biology highlights the mismatch between our Paleolithic-optimized genes and modern diets, which led to the dramatically increased prevalence of CKD in modern societies. In particular, the Standard American Diet (SAD), high in carbohydrates [...] Read more.
Understanding chronic kidney disease (CKD) through the lens of evolutionary biology highlights the mismatch between our Paleolithic-optimized genes and modern diets, which led to the dramatically increased prevalence of CKD in modern societies. In particular, the Standard American Diet (SAD), high in carbohydrates and ultra-processed foods, causes conditions like type 2 diabetes (T2D), chronic inflammation, and hypertension, leading to CKD. Autosomal dominant polycystic kidney disease (ADPKD), a genetic form of CKD, is characterized by progressive renal cystogenesis that leads to renal failure. This review challenges the fatalistic view of ADPKD as solely a genetic disease. We argue that, just like non-genetic CKD, modern dietary practices, lifestyle, and environmental exposures initiate and accelerate ADPKD progression. Evidence shows that carbohydrate overconsumption, hyperglycemia, and insulin resistance significantly impact renal health. Additionally, factors like dehydration, electrolyte imbalances, nephrotoxin exposure, gastrointestinal dysbiosis, and renal microcrystal formation exacerbate ADPKD. Conversely, carbohydrate restriction, ketogenic metabolic therapy (KMT), and antagonizing the lithogenic risk show promise in slowing ADPKD progression. Addressing disease triggers through dietary modifications and lifestyle changes offers a conservative, non-pharmacological strategy for disease modification in ADPKD. This comprehensive review underscores the urgency of integrating diet and lifestyle factors into the clinical management of ADPKD to mitigate disease progression, improve patient outcomes, and offer therapeutic choices that can be implemented worldwide at low or no cost to healthcare payers and patients. Full article
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17 pages, 1016 KiB  
Review
Ketogenic Interventions in Autosomal Dominant Polycystic Kidney Disease: A Comprehensive Review of Current Evidence
by Carla Pezzuoli, Giuseppe Biagini and Riccardo Magistroni
Nutrients 2024, 16(16), 2676; https://doi.org/10.3390/nu16162676 - 13 Aug 2024
Viewed by 4057
Abstract
Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a genetic disorder characterized by the development and enlargement of multiple kidney cysts, leading to progressive kidney function decline. To date, Tolvaptan, the only approved treatment for this condition, is able to slow down the loss [...] Read more.
Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a genetic disorder characterized by the development and enlargement of multiple kidney cysts, leading to progressive kidney function decline. To date, Tolvaptan, the only approved treatment for this condition, is able to slow down the loss of annual kidney function without stopping the progression of the disease. Furthermore, this therapy is approved only for patients with rapid disease progression and its compliance is problematic because of the drug’s impact on quality of life. The recent literature suggests that cystic cells are subject to several metabolic dysregulations, particularly in the glucose pathway, and mitochondrial abnormalities, leading to decreased oxidative phosphorylation and impaired fatty acid oxidation. This finding paved the way for new lines of research targeting potential therapeutic interventions for ADPKD. In particular, this review highlights the latest studies on the use of ketosis, through ketogenic dietary interventions (daily calorie restriction, intermittent fasting, time-restricted feeding, ketogenic diets, and exogenous ketosis), as a potential strategy for patients with ADPKD, and the possible involvement of microbiota in the ketogenic interventions’ effect. Full article
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