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Nutritional Problems of Children and Adults in Chronic Kidney Disease

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

Deadline for manuscript submissions: closed (15 September 2023) | Viewed by 22056

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Prof. Dr. Małgorzata Szczuko

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Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland
Interests: nutrition; inflammation; metabolism; diabetes; microbiome; short-chain fatty acids; vitamins
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Dr. Karolina Kędzierska-Kapuza

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Department of Gastroenterological Surgery and Transplantology, Centre of Postgraduate Medical Education, Marymoncka St. 99/103, 01-813 Warsaw, Poland
Interests: chronic kidney disease; dialysis; transplantation; diabetes; vitamins; liver; pancreas
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Dear Colleagues,

The main cause of chronic kidney disease (CKD) and End-Stage Renal Disease (ESRD) is obesity, hypertension, and diabetes in adults. That is why CKD is called a civilization disease.

The topic of chronic kidney disease nutrition depends on the stage of the patient’s disease and nutritional status.

The slow, irreversible, and progressive deterioration of kidney function, characterized by a reduction in glomerular filtration rate, brings with it many challenges for both adult and pediatric patients.

Increased protein catabolism and protein malnutrition are common symptoms in patients.

The etiology includes, but is not limited to, metabolic acidosis, intestinal dysbiosis; systemic inflammation with activation of the complement, endothelin-1 axis, and renin-angiotensin-aldosterone; resistance to anabolic hormones; increase in energy expenditure; and accumulation of uremic toxins. Moreover, it cannot be determined whether the low levels of thyroid hormones in CKD patients are an adaptation that reduces energy expenditure and minimizes protein catabolism, or the abnormal adaptation involved in the wasting syndrome.

Therefore, diet therapy is focused on: inhibiting kidney damage, preventing malnutrition, reducing the severity of metabolic disorders. An interesting issue is the introduction of a vegetarian diet in the nutrition of CKD patients. A vegetarian diet supplemented with ketoanalogues appears to be more beneficial in patients with more advanced CKD.

However, in the case of children, the topic is even more complicated.

Metabolic disorders include growth hormone (GH) and insulin-like growth factor I (IGF-I), electrolyte disturbances, alteration of bone and mineral (calcium and phosphate) metabolism, leading to osteodystrophy.

Moreover, metabolic acidosis, uremia, anemia, inflammation, as well as hyperparathyroidism and hypogonadism, are problems that occur in the same patient. Nutritional deficiencies, vitamin D, vitamin B12 and folate, recurrent vomiting, appetite disorders, and progressive anorexia are tasks for a well-qualified dietitian. At the same time, there is little evidence and interventions in this group of patients, which makes patient care inadequate. Therefore, the purpose of this Special Issue is to discuss various solutions and help CKD patients.

Dr. Małgorzata Szczuko
Dr. Karolina Kędzierska-Kapuza
Guest Editors

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Keywords

chronic kidney disease
children
malnutrition
ketoanalogues
parenteral nutrition
vegetarian diet
metabolic disorders
osteodystrophy

Published Papers (7 papers)

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Research

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12 pages, 3379 KiB

Open AccessArticle

Glyoxylic Acid, an α-Keto Acid Metabolite Derived from Glycine, Promotes Myogenesis in C2C12 Cells

by Toshio Norikura, Yutaro Sasaki, Akiko Kojima-Yuasa and Atsushi Kon

Nutrients 2023, 15(7), 1763; https://doi.org/10.3390/nu15071763 - 04 Apr 2023

Cited by 1 | Viewed by 1648

Abstract

α-Keto acids may help prevent malnutrition in patients with chronic kidney disease (CKD), who consume protein-restricted diets, because they serve as amino acid sources without producing nitrogenous waste compounds. However, the physiological roles of α-keto acids, especially those derived from non-essential amino acids, remain unclear. In this study, we examined the effect of glyoxylic acid (GA), an α-keto acid metabolite derived from glycine, on myogenesis in C2C12 cells. Differentiation and mitochondrial biogenesis were used as myogenesis indicators. Treatment with GA for 6 d resulted in an increase in the expression of differentiation markers (myosin heavy chain II and myogenic regulatory factors), mitochondrial biogenesis, and intracellular amounts of amino acids (glycine, serine, and alanine) and their metabolites (citric acid and succinic acid). In addition, GA treatment suppressed the 2.5-µM dexamethasone (Dex)-induced increase in mRNA levels of ubiquitin ligases (Trim63 and Fbxo32), muscle atrophy markers. These results indicate that GA promotes myogenesis, suppresses Dex-induced muscle atrophy, and is metabolized to amino acids in muscle cells. Although further in vivo experiments are needed, GA may be a beneficial nutrient for ameliorating the loss of muscle mass, strength, and function in patients with CKD on a strict dietary protein restriction. Full article

(This article belongs to the Special Issue Nutritional Problems of Children and Adults in Chronic Kidney Disease)

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12 pages, 880 KiB

Open AccessArticle

Water-Soluble Vitamins Status in Patients Undergoing Maintenance Hemodialysis

by Małgorzata Kaczkan, Sylwia Czaja-Stolc, Małgorzata Szczuko, Arleta Drozd, Przemysław Rutkowski, Alicja Dębska-Ślizień and Sylwia Małgorzewicz

Nutrients 2023, 15(2), 440; https://doi.org/10.3390/nu15020440 - 14 Jan 2023

Cited by 1 | Viewed by 2330

Abstract

The concentration of water-soluble vitamins (except folic acid and vitamin B₁₂) is not routinely measured, which may lead to undiagnosed deficiencies among hemodialysis (HD) patients. The aim of the study was to assess the blood concentration of water-soluble vitamins in HD patients in comparison with healthy subjects and to assess the impact of diabetes mellitus (DM) coexistence on the concentration of these vitamins. The two-center study included 142 HD patients and a control group of 31 healthy subjects. Vitamins concentration was determined using high-performance liquid chromatography (HPLC). Vitamin B₁, B₆, and B₁₂ levels were significantly lower in the HD group than in the control group (p < 0.001). Vitamin B₁ and B₂ were negatively correlated with blood urea nitrogen (BUN) levels before HD (R = −0.39, R = −0.38; p < 0.05). Vitamin B₃, B₁₂, and C were positively correlated with the albumin concentration (R = 0.26, R = 0.27, R = 0.28; p < 0.05). Among diabetic patients, only the concentration of vitamin B₁ was lower than among non-diabetic patients. The concentration of water-soluble vitamins may be related to the adequacy of dialysis, the time of laboratory determination since the last dialysis, diet, coexistence of other diseases, use of drugs, and dietary supplements in individual patients. Full article

(This article belongs to the Special Issue Nutritional Problems of Children and Adults in Chronic Kidney Disease)

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15 pages, 1695 KiB

Open AccessArticle

Effect of Diet and Supplementation on Serum Vitamin C Concentration and Antioxidant Activity in Dialysis Patients

by Anna Bogacka, Anna Sobczak-Czynsz, Edyta Balejko, Angelika Heberlej and Kazimierz Ciechanowski

Nutrients 2023, 15(1), 78; https://doi.org/10.3390/nu15010078 - 24 Dec 2022

Cited by 3 | Viewed by 2125

Abstract

Loss of vitamin C, especially in conjunction with an inadequate supply, can lead to decreased plasma concentrations of vitamin C. This in turn can lead to overt or subclinical deficiency. The present study aimed to evaluate the effects of diet and supplementation on vitamin C concentrations and serum antioxidant activity (FRAP) in hemodialysis (HD) patients. Sixty-eight HD patients participated in the study. In all of them, the diet was initially determined, and they were divided into five groups according to the diet and supplementation used. Group 1 received an unchanged diet, considered by them to be optimal; in group 2, the standard diet used in HD patients was introduced; in group 3, a standard diet enriched with natural antioxidants was employed; in group 4, a standard diet as in group 2 was used, but enriched with supplements (vitamin C, vitamin E, Se, and Zn). In contrast, group 5 consisted of HD patients with coexisting diabetes. Vitamin C serum levels were determined by high-performance liquid chromatography HPLC and antioxidant activity by The Ferric Reducing Ability of Plasma FRAP. The study shows that a well-chosen diet can slow the build-up of malnutrition and increase antioxidant activity as measured by the FRAP method in the blood of hemodialysis patients. Vitamin C supplementation can improve antioxidant status in hemodialysis patients. * The results presented in this paper complement our study, which assessed the effect of diet on the activity of erythrocyte antioxidant enzymes: Catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px), but also on the concentrations of non-enzymatic antioxidants (tocopherols, carotenoids, and vitamin C) in hemodialysis patients. In the study, plasma malondialdehyde (MDA) concentrations were assessed as an indicator of oxidative damage. Full article

(This article belongs to the Special Issue Nutritional Problems of Children and Adults in Chronic Kidney Disease)

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16 pages, 893 KiB

Open AccessArticle

Adherence to Caloric and Protein Recommendations in Older Hemodialysis Patients: A Multicenter Study

by Sylwia Czaja-Stolc, Ewelina Puchalska-Reglińska, Sylwia Małgorzewicz, Marta Potrykus, Małgorzata Kaczkan, Aneta Kałużna, Zbigniew Heleniak and Alicja Dębska-Ślizień

Nutrients 2022, 14(19), 4160; https://doi.org/10.3390/nu14194160 - 07 Oct 2022

Cited by 3 | Viewed by 1735

Abstract

Hemodialysis (HD) patients are characterized by malnutrition, which adversely affects their survival. The development of malnutrition is influenced, among other factors, by improper diet and the advanced age of patients. The study aimed to assess the nutritional status and adherence to dietary recommendations among older patients. The multicenter study included 179 stable HD patients. The nutritional status was assessed by a 7-point Subjective Global Assessment (SGA). Anthropometry and body composition was analyzed. The diet was assessed based on the 3-day food diary and the Food Frequency Questionnaire with 6 answers (FFQ-6). Blood laboratory tests were performed. Based on the 7-point SGA, malnutrition was diagnosed in 38.5% of HD patients. The decreased content of the muscle tissue (LTI < 14 kg/m²) was observed in 70.4% of the examined patients and the decreased concentration of s-albumin was observed in 44.1% of patients. Older patients had significantly lower LTI. 26% of patients consumed less than 25 kcal/kg body weight and less than 0.8 g protein/kg body weight. Older patients’ diets contained significantly fewer calories. There were significant differences between nutrient intake on a weekday with dialysis, a weekday without dialysis, and a weekend day without dialysis. The lowest intake of nutrients was observed on the day of dialysis. Nutritional education and the determination of whether food is permitted during hemodialysis are necessary to improve patients’ nutrition. Full article

(This article belongs to the Special Issue Nutritional Problems of Children and Adults in Chronic Kidney Disease)

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Review

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18 pages, 848 KiB

Open AccessReview

Does Vitamin Supplementation Play a Role in Chronic Kidney Disease?

by Aleksandra Beata Juszczak, Maciej Kupczak and Tomasz Konecki

Nutrients 2023, 15(13), 2847; https://doi.org/10.3390/nu15132847 - 23 Jun 2023

Cited by 2 | Viewed by 3183

Abstract

Although the role of vitamins in the human body is proven, guidelines for patients with chronic kidney disease (CKD) remain unclear. This narrative review summarizes the findings of 98 studies of CKD and the effects of vitamin D, B, C, A, E, and K supplementation on patients on dialysis for CKD, with the aim of summarizing the existing guidelines. The findings are promising, showing the potential effectiveness of vitamin supplementation with, for example, vitamins B, D, or C. However, recommendations are still ambiguous, especially in the case of vitamins A and K, due to the potential toxicity associated with higher doses for patients. Continued research is needed to rigorously evaluate the effectiveness and carefully consider the potential risks of some vitamin supplementation for patients with CKD. Full article

(This article belongs to the Special Issue Nutritional Problems of Children and Adults in Chronic Kidney Disease)

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15 pages, 774 KiB

Open AccessReview

Diet and Physical Activity in Adult Dominant Polycystic Kidney Disease: A Review of the Literature

by Irene Capelli, Sarah Lerario, Valeria Aiello, Michele Provenzano, Roberta Di Costanzo, Andrea Squadrani, Anna Vella, Valentina Vicennati, Carolina Poli, Gaetano La Manna and Olga Baraldi

Nutrients 2023, 15(11), 2621; https://doi.org/10.3390/nu15112621 - 03 Jun 2023

Cited by 1 | Viewed by 4412

Abstract

Autosomal polycystic kidney disease is the most common inherited kidney disease determining 5% of all end-stage kidney disease. The only therapy approved for this condition is Tolvaptan, which, with its aquaretic effect, has a strong effect on patients’ daily life. Recently, the literature has been enriched with new works that analyze possible non-pharmacological therapeutic strategies to slow cysts’ enlargement and chronic kidney disease progression. Among them, dietary schemes reducing carbohydrate intake and inducing ketoses have been demonstrated to have efficacy in several pre-clinical and clinical studies. A ketogenic diet, calorie restriction, intermittent fasting, and time-restricted feeding can reduce aerobic glycolysis and inhibit the mTOR pathway, producing a reduction in cyst cell proliferation, a reduction in kidney volume, and helping to preserve kidney function. ADPKD’s burden of disease has an impact on patients’ quality of life, and the possibility to play sports or carry out physical exercise can help people in everyday life. The multisystemic character of the disease, especially cardiovascular involvement, needs to be carefully evaluated to establish the quality and quantity of physical activity that patients can safely carry out. Full article

(This article belongs to the Special Issue Nutritional Problems of Children and Adults in Chronic Kidney Disease)

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19 pages, 2362 KiB

Open AccessSystematic Review

Demand for Water-Soluble Vitamins in a Group of Patients with CKD versus Interventions and Supplementation—A Systematic Review

by Karolina Kędzierska-Kapuza, Urszula Szczuko, Hanna Stolińska, Dimitra Rafailia Bakaloudi, Waldemar Wierzba and Małgorzata Szczuko

Nutrients 2023, 15(4), 860; https://doi.org/10.3390/nu15040860 - 08 Feb 2023

Cited by 5 | Viewed by 5115

Abstract

Background: Increasingly, chronic kidney disease (CKD) is becoming an inevitable consequence of obesity, metabolic syndrome, and diabetes. As the disease progresses, and through dialysis, the need for and loss of water-soluble vitamins both increase. This review article looks at the benefits and possible risks of supplementing these vitamins with the treatment of CKD. Methods: Data in the PubMed and Embase databases were analyzed. The keywords “chronic kidney disease”, in various combinations, are associated with thiamin, riboflavin, pyridoxine, pantothenic acid, folates, niacin, cobalamin, and vitamin C. This review focuses on the possible use of water-soluble vitamin supplementation to improve pharmacological responses and the overall clinical condition of patients. Results: The mechanism of supportive supplementation is based on reducing oxidative stress, covering the increased demand and losses resulting from the treatment method. In the initial period of failure (G2-G3a), it does not require intervention, but later, especially in the case of inadequate nutrition, the inclusion of supplementation with folate and cobalamin may bring benefits. Such supplementation seems to be a necessity in patients with stage G4 or G5 (uremia). Conversely, the inclusion of additional B6 supplementation to reduce CV risk may be considered. At stage 3b and beyond (stages 4–5), the inclusion of niacin at a dose of 400–1000 mg, depending on the patient’s tolerance, is required to lower the phosphate level. The inclusion of supplementation with thiamine and other water-soluble vitamins, especially in peritoneal dialysis and hemodialysis patients, is necessary for reducing dialysis losses. Allowing hemodialysis patients to take low doses of oral vitamin C effectively reduces erythropoietin dose requirements and improves anemia in functional iron-deficient patients. However, it should be considered that doses of B vitamins that are several times higher than the recommended dietary allowance of consumption may exacerbate left ventricular diastolic dysfunction in CKD patients. Conclusions: Taking into account the research conducted so far, it seems that the use of vitamin supplementation in CKD patients may have a positive impact on the treatment process and maintaining a disease-free condition. Full article

(This article belongs to the Special Issue Nutritional Problems of Children and Adults in Chronic Kidney Disease)

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