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Nutritional Continuation and Gap between in Early CKD and Advanced CKD including Dialysis Patients

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Special Issue Editor

Dr. Yasuyuki Nagasawa

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Guest Editor

Department of General Internal Medicine, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan
Interests: CKD; IgA nephropathy; dialysis; periodontal diseases; nutrition; heart failure

Special Issue Information

Dear Colleagues,

In CKD patients, nutritional intervention is one of the important therapeutic methods used from early CKD stages to advanced CKD stages, including dialysis patients. During early CKD stages, the purpose of nutritional intervention is mainly to maintain kidney function. However, in advanced CKD patients, nutritional therapies became multi-purpose, as they could maintain residual kidney function, prolong duration of life, make dialysis therapy safe and convenient, and so on. Therefore, there are nutritional continuations and gaps between early CKD and advanced CKD stages, including dialysis patients. Moreover, nutritional components consist of many factors, such as sodium, potassium, water, calories, protein, phosphate, and many micro-elements. Kidney dysfunction and dialysis therapy can impact each component differently. In this Special Issue, reviews and original articles intend to reveal the gap between early CKD stages to advanced CKD stages, including dialysis patients, in each nutritional component.

Dr. Yasuyuki Nagasawa
Guest Editor

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Keywords

CKD
nutrition
sodium
potassium
protein
energy
microelements
magnesium
iron

Published Papers (2 papers)

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Research

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12 pages, 17883 KiB

Open AccessArticle

Association between Intra- and Extra-Cellular Water Ratio Imbalance and Natriuretic Peptides in Patients Undergoing Hemodialysis

by Yui Nakayama, Yosuke Yamada, Shingo Ishii, Mai Hitaka, Keisuke Yamazaki, Motoyuki Masai, Nobuhiko Joki, Ken Sakai and Yasushi Ohashi

Nutrients 2023, 15(5), 1274; https://doi.org/10.3390/nu15051274 - 03 Mar 2023

Cited by 3 | Viewed by 1983

Abstract

Natriuretic peptides are associated with malnutrition and volume overload. Over-hydration cannot simply be explained by excess extracellular water in patients undergoing hemodialysis. We assessed the relationship between the extracellular and intracellular water (ECW/ICW) ratio, N-terminal pro-B-type natriuretic peptide (NT-proBNP), human atrial natriuretic peptide (hANP), and echocardiographic findings. Body composition was examined by segmental multi-frequency bioelectrical impedance analysis in 368 patients undergoing maintenance dialysis (261 men and 107 women; mean age, 65 ± 12 years). Patients with higher ECW/ICW ratio quartiles tended to be older, were on dialysis longer, and had higher post-dialysis blood pressure and lower body mass index, ultrafiltration volume, serum albumin, blood urea nitrogen, and creatinine levels (p < 0.05). The ECW/ICW ratio significantly increased with decreasing ICW, but not with ECW. Patients with a higher ECW/ICW ratio and lower percent fat had significantly higher natriuretic peptide levels. After adjusting for covariates, the ECW/ICW ratio remained an independent associated factor for natriuretic peptides (β = 0.34, p < 0.001 for NT-proBNP and β = 0.40, p < 0.001 for hANP) and the left ventricular mass index (β = 0.20, p = 0.002). The ICW-ECW volume imbalance regulated by decreased cell mass may explain the reserve capacity for fluid accumulation in patients undergoing hemodialysis. Full article

(This article belongs to the Special Issue Nutritional Continuation and Gap between in Early CKD and Advanced CKD including Dialysis Patients)

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Review

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12 pages, 985 KiB

Open AccessEditor’s ChoiceReview

Plant-Dominant Low Protein Diet: A Potential Alternative Dietary Practice for Patients with Chronic Kidney Disease

by Yusuke Sakaguchi, Jun-Ya Kaimori and Yoshitaka Isaka

Nutrients 2023, 15(4), 1002; https://doi.org/10.3390/nu15041002 - 16 Feb 2023

Cited by 11 | Viewed by 5074

Abstract

Dietary protein restriction has long been a cornerstone of nutritional therapy for patients with chronic kidney diseases (CKD). However, the recommended amount of dietary protein intake is different across guidelines. This is partly because previous randomized controlled trials have reported conflicting results regarding the efficacy of protein restriction in terms of kidney outcomes. Interestingly, a vegetarian, very low protein diet has been shown to reduce the risk of kidney failure among patients with advanced CKD, without increasing the incidence of hyperkalemia. This finding suggests that the source of protein may also influence the kidney outcomes. Furthermore, a plant-dominant low-protein diet (PLADO) has recently been proposed as an alternative dietary therapy for patients with CKD. There are several potential mechanisms by which plant-based diets would benefit patients with CKD. For example, plant-based diets may reduce the production of gut-derived uremic toxins by increasing the intake of fiber, and are useful for correcting metabolic acidosis and hyperphosphatemia. Plant proteins are less likely to induce glomerular hyperfiltration than animal proteins. Furthermore, plant-based diets increase magnesium intake, which may prevent vascular calcification. More evidence is needed to establish the efficacy, safety, and feasibility of PLADO as a new adjunct therapy in real-world patients with CKD. Full article

(This article belongs to the Special Issue Nutritional Continuation and Gap between in Early CKD and Advanced CKD including Dialysis Patients)

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