Search Results (122)

Kidney transplant recipients face a substantial burden of premature mortality and morbidity, primarily due to persistent inflammation, cardiovascular risk, and nutritional deficiencies. Traditional nutritional interventions in this population have either focused on supplementing individual nutrients—often with limited efficacy—or required comprehensive dietary overhauls that compromise patient adherence. In this narrative review, we explore the rationale for dietary nut enrichment as a feasible, multi-nutrient strategy tailored to the needs of kidney transplant recipients. Nuts, including peanuts and tree nuts with no added salt, sugar, or oil, are rich in beneficial fats, proteins, vitamins, minerals, and bioactive compounds. We summarize the multiple post-transplant challenges—including obesity, sarcopenia, dyslipidemia, hypertension, immunological dysfunction, and chronic inflammation—and discuss how nut consumption may mitigate these issues through mechanisms involving improved micro-nutrient intake (e.g., magnesium, potassium, selenium), lipid profile modulation, endothelial function, immune support, and gut microbiota health. Additionally, we highlight the scarcity of randomized controlled trials in high-risk populations such as kidney transplant recipients and make the case for studying this group as a model for investigating the clinical efficacy of nuts as a nutritional intervention. We also consider practical aspects for future clinical trials, including the choice of study population, intervention design, duration, nut type, dosage, and primary outcome measures such as systemic inflammation. Finally, potential risks such as nut allergies and oxalate or mycotoxin exposure are addressed. Altogether, this review proposes dietary nut enrichment as a promising, simple, and sustainable multi-nutrient approach to support cardiometabolic and immune health in kidney transplant recipients, warranting formal investigation in clinical trials. Full article

Background: Magnesium (Mg) is an essential mineral that plays a vital role in various physiological processes, including enzyme regulation, neuromuscular function, and cardiovascular health. Dysmagnesemia has been associated with arrhythmias, neuromuscular dysfunction, and poor outcomes in intensive care unit (ICU) settings, representing diagnostic and therapeutic challenges. However, the relationship between dysmagnesemia and health outcomes in the ICU remains inadequately defined. Aim/Objective: This study aimed to assess the prevalence of dysmagnesemia and evaluate the correlation between total (tMg) and ionized magnesium (iMg) levels in a cohort of ICU and high dependency unit (HDU) patients. It also sought to evaluate patient characteristics and relevant health outcomes by comparing both concentrations of iMg and tMg. Methods: This prospective study was conducted among adult patients admitted to the ICU and the high dependency unit (HDU). Results: Among the 134 included patients, the median age was 63.5 years (IQR: 52.0–77.0). The majority, 91.0%, required mechanical ventilation. Additionally, 50.0% were diagnosed with diabetes, 28.4% had chronic kidney disease, and proton pump inhibitors (PPIs) were administered to 67.2% of the patients. The prevalence of hypomagnesemia, as measured by iMg, was 6.7%, while hypermagnesemia was at 39.6%. When measured by tMg, hypomagnesemia and hypermagnesemia were observed at rates of 14.9% and 22.4%, respectively. The iMg measurements showed an association between the incidence of atrial fibrillation and hypomagnesemia (p = 0.015), whereas tMg measurements linked hypomagnesemia with longer hospital stays. Notably, only a few patients identified with iMg-measured hypomagnesemia received magnesium replacement during their ICU stay. Conclusions: Dysmagnesemia is prevalent among critically ill patients, with discordance between iMg and tMg measurements. iMg appears more sensitive in detecting arrhythmia risk, while tMg correlates with length of stay. These findings support the need for larger studies and suggest considering iMg in magnesium monitoring and replacement strategies. Full article

Acid–base balance is critical to human health and can be significantly influenced by dietary choices. The Western diet, characterized by high meat and cheese consumption, induces excess acidity, highlighting the need for strategies to mitigate this. Recent studies have focused on bicarbonate-rich mineral water as a viable solution. In this context, the present narrative review synthesizes the findings from recent scientific studies on bicarbonate-rich mineral water, specifically those with bicarbonate levels over 1300 mg/L and medium or low PRAL values. This water has been shown to exert beneficial effects on both urinary and blood parameters. The key effects include an increase in the urine pH and a profound reduction in net acid excretion as a sign for a reduced acid load. Additionally, bicarbonate mineral water has been shown to decrease the excretion of nephrolithiasis-related constituents, including calcium and oxalates, as well as inhibitory substances such as magnesium and citrates. In blood, bicarbonate-rich water has been demonstrated to stabilize pH and increase bicarbonate levels, thereby enhancing systemic buffering capacity. Clinically, these changes have been associated with a lowered risk of calcium oxalate stone formation and improved kidney health. Furthermore, bicarbonate-rich water has been shown to support bone health by reducing bone resorption markers. Consequently, the integration of bicarbonate-rich mineral water into the diet has the potential to enhance urinary and blood parameters, mitigate the risk of kidney stones, and strengthen skeletal integrity, thereby serving as a promising strategy for health promotion and disease prevention. While promising, these findings underscore the need for further research to establish long-term recommendations. Future interventional studies should be designed with rigorous randomization, larger sample sizes, cross-over methodologies, and comprehensive dietary assessments to address the methodological limitations of previous research. Full article

Hypomagnesemia is the most common electrolyte disorder in kidney transplant recipients (KTR), yet its causes remain unclear. Few studies have explored its underlying factors. This study aimed to assess its prevalence and identify risk factors in KTR. We conducted a retrospective cross-sectional study in 489 outpatient KTR. Demographic, clinical, and laboratory data were collected. Univariate and multivariate logistic regression analyses were used to identify factors associated with hypomagnesemia (≤1.7 mg/dL). Hypomagnesemia was present in 50.7% of patients. Multivariate analysis identified tacrolimus [OR 2.91 (1.62–5.22)], thiazides [OR 2.23 (1.21–4.08)], cinacalcet [OR 2.31 (1.29–4.13)], serum phosphate < 3.7 mg/dL [1.99 (1.29–3.05)], serum calcium ≤ 10 mg/dL [1.99 (1.29–3.05)] and diabetes [1.94 (1.22–3.08)] as risk factors. Protective factors included SGLT2 inhibitors (SGLT2i) [OR 0.17 (0.10–0.27)] and mTOR inhibitors (mTORi) [OR 0.62 (0.38–0.98)]. Among hypomagnesemic patients, those receiving Mg²⁺ supplements had lower Mg²⁺ levels [1.54 (0.15) vs. 1.59 (0.13) mg/dL, p = 0.005] and higher fractional Mg²⁺ excretion [8.28 (4.48)% vs. 7.36 (4.19)%, p = 0.05]. Hypomagnesemia is highly prevalent in KTR. Tacrolimus, thiazides, and cinacalcet are key risk factors and, in some patients, risks and benefits of continuing these medications should be carefully weighed. In refractory cases, SGLT2i or mTORi may offer benefit. Full article

Renal function refers to the combined actions of the glomerulus and tubular system to achieve homeostasis in bodily fluids. While the glomerulus is essential in the first step of urine formation through a coordinated filtration mechanism, the tubular system carries out active mechanisms of secretion and reabsorption of solutes and proteins using specific transporters in the epithelial cells. The assessment of renal function usually focuses on glomerular function, so the tubular function is often underestimated as a fundamental part of daily clinical practice. Therefore, it is essential to properly understand the tubular physiological mechanisms and their clinical association with prevalent human pathologies. This review discusses the primary solutes handled by the kidneys, including glucose, amino acids, sodium, potassium, calcium, phosphate, citrate, magnesium and uric acid. Additionally, it emphasizes the significance of physicochemical characteristics of urine, such as pH and osmolarity. The use of a concise methodology for the comprehensive assessment of urine should be strengthened in the basic training of nephrologists when dealing with problems such as water and electrolyte balance disorders, acid-base disorders, and harmful effects of commonly used drugs such as chemotherapy, antibiotics, or diuretics to avoid isolated replacement of the solute without carrying out comprehensive approaches, which can lead to potentially severe complications. Full article

Objectives: Fosfomycin is an old antibiotic that has recently gained attention owing to its preserved activity against multidrug-resistant (MDR) bacteria. Data on its use in real life are limited. Thus, we evaluated the efficacy and safety of fosfomycin disodium in the context of our hospital clinical practice. Methods: Single-center, retrospective, observational study on 56 patients who received fosfomycin disodium from September 2016 to July 2023, focusing on clinical and microbiological outcomes and adverse events. Results: Included in this study were 56 patients. Fosfomycin disodium was administered for a median duration of 10 days [5–13.5] and was always used in combination with other antibiotics, more frequently with meropenem (16 cases, 28.6%) and colistin (11 cases, 19.6%). It was mostly used for treating pneumonia (41%), followed by bloodstream infections (19.6%), urinary tract infections (16.1%), bone infections (16.1%), and surgical site infections (7.1%). The most common isolated pathogen was Pseudomonas aeruginosa (17%), and polymicrobial infections were detected in 18 patients (32%). Among the isolated bacteria, 36 (44.4%) were MDR. The complete resolution, defined as the disappearance of symptoms, eradication of the causative microorganism, and decrease in CRP levels, was achieved in 39% of cases. During treatment, we observed electrolyte imbalances, in particular a decrease in serum potassium (0.6 mEq/L [0.3–1.1]), calcium (0.7 mEq/L [0.3–1.1]) and magnesium levels (0.3 mg/dL [0.20–0.48]), and an increase in serum sodium levels (4 mEq/dL [2–7]). Changes in potassium and sodium levels were more pronounced in patients with prior kidney dysfunction and heart failure, respectively, and in patients receiving fosfomycin diluted with saline compared with 5% glucose solution (p = 0.04). Conclusions: Fosfomycin is effective in treating complicated infections in comorbid patients when combined with other antimicrobials. During treatment, major electrolyte imbalances occur that require careful monitoring and correction, especially in patients with prior kidney disease. Full article

It is now widely recognized that maintaining magnesium (Mg) homeostasis is critical for health, especially in the context of chronic kidney disease (CKD). Patients with CKD commonly develop hyperphosphatemia and secondary hyperparathyroidism, which are controlled by therapies targeting intestinal phosphate absorption and circulating calcium levels or by modulating parathyroid calcium sensing. Notably, Mg supplementation may provide dual benefits by promoting bone formation and maintaining normal mineralization with slightly elevated serum levels. Importantly, low Mg levels are associated with mortality risk in CKD, highlighting the importance of maintaining adequate serum Mg levels in these patients. Particularly, kidney transplant (KT) patients have lower circulating Mg levels, likely due to interactions with immunosuppressive treatments. Sodium-glucose co-transporter 2 (SGLT2) inhibitors have shown survival benefits in CKD and increased serum Mg levels, suggesting that Mg regulation may contribute to these outcomes. Overall, Mg plays a key role in CKD-associated mineral and bone disorders (CKD-MBD). Thus, understanding the mechanisms underlying the alteration of Mg homeostasis in CKD could improve clinical outcomes. This review summarizes the basic and clinical studies demonstrating (1) the key actions of Mg in CKD-MBD, including secondary hyperparathyroidism and bone abnormalities; (2) the distinctive profile of KT patients for Mg homeostasis; and (3) the interaction between commonly used drugs, such as SGLT2 inhibitors or immunosuppressive treatments, and Mg metabolism, providing a broad understanding of both the key role of Mg in the context of CKD and the treatments that should be considered to manage Mg levels in CKD patients. Full article

Lifestyle and dietary modifications are unanimously suggested as the initial step to treat hypertension in the general population and in patients with chronic kidney disease (CKD). Limiting sodium intake constitutes the cornerstone of dietary interventions, but augmenting dietary potassium intake has also been associated with a significant blood pressure (BP)-lowering effect. Although there may be a consensus about restraining the daily sodium intake to <2 g per day, the target for optimal potassium intake is vague. In hypertensive patients with CKD, the desired amount of potassium in the diet remains a controversial issue, as evidence from studies concerning the effect on CKD progression is contradictory. Hence, medical societies and food authorities worldwide do not share a joint recommendation. Other dietary components, including calcium, magnesium, protein, phosphorus, zinc, and alcohol intake may play a role in BP control, but the evidence in the CKD population so far is inconclusive. Further studies are needed to establish solid evidence about the safety and efficacy of dietary interventions, particularly in CKD patients, the majority of whom suffer from hypertension. The purpose of this review is to summarize the existing recommendations and evidence concerning dietary interventions in hypertensives with CKD, with a primary focus on sodium and potassium intake. Additionally, we briefly address other dietary components that may play a role in BP regulation or kidney function. Full article

Background: Different types of kidney stones are associated with distinct changes in urine chemistry. Methods: We assessed urinary parameters of 98 patients with calcium oxalate (CaOx) stones one month following endoscopic stone removal. The 24 h urine analysis encompassed the assessment of various parameters, including volume, sodium, chloride, sulfate, nitrate, fluoride, phosphate, calcium, potassium, magnesium, oxalate, uric acid, citrate, creatinine, and pH levels. Results: Hypocitraturia was the most prevalent urinary abnormality (61.2%, n = 63), followed by low urine volume (53%, n = 52) and hypercalciuria (50%, n = 49). We did not find any statistically significant differences between patients with whewellite (COM) (n = 69) and weddellite (COD) stones (n = 29) (p > 0.05). However, oxalate concentration was the only parameter with a statistically significant intergroup difference (p = 0.0297). Additionally, in univariate linear regression analysis, urinary phosphate levels ≥ 48.0 mmol/d showed a trend towards significance (OR 0.17, 95% CI 0.02–1.15, p = 0.0692), indicating that phosphaturia is associated with a significant increase in the odds ratio of COD stones. To further explore metabolic heterogeneity among stone formers, we conducted cluster analysis, which revealed three distinct metabolic subgroups. Cluster 1 was predominantly associated with COM stones (80.5%) and exhibited significantly higher urinary excretion of sodium, calcium, oxalate, phosphate, and uric acid compared to Cluster 2, which had a more balanced distribution of monohydrate and dihydrate stones. Conclusions: These findings suggest that a specific metabolic phenotype may be linked to COM stone formation, providing a framework for risk stratification and personalized prevention strategies in calcium oxalate stone formers. Full article

Background/Objectives: Retinal vein occlusion (RVO) is a major cause of vision loss globally. Although magnesium (Mg) is crucial for vascular health, its association with RVO risk is unknown. Thus, we aimed to further examine this association. Methods: This cross-sectional study included participants of the Korean National Health and Nutrition Examination Survey 2017–2021 aged ≥19 years (n = 16,358). RVO diagnosis was based on fundus imaging or was self-reported. Based on their daily Mg intake, we categorized participants into low (<120 mg), intermediate (men: 120–300 mg; women: 120–400 mg), and sufficient (men: ≥300 mg; women: ≥400 mg) intake groups and compared their characteristics across groups. Results: RVO prevalence was 0.7%. Compared to the non-RVO group, the RVO group was characterized by older individuals, fewer current alcohol consumers, a higher prevalence of hypertension and chronic kidney disease, and a lower intake of fiber, iron, calcium, vitamin E, and Mg. After full adjustment, sufficient Mg intake was significantly associated with a 64% reduced risk of RVO (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.18–0.71, p = 0.003). This association was particularly notable among individuals aged 19–59 years (OR 0.18, 95% CI 0.04–0.82, p = 0.027), those with hypertension (OR 0.29, 95% CI 0.13–0.67, p = 0.003), and those without glaucoma (OR 0.33, 95% CI 0.15–0.71, p = 0.004). Conclusions: Sufficient Mg intake may reduce RVO risk among adults aged <60 years, individuals with hypertension, and those without glaucoma. Further research should validate the benefits of Mg supplementation in preventing RVO. Full article

Background: Many natural phytochemicals support the work of the kidneys. The health effects of genistein have been confirmed in many kidney diseases (inflammation and acute kidney injury, cancer or menopausal or senile changes). Genistein through various mechanisms can affect kidney conditions. Objectives: The purpose of this work was to analyze the supply of various forms of genistein at a low dose (0.2 mg/kg b.w.) on the renal mineral composition of rats under conditions of mammary gland tumorigenesis (induced with DMBA). Methods: Sprague rats at the age of 40 days were divided into four research groups, i.e., a control group receiving only standard feed and four groups receiving feed supplemented with genistein in the form of nanoparticles (0.1 mg/mL, i.e., 0.2 mg/kg.i.d.) (size: 92 ± 41 nm), genistein in microparticle form (0.1 mg/mL, i.e., 0.2 mg/kg.i.d.) (size: 587 ± 83 nm) and genistein in macroparticle form (normal, classical) (0.1 mg/mL, i.e., 0.2 mg/kg.i.d.). Mammary gland cancer was induced using DMBA (7,12-dimethyl-1,2-benz(a)anthracene). The experiment lasted 100 days. The concentrations of Ca, Zn, Fe, Cu, As, Se, Rb, Sr, Mo, B, and Mn were measured using the ICP-MS method, while the levels of K, Mg, and Na were measured using the FAAS method. Results: It was shown that, depending on the degree of miniaturization of genistein, its administration affected changes in kidney mineral composition, primarily resulting in a strongly reduced calcium content in the group of rats receiving nanogenistein. We found a negative impact of nanogenistein administration on the amount of calcium and iron, indicating an increased distribution or excretion of these elements from the body, as well as an increase in the number of elements, especially magnesium, sodium, zinc, boron, and copper concentrations, compared to the non-supplemented group. Conclusions: This study confirms the need for thorough clinical analyses in the future, with regard to the effects of genistein, especially its nanoforms on the body. Full article

Magnesium (Mg²⁺) is essential for cardiovascular and metabolic health, yet hypomagnesemia is common in kidney transplant recipients (KTRs) due to immunosuppressive therapy and renal dysfunction. Oral Mg²⁺ supplementation is often ineffective due to poor absorption and side effects. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been shown to increase serum Mg²⁺ in chronic kidney disease, but their effects in KTRs, particularly patients without diabetes, remain unclear. This observational study assessed 63 KTRs treated with dapagliflozin, analyzing the serum Mg²⁺ levels at baseline and after 3 and 6 months. The hypomagnesemia prevalence, associations with oral supplementation, diabetes status, and diuretic use were evaluated. The results showed a significant Mg²⁺ increase with SGLT2i therapy, reducing hypomagnesemia regardless of the diabetes status. Oral supplementation did not correlate with improved Mg²⁺ levels, reinforcing its limited efficacy. Additional benefits included reductions in the body weight, blood pressure, and serum urate without compromising graft function. SGLT2i may offer a novel approach to managing hypomagnesemia in KTRs, potentially reducing the reliance on ineffective supplements while providing renal and cardiovascular benefits. Further research is needed to confirm these findings and elucidate the underlying mechanisms. Full article

Electrolyte imbalances are a frequently overlooked yet critical component of obesity-related metabolic dysfunction, contributing to an increased risk of cardiovascular disease, kidney impairment, and metabolic emergencies such as diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), and acute kidney injury (AKI). These disturbances arise from insulin resistance, chronic inflammation, hormonal dysregulation, and renal dysfunction, leading to sodium retention, potassium depletion, and deficiencies in calcium and magnesium homeostasis. Managing electrolyte imbalances is essential in obesity management, as imbalances exacerbate hypertension, metabolic acidosis, neuromuscular complications, and insulin resistance. This review explores the pathophysiology of electrolyte disturbances in obesity and their impact on fluid balance, acid–base status, and metabolic health. Effective management strategies include individualized electrolyte monitoring, dietary sodium restriction, potassium supplementation, vitamin D and magnesium correction, and pharmacologic interventions targeting renin–angiotensin–aldosterone system (RAAS) activity and insulin resistance. Additionally, lifestyle interventions, including dietary modification, weight loss strategies, and hydration optimization, play a key role in preventing metabolic complications. Future research should investigate the long-term impact of electrolyte imbalances in obesity, the role of emerging therapies, and how lifestyle interventions can optimize electrolyte homeostasis and metabolic outcomes. A personalized, multidisciplinary approach integrating endocrinology, nephrology, and clinical nutrition is essential to improving the prevention and management of electrolyte imbalances in obese individuals. Full article

Background/Objectives: Chronic kidney disease (CKD), the most common cause of which is hypertension and diabetes, is a recognized risk factor for cardiovascular disease (CVD). This study investigated the association between selected serum biomarkers in the context of intima-media thickness (IMT) changes, a common predictor of subsequent cardiovascular (CV) events. Methods: A total of 251 individuals were enrolled in the study, divided into groups based on the severity of CKD, the presence of CVD, and healthy controls. For this purpose, the data from the following groups of participants were analyzed: (1) end-stage renal disease (ESRD) (n = 106), (2) pre-dialyzed (PRE) (n = 48), (3) patients at stages 1 and 2 of CKD (CKD1-2) (n = 37), (4) patients with CVD and no kidney disease (CARD) (n = 28), and (5) healthy controls (HV) (n = 31). To find markers associated with elevated IMT, the each group with CVD (ESRD, PRE and CARD) was separated into two subgroups with normal and elevated IMT and compared in the relation of the studied serum biomarkers. Results: The findings identified glucose as the only marker exclusively associated with CVD. Markers uniquely linked to CKD included urea, creatinine, eGFR, total protein, CEL, neopterin, total calcium, phosphates, iPTH, sodium, iron, ferritin, and AST. All other markers reflected a combined influence of both CKD and CVD. By comparing patients with normal and elevated IMT, distinct types of CKD–CVD interactions were observed, i.e., independent (additive effects of CKD and CVD) for MPO, ALP, MMP-9, and MMP-9/TIMP-1; combined (enhanced effect due to interactions) for AOPPs and TIMP-1; and conditional (CVD impact specific to CKD patients) for AGEs, 3-NT, magnesium, UIBC, TIBC, ALT, and TIMP-1/MMP-9. However, certain markers, i.e., CML, sRAGEs, carbamylated protein groups, protein carbamylation, hsCRP, TC, HDL-C, LDL-C, TG, IL-18, klotho, FGF-23, klotho/FGF-23 ratio, potassium, NT-proBNP, and AIP were associated with both CKD and CVD, though the exact nature of their interaction could not be determined using IMT as a distinguishing factor. Conclusions: The results showed that relations between IMT and the remaining studied factors were not trivial, and most of the analyzed parameters were altered in CKD patients, especially if compared to patients with CVD but without CKD. IMT cannot be used as a universal CVD marker. Full article

Background/Objectives: In chronic kidney disease (CKD), poor nutrition is associated with poorer clinical outcomes. There are limited data on milder stages of childhood CKD. Methods: This study characterised the nutritional state of a cohort of children with CKD. Results: Within the cohort (mean age 10.5 years, mean eGFR = 57 mL/min/1.73 m²), obesity defined by body mass index rates was comparable to that in the general population, but central obesity (waist-to-height ratio > 0.5) was evident in 44% of children. Although average nutrient intakes for the cohort were acceptable, there was marked variability in the risk of poor nutrient intake (<LRNI): selenium (35%), magnesium (35%), iodine (30%), and zinc (30%). No child met the recommended dietary fibre intake. The prevalence of frank deficiency of vitamins and minerals in blood concentrations was low. Blood concentrations of vitamins A and E were near-universally elevated. In those who had a decline in kidney function at the 12-month follow-up, dietary intake of fibre correlated with the degree of decline. Conclusions: Much work is needed to optimise the nutritional status of children with CKD as an important modifiable risk factor for disease progression and other important outcomes. Full article