Search Results (365)

Background: Nutritional therapy is central in the management of chronic kidney disease (CKD) and cancer, yet these conditions impose partially conflicting requirements. The 2024 KDIGO guideline recommends a controlled protein intake (~0.8 g/kg/day) to reduce metabolic burden in non-dialysis CKD patients, whereas the ESPEN (European Society for Clinical Nutrition and Metabolism) guidelines support higher protein intake (≥1.0–1.5 g/kg/day) to prevent cancer-related malnutrition. Evidence guiding patients affected by both conditions is limited. We evaluated the effects of a Mediterranean-like controlled protein diet in onconephrological patients compared with CKD controls. Methods: In this retrospective study, 358 CKD patients (183 onconephrological, 175 controls) were followed at a tertiary center (2017–2024). Patients received a protein-controlled diet (0.6–1.0 g/kg/day) tailored to comorbidities and nutritional status. Nutritional assessment included bioelectrical impedance analysis and anthropometry. Renal function was evaluated using creatinine and cystatin C, and measured GFR by iohexol clearance at baseline and 12 months. Results: Baseline body composition was comparable between groups. After intervention, serum urea significantly decreased in both groups, without a decline in measured or estimated GFR. Fat mass and central adiposity indices were reduced, while lean mass and phase angle remained stable. No evidence of protein–energy wasting or catabolic activation emerged. Longitudinal analyses showed no significant time × cancer interaction for renal function or most bioimpedance-derived body composition parameters. However, at extended follow-up, arm circumference and tricipital skinfold thickness showed significant time × cancer interactions, suggesting different longer-term peripheral anthropometric trajectories according to cancer status. Conclusions: In this retrospective real-world cohort, structured nephro-nutritional management with an individualized Mediterranean-like controlled protein prescription was associated with preserved renal function and no evidence of overt nutritional deterioration in onconephrological patients. These findings support the feasibility and apparent safety of this approach in selected patients, while highlighting the need for prospective studies with objective dietary adherence assessment and longer-term evaluation of cancer-related anthropometric trajectories. Full article

The kidney is a highly specialized organ that maintains systemic homeostasis through tightly coordinated cellular and molecular mechanisms. Renal parenchymal cells regulate metabolic waste excretion, electrolyte and acid–base balance, and blood pressure control—functions that rely on the dynamic integration of intracellular organelles. Recent advances in molecular and biochemical research have highlighted how inter-organelle communication is essential for preserving renal cell function and adaptive responses to stress. This review focuses on the molecular crosstalk among key organelles—including the nucleus, endoplasmic reticulum (ER), Golgi apparatus, mitochondria, lysosomes, and peroxisomes—primarily in tubular epithelial cells. We discuss how these interactions coordinate metabolic signaling, protein homeostasis, redox balance, and energy production and how their disruption contributes to maladaptive pathways during acute kidney injury (AKI), ultimately promoting chronic kidney disease (CKD) transition. Particular focus is placed on emerging pathways linking organelle dysfunction to inflammation, fibrosis, and metabolic reprogramming. Furthermore, we highlight recent advances in genetics and molecular therapeutics targeting organelle communication, including modulation of ER stress responses, mitochondrial biogenesis, and lysosomal function. Clinically approved agents, such as mTOR inhibitors, and experimental approaches—such as chemical chaperones and mitochondrial transplantation—demonstrate the potential to restore organelle homeostasis and mitigate renal injury. Overall, elucidating the molecular networks governing organelle crosstalk provides critical insights into kidney disease pathogenesis and identifies novel targets for therapeutic intervention in AKI-to-CKD transition. Full article

Background: Arteriovenous fistula (AVF) maturation is a critical determinant for successful hemodialysis in patients with end-stage renal disease (ESRD). Endothelial dysfunction and arterial stiffness, which are highly prevalent in advanced chronic kidney disease (CKD), frequently impair AVF maturation. Emerging evidence suggests that a very-low-protein diet (VLPD) supplemented with ketoacid analogues (KA) mitigates nitrogenous waste accumulation and positively influences vascular health by reducing inflammation and improving endothelial function. This prospective observational study evaluates the effect of VLPD+KA on AVF maturation, endothelial function, inflammatory markers, nutritional status, and the timing of dialysis initiation. We enrolled 20 patients with advanced CKD (stage V) scheduled for AVF creation. Participants adhered to a strict VLPD protocol (0.3–0.4 g/kg/day) with KA supplementation (1 tablet/5 kg/day). We assessed biochemical parameters, inflammatory markers (CRP, ESR), uremic toxins (indoxyl sulfate [IS], p-cresyl sulfate [PCS]), endothelial function via flow-mediated dilation (FMD), and vascular imaging metrics. AVF maturation, central venous catheter (CVC) requirement, dialysis initiation, and nutritional parameters were monitored over a three-month follow-up period. Statistical analyses included paired t-tests or Wilcoxon signed-rank tests for within-group comparisons, Fisher’s exact test for categorical variables, and Kaplan–Meier analysis for time-to-event endpoints, performed using SPSS version 27.0. Results: The intervention led to significant improvements in endothelial function (FMD +1.7%, p < 0.01), substantial reductions in the uremic toxins IS (−38%, p < 0.001) and PCS (−43%, p < 0.001), and a marked decrease in CRP levels (from 3.2 to 1.1 mg/L, p < 0.01). Nutritional status, assessed by BMI, BIA-derived phase angle, and handgrip strength, remained stable throughout the intervention period, confirming the metabolic safety of the VLPD+KA regimen. Notably, AVF maturation was achieved in 95% of patients, with zero CVC dependency among those who initiated dialysis. Conclusions: These findings strongly support the hypothesis that VLPD+KA therapy enhances vascular integrity, reduces uremic endotheliotoxicity, and facilitates successful AVF maturation. This nutritional intervention warrants further investigation in larger, randomized controlled trials as a standard pre-dialysis care strategy. Full article

Muscle wasting contributes substantially to inflammatory bowel disease (IBD)-related disability, but its association with colitis severity across disease stages remains poorly characterized. We therefore assessed skeletal muscle mass, fiber morphology, and voluntary wheel-running performance in Winnie mice—a spontaneous Muc2 mutant model of chronic colitis—in separate female and male homozygous mutant and WT littermate cohorts. Assessments were performed at 5 weeks, before overt colitis, and at 15 weeks, in a cohort with more pronounced colitis. Outcomes included disease activity index (DAI), fecal lipocalin-2 (LCN-2), wheel-running metrics, soleus and tibialis anterior mass, and minimal Feret’s diameter distributions. At 5 weeks, Winnie mice showed no overt disease activity and no consistent structural muscle deficit. In contrast, the 15-week cohort exhibited marked colitis in both sexes, with increased DAI and LCN-2, reduced voluntary wheel-running performance, lower soleus and tibialis anterior mass, and smaller muscle fiber diameters with left-shifted size distributions. Correlation analyses identified associations between fecal LCN-2, skeletal muscle mass and size, and wheel-running distance and velocity, supporting a link between intestinal inflammation and muscle impairment in this model. These cross-sectional data are consistent with reduced voluntary activity and structural myopathy during progression of spontaneous colitis. The Winnie mouse model therefore provides a clinically relevant preclinical platform to study IBD-associated muscle wasting and its association with intestinal inflammation. Full article

Background and Aims: The global rise of chronic kidney disease (CKD) has led to a rapid expansion of dialysis services, which, although life-saving, are associated with substantial environmental costs. This study aims to analyze the environmental impacts of dialysis therapies and identify pathways toward more sustainable practices. Methods: This study conducts a comprehensive and integrative literature review on research in renal replacement therapy, adopting the PRISMA-ScR procedure to analyze papers published between 2005 and 2023. Results: The literature primarily focuses on four environmental dimensions: carbon emissions, water consumption, energy use, and waste generation. Dialysis therapies—particularly hemodialysis—are resource-intensive and contribute significantly to environmental degradation though repeated treatments, transportation requirements, and high consumption of materials and energy. Conclusions: Sustainable dialysis can be promoted through the adoption of green technologies, improved waste management, and policies focused on energy and resource efficiency. While current practices are environmentally demanding, feasible strategies exist to reduce their ecological footprint and align nephrology care with global sustainability goals. Full article

Acute kidney injury (AKI) is a frequent complication in critically ill patients and is associated with high morbidity, mortality, and an increased risk of progression to chronic kidney disease (CKD). In this context, nutritional management represents a key component of supportive therapy, as AKI is commonly characterized by hypercatabolism, negative nitrogen balance, and protein-energy wasting. Current nutritional strategies primarily focus on the quantity of protein intake required to compensate for catabolic losses, particularly in patients undergoing renal replacement therapy (RRT). However, growing evidence suggests that the quality and metabolic effects of dietary protein sources may also influence renal physiology and recovery. Plant-based proteins have recently gained attention as a potentially advantageous nutritional strategy in kidney disease. Compared with animal-derived proteins, plant-based proteins are associated with a lower dietary acid load, reduced production of gut-derived uremic toxins, and beneficial effects on the intestinal microbiota. In addition, their amino acid profile may modulate oxidative stress, inflammatory pathways, and renal hemodynamics. These characteristics may contribute to a more favorable metabolic environment in patients with AKI, potentially supporting renal recovery and reducing the risk of AKI-to-CKD transition. This review examines the pathophysiological mechanisms linking protein metabolism, renal injury, and nutritional support in AKI. Particular attention is given to the role of plant-based proteins, their amino acid composition, and their potential nephroprotective effects. Understanding the interaction between dietary protein sources, metabolic pathways, and the gut–kidney axis may help guide future nutritional strategies aimed at improving outcomes in critically ill patients with AKI. Full article

Sarcopenia, defined as the progressive loss of skeletal muscle mass and strength, is increasingly recognized as a significant concern in patients with chronic kidney disease (CKD) and particularly in kidney transplant recipients (KTx-ps). This review explores the complex interplay of pathophysiological mechanisms, prevalence, and management strategies of sarcopenia in the context of kidney transplantation. CKD contributes to sarcopenia through systemic inflammation, malnutrition, uremic toxin accumulation, and metabolic imbalances, all of which persist or are exacerbated after transplantation due to immunosuppressive therapies especially corticosteroids. Notably, the post-transplant period may introduce additional risks, such as altered body composition and reduced physical activity, further aggravating muscle wasting. Sarcopenia affects approximately 26% of KTx-ps, leading to adverse outcomes including decreased quality of life, increased risk of infection, frailty, delayed recovery, and graft loss. The diagnosis remains challenging due to variability in assessment tools and a lack of standardized criteria. Management strategies must be multifactorial, including personalized nutritional support, targeted physical activity, and, where appropriate, pharmacological interventions. Early identification through imaging and functional testing is critical, especially in older patients and those with prolonged dialysis vintage. Emerging therapies, such as myostatin inhibitors, offer promise but require further validation. Additionally, early steroid withdrawal may mitigate muscle loss without compromising graft survival in selected patients. This review underscores the need for heightened awareness and standardized protocols to identify and manage sarcopenia in kidney transplantation, ultimately improving long-term outcomes and patient-centered care. Full article

Aneurysmal subarachnoid hemorrhage (SAH) remains a devastating cerebrovascular disorder with high morbidity and mortality, despite advances in aneurysm securing and neurocritical care. Clinical outcomes are determined by early brain injury (EBI), delayed cerebral ischemia (DCI), hydrocephalus, and long-term cognitive impairment, extending beyond the traditional focus on large-vessel vasospasm alone. Emerging evidence identifies the dysfunction of the glymphatic system and meningeal lymphatic pathway, the brain’s primary clearance pathways, as a central and unifying mechanism linking acute hemorrhagic injury to delayed and chronic neurological sequelae. Following SAH, acute intracranial pressure elevation, subarachnoid blood clot burden, loss of arterial pulsatility, venous congestion, astrocytic aquaporin-4 perivascular depolarization, and neuroinflammation converge to suppress cerebrospinal fluid–interstitial fluid exchange and outflow in glymphatic system and subsequent meningeal lymphatic drainage. Persistent clearance failure promotes the retention of blood breakdown products, inflammatory mediators, and metabolic waste, amplifying microvascular dysfunction, cortical spreading depolarizations, blood–brain barrier disruption, and secondary ischemic injury. Importantly, accumulating data highlight venous pathology and meningeal lymphatic impairment as critical, yet underappreciated, contributors to delayed injury and post-SAH hydrocephalus. In this review, we synthesize the current knowledge of the physiological organization of glymphatic and meningeal lymphatic systems, delineate the mechanistic and molecular drivers of their dysfunction after SAH, and discuss clinical implications for EBI, DCI, hydrocephalus, and long-term cognitive outcomes. We further outline future directions, including translational imaging, biomarker development, and therapeutic strategies targeting clearance pathways, to advance disease-modifying approaches in SAH. Full article

Background and aim: Celiac disease (CD) is a systemic autoimmune disorder triggered by gluten ingestion, and the only effective treatment is strict adherence to a gluten-free diet (GFD). Many factors, including limited dietary diversity and poor adherence, are associated with an increased risk of specific micronutrient deficiencies and malnutrition. This study aims to evaluate the relationship between adherence to GFD, celiac antibody levels, micronutrient levels, and nutritional status in children with CD. Methods: This retrospective study was conducted on 402 children aged 2–18 years with a diagnosis of CD confirmed positive by anti-tTG IgA and duodenal biopsy, all of whom had been on GFD for at least six months. Demographic, anthropometric, clinical, serological, and biochemical data (including hemogram, serum iron, ferritin, vitamin D, folate, and B12 levels), and GFD adherence were collected from medical records. Results: Most individuals are girls (64.9%), with a mean age of 10.6 ± 4.20 years. Chronic malnutrition was observed in 29.4% of patients. Acute malnutrition was identified in 27.8% of children, and wasting was observed in 6.7%. Iron deficiency anemia was the most frequently encountered micronutrient deficiency among the patients (23.9%). The prevalence of stunting was significantly higher among individuals with positive tTG-IgA levels and poor adherence to the GFD. Conclusions: Poor adherence to the GFD and positive tTG-IgA levels were associated with higher rates of stunting, underlining the need for individualized dietary follow-up and regular monitoring of both nutritional status and serological response in children with CD. Full article

Chronic kidney disease is defined as a progressive pathology that affects more than 10% of the world’s population, affecting waste filtration capacity. Sarcopenia, characterized by loss of muscle mass and strength, is a common complication in patients with chronic kidney disease undergoing hemodialysis. It is associated with inflammation, malnutrition and reduced quality of life. Hemodialysis is the fundamental treatment for people with chronic kidney disease, as it is key to the elimination of toxins from the body. Objective: The objective of this study was to determine the prevalence of probable sarcopenia in patients with chronic kidney disease in the Dialysis Unit of Extremadura (Spain). Material and Methods: This is a descriptive study in which 33 patients with chronic kidney disease receiving hemodialysis were selected as participants in the assessment of functional capacity and physical fitness. The procedure was performed prior to the dialysis session. Socio-demographic, clinical and physical variables were assessed. The assessment of probable sarcopenia was carried out using manual grip strength test (dynamometry), physical performance (4-meter walk test) and phase angle (PhA) (single frequency 50 Hz bioimpedance). The Charlson Comorbidity Index (CCI) was used to determine the severity of chronic disease and its impact, and analytical variables such as albumin, C-reactive protein (CRP), Neutrophil/Lymphocyte Index (NLI), Lymphocyte–Platelet Index (LPI) and total protein (TP), among others, were also included. Results: The prevalence of probable sarcopenia was 93.9% according to the criteria for muscle strength and physical performance (EWGSOP2). PhA showed statistically significant differences between the groups with and without sarcopenia (p = 0.039), suggesting its usefulness as a nutritional marker. No statistically significant differences were found between sarcopenia and age, albumin, Neutrophil/Lymphocyte Index or C-reactive protein (p > 0.05). Conclusions: There is a high prevalence of probable sarcopenia, associated with decreased handgrip strength and gait speed in patients with chronic kidney disease in hemodialysis. In addition, PhA stands out as an influential factor in the development of sarcopenia. Full article

Background: Food literacy (FL) comprises the knowledge, skills, and motivation needed for food production, selection, preparation, intake, and waste management. This study examined whether socio-ecological correlates of FL differ across settlement contexts in China. Methods: Cross-sectional survey data from Chinese adults (N = 1145) were analyzed across four settlement tiers: tier-1 metropolitan cities (R1), provincial/secondary cities (R2), smaller prefecture-level cities (R3), and county/rural areas (R4). General linear models estimated associations between socio-ecological predictors and overall FL after adjustment for sociodemographics, health behaviors, chronic disease, and BMI. Significant interactions were probed using HC3-robust simple slopes and pairwise slope contrasts. Robustness checks included domain-specific measurement invariance, variance inflation factor (VIF) diagnostics, and a regional sensitivity analysis. Results: The fully adjusted model explained substantial variance in FL (R² = 0.629). Awareness showed the strongest association with FL, followed by family support, injunctive norms, and social norms. Moderation was modest and predictor-specific: dining preferences and family support were positively associated with FL across all regions, with the strongest effects in county/rural areas. Although the omnibus interaction for injunctive norms was statistically significant, follow-up slope contrasts were not, indicating limited substantive regional heterogeneity. Component analyses indicated that preference-related heterogeneity was concentrated in food intake and food choices/selection, whereas family-support heterogeneity was most pronounced for waste disposal. Domain-level invariance analyses supported broad cross-regional comparability of the FL structure, VIFs were all below 5, and the regional distribution of valid and invalid responses did not differ significantly. Conclusions: Socio-ecological correlates of FL were broadly robust across China, with limited context-specific variation driven mainly by stronger household-support effects in county/rural settings. These findings support region-sensitive FL strategies that strengthen household-based support while leveraging normative influences across regions. Full article

Bio-waste (i.e., peels), the by-products obtained from the processing of fruits and vegetables, represents an outstanding advance in agricultural waste valorization due to phytochemical (bioactive compounds) enrichment and the approach to a bio-circular economy and agronomic systems free of hazardous pesticides (soil remediation). These alternatives, which are environmentally friendly and sustainable, are greatly relevant to food and nutraceuticals based on bioactive compounds extracted mostly from peels. Bioactive compounds are defined as natural chemical compounds that have a positive influence on human health. They can aid in the prevention of chronic disease (cancer and degenerative, intestinal bowel and cardiovascular disease) and other types of disease. The bioactive compounds with these properties belong to the family of polyphenol compounds, which include flavonoids (i.e., flavones, flavanones, and anthocyanins), non-flavonoids (phenolic acids, stilbenes, lignin, coumarins, and tannins), and terpenes (carotenoids, lycopene, phytosterols, and monoterpenes). The extraction of these compounds from the peels of fruits and vegetables has gained increasing interest as a sustainable technology because of the use of safety solvents. Another important issue to highlight is the enormous potential of bioactive compounds, as mentioned above, in the biotechnology of these compounds, particularly in terms of the development of a delivery system targeting the site of action. Full article

The Carpathian Basin is a coherent biogeographic unit whose wildlife populations and pathogen dynamics are increasingly reshaped by administratively fragmented governance, land-use change and linear infrastructure. This review synthesizes evidence that the permeability patterns governing host movement also structure the transboundary exchange of genes and infections, creating a connectivity substrate for conservation genetics and One Health risk. Focusing on wild boar (Sus scrofa), red deer (Cervus elaphus), roe deer (Capreolus capreolus), fallow deer (Dama dama) and the expanding golden jackal (Canis aureus), we integrate population genetic inferences with wildlife epidemiology to examine how highways, border fences and asymmetric management (e.g., supplemental, feeding practices, hunting pressure and surveillance regimes) can generate biological asymmetries across boundaries. We highlight African swine fever as an emblematic disturbance in wild boar populations, discuss cervid risks including tick-borne pathogens and chronic wasting disease (CWD) preparedness and evaluate zoonotic threats associated with carnivore expansion (e.g., Echinococcus spp.). We propose a Carpathian Basin-level monitoring and data-sharing architecture, coupling harmonized passive surveillance, strategic active surveillance for priority pathogens, and standardized genetic marker panels supported by interoperable metadata. A Basin-scale One Health approach is a pragmatic prerequisite for the coordinated prevention, early detection and resilient management of cross-border epizootics and zoonotic threats. Full article

Canine cognitive dysfunction (CCD) is a common age-related neurodegenerative disorder in dogs that shares several pathological and clinical features with human Alzheimer’s disease (AD). In both species, β-amyloid (Aβ) accumulates within the brain parenchyma and cerebral vessel walls and is associated with synaptic loss, oxidative stress, mitochondrial dysfunction, and chronic neuroinflammation, ultimately leading to progressive cognitive decline. Increasing evidence indicates that impairment of brain clearance mechanisms, particularly the glymphatic system, represents a central pathogenic mechanism in both CCD and AD. The glymphatic system is a glia-dependent perivascular network involved in the clearance of Aβ and other metabolic waste products from the brain. Its function declines with aging, vascular disease, and astrocytic alterations, including changes in aquaporin-4 distribution. Reduced glymphatic and periarterial drainage promotes the retention and aggregation of Aβ and tau proteins. Compared with AD, tau pathology in CCD is generally less extensive, supporting the interpretation of CCD as an Aβ-predominant condition and a partial pathological analog of Alzheimer’s disease. Clinically, CCD is characterized by a constellation of behavioral changes including, disorientation, altered social interactions, sleep–wake cycle disturbances, a loss of housetraining, changes in activity levels, and increased anxiety, commonly summarized by the DISHAA acronym. Overall, CCD represents a valuable spontaneous large-animal model for investigating neurodegenerative mechanisms and clearance-related therapeutic targets relevant to both veterinary and human medicine. Full article

Functional seafoods derived from marine organisms, including fish, shellfish and algae, are gaining increasing attention due to their high content of bioactive compounds, such as omega-3 fatty acids, peptides, polysaccharides and antioxidants, which provide health benefits beyond basic nutrition. These marine-derived compounds exhibit a wide range of biological activities and have been investigated for their potential roles in the prevention and management of chronic diseases, including cardiovascular, neurodegenerative, cancer and gastrointestinal disorders. Their effects are largely mediated through anti-inflammatory, antioxidant and immunomodulatory mechanisms. Advances in biotechnology, including genetic engineering and improved extraction of bioactive compounds, have enhanced the nutritional quality and pharmacological relevance of functional seafoods. At the same time, sustainable aquaculture practices are being developed to reduce environmental impacts. Nevertheless, challenges such as regulatory inconsistencies, scalability issues and limited understanding of bioavailability and long-term effects still persist. These constraints should be considered when interpreting mechanistic and efficacy findings presented across different study designs and exposure conditions. Future perspectives highlight innovations in precision aquaculture, waste valorisation and traceability as key strategies to improve sustainability and strengthen consumer trust. This review summarizes current knowledge on functional seafoods, with emphasis on pharmacological mechanisms, clinical applications and the need for interdisciplinary research to optimize their health benefits and commercial potential. Full article