An update on nutrition in chronic kidney disease

Fouque, Denis; Guebre-Egziabher, Fitsum

doi:10.1007/s11255-006-9108-3

Cited by 26 publications

(15 citation statements)

References 53 publications

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“…The lack of a lower threshold level for mortality risk in the above study is also in contrast to studies in MHD patients, in which the association of PTH level with mortality was U-shaped [3,75]. A significant proportion of the higher mortality seen with lower PTH levels in MHD patients was, however, related to confounding by markers of malnutrition and inflammation [3], which themselves have been linked to higher mortality [76,77].…”

Section: Serum Calcium Level and Calcium Intake In Ckdcontrasting

confidence: 50%

Bone and mineral disorders in pre-dialysis CKD

Kövesdy

Kalantar-Zadeh

2008

Int Urol Nephrol

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Disorders in calcium, phosphorus, and parathyroid hormone (PTH) are common in chronic kidney disease (CKD) and may be associated with poor outcomes including a higher rate of CKD progression and increased death risk. Although these abnormalities have been examined extensively in patients with CKD stage 5 who are receiving chronic maintenance dialysis, they have not been studied to the same extent at earlier stages of CKD, in spite of the much larger numbers of patients in the early CKD population. We summarize the available literature on outcomes associated with bone and mineral disorders in patients with CKD not yet receiving maintenance dialysis. We have reviewed novel data linking fibroblast growth factor 23 (FGF-23) to phosphorus and vitamin D homeostasis. More rapid CKD progression is linked to hyperphosphatemia and its associated hyperparathyroidism and vitamin D deficiency. Hence, hyperphosphatemia may play a central role in the diverse disorders characterizing CKD. We provide a brief overview of the available treatment recommendations for bone and mineral disorders, with an emphasis on areas needing further research.

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Section: Serum Calcium Level and Calcium Intake In Ckdcontrasting

confidence: 50%

Bone and mineral disorders in pre-dialysis CKD

Kövesdy

Kalantar-Zadeh

2008

Int Urol Nephrol

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“…Whereas predialysis nutritional requirements are not different from those of healthy adults and allow for moderate protein intakes of 0.7-0.8 g/kg/day; in maintenance PD, these intakes are not enough to maintain good nutritional status and are associated with signs of malnutrition. 23 In general, both protein and energy requirements are greater in dialysis patients than in healthy persons. 24 The Dialysis Outcome Quality Initiative (DOQI) guidelines in nutrition have proposed that, based on nitrogen studies in HD and PD patients, a minimum of 1.2 g of protein/kg BW in HD and 1.3 g of protein/kg BW in PD represent the minimum daily intake to ensure a neutral protein balance.…”

Section: Discussionmentioning

confidence: 99%

Daily Dietary Energy and Macronutrient Intake and Anthropometric Measurements of the Peritoneal Dialysis Patients

et al. 2012

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Introduction: This study was planned to investigate the relation between dietary macronutrient status and anthropometric measurements in peritoneal dialysis (PD) patients. Materials and methods: A total of 28 clinically stable patients were enrolled in this study. All patients were taken a dietary therapy according to the guidelines of the American Journal of Kidney Foundation for 12 weeks. The anthropometric measurements were taken by bioelectrical impedance analyzer. The daily macronutrient intakes of the patients were calculated by the food consumption records. Results: The mean age was 48.3 AE 13.10 years [56.3 AE 7.41 years for males (n ¼ 14) and 40.3 AE 12.84 years for females (n ¼ 14)]. There were significant changes in fat percentage (%), total body water (TBW; %, L), extracellular water (ECW; %, L), basal metabolic rate over body weight (BMR/BW), and body fat mass index (BMFI) in males (p < 0.05), but there was no change in females (p > 0.05). The daily dietary energy and protein intakes were under the recommended level in the study period. Conclusion: Patients undergoing PD frequently have low intakes of protein and energy. It is recommended that individuals undergoing PD periodically maintain 3-day dietary records followed by dietary interviews conducted by a dietitian.

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“…All our 478 stage 5 patients received conservative treatment such as dietary instruction, ACEi/ARBs and other anti-hypertensive treatment, nutritional consultation, erythropoietin, diuretics, phosphate binders and active vitamin D 3 [18,19].…”

Section: Discussionmentioning

confidence: 99%

Natural history of CKD stage 4 and 5 patients following referral to renal management clinic

et al. 2009

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During a median follow-up of 1.57 year (range 0.5-8.7 year) of stage 4 patients, eGFR improved in 10.6%, showed mild improvement in 24.2%, was stable in 27.5%, showed slow progression in 28.8% and rapid progression in 8.9% of patients. During a median follow-up of 1.4 year (range 0.5-8 year) of CKD stage 5 patients, eGFR improved in only 1.3%, showed mild improvement in 4.3%, remained stable in 35.6%; showed slow progression in 19.7% and rapid progression in 39.1%. Between the two hospitals (TGH and TSH) there was a statistically significant difference in the number of visits per year for CKD stage 4 patients during the first, second and third year. However, the number of visits per year had no effect on the rate of decline. On univariate analysis, factors predicting non-progression in eGFR slope were eGFR at referral, the use of ACE inhibitors-ARBs and absence of cardiovascular disease. However, in logistic multivariate regression analysis, after adjusting for confounding factors only the eGFR at referral and ACE inhibitors-ARBs were independent factors for non-progression in eGFR. A significant percentage of CKD stage 4 patients attending a renal management clinic (RMC) showed non-progression or improvement in their kidney function. Although only few stage 5 CKD patients had improvement in their eGFR, 32% of them maintained their eGFR on conservative treatment for over 2 years delaying the initiation of dialysis.

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An update on nutrition in chronic kidney disease

Cited by 26 publications

References 53 publications

Bone and mineral disorders in pre-dialysis CKD

Bone and mineral disorders in pre-dialysis CKD

Daily Dietary Energy and Macronutrient Intake and Anthropometric Measurements of the Peritoneal Dialysis Patients

Natural history of CKD stage 4 and 5 patients following referral to renal management clinic

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