Dietary management in slowing down the progression of CKDu

Abstract

Chronic kidney disease of unknown etiology (CKDu) is an emerging entity in the South Asian region. This predominately affects the farming community belonging to the lower socioeconomic status. CKDu being a progressive condition often leads to end-stage renal failurerequiring renal replacement therapy (RRT). Due to the high cost and limited availability of RRT in many areas of geographical locations in India and worldwide, there is an unmet need to slow down the progression of CKDu. The intestinal microbiota is different in patients with CKD, with low levels of beneficial bacteria such as Lactobacillus and Bifidobacteria . Prebiotics and probiotics modify the intestinal microbiota and thereby slow down the progression. Soda bicarbonate therapy is cheap and cost-effective in slowing down the progression of CKDu in a subset of patients. There is also evidence of the beneficial effect of N-acetyl cysteine in early stages of CKD and it should benefit CKDu also. Dietary interventions to prevent dehydration, by providing uncontaminated drinking water, sufficient protein containing diet with adequate calories, and tailored salt intake to prevent hypotension, are necessary compared to other causes of CKD. The objective is to prevent malnutrition, and uremic symptoms. Early diagnosis and prompt intervention may delay the progression of CKDu in the early stages.

‘A disease of disparity’: chronic kidney disease of unknown aetiology in endemic immigrant communities

“…Supportive measures include the use of oral sodium bicarbonate as management for metabolic acidosis in Stages 4 and 5 CKD, as well as an interest in the role of uric acid in progressive disease due to the frequent presence of hyperuricaemia. 13 However, there is limited evidence for the role of uric acid lowering therapy in clinical trials for protection. 6 In terms of the role of renin-angiotensin-aldosterone system (RAAS) blockers in CKD of unknown aetiology, there has previously been caution about their use, given concerns about volume depletion and dehydration.…”

“…Preventative management strategies on a population level focus on reducing heat stress and trying to identify potential exposure risk factors that can be mitigated. Supportive measures include the use of oral sodium bicarbonate as management for metabolic acidosis in Stages 4 and 5 CKD, as well as an interest in the role of uric acid in progressive disease due to the frequent presence of hyperuricaemia 13 . However, there is limited evidence for the role of uric acid lowering therapy in clinical trials for protection 6 …”

Chronic Kidney Disease of Unknown Origin: Think Beyond Common Etiologies

“…Regarding a small group of individuals, soda bicarbonate treatment is inexpensive and effective in halting the advancement of CKDu. Contrary to various sources of CKD, culinary adjustments to combat dehydration are required [ 12 ].…”

Association between the Polymorphisms rs2070744, 4b/a and rs1799983 of the NOS3 Gene with Chronic Kidney Disease of Uncertain or Non-Traditional Etiology in Mexican Patients

“…This disease has been related to the use of pesticides, recurrent episodes of dehydration and changes in the intestinal microbiota, among other environmental factors. The genetic components have been minimally studied in this disease [ 6 , 7 ].…”