The Influence of Dietary Interventions on Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD)

Abstract

Chronic kidney disease is a health problem whose prevalence is increasing worldwide. The kidney plays an important role in the metabolism of minerals and bone health and therefore, even at the early stages of CKD, disturbances in bone metabolism are observed. In the course of CKD, various bone turnover or mineralization disturbances can develop including adynamic hyperparathyroid, mixed renal bone disease, osteomalacia. The increased risk of fragility fractures is present at any age in these patients. Nutritional treatment of patients with advanced stages of CKD is aiming at prevention or correction of signs, symptoms of renal failure, avoidance of protein-energy wasting (PEW), delaying or prevention of the occurrence of mineral/bone disturbances, and delaying the start of dialysis. The results of studies suggest that progressive protein restriction is beneficial with the progression of renal insufficiency; however, other aspects of dietary management of CKD patients, including changes in sodium, phosphorus, and energy intake, as well as the source of protein and lipids (animal or plant origin) should also be considered carefully. Energy intake must cover patients’ energy requirement, in order to enable correct metabolic adaptation in the course of protein-restricted regimens and prevent negative nitrogen balance and protein-energy wasting.

Long-Term Cola Intake Does Not Cause Evident Pathological Alterations in the Femoral Bone Microstructure: An Animal Study in Adult Mice

“…In our study, significant pathological alterations in the femoral bone microstructure and mechanical properties related to cola consumption were not reported, probably due to well-functioning kidneys. It is known that the kidneys, as a major organ involved in the regulation of mineral homeostasis (e.g., Ca and P), play a key role in regulating bone mineralization, metabolism and development [ 75 , 76 ]. In this context, 3-month cola intake had no impact on renal function and glomerular morphology parameters in adult male rats [ 35 ].…”

Urinary Phosphorus Excretion and Cardiovascular Outcomes in Patients with Pre-Dialysis Chronic Kidney Disease: The KNOW-CKD Study

“…Yet, we still cannot completely exclude the possibility that low 24 h UPE may indicate protein malnutrition that is closely related to adverse CV outcomes in patients with CKD [ 28 , 29 ]. Although dietary restriction of phosphorus is commonly associated with improved outcomes in patients with CKD [ 30 , 31 ], dietary phosphorus intake is usually closely linked to protein intake, suggesting low 24 h UPE might be a result of inadequately low amount of protein calorie [ 17 ]. Indeed, nutritional indices, such as serum albumin and total cholesterol levels, were significantly lower in the subjects with low 24 h UPE levels ( Table 1 ).…”

“…As dietary phosphorus restriction is a critical strategy to avoid hyperphosphatemia in patients with CKD [ 15 , 16 , 17 ], 24-h urinary phosphorus excretion (24 h UPE) has been implemented in previous studies to estimate the intestinal absorption of dietary phosphorus [ 18 , 19 ], In this regard, it is surprising that the relationship between 24 h UPE and the risk of CVE in patients with CKD has received so little attention [ 20 ] because, if 24 h UPE is a reliable indicator of intestinal absorption of dietary phosphorus, a high 24 h UPE as a result of a high dietary phosphorus load could be assumed to ultimately increase the risk of CVE.…”

Relationship between Nutrition-Related Problems and Falls in Hemodialysis Patients: A Narrative Review

“…The association between PEW and falls in HD patients is unclear. HD patients with increased risk of frailty, inadequate nutrition, and impaired bone mineral content are likely to be associated with fractures [ 61 ]. Therefore, PEW may be associated with falls and fractures.…”