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Cecchini V, Sabatino A, Contzen B, Avesani CM. Food additives containing potassium, phosphorus, and sodium in ultra-processed foods: potential harms to individuals with chronic kidney disease. Eur J Clin Nutr 2025:10.1038/s41430-025-01600-6. [PMID: 40119134 DOI: 10.1038/s41430-025-01600-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 02/14/2025] [Accepted: 03/11/2025] [Indexed: 03/24/2025]
Affiliation(s)
- Valeria Cecchini
- Division of Renal Medicine, Baxter Novum. Department of Clinical Science, Intervention and Technology. Karolinska Institutet, Solna, Sweden.
| | - Alice Sabatino
- Division of Renal Medicine, Baxter Novum. Department of Clinical Science, Intervention and Technology. Karolinska Institutet, Solna, Sweden
| | - Barbara Contzen
- Nephrologik, Nutritional therapy for patients with chronic kidney disease, Bergisch Gladbach, Germany
| | - Carla Maria Avesani
- Division of Renal Medicine, Baxter Novum. Department of Clinical Science, Intervention and Technology. Karolinska Institutet, Solna, Sweden
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Rodelo-Haad C, Rodríguez-Ortiz ME, Garcia-Sáez R, Rivas-Domínguez A, Jurado-Montoya D, Martín-Malo A, Rodríguez M, Pendón-Ruiz de Mier MV, Muñoz-Castañeda JR. The true cost of phosphate control in chronic kidney disease. Clin Kidney J 2025; 18:i46-i60. [PMID: 40083951 PMCID: PMC11903093 DOI: 10.1093/ckj/sfae434] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Indexed: 03/16/2025] Open
Abstract
The loss of kidney function entails the development of a positive phosphate balance. The burden of addressing elevated phosphate levels is high. Both parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) are increased to promote phosphaturia, thereby preventing the rise in serum phosphate. However, if the phosphate load is excessive, the corresponding phosphaturia is maximal, kidney function deteriorates and hyperphosphataemia becomes clinically evident in advanced stages of chronic kidney disease (CKD). In addition to its role in CKD progression, hyperphosphataemia has been linked to a multitude of adverse outcomes, including overt inflammation, vascular calcifications, endothelial dysfunction, cardiovascular disease, renal osteodystrophy and secondary hyperparathyroidism. Collectively, these factors contribute to the markedly elevated mortality rates observed among individuals with CKD. Furthermore, hyperphosphataemia has been identified as a significant contributor to the development of inflammatory processes, oxidative stress and fibrosis, which underlie the aetiology of numerous comorbidities. Additionally, elevated levels of PTH and FGF23 have been demonstrated to independently induce organ and tissue injury, which is associated with poor outcomes in CKD. This article provides a concise overview of the current understanding of phosphate handling by the kidney in the context of CKD. It outlines the detrimental effects of phosphate on various organs and the mechanisms through which it contributes to CKD progression. Additionally, we discuss the tools available for clinicians to identify patients at risk of an excessive phosphate load.
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Affiliation(s)
- Cristian Rodelo-Haad
- GC13, Mineral Metabolism, Vascular Calcification, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- University of Cordoba, Cordoba, Spain
- Nephrology Service, Reina Sofia University Hospital, Cordoba, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud, RICORS2040, Institute of Health Carlos III, Madrid, Spain
| | - María E Rodríguez-Ortiz
- GC13, Mineral Metabolism, Vascular Calcification, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- University of Cordoba, Cordoba, Spain
- Nephrology Service, Reina Sofia University Hospital, Cordoba, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud, RICORS2040, Institute of Health Carlos III, Madrid, Spain
| | - Raquel Garcia-Sáez
- GC13, Mineral Metabolism, Vascular Calcification, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- University of Cordoba, Cordoba, Spain
- Nephrology Service, Reina Sofia University Hospital, Cordoba, Spain
| | - Antonio Rivas-Domínguez
- GC13, Mineral Metabolism, Vascular Calcification, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- University of Cordoba, Cordoba, Spain
- Nephrology Service, Reina Sofia University Hospital, Cordoba, Spain
| | - Daniel Jurado-Montoya
- GC13, Mineral Metabolism, Vascular Calcification, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- University of Cordoba, Cordoba, Spain
- Nephrology Service, Reina Sofia University Hospital, Cordoba, Spain
| | - Alejandro Martín-Malo
- GC13, Mineral Metabolism, Vascular Calcification, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- University of Cordoba, Cordoba, Spain
- Nephrology Service, Reina Sofia University Hospital, Cordoba, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud, RICORS2040, Institute of Health Carlos III, Madrid, Spain
| | - Mariano Rodríguez
- GC13, Mineral Metabolism, Vascular Calcification, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- University of Cordoba, Cordoba, Spain
- Nephrology Service, Reina Sofia University Hospital, Cordoba, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud, RICORS2040, Institute of Health Carlos III, Madrid, Spain
- European Uremic Toxins Group (EUTOx)
- COST Action CA21165 – Personalized medicine in chronic kidney disease: improved outcome based on Big Data (PerMediK)
| | - M Victoria Pendón-Ruiz de Mier
- GC13, Mineral Metabolism, Vascular Calcification, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- University of Cordoba, Cordoba, Spain
- Nephrology Service, Reina Sofia University Hospital, Cordoba, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud, RICORS2040, Institute of Health Carlos III, Madrid, Spain
| | - Juan Rafael Muñoz-Castañeda
- GC13, Mineral Metabolism, Vascular Calcification, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- University of Cordoba, Cordoba, Spain
- Nephrology Service, Reina Sofia University Hospital, Cordoba, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud, RICORS2040, Institute of Health Carlos III, Madrid, Spain
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Hill Gallant KM, Sprague SM, Rosenbaum DP, Spiegel DM, Kozuka K, Edelstein S, Chertow GM. Tenapanor: A Phosphate Absorption Inhibitor for the Management of Hyperphosphatemia in Patients With Kidney Failure. J Ren Nutr 2025; 35:25-34. [PMID: 38992521 DOI: 10.1053/j.jrn.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024] Open
Abstract
Because of increased risks of cardiovascular disease and death, patients with hyperphosphatemia receiving maintenance dialysis are advised to limit phosphorus consumption and are prescribed phosphate binders in an effort to better control serum phosphate concentrations. Because of large pill size, pill burden, and tolerability issues, phosphate binder adherence is relatively poor. On ingestion, phosphate is absorbed from the intestine via transcellular or paracellular transport. Data show that inhibiting sodium-hydrogen exchanger 3 modulates paracellular phosphate absorption (the predominant pathway in humans). Tenapanor is a first-in-class, minimally absorbed, phosphate absorption inhibitor that selectively inhibits sodium-hydrogen exchanger 3, with a mechanism distinct from, and complementary to, that of phosphate binders. In phase 3 and postregistrational studies, tenapanor conferred statistically significant and clinically meaningful reductions in serum phosphate in patients receiving maintenance dialysis with hyperphosphatemia. Here, we review the available preclinical and clinical data on the effects of tenapanor on controlling intestinal phosphate absorption.
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Affiliation(s)
- Kathleen M Hill Gallant
- Associate Professor, Department of Food Science and Nutrition, University of Minnesota, Saint Paul, Minnesota.
| | - Stuart M Sprague
- Clinical Professor of Medicine, Endeavor Health, University of Chicago, Evanston, Illinois
| | | | - David M Spiegel
- Vice President, Nephrology, Ardelyx, Inc., Waltham, Massachusetts
| | - Kenji Kozuka
- Director, Preclinical Research and Nonclinical Development, Ardelyx, Inc., Fremont, California
| | - Susan Edelstein
- Senior Vice President, Clinical Research, Ardelyx, Inc., Waltham, Massachusetts
| | - Glenn M Chertow
- Professor of Medicine - Nephrology, Departments of Medicine and Epidemiology and Population Health, Stanford University, Palo Alto, California
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Akinlawon OJ, Zhang X, Duong CN, Li W, Garelnabi M, Noel SE, Bello D, Tucker KL. Phosphorous intake in foods and phosphorus status markers in circulation in the Boston Puerto Rican Health Study. J Food Compost Anal 2024; 136:106681. [PMID: 39399356 PMCID: PMC11469587 DOI: 10.1016/j.jfca.2024.106681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
Abstract
Phosphorus (P) additives may be deleterious for health. We measured the P content of key foods, and associations of P intake with biomarkers in the Boston Puerto Rican Health Study (BPRHS). Direct chemical analysis of 92 foods was done with the molybdenum blue spectrophotometric method and inductively coupled plasma mass spectrometry (ICP-MS). A novel algorithm was used to determine bioavailable, natural, and added P. We estimated P intakes from foods in 1323 participants, aged 45-75 y, and associations of these with serum P, fibroblast growth factor 23 (FGF23), parathyroid hormone (PTH), and Klotho. Relationships between intakes and status markers were assessed with Pearson's correlations and t-tests. Our food analyses generally support P values in the USDA nutrient database, with the exceptions of American and cheddar cheese, which had more P than in the database. Women had higher added P intake than men, and younger participants had higher added P than those older. Total P intake tended to be positively associated with serum P and klotho, and inversely associated with PTH, but relationships were not strong. Puerto Rican adults have high intake of additive P. Culturally sensitive interventions that highlight dietary quality are needed.
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Affiliation(s)
- Oladimeji J. Akinlawon
- Department of Biomedical and Nutritional Sciences and Center for Population Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Xiyuan Zhang
- Department of Biomedical and Nutritional Sciences and Center for Population Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Chi N. Duong
- Department of Biomedical and Nutritional Sciences and Center for Population Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Wenjun Li
- Department of Public Health and Center for Population Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Mahdi Garelnabi
- Department of Biomedical and Nutritional Sciences and Center for Population Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Sabrina E. Noel
- Department of Biomedical and Nutritional Sciences and Center for Population Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Dhimiter Bello
- Department of Biomedical and Nutritional Sciences and Center for Population Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Katherine L. Tucker
- Department of Biomedical and Nutritional Sciences and Center for Population Health, University of Massachusetts Lowell, Lowell, MA, USA
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Torrijo-Belanche C, Moreno-Franco B, Laclaustra M, Gimeno-Ruiz S, Calvo-Galiano N, Rey-García J, Guallar-Castillón P. Urinary Phosphate and Subclinical Atherosclerosis: The AWHS Study. Nutrients 2024; 16:2780. [PMID: 39203916 PMCID: PMC11357142 DOI: 10.3390/nu16162780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/07/2024] [Accepted: 08/19/2024] [Indexed: 09/03/2024] Open
Abstract
(1) Background: Atherosclerosis is a leading cause of vascular death worldwide. High urinary phosphate has recently been identified as a cardiovascular risk factor, but its role has not been fully established. The aim of this study was to investigate the association between urinary phosphate and subclinical atherosclerosis in the carotid, femoral as well as coronary territories; (2) Methods: We performed a cross-sectional analysis of a sample of 1169 middle-aged men, aged 50.9 years (SD 3.7), without previous cardiovascular disease, belonging to the Aragon Workers Health Study (AWHS). Urinary phosphate was analyzed in urine samples using the Fiske-Subbarow method. The presence of carotid plaque and femoral plaque was assessed by ultrasound and coronary artery calcium score (CACS) by computed tomography. Demographic, anthropometric and clinical data were collected at annual medical examinations. Logistic regression models were used to estimate the prevalence of adjusted atherosclerosis in the different vascular arteries; (3) Results: A significant inverse association was observed between urinary phosphate and subclinical atherosclerosis in the carotid [OR 95% CI 0.69 (0.49-0.99)] and coronary (CACS > 200) [OR 95% CI 0.46 (0.23-0.88)] arteries; however, no statistically significant association was found between urinary phosphate and the presence of atheroma plaques in the femoral territory [OR 1.02 (0.72-1.45)]; (4) Conclusions: In middle-aged men, a higher urinary phosphate concentration is associated with a lower prevalence of subclinical carotid and coronary atherosclerosis compared with those with a lower urinary phosphate concentration.
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Affiliation(s)
- Carolina Torrijo-Belanche
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, 50009 Zaragoza, Spain;
| | - Belén Moreno-Franco
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, 50009 Zaragoza, Spain;
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (M.L.); (N.C.-G.)
- CIBERCV (CIBER de Enfermedades Cardiovasculares), 28029 Madrid, Spain
| | - Martín Laclaustra
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (M.L.); (N.C.-G.)
- CIBERCV (CIBER de Enfermedades Cardiovasculares), 28029 Madrid, Spain
- Department of Medicine, Psychiatry and Dermatology, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | | | - Naiara Calvo-Galiano
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (M.L.); (N.C.-G.)
- Department of Medicine, Psychiatry and Dermatology, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Jimena Rey-García
- Internal Medicine Department, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, 28034 Madrid, Spain;
| | - Pilar Guallar-Castillón
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain;
- CIBERESP (CIBER de Epidemiología y Salud Pública), 28029 Madrid, Spain
- IMDEA-Food Institute, CEIUAM+CSIC, Carretera de Cantoblanco 8, 28049 Madrid, Spain
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Yoshikawa K, Kogure F, Tsukada K, Toyama T, Sakuragawa A, Nagashima H. Determination of phosphorus in commercially available milk using ion chromatography with perchloric acid deproteinization. ANAL SCI 2024; 40:1365-1371. [PMID: 38573452 DOI: 10.1007/s44211-024-00552-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/05/2024] [Indexed: 04/05/2024]
Abstract
Suppressed ion chromatography with perchloric acid deproteinization was developed for the determination of phosphorus in commercially available milk. Although the perchloric acid deproteinization method is widely used in the medical field, it sees limited application in the food industry. Herein, the concentration of perchloric acid and hydrolysis conditions were examined, specifically regarding perchloric acid deproteinization, which was used as a deproteinization method in this study. The calibration curve constructed from the peak area of orthophosphoric acid (monohydrogen phosphate ion: HPO42-) was linear, with a correlation coefficient of 0.999. The relative standard deviation of the peak area of 50 mg/L of HPO42- from six replicates was 0.35%. The detection and quantitative limits of HPO42-, calculated from its signal-to-noise ratio were 0.033 mg/L and 0.100 mg/L, respectively. The proposed method was applied to the analysis of phosphorus in commercially available milk. Perchloric acid deproteinization has proved to be useful in the food industry.
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Affiliation(s)
- Kenji Yoshikawa
- Department of Materials and Applied Chemistry, College of Science and Technology, Nihon University, 1-8-14, Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8308, Japan.
| | - Futa Kogure
- Department of Materials and Applied Chemistry, College of Science and Technology, Nihon University, 1-8-14, Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8308, Japan
| | - Kohei Tsukada
- Department of Materials and Applied Chemistry, College of Science and Technology, Nihon University, 1-8-14, Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8308, Japan
| | - Takeshi Toyama
- Department of Materials and Applied Chemistry, College of Science and Technology, Nihon University, 1-8-14, Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8308, Japan
| | - Akio Sakuragawa
- Department of Materials and Applied Chemistry, College of Science and Technology, Nihon University, 1-8-14, Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8308, Japan
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Torrijo-Belanche C, Moreno-Franco B, Muñoz-Cabrejas A, Calvo-Galiano N, Casasnovas JA, Sayón-Orea C, Guallar-Castillón P. High Serum Phosphate Is Associated with Cardiovascular Mortality and Subclinical Coronary Atherosclerosis: Systematic Review and Meta-Analysis. Nutrients 2024; 16:1599. [PMID: 38892532 PMCID: PMC11174514 DOI: 10.3390/nu16111599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
(1) Background: Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. The aim of the study was to examine the existing published results of the association between elevated serum phosphate concentrations and cardiovascular mortality, along with the CVD incidence and subclinical coronary atherosclerosis, in primary prevention among non-selected samples of the general population. (2) Methods: A systematic review and meta-analysis were carried out using literature obtained from PubMed, SCOPUS, and the Web Of Science until March 2024 and following the PRISMA guidelines. Relevant information was extracted and presented. Random and fixed effects models were used to estimate the pooled odds ratio (OR) and hazard ratio (HR) with their 95% coefficient interval (CI), and I2 was used to assess heterogeneity. (3) Results: Twenty-five studies met our inclusion criteria and were included in the meta-analysis (11 cross-sectional and 14 cohort studies). For cardiovascular mortality, which included 7 cohort studies and 41,764 adults, the pooled HR was 1.44 (95% CIs 1.28, 1.61; I2 0%) when the highest versus the reference level of serum phosphate concentrations were compared. For CVDs, which included 8 cohort studies and 61,723 adults, the pooled HR was 1.12 (95% CIs 0.99, 1.27; I2 51%). For subclinical coronary atherosclerosis, which included 11 cross-sectional studies and 24,820 adults, the pooled OR was 1.44 (95% CIs 1.15, 1.79; I2 88%). (4) Conclusions: The highest serum phosphate concentrations were positively associated with a 44% increased risk of cardiovascular mortality and subclinical coronary atherosclerosis.
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Affiliation(s)
- Carolina Torrijo-Belanche
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, 50009 Zaragoza, Spain; (C.T.-B.); (A.M.-C.)
| | - Belén Moreno-Franco
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, 50009 Zaragoza, Spain; (C.T.-B.); (A.M.-C.)
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (N.C.-G.); (J.A.C.)
- CIBERCV (CIBER de Enfermedades Cardiovasculares), 28029 Madrid, Spain
| | - Ainara Muñoz-Cabrejas
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, 50009 Zaragoza, Spain; (C.T.-B.); (A.M.-C.)
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (N.C.-G.); (J.A.C.)
| | - Naiara Calvo-Galiano
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (N.C.-G.); (J.A.C.)
- Department of Medicine, Psychiatry and Dermatology, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - José Antonio Casasnovas
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (N.C.-G.); (J.A.C.)
- CIBERCV (CIBER de Enfermedades Cardiovasculares), 28029 Madrid, Spain
- Department of Medicine, Psychiatry and Dermatology, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Carmen Sayón-Orea
- Department of Preventive Medicine and Public Health, University of Navarra-IDISNA, 31008 Pamplona, Spain;
- CIBERobn (CIBER Fisiopatología de la Obesidad y Nutrición), 28029 Madrid, Spain
| | - Pilar Guallar-Castillón
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain;
- CIBERESP (CIBER de Epidemiología y Salud Pública), 28029 Madrid, Spain
- IMDEA-Food Institute, CEI UAM + CSIC, Carretera de Cantoblanco 8, 28049 Madrid, Spain
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Vergili JM, Proaño GV, Jimenez EY, Moloney L, Papoutsakis C, Steiber A. Academy of Nutrition and Dietetics Commentary on the Phosphorus Recommendation in the KDOQI Clinical Practice Guidelines for Nutrition in CKD: 2020 Update. J Ren Nutr 2024; 34:192-199. [PMID: 38007185 DOI: 10.1053/j.jrn.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 11/27/2023] Open
Abstract
The Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Nutrition in Chronic Kidney Disease: 2020 Update recommends adjusting dietary phosphorus to maintain a serum phosphate goal for hemodialysis patients in the normal range (0.81 to 1.45 mmol/L [2.5 to 4.5 mg/dL]). This is lower than the serum phosphate goal used by many dialysis centers (0.97 to 1.78 mmol/L [3.0 and 5.5 mg/dL]). Although context and clinical judgment must always be considered when providing individualized care to patients, a guideline implementation study conducted from December 2020 to December 2022 found that, based on their documentation, registered dietitian nutritionists from two national dialysis chains are almost universally using dialysis center goals instead of the lower phosphate goal recommended by the guideline. This commentary discusses the possible barriers to implementing the Kidney Disease Outcomes Quality Initiative 2020 nutrition guideline's phosphorus recommendation and proposes a systems level approach to promote and support adoption of the recommendation. Calls to action for potential changes in clinician practices, organizational/institutional culture, and government regulations are put forth.
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Affiliation(s)
- Joyce Marcley Vergili
- Registered Dietitian, Board Certified Specialist in Renal Nutrition, Research Consultant, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Gabriela V Proaño
- Senior Research Project Manager, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois.
| | - Elizabeth Yakes Jimenez
- Professor and Assistant Dean for Research, College of Population Health and Departments of Pediatrics and Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Lisa Moloney
- Nutrition Researcher, Level 2, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Constantina Papoutsakis
- Senior Director, Data Science Center, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Alison Steiber
- Chief Science Officer, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois
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Donat-Vargas C, Guallar-Castillon P, Nyström J, Larsson SC, Kippler M, Vahter M, Faxén-Irving G, Michaelsson K, Wolk A, Stenvinkel P, Åkesson A. Urinary phosphate is associated with cardiovascular disease incidence. J Intern Med 2023; 294:358-369. [PMID: 37330983 DOI: 10.1111/joim.13686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Elevated phosphate (P) in urine may reflect a high intake of inorganic P salts from food additives. Elevated P in plasma is linked to vascular dysfunction and calcification. OBJECTIVE To explore associations between P in urine as well as in plasma and questionnaire-estimated P intake, and incidence of cardiovascular disease (CVD). METHODS We used the Swedish Mammography Cohort-Clinical, a population-based cohort study. At baseline (2004-2009), P was measured in urine and plasma in 1625 women. Dietary P was estimated via a food-frequency questionnaire. Incident CVD was ascertained via register-linkage. Associations were assessed using Cox proportional hazards regression. RESULTS After a median follow-up of 9.4 years, 164 composite CVD cases occurred (63 myocardial infarctions [MIs] and 101 strokes). Median P (percentiles 5-95) in urine and plasma were 2.4 (1.40-3.79) mmol/mmol creatinine and 1.13 (0.92-1.36) mmol/L, respectively, whereas dietary P intake was 1510 (1148-1918) mg/day. No correlations were observed between urinary and plasma P (r = -0.07) or dietary P (r = 0.10). Urinary P was associated with composite CVD and MI. The hazard ratio of CVD comparing extreme tertiles was 1.57 (95% confidence interval 1.05, 2.35; P trend 0.037)-independently of sodium excretion, the estimated glomerular filtration rate, both P and calcium in plasma, and diuretic use. Association with CVD for plasma P was 1.41 (0.96, 2.07; P trend 0.077). CONCLUSION Higher level of urinary P, likely reflecting a high consumption of highly processed foods, was linked to CVD. Further investigation is needed to evaluate the potential cardiovascular toxicity associated with excessive intake of P beyond nutritional requirements.
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Affiliation(s)
- Carolina Donat-Vargas
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- ISGlobal, Barcelona, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Pilar Guallar-Castillon
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Jenny Nyström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Susanna C Larsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Maria Kippler
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marie Vahter
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gerd Faxén-Irving
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Karl Michaelsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Alicja Wolk
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Peter Stenvinkel
- Department of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Agneta Åkesson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Sinha S, Haque M. Obesity, Diabetes Mellitus, and Vascular Impediment as Consequences of Excess Processed Food Consumption. Cureus 2022; 14:e28762. [PMID: 36105908 PMCID: PMC9441778 DOI: 10.7759/cureus.28762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2022] [Indexed: 12/15/2022] Open
Abstract
Regular intake of ready-to-eat meals is related to obesity and several noninfectious illnesses, such as cardiovascular diseases, hypertension, diabetes mellitus (DM), and tumors. Processed foods contain high calories and are often enhanced with excess refined sugar, saturated and trans fat, Na+ andphosphate-containing taste enhancers, and preservatives. Studies showed that monosodium glutamate (MSG) induces raised echelons of oxidative stress, and excessive hepatic lipogenesis is concomitant to obesity and type 2 diabetes mellitus (T2DM). Likewise, more than standard salt intake adversely affects the cardiovascular system, renal system, and central nervous system (CNS), especially the brain. Globally, excessive utilization of phosphate-containing preservatives and additives contributes unswervingly to excessive phosphate intake through food. In addition, communities and even health experts, including medical doctors, are not well-informed about the adverse effects of phosphate preservatives on human health. Dietary phosphate excess often leads to phosphate toxicity, ultimately potentiating kidney disease development. The mechanisms involved in phosphate-related adverse effects are not explainable. Study reports suggested that high blood level of phosphate causes vascular ossification through the deposition of Ca2+ and substantially alters fibroblast growth factor-23 (FGF23) and calcitriol.
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11
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Kusumi K, Kremsdorf R, Kakajiwala A, Mahan JD. Pediatric Mineral and Bone Disorder of Chronic Kidney Disease and Cardiovascular Disease. Adv Chronic Kidney Dis 2022; 29:275-282. [PMID: 36084974 DOI: 10.1053/j.ackd.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/29/2022] [Accepted: 04/05/2022] [Indexed: 11/11/2022]
Abstract
Chronic kidney disease is common and causes significant morbidity including shortened lifespans and decrease in quality of life for patients. The major cause of mortality in chronic kidney disease is cardiovascular disease. Cardiovascular disease within the chronic kidney disease population is closely tied with disordered calcium and phosphorus metabolism and driven in part by renal bone disease. The complex nature of renal, bone, and cardiovascular diseases was renamed as mineral and bone disorder of chronic kidney disease to encompass how bone disease drives vascular calcification and contributes to the development of long-term cardiovascular disease, and recent data suggest that managing bone disease well can augment and improve cardiovascular disease status. Pediatric nephrologists have additional obstacles in optimal mineral and bone disorder of chronic kidney disease management such as linear growth and skeletal maturation. In this article, we will discuss cardiovascular and bone diseases in chronic kidney disease and end-stage kidney disease patients with a focus on pediatric issues and concerns.
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Affiliation(s)
- Kirsten Kusumi
- Department of Pediatric Nephrology, Akron Children's Hospital, Akron, OH.
| | - Robin Kremsdorf
- Pediatric Nephrology and Hypertension, Hasbro Children's Hospital, Providence, RI
| | - Aadil Kakajiwala
- Departments of Pediatric Critical Care Medicine and Nephrology, Children's National Hospital, Washington, DC
| | - John D Mahan
- Division of Nephrology and Hypertension at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
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12
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Naber T, Purohit S. Chronic Kidney Disease: Role of Diet for a Reduction in the Severity of the Disease. Nutrients 2021; 13:3277. [PMID: 34579153 PMCID: PMC8467342 DOI: 10.3390/nu13093277] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 12/15/2022] Open
Abstract
Chronic kidney disease affects ~37 million adults in the US, and it is often undiagnosed due to a lack of apparent symptoms in early stages. Chronic kidney disease (CKD) interferes with the body's physiological and biological mechanisms, such as fluid electrolyte and pH balance, blood pressure regulation, excretion of toxins and waste, vitamin D metabolism, and hormonal regulation. Many CKD patients are at risk of hyperkalemia, hyperphosphatemia, chronic metabolic acidosis, bone deterioration, blood pressure abnormalities, and edema. These risks may be minimized, and the disease's progression may be slowed through careful monitoring of protein, phosphorus, potassium, sodium, and calcium, relieving symptoms experienced by CKD patients. In this review, the current Kidney Disease Outcomes Quality Initiative (KDOQI) recommendations are highlighted, reflecting the 2020 update, including explanations for the pathophysiology behind the recommendations. The Dietary Approaches to Stop Hypertension, the Mediterranean diet, and the whole foods plant-based diet are currently being examined for their potential role in delaying CKD progression. Biological explanations for why the whole foods plant-based diet may benefit CKD patients compared to diets that include animal products are examined. Strong evidence continues to support the importance of diet meeting the daily requirement in the prevention and progression of kidney disease, and medical nutrition therapy with a registered dietitian is a critical aspect in medical intervention for CKD.
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Affiliation(s)
- Tania Naber
- Department of Interdisciplinary Research, College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA;
| | - Sharad Purohit
- Department of Undergraduate Health Professionals, College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA
- Department of Gynecology and Obstetrics, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Center for Biotechnology and Genomic Medicine, Augusta University, Augusta, GA 30912, USA
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13
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Soutar L, Coltherd JC, Steele VR, Staunton R, Carvell-Miller L, Hughes KR, Bakke AM, Marshall JW. Comparisons of In Vitro and In Vivo Digestibility Assays for Phosphorus in Feline Diets and Associations with Dietary Nutrient Content. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2021; 69:10688-10699. [PMID: 34472353 DOI: 10.1021/acs.jafc.1c03308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Phosphorus (P) is an essential nutrient; however, potential health impacts of high dietary levels of added soluble, highly bioavailable P salts especially are a concern. P sources with lower bioavailability are considered safer. Yet, speciation of different P sources to assess diets' risk to health is challenging. This investigation tested the value of in vitro water extraction and digestion assays to predict in vivo P apparent bioavailability/digestibility in feline diets. Thirty wet (n = 18) and dry (n = 12) format experimental and commercial cat foods were analyzed for nutrient content. Triplicate samples were subjected to in vitro water extraction, single-phase acidic (gastric; G) digestion, and dual-phase gastric and small intestinal (G-SI) digestion assays. Soluble and insoluble P were determined in the supernatant and pellet, respectively. A subset of the diets (seven wet, nine dry diets) was fed to healthy, adult cats (n = 7-24) to determine in vivo apparent P digestibility. Information on the soluble P salt sources and their contribution to total dietary P was available for some diets. Associations between data from the different in vitro assays and in vivo digestibility trials and the influence of different diet parameters were obtained using Pearson correlation and linear regression modeling. The % soluble P obtained from G-SI digestion assay correlated well with in vivo apparent P digestibility for wet (Pearson coefficient 0.926, p = 0.003), but not for dry diets (Pearson coefficient -0.074, p = 0.849). In contrast, the % soluble P determined by water extraction correlated well with the % soluble P salt contribution to total P for dry (Pearson coefficient 0.901, p < 0.001), but not for wet diets (Pearson coefficient -0.407, p = 0.365). Thus, 20 min water extraction can be used to predict soluble P salt content in dry diets; however, differing Ca:P ratios and water solubility of the P sources may affect the outcome and false-positive results can occur. The G-SI digestion assay employed can also be used to predict in vivo P digestibility. However, again, diet format, Ca:P ratios in diets, and possibly other factors can impact the results. Thus, data from in vitro assays to assess P sources and bioavailability need to be interpreted with care.
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Affiliation(s)
- Lyndsay Soutar
- Waltham Petcare Science Institute, Freeby Lane, Waltham-on-the-Wolds, Melton Mowbray LE14 4RT, Leicestershire, United Kingdom
| | - Jennifer C Coltherd
- Waltham Petcare Science Institute, Freeby Lane, Waltham-on-the-Wolds, Melton Mowbray LE14 4RT, Leicestershire, United Kingdom
| | - Victoria R Steele
- Waltham Petcare Science Institute, Freeby Lane, Waltham-on-the-Wolds, Melton Mowbray LE14 4RT, Leicestershire, United Kingdom
| | - Ruth Staunton
- Waltham Petcare Science Institute, Freeby Lane, Waltham-on-the-Wolds, Melton Mowbray LE14 4RT, Leicestershire, United Kingdom
| | - Laura Carvell-Miller
- Waltham Petcare Science Institute, Freeby Lane, Waltham-on-the-Wolds, Melton Mowbray LE14 4RT, Leicestershire, United Kingdom
| | - Kevin R Hughes
- Waltham Petcare Science Institute, Freeby Lane, Waltham-on-the-Wolds, Melton Mowbray LE14 4RT, Leicestershire, United Kingdom
| | - Anne Marie Bakke
- Waltham Petcare Science Institute, Freeby Lane, Waltham-on-the-Wolds, Melton Mowbray LE14 4RT, Leicestershire, United Kingdom
| | - James W Marshall
- Waltham Petcare Science Institute, Freeby Lane, Waltham-on-the-Wolds, Melton Mowbray LE14 4RT, Leicestershire, United Kingdom
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14
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Dobenecker B. [Phosphate intake with complete food and diets for chronic kidney disease available on the German market]. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2021; 49:247-254. [PMID: 34425603 DOI: 10.1055/a-1487-8625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Complete foods and renal diets for dogs and cats available on the German market were analyzed for their concentrations of total phosphorus as well as highly soluble and therefore highly available phosphorus due to the possible effects of this element on the animal's health. MATERIAL AND METHODS A total of 133 complete foods for healthy dogs and cats, 8 snacks and 43 diets for patients with chronic kidney disease were analyzed for total phosphorus and the fraction of phosphorus soluble in water after 1 minute (Psol1). RESULTS In the tested compound food, the amount of phosphorus in relation to the recommended daily allowance ranged from 90 to 740 %. More than 90 % of the products supplied twice the required amounts; in 6 dog feeds the nutritional maximum wasexceeded. For almost 75 % of the products, the recommended daily allowance for phosphorus was already met vollby Psol1. More than 50 % of the tested renal diets contained more than twice the recommended amounts for healthy individuals and with this also exceeded the legal limits. Even in the renal diets, the amount of Psol1 alone exceeded the recommended daily allowance for this element. CONCLUSION This work demonstrates that compound food and renal diets available on the German market may contain a multiple of the recommended or legally permitted phosphorus concentrations. Therefore, a considerable number of products may be expected to not meet the expectations of customers and veterinarians.
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Affiliation(s)
- Britta Dobenecker
- Lehrstuhl für Tierernährung und Diätetik, Veterinärmedizinisches Department, Ludwig-Maximilians-Universität München
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15
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Ravi KS, Reeves PB, Correa S, Neves JS, Waikar SS, Mothi SS, Mc Causland FR. Predialysis serum phosphate and intradialytic hypotension. Hemodial Int 2021; 26:38-47. [PMID: 34236130 DOI: 10.1111/hdi.12971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Intradialytic hypotension (IDH) is a common complication of hemodialysis (HD) and is associated with excess morbidity and mortality. Higher serum phosphate is associated with adverse cardiovascular outcomes in maintenance HD patients; however, its association with IDH has not previously been assessed. METHODS This is an analysis of a prospective cohort of 969 HD patients (80,968 HD sessions) receiving HD at a large dialysis organization (LDO) and a post-hoc analysis of 1838 HD patients (10,594 HD sessions) in the Hemodialysis study (HEMO), a multicenter randomized controlled trial that examined standard or high-dose HD and low-flux or high-flux membranes. Unadjusted and adjusted mixed effects regression models were fit to determine the association of pre-HD serum phosphate with IDH, defined as a nadir intra-HD systolic blood pressure (SBP) <90 mmHg. FINDINGS In the LDO cohort, baseline mean pre-HD serum phosphate was 5.2 ± 1.7 mg/dl. IDH occurred in 15.6% of HD sessions. In the adjusted model, higher pre-HD serum phosphate (per 1 mg/dl) was associated with a 12% increased risk of IDH (aOR 1.12, 95% CI 1.10-1.13, p <0.001). In exploratory models where pre-HD laboratory values were available, the effect estimate was attenuated but remained statistically significant (aOR 1.05; 95% CI 1.02-1.08; p <0.01). Participants in the highest (compared with the lowest) quartile of pre-HD serum phosphate had a 56% greater risk of IDH in the adjusted model (aOR Q4:Q1 1.56; 95% CI 1.44-1.68, p <0.001). The association of higher phosphate with IDH was consistent in the HEMO data. DISCUSSION Higher pre-HD serum phosphate is independently associated with an increased risk of IDH. As HD may cause an acute decline in serum phosphate, future studies to investigate the mechanisms of this association are warranted.
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Affiliation(s)
- Katherine Scovner Ravi
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick B Reeves
- Kidney Specialists of Central Oklahoma, Oklahoma City, Oklahoma, USA
| | - Simon Correa
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - João Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Sushrut S Waikar
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - Suraj S Mothi
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Finnian R Mc Causland
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Atwal J, Stockman J, Gilham M, Allaway D, Renfrew H, Bakke AM, Watson P. No Observed Adverse Effects on Health Were Detected in Adult Beagle Dogs When Fed a High-Calcium Diet for 40 Weeks. Animals (Basel) 2021; 11:ani11061799. [PMID: 34208630 PMCID: PMC8234157 DOI: 10.3390/ani11061799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/04/2021] [Accepted: 06/11/2021] [Indexed: 11/29/2022] Open
Abstract
Simple Summary Calcium (Ca) is an essential mineral that plays a vital role in many bodily functions. There is evidence that high levels of dietary Ca for puppies and growing dogs can result in adverse growth and health effects, with certain breeds and dog size categories being most susceptible, for example, large breed sizes or beagles. Until recently, little was known about the health consequences of high Ca diets to adult dog, however, a study in the large sized breed Labrador retriever found no adverse health consequences when feeding diets containing levels of Ca near maximum levels set by pet food regulators (2.5 g per 100 g dry matter) for 40 weeks. This current study fed a similar high Ca diet to adult beagles, a medium sized breed for 40 weeks and monitored the dogs’ health using an extensive suite of health parameters. All dogs remained healthy and did not display any clinically relevant signs of adverse health relating to diet at any point during or following completion of the study. Abstract The implications of long-term high calcium (Ca) intake are well documented in growing dogs and in adult dogs of large breed size, however, the consequences on other breeds and breed sizes are yet to be determined. Eighteen neutered adult beagles, nine males and nine females aged 1.4–4.4 years, were randomized to control or test diets providing in g∙4184 kJ−1 (1000 kcal−1): 1.44 and 7.19 total Ca balanced with 1.05 and 4.25 total phosphorus, respectively, for 40 weeks. Health parameters, ultrasound scans, radiographs, glomerular filtration rate, and mineral balance were measured at eight-week intervals. All dogs remained healthy with no measured evidence of orthopedic, urinary, or renal disease. The test diet resulted in a 5.2 fold increase in fecal Ca excretion. Apparent Ca digestibility (%) and Ca balance (g/d) did not significantly (p > 0.05) change from baseline in the test diet group, although dogs displayed a positive Ca balance (maximum at week 8, 1.11 g/d with 95% CI (0.41, 1.80)) before a neutral Ca balance was restored at week 32. Despite an initial positive Ca balance, we can conclude that no measurable adverse health effects were observed as a result of the test diet fed in this study in beagles over a period of 40 weeks.
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Affiliation(s)
- Jujhar Atwal
- WALTHAM Petcare Science Institute, Melton Mowbray, Leicestershire LE14 4RT, UK; (J.S.); (M.G.); (D.A.); (A.M.B.); (P.W.)
- Correspondence:
| | - Jonathan Stockman
- WALTHAM Petcare Science Institute, Melton Mowbray, Leicestershire LE14 4RT, UK; (J.S.); (M.G.); (D.A.); (A.M.B.); (P.W.)
| | - Matthew Gilham
- WALTHAM Petcare Science Institute, Melton Mowbray, Leicestershire LE14 4RT, UK; (J.S.); (M.G.); (D.A.); (A.M.B.); (P.W.)
| | - David Allaway
- WALTHAM Petcare Science Institute, Melton Mowbray, Leicestershire LE14 4RT, UK; (J.S.); (M.G.); (D.A.); (A.M.B.); (P.W.)
| | - Helen Renfrew
- Renfrew Imaging, Grove Road, Bladon, Woodstock OX20 1RD, UK;
| | - Anne Marie Bakke
- WALTHAM Petcare Science Institute, Melton Mowbray, Leicestershire LE14 4RT, UK; (J.S.); (M.G.); (D.A.); (A.M.B.); (P.W.)
| | - Phillip Watson
- WALTHAM Petcare Science Institute, Melton Mowbray, Leicestershire LE14 4RT, UK; (J.S.); (M.G.); (D.A.); (A.M.B.); (P.W.)
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Abstract
Two papers, one in 1986 and another one in 1988, reported a strong inverse correlation between urinary anion gap (UAG) and urine ammonia excretion (UNH4) in patients with metabolic acidosis and postulated that UAG could be used as an indirect measure of UNH4 This postulation has persisted until now and is widely accepted. In this review, we discuss factors regulating UAG and examine published evidence to uncover errors in the postulate and the design of the original studies. The essential fact is that, in the steady state, UAG reflects intake of Na, K, and Cl. Discrepancy between intake and urinary output of these electrolytes (i.e, UAG) indicates selective extrarenal loss of these electrolytes or nonsteady state. UNH4 excretion, which depends, in the absence of renal dysfunction, mainly on the daily acid load, has no consistent relationship to UAG either theoretically or in reality. Any correlation between UAG and UNH4, when observed, was a fortuitous correlation and cannot be extrapolated to other situations. Furthermore, the normal value of UAG has greatly increased over the past few decades, mainly due to increases in dietary intake of potassium and widespread use of sodium salts with anions other than chloride as food additives. The higher normal values of UAG must be taken into consideration in interpreting UAG.
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Affiliation(s)
- Jaime Uribarri
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Man S. Oh
- Renal Division, Department of Medicine, State University of New York at Downstate, Brooklyn, New York
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18
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Matuszewska E, Klupczynska A, Maciołek K, Kokot ZJ, Matysiak J. Multielemental Analysis of Bee Pollen, Propolis, and Royal Jelly Collected in West-Central Poland. Molecules 2021; 26:2415. [PMID: 33919229 PMCID: PMC8122449 DOI: 10.3390/molecules26092415] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 12/16/2022] Open
Abstract
Beehive products possess nutritional value and health-promoting properties and are recommended as so-called "superfoods". However, because of their natural origin, they may contain relevant elemental contaminants. Therefore, to assess the quality of bee products, we examined concentrations of a broad range of 24 selected elements in propolis, bee pollen, and royal jelly. The quantitative analyses were performed with inductively coupled plasma-mass spectrometry (ICP-MS) and inductively coupled plasma optical emission spectrometry (ICP-OES) techniques. The results of our research indicate that bee products contain essential macronutrients (i.e., K, P, and S) and micronutrients (i.e., Zn and Fe) in concentrations depending on the products' type. However, the presence of toxic heavy metals makes it necessary to test the quality of bee products before using them as dietary supplements. Bearing in mind that bee products are highly heterogenous and, depending on the environmental factors, differ in their elemental content, it is necessary to develop standards regulating the acceptable levels of inorganic pollutants. Furthermore, since bees and their products are considered to be an effective biomonitoring tool, our results may reflect the environment's condition in west-central Poland, affecting the health and well-being of both humans and bees.
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Affiliation(s)
- Eliza Matuszewska
- Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, Grunwaldzka 6 Street, 60-780 Poznań, Poland; (E.M.); (A.K.)
| | - Agnieszka Klupczynska
- Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, Grunwaldzka 6 Street, 60-780 Poznań, Poland; (E.M.); (A.K.)
| | | | - Zenon J. Kokot
- Faculty of Health Sciences, Calisia University, 13 Street, 62-800 Kalisz, Poland;
| | - Jan Matysiak
- Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, Grunwaldzka 6 Street, 60-780 Poznań, Poland; (E.M.); (A.K.)
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Dobenecker B, Reese S, Herbst S. Effects of dietary phosphates from organic and inorganic sources on parameters of phosphorus homeostasis in healthy adult dogs. PLoS One 2021; 16:e0246950. [PMID: 33606750 PMCID: PMC7894875 DOI: 10.1371/journal.pone.0246950] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/28/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The impact of dietary phosphorus (P) excess, especially on renal and cardiovascular health, has been investigated in several species, but little is known in dogs. OBJECTIVE The aim of this study was to examine effects of different P sources on concentration and postprandial kinetics of selected parameters of P homeostasis in dogs. METHODS Eight beagles received one control diet (P 0.5% dry matter [DM]) and three high P diets (poultry meal, NaH2PO4, and KH2PO4; P 1.7% DM) for 18d. Urine samples were collected pre- and postprandially while faeces were collected quantitatively for 5d and analysed for minerals. On day 18, blood was sampled 1h pre- and 0.5, 1, 1.5, 2, 3, 5 and 7h postprandially. RESULTS Pi (KH2PO4, NaH2PO4) but not organic P caused an increased apparent P digestibility and significantly influenced kinetics of serum FGF23, parathyroid hormone, P, CrossLaps and bonespecific alkaline phosphatase, demonstrating a disrupted calcium (Ca) and P homeostasis with potential harm for renal, cardiovascular and skeletal health. CONCLUSIONS Results of feeding Pi to dogs indicate distinct disturbances of Ca and P metabolism, in contrast to organic sources. The use of Pi in food can therefore not be considered as safe. Further research, especially on dose and long-term effects, is warranted.
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Affiliation(s)
- Britta Dobenecker
- Chair of Animal Nutrition and Dietetics, Department of Animal Science, Ludwig-Maximilians- Universität, Munich, Germany
| | - Sven Reese
- Chair of Anatomy, Histology and Embryology, Department of Animal Science, Ludwig-Maximilians- Universität, Munich, Germany
| | - Sarah Herbst
- Chair of Animal Nutrition and Dietetics, Department of Animal Science, Ludwig-Maximilians- Universität, Munich, Germany
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20
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Rey-García J, Donat-Vargas C, Sandoval-Insausti H, Bayan-Bravo A, Moreno-Franco B, Banegas JR, Rodríguez-Artalejo F, Guallar-Castillón P. Ultra-Processed Food Consumption is Associated with Renal Function Decline in Older Adults: A Prospective Cohort Study. Nutrients 2021; 13:428. [PMID: 33525613 PMCID: PMC7912450 DOI: 10.3390/nu13020428] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/23/2021] [Accepted: 01/25/2021] [Indexed: 12/11/2022] Open
Abstract
Ultra-processed food (UPF) consumption has been associated with increased risk of cardiovascular risk factors and mortality. However, little is known on the UPF effect on renal function. The aim of this study is to assess prospectively the association between consumption of UPF and renal function decline. This is a prospective cohort study of 1312 community-dwelling individuals aged 60 and older recruited during 2008-2010 and followed up to December 2015. At baseline, a validated dietary history was obtained. UPF was identified according to NOVA classification. At baseline and at follow-up, serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) levels were ascertained and changes were calculated. A combined end-point of renal decline was considered: SCr increase or eGFR decreased beyond that expected for age. Logistic regression with adjustment for potential confounders was performed. During follow-up, 183 cases of renal function decline occurred. The fully adjusted odds ratios (95% CI) of renal function decline across terciles of percentage of total energy intake from UPF were 1.56 (1.02-2.38) for the second tercile, and 1.74 (1.14-2.66) for the highest tercile; p-trend was 0.026. High UPF consumption is independently associated with an increase higher than 50% in the risk of renal function decline in Spanish older adults.
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Affiliation(s)
- Jimena Rey-García
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain; (J.R.-G.); (H.S.-I.); (J.R.B.); (F.R.-A.); (P.G.-C.)
- Internal Medicine Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain
| | - Carolina Donat-Vargas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain; (J.R.-G.); (H.S.-I.); (J.R.B.); (F.R.-A.); (P.G.-C.)
- IMDEA-Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Helena Sandoval-Insausti
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain; (J.R.-G.); (H.S.-I.); (J.R.B.); (F.R.-A.); (P.G.-C.)
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Ana Bayan-Bravo
- Department of Nutrition, 12 de Octubre Hospital, 28041 Madrid, Spain;
| | - Belén Moreno-Franco
- Department of Microbiology, Radiology, Pediatrics and Public Health, Universidad de Zaragoza, 50009 Zaragoza, Spain;
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain
| | - José Ramón Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain; (J.R.-G.); (H.S.-I.); (J.R.B.); (F.R.-A.); (P.G.-C.)
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain; (J.R.-G.); (H.S.-I.); (J.R.B.); (F.R.-A.); (P.G.-C.)
- IMDEA-Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
| | - Pilar Guallar-Castillón
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain; (J.R.-G.); (H.S.-I.); (J.R.B.); (F.R.-A.); (P.G.-C.)
- IMDEA-Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
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Assessment of Inorganic Phosphate Intake by the Measurement of the Phosphate/Urea Nitrogen Ratio in Urine. Nutrients 2021; 13:nu13020292. [PMID: 33498560 PMCID: PMC7909516 DOI: 10.3390/nu13020292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
In chronic kidney disease (CKD) patients, it would be desirable to reduce the intake of inorganic phosphate (P) rather than limit the intake of P contained in proteins. Urinary excretion of P should reflect intestinal absorption of P(inorganic plus protein-derived). The aim of the present study is to determine whether the ratio of urinary P to urinary urea nitrogen (P/UUN ratio) helps identify patients with a high intake of inorganic P.A cross-sectional study was performed in 71 patients affected by metabolic syndrome with CKD (stages 2–3) with normal serum P concentration. A 3-day dietary survey was performed to estimate the average daily amount and the source of P ingested. The daily intake of P was 1086.5 ± 361.3 mg/day; 64% contained in animal proteins, 22% in vegetable proteins, and 14% as inorganic P. The total amount of P ingested did not correlate with daily phosphaturia, but it did correlate with the P/UUN ratio (p < 0.018). Patients with the highest tertile of the P/UUN ratio >71.1 mg/g presented more abundant inorganic P intake (p < 0.038).The P/UUN ratio is suggested to be a marker of inorganic P intake. This finding might be useful in clinical practices to identify the source of dietary P and to make personalized dietary recommendations directed to reduce inorganic P intake.
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Lundin MT, Bressendorff I, Kristensen B, Jørgensen NR, Butt R, Hansen D. Randomized Trial of Acute Changes in Plasma Phosphate After Phosphorus-Standardized Meals in Peritoneal Dialysis. Kidney Int Rep 2021; 6:304-312. [PMID: 33615055 PMCID: PMC7879124 DOI: 10.1016/j.ekir.2020.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/14/2020] [Accepted: 11/03/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction Hyperphosphatemia is associated with increased morbidity and mortality in patients with chronic kidney disease. The aim of this study was to assess whether a meal with high phosphorus content would affect plasma phosphate in the hours that follow among subjects with end-stage kidney disease on peritoneal dialysis. Methods This was a single-blinded randomized cross-over trial of 12 subjects on maintenance peritoneal dialysis, in which subjects were randomized to consume a meal with either high or low phosphorus content on 2 separate trial days. On each trial day, plasma phosphate was measured immediately before consumption of the standardized meal and after 1, 2, 3, and 5 hours. Results The mean fasting plasma phosphate at baseline was 1.69 ± 0.22 mmol/l. Plasma phosphate was similar between the 2 meals at baseline, as well as at 1, 2, 3, and 5 hours after consumption. The largest observed difference in plasma phosphate between the 2 meals was 0.15 mmol/l, which occurred 5 hours after consumption (high-phosphorus meal 1.75 ± 0.32 mmol/l vs. low-phosphorus meal 1.60 ± 0.14 mmol/l (P = 0.06)). Using summary analyses for repeated measures, we observed a significant difference in the plasma phosphate between the 2 meals (P = 0.03). Conclusion Our results show that in subjects with end-stage kidney disease, a meal with high phosphorus content has only a negligible effect on plasma phosphate compared to a meal with low phosphorus content. Thus, large increases in plasma phosphate cannot be accounted for by a high intake of phosphorus in the hours before blood sampling.
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Affiliation(s)
| | - Iain Bressendorff
- Department of Nephrology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Bent Kristensen
- Department of Nuclear Medicine, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rizwan Butt
- Department of Nephrology, Herlev and Gentofte Hospital, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Hansen
- Department of Nephrology, Herlev and Gentofte Hospital, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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23
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Rubio-Aliaga I. Phosphate and Kidney Healthy Aging. Kidney Blood Press Res 2020; 45:802-811. [DOI: 10.1159/000509831] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/29/2020] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> The aging population is increasing rapidly, much faster than our understanding on how to promote healthy aging free of multimorbidities. The aging kidney shows a decline in its function. Whether this decline is preventable or physiological is still debated. Main risks factors for developing CKD are aging common comorbidites, such as hypertension, diabetes, and obesity. Phosphate is vital for our organism, but it is also present in a great variety of food products as food additive and preservative. Due to the higher consumption of processed food in the last century, concern has arisen if a chronic high consumption of phosphate may be toxic impacting on healthy aging. <b><i>Summary:</i></b> Several studies show an association between higher serum phosphate levels and a higher risk of overall mortality and cardiovascular disease. Moreover, higher phosphate levels also worsen CKD progression and may contribute to renal dysfunction in healthy individuals. Acute high phosphate intake is rare but can cause acute kidney injury. Yet, the question if controlling phosphate intake may modulate serum phosphate concentrations remains unanswered, as assessment of phosphate intake is still a difficult task. Phosphate consumption estimations by dietary recalls are largely underestimated, especially in populations groups consuming high amount of processed food. <b><i>Key Message:</i></b> A healthy diet with phosphate source from food may contribute to promote healthy aging and longevity.
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24
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Ikizler TA, Burrowes JD, Byham-Gray LD, Campbell KL, Carrero JJ, Chan W, Fouque D, Friedman AN, Ghaddar S, Goldstein-Fuchs DJ, Kaysen GA, Kopple JD, Teta D, Yee-Moon Wang A, Cuppari L. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. Am J Kidney Dis 2020; 76:S1-S107. [PMID: 32829751 DOI: 10.1053/j.ajkd.2020.05.006] [Citation(s) in RCA: 985] [Impact Index Per Article: 197.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/29/2020] [Indexed: 12/14/2022]
Abstract
The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for nutrition in kidney diseases since 1999. Since the publication of the first KDOQI nutrition guideline, there has been a great accumulation of new evidence regarding the management of nutritional aspects of kidney disease and sophistication in the guidelines process. The 2020 update to the KDOQI Clinical Practice Guideline for Nutrition in CKD was developed as a joint effort with the Academy of Nutrition and Dietetics (Academy). It provides comprehensive up-to-date information on the understanding and care of patients with chronic kidney disease (CKD), especially in terms of their metabolic and nutritional milieu for the practicing clinician and allied health care workers. The guideline was expanded to include not only patients with end-stage kidney disease or advanced CKD, but also patients with stages 1-5 CKD who are not receiving dialysis and patients with a functional kidney transplant. The updated guideline statements focus on 6 primary areas: nutritional assessment, medical nutrition therapy (MNT), dietary protein and energy intake, nutritional supplementation, micronutrients, and electrolytes. The guidelines primarily cover dietary management rather than all possible nutritional interventions. The evidence data and guideline statements were evaluated using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. As applicable, each guideline statement is accompanied by rationale/background information, a detailed justification, monitoring and evaluation guidance, implementation considerations, special discussions, and recommendations for future research.
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Byrne FN, Gillman B, Kiely M, Bowles M, Connolly P, Earlie J, Murphy J, Rennick T, Reilly EO, Shiely F, Kearney P, Eustace J. Revising Dietary Phosphorus Advice in Chronic Kidney Disease G3-5D. J Ren Nutr 2020; 31:132-143. [PMID: 32586712 DOI: 10.1053/j.jrn.2020.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/15/2020] [Accepted: 04/12/2020] [Indexed: 12/20/2022] Open
Abstract
We summarize how practicing dietitians combined available evidence with clinical experience, to define revised dietary recommendations for phosphorus in chronic kidney disease G3-5D. As well as a review of the evidence base, 4 priority topics were reviewed. These were translated into 3 nutrient level recommendations: the introduction of some plant protein where phosphorus is largely bound by phytate; consideration of protein intake in terms of phosphorus load and the phosphorus to protein ratio; and an increased focus on avoiding phosphate additives. This review summarizes and interprets the available evidence in order to support the development of practical food-based advice for patients with chronic kidney disease.
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Affiliation(s)
- Fiona N Byrne
- Department of Nutrition & Dietetics, Cork University Hospital, Cork, Ireland; Department of Renal Medicine, Cork University Hospital, Cork, Ireland; Health Research Board, Clinical Research Facility, Cork, Ireland.
| | - Barbara Gillman
- Department of Nutrition & Dietetics, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Mairead Kiely
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Maria Bowles
- Department of Nutrition & Dietetics, University Hospital Limerick, Limerick, Ireland
| | - Pauline Connolly
- Department of Nutrition & Dietetics, Cavan General Hospital, Cavan, Ireland
| | - Joyce Earlie
- Beacon Renal, Sandyford & Tallaght, Dublin, Ireland
| | - Jean Murphy
- Department of Nutrition & Dietetics, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Theresa Rennick
- Department of Nutrition & Dietetics, Midland Regional Hospital, Tullamore, Ireland
| | | | - Frances Shiely
- Health Research Board, Clinical Research Facility, Cork, Ireland; School of Public Health, University College Cork, Cork, Ireland
| | | | - Joseph Eustace
- Department of Renal Medicine, Cork University Hospital, Cork, Ireland; Health Research Board, Clinical Research Facility, Cork, Ireland
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26
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Gutiérrez OM, Porter AK, Viggeswarapu M, Roberts JL, Beck GR. Effects of phosphorus and calcium to phosphorus consumption ratio on mineral metabolism and cardiometabolic health. J Nutr Biochem 2020; 80:108374. [PMID: 32278118 DOI: 10.1016/j.jnutbio.2020.108374] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 02/13/2020] [Accepted: 03/04/2020] [Indexed: 12/21/2022]
Abstract
Phosphorus is a common additive used in food processing that is typically consumed in excess of the recommended daily allowance; however, our knowledge of its effects on health, in the context of normal renal function, is limited. Unlike phosphorus, calcium intake is generally less than recommended, and it has been hypothesized that the calcium to phosphorus ratio may be partly responsible for the proposed negative health consequences. Therefore, this study sought to determine the effects of increased phosphorus additive intake, in the context of high calcium consumption, on endocrine markers of mineral metabolism and cardiometabolic health. An outpatient feeding study was performed in which healthy adults were fed a run-in control diet for 2 weeks followed by a phosphorus additive enhanced diet with supplemental calcium to an approximate ratio of 1 (experimental diet) for 2 weeks. Blood and urine samples were collected, and participants had brachial flow-mediated dilatation measured, with analyses comparing follow-up measures to baseline. Two weeks of experimental diet increased serum fibroblast growth factor 23 concentrations but lowered body weight and serum leptin; however, other phosphorus responsive factors such as osteopontin and osteocalcin did not increase. A complementary study in male mice also demonstrated that the regulation of known dietary phosphorus responsive factors was mostly abrogated when dietary calcium was raised in parallel with phosphorus. In conclusion, the study identifies weight, leptin and insulin as responsive to dietary phosphorus and that certain aspects of the systemic phosphorus response are attenuated by a corresponding high calcium intake.
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Affiliation(s)
- Orlando M Gutiérrez
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.
| | - Anna K Porter
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; School of Health Professions, College of Nursing and Health Professions, University of Southern Mississippi, Hattiesburg, MS
| | | | - Joseph L Roberts
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University, Atlanta, GA
| | - George R Beck
- The Atlanta Department of Veterans Affairs Medical Center, Decatur, GA; Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University, Atlanta, GA; The Winship Cancer Institute, Emory University, Atlanta, GA.
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Summers SC, Stockman J, Larsen JA, Zhang L, Rodriguez AS. Evaluation of phosphorus, calcium, and magnesium content in commercially available foods formulated for healthy cats. J Vet Intern Med 2019; 34:266-273. [PMID: 31883277 PMCID: PMC6979088 DOI: 10.1111/jvim.15689] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 12/11/2019] [Indexed: 01/06/2023] Open
Abstract
Background High dietary phosphorus (P) and low calcium‐to‐phosphorus ratio (Ca:P) are associated with kidney damage in cats. There are no established guidelines for dietary P maximum for cats. Objectives To quantify crude protein, P, Ca, and magnesium (Mg) concentrations in cat foods and compare among food formats (dry, canned, raw), primary protein ingredients, protein concentrations (low, moderate, high), grain‐free versus grain‐containing foods, foods intended for adult maintenance versus all life stages, and cost. Samples Eighty‐two commercial nonprescription cat foods. Methods Descriptive study. Mineral concentrations were measured using inductively coupled argon plasma‐optical emission spectroscopy. Crude protein was measured using the Dumas nitrogen combustion method. Mineral and crude protein concentrations were compared among food categories. Results Twenty‐seven foods contained ≥3.6 g P/1000 kcal metabolizable energy (ME), of which 7 exceeded 4.8 g/1000 kcal ME. Thirteen foods had low Ca:P ratio (≤1.0). The low‐protein diet group had no products ≥3.6 g P/1000 kcal ME, which was significantly different compared to the high‐protein diet group (52% of products had ≥3.6 g P/1000 kcal ME; P = .01). No significant differences in P content and Ca:P ratio were found among other diet categories. Canned foods had significantly lower Mg compared to dry (P < .001) and raw (P = .007) foods. Declared minimum P and Ca were significantly lower than analyzed concentrations (P = .0005 and P = .003, respectively). Conclusions and Clinical Importance The high number of foods with high P and low Ca suggest that pet food regulatory reform should be considered.
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Affiliation(s)
| | | | | | - Lei Zhang
- Colorado State University, Fort Collins, Colorado
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Effects of the long-term feeding of diets enriched with inorganic phosphorus on the adult feline kidney and phosphorus metabolism. Br J Nutr 2018; 121:249-269. [PMID: 30572965 PMCID: PMC6390406 DOI: 10.1017/s0007114518002751] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Renal disease has a high incidence in cats, and some evidence implicates dietary P as well. To investigate this further, two studies in healthy adult cats were conducted. Study 1 (36 weeks) included forty-eight cats, stratified to control or test diets providing 1·2 or 4·8 g/1000 kcal (4184 kJ) P (0 or approximately 3·6 g/1000 kcal (4184 kJ) inorganic P, Ca:P 1·2, 0·6). Study 2 (29 weeks) included fifty cats, stratified to control or test diets, providing 1·3 or 3·6 g/1000 kcal (4184 kJ) P (0 or approximately 1·5 g/1000 kcal (4184 kJ) inorganic P, Ca:P 1·2, 0·9). Health markers, glomerular filtration rate (GFR) and mineral balance were measured regularly, with abdominal ultrasound. Study 1 was halted after 4 weeks as the test group GFR reduced by 0·4 (95 % CI 0·3, 0·5) ml/min per kg, and ultrasound revealed changes in renal echogenicity. In study 2, at week 28, no change in mean GFR was observed (P >0·05); however, altered renal echogenicity was detected in 36 % of test cats. In agreement with previous studies, feeding a diet with Ca:P <1·0, a high total and inorganic P inclusion resulted in loss of renal function and changes in echogenicity suggestive of renal pathology. Feeding a diet containing lower total and inorganic P with Ca:P close to 1·0 led to more subtle structural changes in a third of test cats; however, nephrolithiasis occurred in both diet groups, complicating data interpretation. We conclude that the no observed adverse effects level for total dietary P in adult cats is lower than 3·6 g/1000 kcal (4184 kJ), however the effect of inorganic P sources and Ca:P require further investigation.
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30
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Avesani CM, Teta D, Carrero JJ. Liberalizing the diet of patients undergoing dialysis: are we ready? Nephrol Dial Transplant 2018; 34:180-183. [DOI: 10.1093/ndt/gfy309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 08/30/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Carla M Avesani
- Renal Medicine and Baxter Novum, Department of Clinical Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil
- European Renal Nutrition-ERN, Working Group at the European Renal Association – European Dialysis Transplant Association – ERA-EDTA
| | - Daniel Teta
- European Renal Nutrition-ERN, Working Group at the European Renal Association – European Dialysis Transplant Association – ERA-EDTA
- Service of Nephrology, Hospital of Sion, University of Lausanne, Switzerland
| | - Juan J Carrero
- European Renal Nutrition-ERN, Working Group at the European Renal Association – European Dialysis Transplant Association – ERA-EDTA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Awobajo FO, Okafor AE, Adebayo HO. The immune system cell populations were increased in salt-induced hypertensive rats without an increase in the serum testosterone level (Short communication). Physiol Int 2018; 105:110-115. [PMID: 29975124 DOI: 10.1556/2060.105.2018.2.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The consumption of dietary salt has significantly increased globally, especially in the developed countries. High dietary salt intake has been linked to onset and complications in hypertension with a dimorphism tendency. There is scanty information about the influence of high salt diet on the immune cell population and androgen level in circulation. Male Sprague-Dawley rats of 8 weeks old were used for this study. They were divided into control (fed 0.1% salted feed) and salt-loaded groups (fed 8% salted feed) for 8 weeks. All experimental rats were allowed access to clean drinking water; daily feed consumption was measured in addition to weekly weight. On confirmation of hypertension using PowerLab® data acquisitions system, the rats were sacrificed and blood samples were collected into EDTA and sterile sample bottles. EDTA-blood samples were used for white blood cell and CD4 counts while the serum was used for hormonal assays. All salt-loaded rats became hypertensive, with a significant increase in total white blood cell, lymphocyte, neutrophil, monocyte, and CD4 cell counts. However, the eosinophil count was significantly decreased in salt-loaded rats. This study showed no change in the serum testosterone in salt-loaded male rats compared with control. In summary, dietary salt loading while precipitating hypertension also activated increased production of white blood cells and CD4 cells without any change in the serum testosterone level.
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Affiliation(s)
- F O Awobajo
- 1 Faculty of Basic Medical Sciences, Department of Physiology, College of Medicine, University of Lagos , Lagos, Nigeria
| | - A E Okafor
- 1 Faculty of Basic Medical Sciences, Department of Physiology, College of Medicine, University of Lagos , Lagos, Nigeria
| | - H O Adebayo
- 1 Faculty of Basic Medical Sciences, Department of Physiology, College of Medicine, University of Lagos , Lagos, Nigeria
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Turunen S, Kaisto S, Skovorodkin I, Mironov V, Kalpio T, Vainio S, Rak-Raszewska A. 3D bioprinting of the kidney—hype or hope? ACTA ACUST UNITED AC 2018. [DOI: 10.3934/celltissue.2018.3.119] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Peñuelas J, Janssens IA, Ciais P, Obersteiner M, Krisztin T, Piao S, Sardans J. Increasing gap in human height between rich and poor countries associated to their different intakes of N and P. Sci Rep 2017; 7:17671. [PMID: 29247185 PMCID: PMC5732171 DOI: 10.1038/s41598-017-17880-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 12/02/2017] [Indexed: 11/24/2022] Open
Abstract
We analyzed mean height of men born in the 1960s, 1970s and 1980s in 80 countries. Both height and the change in height during the last decades were correlated with N and P intake, as well as the N:P intake ratio. Rich countries had higher per capita N and P intake than poor countries (on average 19.5 ± 0.3 versus 9.66 ± 0.18 kg N y-1 and 2.17 ± 0.04 versus 1.35 ± 0.02 kg P y-1), and also larger increases in per capita N intake (12.1 ± 2.0% vs. 7.0 ± 2.1%) and P intake (7.6 ± 1.0% vs 6.01 ± 0.7%), during the period 1961-2009. The increasing gap in height trends between rich and poor countries is associated with an increasing gap in nutrition, so a more varied diet with higher N, P, and N:P intake is a key factor to improve food intake quality in poor countries and thus shorten the gap with rich countries. More N and P are needed with the consequent requirements for a better management of the socioeconomic and environmental associated problems.
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Affiliation(s)
- Josep Peñuelas
- CSIC, Global Ecology Unit CREAF-CEAB-UAB, Cerdanyola del Valles, 08193, Catalonia, Spain.
- CREAF, Cerdanyola del Valles, 08193, Catalonia, Spain.
| | - Ivan A Janssens
- Research Group of Plant and Vegetation Ecology (PLECO), Department of Biology, University of Antwerp, B-2610, Wilrijk, Belgium
| | - Philippe Ciais
- Laboratoire des Sciences du Climat et de l'Environnement, IPSL, 91191, Gif-sur-Yvette, France
| | - Michael Obersteiner
- International Institute for Applied Systems Analysis (IIASA), Ecosystems Services and Management, Schlossplatz 1, A-2361, Laxenburg, Austria
| | - Tamás Krisztin
- International Institute for Applied Systems Analysis (IIASA), Ecosystems Services and Management, Schlossplatz 1, A-2361, Laxenburg, Austria
| | - Shilong Piao
- Sino-French Institute for Earth System Science, College of Urban and Environmental Sciences, Peking University, Beijing, 100871, China
| | - Jordi Sardans
- CSIC, Global Ecology Unit CREAF-CEAB-UAB, Cerdanyola del Valles, 08193, Catalonia, Spain
- CREAF, Cerdanyola del Valles, 08193, Catalonia, Spain
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Isakova T, Nickolas TL, Denburg M, Yarlagadda S, Weiner DE, Gutiérrez OM, Bansal V, Rosas SE, Nigwekar S, Yee J, Kramer H. KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD). Am J Kidney Dis 2017; 70:737-751. [DOI: 10.1053/j.ajkd.2017.07.019] [Citation(s) in RCA: 242] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 07/29/2017] [Indexed: 12/25/2022]
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Abstract
Although phosphorus is an essential nutrient required for multiple physiological functions, recent research raises concerns that high phosphorus intake could have detrimental effects on health. Phosphorus is abundant in the food supply of developed countries, occurring naturally in protein-rich foods and as an additive in processed foods. High phosphorus intake can cause vascular and renal calcification, renal tubular injury, and premature death in multiple animal models. Small studies in human suggest that high phosphorus intake may result in positive phosphorus balance and correlate with renal calcification and albuminuria. Although serum phosphorus is strongly associated with cardiovascular disease, progression of kidney disease, and death, limited data exist linking high phosphorus intake directly to adverse clinical outcomes. Further prospective studies are needed to determine whether phosphorus intake is a modifiable risk factor for kidney disease.
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Affiliation(s)
- Alex R Chang
- Kidney Health Research Institute, Geisinger Health System, Danville, Pennsylvania 17822; .,Department of Epidemiology and Health Services Research, Geisinger Health System, Geisinger Health System, Danville, Pennsylvania 17822
| | - Cheryl Anderson
- Division of Preventive Medicine, School of Medicine, University of California, San Diego, La Jolla, California 92093
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Wai SN, Kelly JT, Johnson DW, Campbell KL. Dietary Patterns and Clinical Outcomes in Chronic Kidney Disease: The CKD.QLD Nutrition Study. J Ren Nutr 2016; 27:175-182. [PMID: 27939593 DOI: 10.1053/j.jrn.2016.10.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/09/2016] [Accepted: 10/19/2016] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Emerging evidence suggests that dietary patterns are associated with survival in people with chronic kidney disease (CKD). This study evaluated the relationship between dietary habits and renal-related clinical outcomes in an established CKD cohort. DESIGN Prospective cohort study. SETTING Three outpatient nephrology clinics in Queensland, Australia. SUBJECTS A total of 145 adult patients with Stage 3 or 4 CKD (estimated glomerular filtration rate 15-59 mL/minute/1.73 m2). INTERVENTION Dietary intake was measured using 24-hour recall and the HeartWise Dietary Habits Questionnaire (DHQ), which evaluates 10 components of dietary patterns in relation to cooking habits and intake of food groups. MAIN OUTCOME MEASURE The primary outcome was a composite end point of all-cause mortality, commencement of dialysis, and doubling of serum creatinine. Secondary outcome was all-cause mortality alone. Multivariate cox regression analyses calculated hazard ratios (HRs) for associations between DHQ domains and occurrence of composite outcome and adjusted for confounders, including comorbidities and renal function. RESULTS Over a median follow-up of 36 months, 32% (n = 47) reached the composite end point, of which 21% died (n = 30). Increasing DHQ score was associated with a lower risk of the composite end point with increasing intake of fruits and vegetables (HR: 0.61; 95% CI, 0.39-0.94) and limiting alcohol consumption (HR, 0.79; 95% CI: 0.65-0.96). For the secondary outcome of all-cause mortality, there was a significant association with adequate intake of fruits and vegetables (HR: 0.35; 95% CI, 0.15-0.83). CONCLUSION Healthy dietary patterns consisting of adequate fruits and vegetables and limited alcohol consumption are associated with a delay in CKD progression and improved survival in patients with Stage 3 or 4 CKD.
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Affiliation(s)
- Shu Ning Wai
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Jaimon T Kelly
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Katrina L Campbell
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
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Liu Y, Kuczmarski MF, Miller ER, Nava MB, Zonderman AB, Evans MK, Powe NR, Crews DC. Dietary Habits and Risk of Kidney Function Decline in an Urban Population. J Ren Nutr 2016; 27:16-25. [PMID: 27771303 DOI: 10.1053/j.jrn.2016.08.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/30/2016] [Accepted: 08/15/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Explore the association between following a Dietary Approaches to Stop Hypertension (DASH)-accordant diet and kidney end points among urban adults. DESIGN Prospective cohort study. SETTING Healthy Aging in Neighborhoods of Diversity across the Life Span study. SUBJECTS A total of 1,534 urban dwelling participants of the Healthy Aging in Neighborhoods of Diversity across the Life Span study with a baseline estimated glomerular filtration rate (eGFR) ≥60 mL/minute/1.73 m2. INTERVENTION DASH diet accordance determined via a score based on nine target nutrients. MAIN OUTCOME MEASURE Rapid kidney function decline (eGFR decline >3 mL/minute/1.73 m2 per year), incident chronic kidney disease (CKD) (follow-up eGFR <60 mL/minute/1.73 m2), and eGFR decline >25%. RESULTS Participants' mean age was 48 years, and 59% were African-American. Median DASH score was 1.5 (range, 0-8). Over a median of 5 years, 13.4% experienced rapid eGFR decline, including 15.2% among participants not following a DASH-accordant diet (score ≤1) and 12.0% with higher accordance (score >1) (P = .08). Outcomes varied by hypertension status. In multinomial logistic regression models, following adjustment for sociodemographic and clinical factors, including total energy intake, low DASH diet accordance was associated with rapid eGFR decline among participants with hypertension (risk ratio, 1.68; 95% confidence interval: 1.17-2.42) but not among those without hypertension (risk ratio, 0.83; 95% confidence interval: 0.56-1.24; P interaction .001). There was no statistically significant association between DASH diet accordance and incident CKD or eGFR decline >25%. Results were similar when DASH diet accordance was analyzed in tertiles. CONCLUSIONS Among urban adults, low accordance to a DASH-type diet was not associated with incident CKD, but was associated with higher risk of rapid eGFR decline among those with hypertension, yet not among those without hypertension. Further study of dietary patterns as a potential target for improving kidney outcomes among high-risk populations is warranted.
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Affiliation(s)
- Yang Liu
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Edgar R Miller
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - M Berenice Nava
- Division of Nephrology, Columbia University Medical Center, New York, New York
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Neil R Powe
- Department of Medicine, San Francisco General Hospital and University of California at San Francisco, San Francisco, California
| | - Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.
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Biruete A, Jeong JH, Barnes JL, Wilund KR. Modified Nutritional Recommendations to Improve Dietary Patterns and Outcomes in Hemodialysis Patients. J Ren Nutr 2016; 27:62-70. [PMID: 27471172 DOI: 10.1053/j.jrn.2016.06.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/05/2016] [Indexed: 12/24/2022] Open
Abstract
The renal diet has traditionally been regarded as one of the most complex medical nutrition therapies to teach, understand, and implement. Specifically, patients are instructed to limit fruits, vegetables, nuts, legumes, dairy, and whole grains because of both phosphorus and potassium concerns. Furthermore, hemodialysis patients are often encouraged to decrease fluid intake to control interdialytic weight gain. These restrictions can result in frustration, lack of autonomy, and the perception that there is nothing left to eat. It is possible that the traditional renal diet may be liberalized, with a focus on whole foods low in sodium and phosphorus additives, to afford patients greater choices and ultimately improved outcomes. Therefore, the objective of this review is to concisely assess the evidence in support of a renal diet focused primarily on reducing the intake of sodium and inorganic phosphorus. Finally, the limited evidence for restrictions on dietary potassium intake is summarized.
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Affiliation(s)
- Annabel Biruete
- Division of Nutritional Sciences, University of Illinois, Urbana, Illinois
| | - Jin Hee Jeong
- Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois
| | - Jennifer L Barnes
- Department of Family and Consumer Sciences, Illinois State University, Normal, Illinois
| | - Kenneth R Wilund
- Division of Nutritional Sciences, University of Illinois, Urbana, Illinois; Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois.
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Yuen SN, Kramer H, Luke A, Bovet P, Plange-Rhule J, Forrester T, Lambert V, Wolf M, Camacho P, Harders R, Dugas L, Cooper R, Durazo-Arvizu R. Fibroblast Growth Factor-23 (FGF-23) Levels Differ Across Populations by Degree of Industrialization. J Clin Endocrinol Metab 2016; 101:2246-53. [PMID: 27003300 PMCID: PMC4870853 DOI: 10.1210/jc.2015-3558] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Compensatory increases in fibroblast growth factor 23 (FGF23) with increasing phosphate intake may adversely impact health. However, population and clinical studies examining the link between phosphate intake and FGF23 levels have focused mainly on populations living in highly industrialized societies in which phosphate exposure may be homogenous. OBJECTIVE The objective of the study was to contrast dietary phosphate intake, urinary measures of phosphate excretion, and FGF23 levels across populations that differ by the level of industrialization. DESIGN This was a cross-sectional analysis of three populations. SETTING The study was conducted in Maywood, Illinois; Mahé Island, Seychelles; and Kumasi, Ghana. PARTICIPANTS Adults with African ancestry aged 25-45 years participated in the study. MAIN OUTCOME FGF23 levels were measured. RESULTS The mean age was 35.1 (6.3) years and 47.9% were male. Mean phosphate intake and fractional excretion of phosphate were significantly higher in the United States vs Ghana, whereas no significant difference in phosphate intake or fractional excretion of phosphate was noted between the United States and Seychelles for men or women. Overall, median FGF23 values were 57.41 RU/mL (interquartile range [IQR] 43.42, 75.09) in the United States, 42.49 RU/mL (IQR 33.06, 55.39) in Seychelles, and 33.32 RU/mL (IQR 24.83, 47.36) in Ghana. In the pooled sample, FGF23 levels were significantly and positively correlated with dietary phosphate intake (r = 0.11; P < .001) and the fractional excretion of phosphate (r = 0.13; P < .001) but not with plasma phosphate levels (r = -0.001; P = .8). Dietary phosphate intake was significantly and positively associated with the fractional excretion of phosphate (r = 0.23; P < .001). CONCLUSION The distribution of FGF23 levels in a given population may be influenced by the level of industrialization, likely due to differences in access to foods preserved with phosphate additives.
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Affiliation(s)
- Shennin N Yuen
- Departments of Public Health Sciences (S.N.Y., H.K., A.L., R.H., L.D., R.C., R.D.-A.) and Medicine (H.K.), Division of Nephrology and Hypertension, and Division of Endocrinology (P.C.), Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois 60153; Institute of Social and Preventive Medicine (P.B.), Division of Chronic Disease, Biopole 2, Bureau no. 01-171, 1010 Lausanne, Switzerland; Ministry of Health (P.B.), Victoria, Republic of Seychelles; School of Medical Sciences, Kwame Nkrumah University of Science and Technology (J.P.-R.), Kumasi, Ghana; Tropical Medicine Research Institute (T.F.), University of the West Indies, Solutions for Developing Countries, Mona, Kingston 7, Jamaica; Department of Human Biology (V.L.), Division of Exercise Science and Sports Medicine, Division of Exercise Science and Sports Medicine Department of Human Biology, Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, 7725 Cape Town, South Africa and Institute of Public Health Sciences (M.W.), Northwestern Medical Center, Chicago, Illinois 60208
| | - Holly Kramer
- Departments of Public Health Sciences (S.N.Y., H.K., A.L., R.H., L.D., R.C., R.D.-A.) and Medicine (H.K.), Division of Nephrology and Hypertension, and Division of Endocrinology (P.C.), Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois 60153; Institute of Social and Preventive Medicine (P.B.), Division of Chronic Disease, Biopole 2, Bureau no. 01-171, 1010 Lausanne, Switzerland; Ministry of Health (P.B.), Victoria, Republic of Seychelles; School of Medical Sciences, Kwame Nkrumah University of Science and Technology (J.P.-R.), Kumasi, Ghana; Tropical Medicine Research Institute (T.F.), University of the West Indies, Solutions for Developing Countries, Mona, Kingston 7, Jamaica; Department of Human Biology (V.L.), Division of Exercise Science and Sports Medicine, Division of Exercise Science and Sports Medicine Department of Human Biology, Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, 7725 Cape Town, South Africa and Institute of Public Health Sciences (M.W.), Northwestern Medical Center, Chicago, Illinois 60208
| | - Amy Luke
- Departments of Public Health Sciences (S.N.Y., H.K., A.L., R.H., L.D., R.C., R.D.-A.) and Medicine (H.K.), Division of Nephrology and Hypertension, and Division of Endocrinology (P.C.), Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois 60153; Institute of Social and Preventive Medicine (P.B.), Division of Chronic Disease, Biopole 2, Bureau no. 01-171, 1010 Lausanne, Switzerland; Ministry of Health (P.B.), Victoria, Republic of Seychelles; School of Medical Sciences, Kwame Nkrumah University of Science and Technology (J.P.-R.), Kumasi, Ghana; Tropical Medicine Research Institute (T.F.), University of the West Indies, Solutions for Developing Countries, Mona, Kingston 7, Jamaica; Department of Human Biology (V.L.), Division of Exercise Science and Sports Medicine, Division of Exercise Science and Sports Medicine Department of Human Biology, Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, 7725 Cape Town, South Africa and Institute of Public Health Sciences (M.W.), Northwestern Medical Center, Chicago, Illinois 60208
| | - Pascal Bovet
- Departments of Public Health Sciences (S.N.Y., H.K., A.L., R.H., L.D., R.C., R.D.-A.) and Medicine (H.K.), Division of Nephrology and Hypertension, and Division of Endocrinology (P.C.), Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois 60153; Institute of Social and Preventive Medicine (P.B.), Division of Chronic Disease, Biopole 2, Bureau no. 01-171, 1010 Lausanne, Switzerland; Ministry of Health (P.B.), Victoria, Republic of Seychelles; School of Medical Sciences, Kwame Nkrumah University of Science and Technology (J.P.-R.), Kumasi, Ghana; Tropical Medicine Research Institute (T.F.), University of the West Indies, Solutions for Developing Countries, Mona, Kingston 7, Jamaica; Department of Human Biology (V.L.), Division of Exercise Science and Sports Medicine, Division of Exercise Science and Sports Medicine Department of Human Biology, Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, 7725 Cape Town, South Africa and Institute of Public Health Sciences (M.W.), Northwestern Medical Center, Chicago, Illinois 60208
| | - Jacob Plange-Rhule
- Departments of Public Health Sciences (S.N.Y., H.K., A.L., R.H., L.D., R.C., R.D.-A.) and Medicine (H.K.), Division of Nephrology and Hypertension, and Division of Endocrinology (P.C.), Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois 60153; Institute of Social and Preventive Medicine (P.B.), Division of Chronic Disease, Biopole 2, Bureau no. 01-171, 1010 Lausanne, Switzerland; Ministry of Health (P.B.), Victoria, Republic of Seychelles; School of Medical Sciences, Kwame Nkrumah University of Science and Technology (J.P.-R.), Kumasi, Ghana; Tropical Medicine Research Institute (T.F.), University of the West Indies, Solutions for Developing Countries, Mona, Kingston 7, Jamaica; Department of Human Biology (V.L.), Division of Exercise Science and Sports Medicine, Division of Exercise Science and Sports Medicine Department of Human Biology, Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, 7725 Cape Town, South Africa and Institute of Public Health Sciences (M.W.), Northwestern Medical Center, Chicago, Illinois 60208
| | - Terrence Forrester
- Departments of Public Health Sciences (S.N.Y., H.K., A.L., R.H., L.D., R.C., R.D.-A.) and Medicine (H.K.), Division of Nephrology and Hypertension, and Division of Endocrinology (P.C.), Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois 60153; Institute of Social and Preventive Medicine (P.B.), Division of Chronic Disease, Biopole 2, Bureau no. 01-171, 1010 Lausanne, Switzerland; Ministry of Health (P.B.), Victoria, Republic of Seychelles; School of Medical Sciences, Kwame Nkrumah University of Science and Technology (J.P.-R.), Kumasi, Ghana; Tropical Medicine Research Institute (T.F.), University of the West Indies, Solutions for Developing Countries, Mona, Kingston 7, Jamaica; Department of Human Biology (V.L.), Division of Exercise Science and Sports Medicine, Division of Exercise Science and Sports Medicine Department of Human Biology, Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, 7725 Cape Town, South Africa and Institute of Public Health Sciences (M.W.), Northwestern Medical Center, Chicago, Illinois 60208
| | - Vicki Lambert
- Departments of Public Health Sciences (S.N.Y., H.K., A.L., R.H., L.D., R.C., R.D.-A.) and Medicine (H.K.), Division of Nephrology and Hypertension, and Division of Endocrinology (P.C.), Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois 60153; Institute of Social and Preventive Medicine (P.B.), Division of Chronic Disease, Biopole 2, Bureau no. 01-171, 1010 Lausanne, Switzerland; Ministry of Health (P.B.), Victoria, Republic of Seychelles; School of Medical Sciences, Kwame Nkrumah University of Science and Technology (J.P.-R.), Kumasi, Ghana; Tropical Medicine Research Institute (T.F.), University of the West Indies, Solutions for Developing Countries, Mona, Kingston 7, Jamaica; Department of Human Biology (V.L.), Division of Exercise Science and Sports Medicine, Division of Exercise Science and Sports Medicine Department of Human Biology, Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, 7725 Cape Town, South Africa and Institute of Public Health Sciences (M.W.), Northwestern Medical Center, Chicago, Illinois 60208
| | - Myles Wolf
- Departments of Public Health Sciences (S.N.Y., H.K., A.L., R.H., L.D., R.C., R.D.-A.) and Medicine (H.K.), Division of Nephrology and Hypertension, and Division of Endocrinology (P.C.), Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois 60153; Institute of Social and Preventive Medicine (P.B.), Division of Chronic Disease, Biopole 2, Bureau no. 01-171, 1010 Lausanne, Switzerland; Ministry of Health (P.B.), Victoria, Republic of Seychelles; School of Medical Sciences, Kwame Nkrumah University of Science and Technology (J.P.-R.), Kumasi, Ghana; Tropical Medicine Research Institute (T.F.), University of the West Indies, Solutions for Developing Countries, Mona, Kingston 7, Jamaica; Department of Human Biology (V.L.), Division of Exercise Science and Sports Medicine, Division of Exercise Science and Sports Medicine Department of Human Biology, Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, 7725 Cape Town, South Africa and Institute of Public Health Sciences (M.W.), Northwestern Medical Center, Chicago, Illinois 60208
| | - Pauline Camacho
- Departments of Public Health Sciences (S.N.Y., H.K., A.L., R.H., L.D., R.C., R.D.-A.) and Medicine (H.K.), Division of Nephrology and Hypertension, and Division of Endocrinology (P.C.), Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois 60153; Institute of Social and Preventive Medicine (P.B.), Division of Chronic Disease, Biopole 2, Bureau no. 01-171, 1010 Lausanne, Switzerland; Ministry of Health (P.B.), Victoria, Republic of Seychelles; School of Medical Sciences, Kwame Nkrumah University of Science and Technology (J.P.-R.), Kumasi, Ghana; Tropical Medicine Research Institute (T.F.), University of the West Indies, Solutions for Developing Countries, Mona, Kingston 7, Jamaica; Department of Human Biology (V.L.), Division of Exercise Science and Sports Medicine, Division of Exercise Science and Sports Medicine Department of Human Biology, Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, 7725 Cape Town, South Africa and Institute of Public Health Sciences (M.W.), Northwestern Medical Center, Chicago, Illinois 60208
| | - Regina Harders
- Departments of Public Health Sciences (S.N.Y., H.K., A.L., R.H., L.D., R.C., R.D.-A.) and Medicine (H.K.), Division of Nephrology and Hypertension, and Division of Endocrinology (P.C.), Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois 60153; Institute of Social and Preventive Medicine (P.B.), Division of Chronic Disease, Biopole 2, Bureau no. 01-171, 1010 Lausanne, Switzerland; Ministry of Health (P.B.), Victoria, Republic of Seychelles; School of Medical Sciences, Kwame Nkrumah University of Science and Technology (J.P.-R.), Kumasi, Ghana; Tropical Medicine Research Institute (T.F.), University of the West Indies, Solutions for Developing Countries, Mona, Kingston 7, Jamaica; Department of Human Biology (V.L.), Division of Exercise Science and Sports Medicine, Division of Exercise Science and Sports Medicine Department of Human Biology, Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, 7725 Cape Town, South Africa and Institute of Public Health Sciences (M.W.), Northwestern Medical Center, Chicago, Illinois 60208
| | - Lara Dugas
- Departments of Public Health Sciences (S.N.Y., H.K., A.L., R.H., L.D., R.C., R.D.-A.) and Medicine (H.K.), Division of Nephrology and Hypertension, and Division of Endocrinology (P.C.), Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois 60153; Institute of Social and Preventive Medicine (P.B.), Division of Chronic Disease, Biopole 2, Bureau no. 01-171, 1010 Lausanne, Switzerland; Ministry of Health (P.B.), Victoria, Republic of Seychelles; School of Medical Sciences, Kwame Nkrumah University of Science and Technology (J.P.-R.), Kumasi, Ghana; Tropical Medicine Research Institute (T.F.), University of the West Indies, Solutions for Developing Countries, Mona, Kingston 7, Jamaica; Department of Human Biology (V.L.), Division of Exercise Science and Sports Medicine, Division of Exercise Science and Sports Medicine Department of Human Biology, Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, 7725 Cape Town, South Africa and Institute of Public Health Sciences (M.W.), Northwestern Medical Center, Chicago, Illinois 60208
| | - Richard Cooper
- Departments of Public Health Sciences (S.N.Y., H.K., A.L., R.H., L.D., R.C., R.D.-A.) and Medicine (H.K.), Division of Nephrology and Hypertension, and Division of Endocrinology (P.C.), Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois 60153; Institute of Social and Preventive Medicine (P.B.), Division of Chronic Disease, Biopole 2, Bureau no. 01-171, 1010 Lausanne, Switzerland; Ministry of Health (P.B.), Victoria, Republic of Seychelles; School of Medical Sciences, Kwame Nkrumah University of Science and Technology (J.P.-R.), Kumasi, Ghana; Tropical Medicine Research Institute (T.F.), University of the West Indies, Solutions for Developing Countries, Mona, Kingston 7, Jamaica; Department of Human Biology (V.L.), Division of Exercise Science and Sports Medicine, Division of Exercise Science and Sports Medicine Department of Human Biology, Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, 7725 Cape Town, South Africa and Institute of Public Health Sciences (M.W.), Northwestern Medical Center, Chicago, Illinois 60208
| | - Ramon Durazo-Arvizu
- Departments of Public Health Sciences (S.N.Y., H.K., A.L., R.H., L.D., R.C., R.D.-A.) and Medicine (H.K.), Division of Nephrology and Hypertension, and Division of Endocrinology (P.C.), Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois 60153; Institute of Social and Preventive Medicine (P.B.), Division of Chronic Disease, Biopole 2, Bureau no. 01-171, 1010 Lausanne, Switzerland; Ministry of Health (P.B.), Victoria, Republic of Seychelles; School of Medical Sciences, Kwame Nkrumah University of Science and Technology (J.P.-R.), Kumasi, Ghana; Tropical Medicine Research Institute (T.F.), University of the West Indies, Solutions for Developing Countries, Mona, Kingston 7, Jamaica; Department of Human Biology (V.L.), Division of Exercise Science and Sports Medicine, Division of Exercise Science and Sports Medicine Department of Human Biology, Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, 7725 Cape Town, South Africa and Institute of Public Health Sciences (M.W.), Northwestern Medical Center, Chicago, Illinois 60208
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The effect of ambient temperature and humidity on interdialytic weight gains in end-stage renal disease patients on maintenance hemodialysis. Int Urol Nephrol 2016; 48:1171-6. [DOI: 10.1007/s11255-016-1297-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
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Epidemiologic insights on the role of fibroblast growth factor 23 in cardiovascular disease. Curr Opin Nephrol Hypertens 2016; 24:260-7. [PMID: 26066475 DOI: 10.1097/mnh.0000000000000123] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Fibroblast growth factor 23 (FGF23) regulates phosphate and vitamin D homeostasis and rises as kidney function declines. Animal studies have demonstrated direct and indirect effects of FGF23 that may promote heart disease. Herein, we review the recent epidemiologic literature evaluating the relationship between FGF23 and cardiovascular disease. RECENT FINDINGS In observational prospective studies, higher FGF23 associates with a greater risk of incident cardiovascular disease including ischemic heart disease, stroke, heart failure, and atrial fibrillation. These studies establish a temporal sequence of events over long-term follow-up that suggest a possible role of FGF23 in cardiovascular disease pathogenesis. In most studies, risk is generally graded; however, in the largest study to date, higher FGF23 within the low-normal range was not associated with higher risk. In several recent studies higher FGF23 associated more strongly with the risk of congestive heart failure compared with atherosclerotic events, a finding consistent with surrogate endpoints and animal experiments. Currently, the utility of FGF23 as a predictive biomarker of cardiovascular risk is not established, and interventions to reduce FGF23 need to be studied to confirm its possible pathophysiologic role. SUMMARY Higher FGF23 is associated with the subsequent development of cardiovascular disease, and perhaps most notably heart failure, in a growing number of studies. These findings bolster ongoing efforts to lower FGF23 using strategies to reduce phosphate intake and absorption.
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Gutiérrez OM, Luzuriaga-McPherson A, Lin Y, Gilbert LC, Ha SW, Beck GR. Impact of Phosphorus-Based Food Additives on Bone and Mineral Metabolism. J Clin Endocrinol Metab 2015; 100:4264-71. [PMID: 26323022 PMCID: PMC4702463 DOI: 10.1210/jc.2015-2279] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
CONTEXT Phosphorus-based food additives can substantially increase total phosphorus intake per day, but the effect of these additives on endocrine factors regulating bone and mineral metabolism is unclear. OBJECTIVE This study aimed to examine the effect of phosphorus additives on markers of bone and mineral metabolism. Design and Setting, and Participants: This was a feeding study of 10 healthy individuals fed a diet providing ∼1000 mg of phosphorus/d using foods known to be free of phosphorus additives for 1 week (low-additive diet), immediately followed by a diet containing identical food items; however, the foods contained phosphorus additives (additive-enhanced diet). Parallel studies were conducted in animals fed low- (0.2%) and high- (1.8%) phosphorus diets for 5 or 15 weeks. MAIN OUTCOME MEASURES The changes in markers of mineral metabolism after each diet period were measured. RESULTS Participants were 32 ± 8 years old, 30% male, and 70% black. The measured phosphorus content of the additive-enhanced diet was 606 ± 125 mg higher than the low-additive diet (P < .001). After 1 week of the low-additive diet, consuming the additive-enhanced diet for 1 week significantly increased circulating fibroblast growth factor 23 (FGF23), osteopontin, and osteocalcin concentrations by 23, 10, and 11%, respectively, and decreased mean sclerostin concentrations (P < .05 for all). Similarly, high-phosphorus diets in mice significantly increased blood FGF23, osteopontin and osteocalcin, lowered sclerostin, and decreased bone mineral density (P < .05 for all). CONCLUSIONS The enhanced phosphorus content of processed foods can disturb bone and mineral metabolism in humans. The results of the animal studies suggest that this may compromise bone health.
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Affiliation(s)
- Orlando M Gutiérrez
- Division of Nephrology, Department of Medicine (O.M.G., A.L.-M.), and Department of Epidemiology (O.M.G.), University of Alabama at Birmingham, Birmingham, Alabama 35294; Division of Endocrinology, Metabolism, and Lipids, Department of Medicine (Y.L., S.-W.H., G.R.B.), Emory University, Atlanta, Georgia, 30322; The Atlanta Department of Veterans Affairs Medical Center (L.C.G., G.R.B.), Decatur, Georgia 30033; and The Winship Cancer Institute (G.R.B.), Emory University, Atlanta, Georgia 30322
| | - Alexandra Luzuriaga-McPherson
- Division of Nephrology, Department of Medicine (O.M.G., A.L.-M.), and Department of Epidemiology (O.M.G.), University of Alabama at Birmingham, Birmingham, Alabama 35294; Division of Endocrinology, Metabolism, and Lipids, Department of Medicine (Y.L., S.-W.H., G.R.B.), Emory University, Atlanta, Georgia, 30322; The Atlanta Department of Veterans Affairs Medical Center (L.C.G., G.R.B.), Decatur, Georgia 30033; and The Winship Cancer Institute (G.R.B.), Emory University, Atlanta, Georgia 30322
| | - Yiming Lin
- Division of Nephrology, Department of Medicine (O.M.G., A.L.-M.), and Department of Epidemiology (O.M.G.), University of Alabama at Birmingham, Birmingham, Alabama 35294; Division of Endocrinology, Metabolism, and Lipids, Department of Medicine (Y.L., S.-W.H., G.R.B.), Emory University, Atlanta, Georgia, 30322; The Atlanta Department of Veterans Affairs Medical Center (L.C.G., G.R.B.), Decatur, Georgia 30033; and The Winship Cancer Institute (G.R.B.), Emory University, Atlanta, Georgia 30322
| | - Linda C Gilbert
- Division of Nephrology, Department of Medicine (O.M.G., A.L.-M.), and Department of Epidemiology (O.M.G.), University of Alabama at Birmingham, Birmingham, Alabama 35294; Division of Endocrinology, Metabolism, and Lipids, Department of Medicine (Y.L., S.-W.H., G.R.B.), Emory University, Atlanta, Georgia, 30322; The Atlanta Department of Veterans Affairs Medical Center (L.C.G., G.R.B.), Decatur, Georgia 30033; and The Winship Cancer Institute (G.R.B.), Emory University, Atlanta, Georgia 30322
| | - Shin-Woo Ha
- Division of Nephrology, Department of Medicine (O.M.G., A.L.-M.), and Department of Epidemiology (O.M.G.), University of Alabama at Birmingham, Birmingham, Alabama 35294; Division of Endocrinology, Metabolism, and Lipids, Department of Medicine (Y.L., S.-W.H., G.R.B.), Emory University, Atlanta, Georgia, 30322; The Atlanta Department of Veterans Affairs Medical Center (L.C.G., G.R.B.), Decatur, Georgia 30033; and The Winship Cancer Institute (G.R.B.), Emory University, Atlanta, Georgia 30322
| | - George R Beck
- Division of Nephrology, Department of Medicine (O.M.G., A.L.-M.), and Department of Epidemiology (O.M.G.), University of Alabama at Birmingham, Birmingham, Alabama 35294; Division of Endocrinology, Metabolism, and Lipids, Department of Medicine (Y.L., S.-W.H., G.R.B.), Emory University, Atlanta, Georgia, 30322; The Atlanta Department of Veterans Affairs Medical Center (L.C.G., G.R.B.), Decatur, Georgia 30033; and The Winship Cancer Institute (G.R.B.), Emory University, Atlanta, Georgia 30322
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Wolf M. Mineral (Mal)Adaptation to Kidney Disease--Young Investigator Award Address: American Society of Nephrology Kidney Week 2014. Clin J Am Soc Nephrol 2015; 10:1875-85. [PMID: 26350436 PMCID: PMC4594069 DOI: 10.2215/cjn.04430415] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In the short time since its initial discovery as the cause of rare hypophosphatemic disorders, fibroblast growth factor-23 (FGF-23) has emerged as a major regulator of mineral metabolism and critical component of the bone and mineral adaptation to CKD. However, because elevated FGF-23 levels are also a novel biomarker and possible molecular mediator of increased risks of cardiovascular disease and death in CKD, the initially adaptive response to increase FGF-23 levels to maintain neutral phosphate balance in CKD may ultimately become maladaptive. Incorporating FGF-23 into understanding the complex physiology that governs normal bone and mineral metabolism and its alterations in CKD has filled critical knowledge gaps and opened a new landscape of exciting hypotheses and novel therapeutic strategies to be tested in the continued quest to alleviate the burden of CKD.
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Affiliation(s)
- Myles Wolf
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Whey protein coating increases bilayer rigidity and stability of liposomes in food-like matrices. Food Chem 2015; 173:1090-9. [DOI: 10.1016/j.foodchem.2014.10.076] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 09/29/2014] [Accepted: 10/15/2014] [Indexed: 11/17/2022]
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McCarty MF, DiNicolantonio JJ. The Molecular Biology and Pathophysiology of Vascular Calcification. Postgrad Med 2015; 126:54-64. [DOI: 10.3810/pgm.2014.03.2740] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Crews DC, Kuczmarski MF, Miller ER, Zonderman AB, Evans MK, Powe NR. Dietary habits, poverty, and chronic kidney disease in an urban population. J Ren Nutr 2015; 25:103-10. [PMID: 25238697 PMCID: PMC4339637 DOI: 10.1053/j.jrn.2014.07.008] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/20/2014] [Accepted: 07/22/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Poverty is associated with chronic kidney disease (CKD) in the United States and worldwide. Poor dietary habits may contribute to this disparity. STUDY DESIGN Cross-sectional study. SETTING AND PARTICIPANTS A total of 2,058 community-dwelling adults aged 30 to 64 years residing in Baltimore City, Maryland. PREDICTORS Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet. DASH scoring based on 9 target nutrients (total fat, saturated fat, protein, fiber, cholesterol, calcium, magnesium, sodium, and potassium); adherence defined as score ≥4.5 of maximum possible score of 9. Poverty (self-reported household income <125% of 2004 Department of Health and Human Services guideline) and nonpoverty (≥125% of guideline). OUTCOMES AND MEASUREMENTS CKD defined as estimated glomerular filtration rate <60 mL/minute/1.73 m(2) (CKD epidemiology collaboration equation). Multivariable logistic regression was used to calculate adjusted odds ratios (AORs) for relation of DASH score tertile and CKD, stratified by poverty status. RESULTS Among 2,058 participants (mean age 48 years; 57% black; 44% male; 42% with poverty), median DASH score was low, 1.5 (interquartile range, 1-2.5). Only 5.4% were adherent. Poverty, male sex, black race, and smoking were more prevalent among the lower DASH score tertiles, whereas higher education and regular health care were more prevalent among the highest DASH score tertile (P < .05 for all). Fiber, calcium, magnesium, and potassium intake were lower, and cholesterol higher, among the poverty compared with nonpoverty group (P < .05 for all), with no difference in sodium intake. A total of 5.6% of the poverty and 3.8% of the nonpoverty group had CKD (P = .05). The lowest DASH tertile (compared with the highest) was associated with more CKD among the poverty (AOR 3.15, 95% confidence interval 1.51-6.56), but not among the nonpoverty group (AOR 0.73, 95% confidence interval 0.37-1.43; P interaction = .001). CONCLUSIONS Poor dietary habits are strongly associated with CKD among the urban poor and may represent a target for interventions aimed at reducing disparities in CKD.
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Affiliation(s)
- Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | | | - Edgar R Miller
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Neil R Powe
- Department of Medicine, San Francisco General Hospital, University of California at San Francisco, San Francisco, California
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Jain N, Reilly RF. Effects of dietary interventions on incidence and progression of CKD. Nat Rev Nephrol 2014; 10:712-24. [PMID: 25331786 DOI: 10.1038/nrneph.2014.192] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Traditional strategies for management of patients with chronic kidney disease (CKD) have not resulted in any change in the growing prevalence of CKD worldwide. A historic belief that eating healthily might ameliorate kidney disease still holds credibility in the 21(st) century. Dietary sodium restriction to <2.3 g daily, a diet rich in fruits and vegetables and increased water consumption corresponding to a urine output of 3-4 l daily might slow the progression of early CKD, polycystic kidney disease or recurrent kidney stones. Current evidence suggests that a reduction in dietary net acid load could be beneficial in patients with CKD, but the supremacy of any particular diet has yet to be established. More trials of dietary interventions are needed, especially in diabetic nephropathy, before evidence-based recommendations can be made. In the meantime, nephrologists should discuss healthy dietary habits with their patients and provide individualized care aimed at maximizing the potential benefits of dietary intervention, reducing the incidence of CKD and delaying its progression to end-stage renal disease. Keeping in mind the lack of data on hard outcomes, dietary recommendations should take into account barriers to adherence and be tailored to different cultures, ethnicities and geographical locations.
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Affiliation(s)
- Nishank Jain
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8856, USA
| | - Robert F Reilly
- Division of Nephrology, Medical Service, Veterans Affairs North Texas Health Care System, Nephrology Section, MC 111G1, 4500 South Lancaster Road, Dallas, TX 75216-7167, USA
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Ferro CJ, Ritz E, Townend JN. Phosphate: are we squandering a scarce commodity? Nephrol Dial Transplant 2014; 30:163-8. [PMID: 25230707 DOI: 10.1093/ndt/gfu295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Phosphorus is an essential element for life but is a rare element in the universe. On Earth, it occurs mostly in the form of phosphates that are widespread but predominantly at very low concentration. This relative rarity has resulted in a survival advantage, in evolutionary terms, to organisms that conserve phosphate. When phosphate is made available in excess it becomes a cause for disease, perhaps best recognized as a potential cardiovascular and renal risk factor. As a reaction to the emerging public health issue caused by phosphate additives to food items, there have been calls for a public education programme and regulation to bring about a reduction of phosphate additives to food. During the Paleoproterzoic era, an increase in the bioavailability of phosphate is thought to have contributed significantly to the oxygenation of our atmosphere and a dramatic increase in the evolution of new species. Currently, phosphate is used poorly and often wasted with phosphate fertilizers washing this scarce commodity into water bodies causing eutrophication and algal blooms. Ironically, this is leading to the extinction of hundreds of species. The unchecked exploitation of phosphate rock, which is an increasingly rare natural resource, and our dependence on it for agriculture may lead to a strange situation in which phosphate might become a commodity to be fought over whilst at the same time, health and environmental experts are likely to recommend reductions in its use.
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Affiliation(s)
- Charles J Ferro
- Department of Nephrology, Queen Elizabeth Hospital and University of Birmingham, Birmingham, UK
| | - Eberhard Ritz
- Division of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Jonathan N Townend
- Department of Cardiology, Queen Elizabeth Hospital and University of Birmingham, Birmingham, UK
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McCarty MF, DiNicolantonio JJ. Bioavailable dietary phosphate, a mediator of cardiovascular disease, may be decreased with plant-based diets, phosphate binders, niacin, and avoidance of phosphate additives. Nutrition 2014; 30:739-47. [DOI: 10.1016/j.nut.2013.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 12/02/2013] [Accepted: 12/03/2013] [Indexed: 12/17/2022]
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