Hypertension in Chronic Kidney Disease: An Update on Diagnosis and Management

Sustainability and role of plant-based diets in chronic kidney disease prevention and treatment

Chronic kidney disease (CKD) affects 10% of the world's population (namely, 800 million of people) and an increase in CKD prevalence has been observed over the years. This phenomenon in developed countries is related to the spread of chronic degenerative non-communicable diseases (CDNCDs), such as diabetes mellitus, arterial hypertension, obesity, etc., while in low-income to middle-income countries, the CKD prevalence is attributable not only to CDNCDs, but also to infection conditions (like HIV, hepatitis, etc.). Another important difference lies in the age of onset of CKD, which is about 20 years lower in developing countries compared to developed ones. Therefore, CKD is becoming a public health problem, requiring preventive and treatment strategies to counteract its spread and to slow its progression. Moreover, the healthcare costs for the CKD management increase as the disease progresses. In this regard, the approach to prevent and reduce the CKD progression involves pharmacological and nutritional treatments (like Mediterranean Diet, MedRen diet, Flexitarian Diet, Vegetarian Diet and Plant-dominant Low Protein Diet) in order to improve the patients' quality of life and, at the same time, promote the environmental sustainability. Recent studies have highlighted the benefits of these diets not only for individuals, but also for environment. In particular, plant-based diets have increasingly gained an important role in the prevention and management of chronic diseases, including CKD. In fact, recent scientific studies have highlighted how a greater adherence to predominantly plant-based diets, is associated with a lower risk in developing CKD and also in slowing its progression. With regard to environmental sustainability, it is known how our food choices influence the climate crisis, since the food sector contributes for the 25% to the greenhouse gas emissions. Therefore, to reduce the consumption of animal proteins and to replace them with plant-based proteins are key strategies for sustainability and health, also supported by the European policies. In this context, food industries are starting to increase the offer of plant-based products that have similar characteristics, both sensorial and nutritional, to those of animal origin. This innovation, in fact, presents difficulties due to the perception of taste and the organoleptic appearance of these products. An additional challenge concerns the resistance of the traditional food industry and the lack of awareness of the consumer. The paradigm shift is dictated by the obtained benefits for health and for environment. Life cycle assessment studies have compared the land footprint, carbon footprint and blue water footprint of plant-based products with those of animal origin and pointed out the lower environmental impact of the former. In conclusion, the adoption of sustainable food models will slow down the spread of CDNCDs, such as CKD, positively impacting both on human health and on planet, significantly reducing the costs and resources of the National Health Systems, since they absorb up to 70%-80% of the healthcare costs.

The impact of low dietary inflammatory index diet on clinical parameters in patients with chronic kidney disease: a retrospective comparative study

BACKGROUND

Chronic kidney disease (CKD) poses a significant global health challenge. Inflammation plays a central role in the pathogenesis and progression of CKD, which has been proved to be affected by dietary patterns. To understand how dietary inflammatory index (DII) impacts the disease course and clinical parameters, we aim to explore the relationship between DII and multiple clinical parameters in a specific cohort of CKD patients, and to provide insights into the potential of dietary for managing CKD.

METHODS

This retrospective comparative study included 145 CKD patients, categorized into a low DII group (n = 77) and a high DII group (n = 68) based on their DII values. Clinical data, including demographic characteristics, laboratory parameters, dietary intake, inflammatory markers, renal function, and adverse events, were collected and compared between the two groups.

RESULTS

The demographic characteristics were comparable between the groups. The low DII group had significantly lower serum creatinine, phosphorus, and potassium levels (P < 0.05) and higher hemoglobin levels compared to the high DII group. Protein intake was significantly higher in the high DII group (P < 0.001), while fiber intake was significantly higher in the low DII group (P = 0.022). Inflammatory markers, including CRP, TNF-α, fibrinogen, procalcitonin, and WBC, were significantly lower in the low DII group (P < 0.05). The low DII group also showed better renal function, as indicated by higher GFR and lower urinary albumin excretion (P < 0.05). Correlation analysis revealed significant relationships between protein intake and inflammation markers (CRP, TNF-α, fibrinogen) and a negative correlation with GFR. Regression analysis confirmed that DII was independently associated with CRP, GFR, and urinary albumin excretion, while protein intake remained significantly correlated with these outcomes.

CONCLUSION

A low DII diet may be associated with improved clinical parameters, inflammatory markers, and renal function in CKD patients. Tailored nutritional strategies focusing on modulating inflammatory status through low DII diets may offer promising avenues for improving renal function, mitigating inflammation, and enhancing overall well-being in individuals with CKD.

CLINICAL TRIAL NUMBER

Not applicable.

Association Between Blood Pressure Variation During Dialysis and Cardio-Cerebrovascular Events

In hemodialysis patients, blood pressure variability (BPV) is associated with cardiovascular events and all-cause mortality. However, previous research has predominantly concentrated on the predialysis BPV. In contrast, intradialytic BPV, reflecting the cardiovascular regulatory function during the process of rapid clearance of volume overload, holds greater relevance to the prognosis of patients. In this study, a latent category trajectory model was used to identify the patterns of intradialytic BPV and analyze the association between intradialytic BPV and the cardio-cerebrovascular events and other clinical outcomes. We found the variation of intradialytic systolic blood pressure (SBP) was associated with the risk of cardio-cerebrovascular events in hemodialysis patients. Patients in "SBP Class 4" and "SBP Class 3" subgroups were associated with the occurrence of cardio-cerebrovascular events and the number of cardio-cerebrovascular event hospitalizations during the follow-up period. This indicates that the variation pattern of intradialytic SBP results from the comprehensive action of various BP regulatory mechanisms in the body, which can reflect the level of cardiovascular regulatory function in hemodialysis patients and serve as a predictor of recent adverse cardio-cerebrovascular events.

Effects of dialysis on peripheral arterial disease

End-stage renal disease is an independent risk factor for the development of peripheral arterial disease, with considerably worse outcomes in patients with concomitant diseases. It is important to realize the widespread, yet frequently asymptomatic, nature of peripheral arterial disease in patients with end-stage renal disease due to the presence of other comorbidities that decrease activity levels and sensation to allow for early recognition and timely medical management to try and mitigate otherwise poor outcomes. Despite their high risk, properly selected patients derive benefit from revascularization; both open and endovascular approaches provide similar outcomes in terms of overall survival, amputation-free survival, and limb salvage, with perhaps a slight preference toward open repair. This narrative review of the literature evaluates the epidemiology, pathophysiology, outcomes, and management strategies that provide the best possible outcomes for patients with peripheral arterial disease and end-stage renal disease.

Development and Validation of Yoga Program for Patients with Chronic Kidney Disease

Chronic kidney disease (CKD) is a widespread health issue impacting millions globally. Recognizing the potential benefits of yoga in enhancing physical and mental well-being, this research aims to develop and validate a yoga module tailored for CKD patients, with a specific focus on improving their general health. The yoga module was meticulously crafted through an extensive review of traditional and contemporary literature, incorporating postures, breathing techniques and meditation practices deemed safe and beneficial for CKD patients. Content validity was established through input yoga experts with over 7 years of experience. The study spanned from January 2020 to December 2021. The final version of the yoga module retained 83.33% of the proposed yoga techniques, incorporating modifications suggested by experts. The content validity index for the entire yoga module averaged 0.83. This work establishes the viability, validity and practicality of a yoga module designed for CKD patients. With 35 out of 42 items retained, the module exhibited significant health improvements after 12 weeks of practice. The findings position yoga therapy as a potentially effective complementary treatment for CKD patients, offering improvements in general health and quality of life and potentially slowing disease progression.

The Possible Effect of β-Blocker Use on the Circulating MMP-2/TIMP-2 System in Patients with Chronic Kidney Disease on Conservative Treatment

Background: The purpose of the study was to determine whether the use of β-adrenoceptor antagonists (β-blockers) can affect metalloproteinase 2 (MMP-2) and its tissue inhibitor (TIMP-2) in patients with chronic kidney disease (CKD) on conservative treatment. Methods: The circulating MMP-2/TIMP-2 system, proinflammatory cytokines (tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), and the marker of oxidative stress-Cu/Zn superoxide dismutase (Cu/Zn SOD)-were measured in 23 CKD patients treated with β-blockers [β-blockers (+)] and in 27 CKD patients not receiving the above medication [β-blockers (-)]. Results: The levels of MMP-2, TIMP-2, and IL-6 were significantly lower in the β-blockers (+) than in the β-blockers (-) group, whereas Cu/Zn SOD concentrations were not affected by β-blocker use. There was a strong, independent association between MMP-2 and TIMP-2 in both analyzed patient groups. In the β-blockers (+) group, MMP-2 levels were indirectly related to the signs of inflammation, whereas in the β-blockers (-) group, the alterations in the MMP-2/TIMP-2 system were associated with the oxidative stress marker and CKD etiology. Conclusions: This study is the first to suggest that the use of β-blockers was associated with the reduction in IL-6 and the MMP-2/TIMP-2 system in CKD, providing a pharmacological rationale for the use of β-blockers to reduce inflammation and abnormal vascular remodeling in CKD.