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Li Z, Wang X, Du H, Liu W, Zhang C, Talifu Z, Xu X, Pan Y, Zhang J, Ke H, Yang D, Gao F, Yu Y, Jing Y, Li J. Unraveling Spinal Cord Injury Nutrition: Effects of Diet on the Host and Microbiome. Adv Nutr 2025:100448. [PMID: 40383300 DOI: 10.1016/j.advnut.2025.100448] [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: 12/23/2024] [Revised: 03/25/2025] [Accepted: 05/12/2025] [Indexed: 05/20/2025] Open
Abstract
Spinal cord injury (SCI) leads to severe neurological dysfunction with significant nutritional alterations. These alterations are closely associated with gut dysbiosis and neurogenic gut dysfunction after SCI, creating complex interactions that further exacerbate metabolic disturbances and impede neurological recovery. In the context of SCI, diet not only fulfills basic nutritional needs but also serves as an important therapeutic tool to modulate these interactions. This review provides a broad overview of existing research findings, analyzes the impact of existing dietary interventions on SCI, and attempts to clarify the complex relationship between diet and host and gut microbiota. We hope to provide a clear direction for future research and a scientific basis for the development of personalized dietary interventions to improve the nutritional status of SCI patients, reduce the incidence of complications such as metabolic disorders, and promote the recovery of neurological function and overall quality of life of SCI patients. STATEMENT OF SIGNIFICANCE: This review evaluates the nutritional changes in patients with spinal cord injury, comprehensively elucidating the effects of dietary interventions on SCI patients from both the host and gut microbiota perspectives. By revealing the complex interactions among them, it lays the foundation for developing personalized nutritional intervention strategies to optimize recovery and improve long-term health outcomes in the future.
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Affiliation(s)
- ZeHui Li
- School of Rehabilitation, Capital Medical University, Beijing, 100069, P.R. China; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, 100069, P.R. China
| | - XiaoXin Wang
- School of Rehabilitation, Capital Medical University, Beijing, 100069, P.R. China; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, 100069, P.R. China
| | - HuaYong Du
- School of Rehabilitation, Capital Medical University, Beijing, 100069, P.R. China; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, 100069, P.R. China
| | - WuBo Liu
- School of Rehabilitation, Capital Medical University, Beijing, 100069, P.R. China; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, 100069, P.R. China; Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong, 250012, P.R. China
| | - ChunJia Zhang
- School of Rehabilitation, Capital Medical University, Beijing, 100069, P.R. China; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, 100069, P.R. China; Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, 100096, P.R. China
| | - Zuliyaer Talifu
- School of Rehabilitation, Capital Medical University, Beijing, 100069, P.R. China; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, 100069, P.R. China; School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, 100005, P.R. China; University of Health and Rehabilitation Sciences, Shandong, 266100, P.R. China
| | - Xin Xu
- School of Rehabilitation, Capital Medical University, Beijing, 100069, P.R. China; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, 100069, P.R. China; Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong, 250012, P.R. China
| | - Yunzhu Pan
- School of Rehabilitation, Capital Medical University, Beijing, 100069, P.R. China; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, 100069, P.R. China; University of Health and Rehabilitation Sciences, Shandong, 266100, P.R. China; Rehabilitation Department, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100005, P.R. China
| | - JinMing Zhang
- School of Rehabilitation, Capital Medical University, Beijing, 100069, P.R. China; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, 100069, P.R. China
| | - Han Ke
- School of Rehabilitation, Capital Medical University, Beijing, 100069, P.R. China; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, 100069, P.R. China; Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong, 250012, P.R. China; Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100013, P.R. China
| | - DeGang Yang
- School of Rehabilitation, Capital Medical University, Beijing, 100069, P.R. China; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, 100069, P.R. China
| | - Feng Gao
- School of Rehabilitation, Capital Medical University, Beijing, 100069, P.R. China; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, 100069, P.R. China
| | - Yan Yu
- School of Rehabilitation, Capital Medical University, Beijing, 100069, P.R. China; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, 100069, P.R. China; Institute of Rehabilitation medicine, China Rehabilitation Research Center, Beijing, 100069, P.R. China
| | - YingLi Jing
- School of Rehabilitation, Capital Medical University, Beijing, 100069, P.R. China; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, 100069, P.R. China; Institute of Rehabilitation medicine, China Rehabilitation Research Center, Beijing, 100069, P.R. China.
| | - JianJun Li
- School of Rehabilitation, Capital Medical University, Beijing, 100069, P.R. China; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, 100069, P.R. China; Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong, 250012, P.R. China; University of Health and Rehabilitation Sciences, Shandong, 266100, P.R. China.
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Brum ISC, Cardozo LFMF, Alvarenga L, Kemp JA, Baptista BG, Britto IK, Borges NA, Renouf D, Wong MMY, Fouque D, Mafra D. Fad diets for non-dialysis chronic kidney disease patients: Can "the miracle diet" be a threat? Nutrition 2025; 132:112668. [PMID: 39827647 DOI: 10.1016/j.nut.2024.112668] [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: 09/17/2024] [Revised: 10/29/2024] [Accepted: 12/01/2024] [Indexed: 01/22/2025]
Abstract
In the pursuit of an effortless "miracle cure", there has been a significant increase in the proliferation of fad diets. These diets generally exclude a food group or macronutrients and may also restrict energy intake; they become popular quickly but often lack substantial scientific evidence to support their efficacy and safety. They only show short-term results rather than promoting a lifestyle change. Fad diets are nutritionally unbalanced and can be dangerous for some individuals. Most fad diets are generally restrictive in carbohydrates, high in protein, or unbalanced and have low energy intake, which can harm patients with early stages of chronic kidney damage (CKD) who need a low-protein diet with adequate energy intake. This narrative review discusses the risk of fad diet prescriptions for non-dialysis CKD patients.
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Affiliation(s)
- Isabela S C Brum
- Graduate Program in Medical Sciences, Federal Fluminense University (UFF), Niteroi, Rio de Janeiro, Brazil
| | - Ludmila F M F Cardozo
- Graduate Program in Nutrition Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil; Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil
| | - Livia Alvarenga
- Graduate Program in Nutrition Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil; Graduate Program in Biological Sciences - Physiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Julie A Kemp
- Graduate Program in Nutrition Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil
| | - Beatriz G Baptista
- Graduate Program in Medical Sciences, Federal Fluminense University (UFF), Niteroi, Rio de Janeiro, Brazil
| | - Isadora K Britto
- Graduate Program in Biological Sciences - Physiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Natália A Borges
- Institute of Nutrition, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Dani Renouf
- St. Paul's Hospital, Providence Health Care, Vancouver, Rio de Janeiro, Canada
| | - Michelle M Y Wong
- Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Denis Fouque
- Department of Nephrology, Centre Hopitalier Lyon Sud, Lyon, France
| | - Denise Mafra
- Graduate Program in Medical Sciences, Federal Fluminense University (UFF), Niteroi, Rio de Janeiro, Brazil; Graduate Program in Nutrition Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil; Graduate Program in Biological Sciences - Physiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil.
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Marrone G, Di Lauro M, Cornali K, Masci C, Vanni G, Vita C, Noce A. Sustainability and role of plant-based diets in chronic kidney disease prevention and treatment. Front Pharmacol 2025; 16:1562409. [PMID: 40230686 PMCID: PMC11994608 DOI: 10.3389/fphar.2025.1562409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2025] [Accepted: 03/10/2025] [Indexed: 04/16/2025] Open
Abstract
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.
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Affiliation(s)
- Giulia Marrone
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Manuela Di Lauro
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Kevin Cornali
- PhD in Biochemistry and Molecular Biology, University of Rome Tor Vergata, Rome, Italy
| | - Claudia Masci
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Vanni
- Breast Unit Policlinico Tor Vergata, Department of Surgical Science, Tor Vergata University, Rome, Italy
| | - Chiara Vita
- QuMAP - PIN, University Center “Città di Prato” Educational and Scientific Services for the University of Florence, Prato, Italy
| | - Annalisa Noce
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- UOSD Nephrology and Dialysis, Policlinico Tor Vergata, Rome, Italy
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Michail A, Andreou E. A Plant-Dominant Low-Protein Diet in Chronic Kidney Disease Management: A Narrative Review with Considerations for Cyprus. Nutrients 2025; 17:970. [PMID: 40289931 PMCID: PMC11946852 DOI: 10.3390/nu17060970] [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: 02/17/2025] [Revised: 03/03/2025] [Accepted: 03/04/2025] [Indexed: 04/30/2025] Open
Abstract
Chronic kidney disease (CKD) is a major global health challenge, significantly contributing to morbidity and mortality due to its strong association with cardiovascular complications, metabolic imbalances, and reduced quality of life. Among the various interventions for CKD management, nutrition therapy plays a critical role in slowing disease progression and improving patient outcomes. The Plant-Dominant Low-Protein Diet (PLADO) has emerged as a promising dietary strategy that prioritizes plant-based protein sources while restricting overall protein intake, offering potential renal, cardiovascular, and metabolic benefits. This review evaluates current evidence on the efficacy of PLADO in CKD management, analyzing its impact on renal function, cardiovascular health, and systemic inflammation. Key findings suggest that PLADO can delay CKD progression, reduce dialysis dependence, and mitigate cardiovascular risks through lower dietary acid load, increased fiber intake, and anti-inflammatory properties. Additionally, PLADO has been shown to support gut microbiota diversity and reduce uremic toxin production, offering metabolic advantages beyond kidney health. While PLADO appears nutritionally adequate, concerns remain regarding protein sufficiency, potassium management, and long-term adherence. Its successful implementation requires tailored meal planning, patient education, and regular clinical monitoring to optimize outcomes and mitigate potential risks. This review highlights the importance of integrating PLADO into CKD management as a holistic, patient-centered dietary approach, particularly in regions like Cyprus, where no studies have evaluated its applicability. By synthesizing existing research, this review provides insights for clinicians, dietitians, and researchers to further explore long-term outcomes, adherence strategies, and feasibility across diverse healthcare settings. Future studies should focus on large-scale randomized controlled trials (RCTs) to establish PLADO's role in CKD dietary guidelines and clinical practice.
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Affiliation(s)
| | - Eleni Andreou
- Department of Life Sciences, School of Life and Health Sciences, University of Nicosia, Nicosia 2417, Cyprus;
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Wang J, Xiao X, Zhang H, Wu D, Luo F, Yu J. Effects of additional physical exercise on the nutritional status and disease progression during the low-protein diet in Chronic Kidney Disease Patients: a systematic review and meta-analysis. Eur J Clin Nutr 2024; 78:737-747. [PMID: 38961262 DOI: 10.1038/s41430-024-01466-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 07/05/2024]
Abstract
Low-protein diet (LPD) is the core of dietary and nutritional therapy for non-dialysis chronic kidney disease (CKD) patients. In addition, physical exercise could prevent and treat various illnesses and chronic diseases. The objective of the study was to search for and appraise evidence on the effect of additional physical exercise on patients' nutritional status and indicators of disease progression when compared with the LPD alone. PubMed Central, Embase, Cochrane, and Web of Knowledge for randomized controlled trials (published between January 1, 1956 and May 17, 2023) were searched. A total of 8698 identified studies, 9 were eligible and were included in our analysis (N = 250 participants). Compared with the LPD alone, additional physical exercise reduced serum creatinine by a mean of -0.21 mg/dL (95% CI -0.39 to -0.03) in CKD patients. Similarly, blood pressure decreased after physical exercise, with systolic blood pressure decreasing by -7.05 mm Hg (95% CI -13.13 to -0.96) and diastolic blood pressure decreasing by -5.31 mm Hg (95% CI -7.99 to -2.62). Subgroup analyses revealed that resistance exercise (RE) was effective in decreasing estimated glomerular filtration rate (eGFR) of -1.71 mL/min per 1.73 m² (95% CI -3.29 to -0.14). In addition, the VO2peak increasing by 2.41 mL/kg/min (95% CI 0.13 to 4.70) when physical exercise was continued for 24 weeks. The above results suggest that the LPD with additional physical exercise care is more beneficial for patients with CKD.
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Affiliation(s)
- Jing Wang
- Department of Nutrition, Fifth Hospital in Wuhan, Wuhan, China
| | - Xiaofen Xiao
- Department of Nutrition, Fifth Hospital in Wuhan, Wuhan, China
| | - Hui Zhang
- Department of Orthopaedics, Fifth Hospital in Wuhan, Wuhan, China
| | - Dan Wu
- Department of Orthopaedics, Fifth Hospital in Wuhan, Wuhan, China
| | - Feifei Luo
- Department of Cardiac Function, Fourth Hospital in Wuhan, Wuhan, China
| | - Juling Yu
- Department of Infection Management, Fifth Hospital in Wuhan, Wuhan, China.
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Hong Y, Shen H, Chen X, Li G. Gender differences in the association between dietary protein intake and constipation: findings from NHANES. Front Nutr 2024; 11:1393596. [PMID: 38962434 PMCID: PMC11220262 DOI: 10.3389/fnut.2024.1393596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/10/2024] [Indexed: 07/05/2024] Open
Abstract
Purpose Dietary factors play a crucial role in the development and management of chronic constipation, yet the relationship between dietary protein intake and constipation remains underexplored. This study aims to investigate the association between dietary protein intake and the prevalence of constipation among American adults, with a focus on potential gender differences, using large-scale national data. Materials and methods Data from 14,048 participants aged 20 and above (7,072 men and 6,976 women) from the National Health and Nutrition Examination Survey (NHANES) 2005-2010 were analyzed. The Bristol Stool Form Scale's types 1 (separate hard lumps, resembling nuts) and 2 (sausage-shaped, but lumpy) were used to define constipation. A 24-h dietary recall technique was used to measure dietary protein intake. After controlling for covariates, the association between protein consumption and constipation risk was examined using multivariable logistic regression, smooth curve fitting, and testing for gender interaction effects. We then further determined the threshold effect between dietary protein intake and constipation risk. Results Constipation was present in 7.49% of people overall, with a higher proportion among women (10.19%) than among males (4.82%). In men, higher protein intake was significantly associated with a lower rate of constipation. However, in women, higher protein intake correlated with an increased risk of constipation, and the interaction between gender was significant (P for interaction = 0.0298). These results were corroborated by smooth curve fits, which also demonstrated a dose-response effect. Further threshold effect analysis showed that the turning points of dietary protein intake differed between male and female participants (119.42 gm/day for men; 40.79 gm/day for women). Conclusion The association between dietary protein intake and constipation was different in different genders with threshold effect. For men, moderately increasing protein intake could be beneficial, while for women, exceeding a certain level may increase the risk of constipation. These insights are crucial for guiding dietary protein recommendations for different genders and have significant clinical implications.
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Affiliation(s)
- Yongping Hong
- Department of Anorectal Surgery, The First People’s Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, China
| | - Hongchen Shen
- The Second Department of Medicine, Renji College of Wenzhou Medical University, Wenzhou, China
| | - Xingxing Chen
- Department of Clinical Research, The First People’s Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, China
| | - Guofeng Li
- Department of Anorectal Surgery, The First People’s Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, China
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Pavlidou E, Papadopoulou SK, Fasoulas A, Papaliagkas V, Alexatou O, Chatzidimitriou M, Mentzelou M, Giaginis C. Diabesity and Dietary Interventions: Evaluating the Impact of Mediterranean Diet and Other Types of Diets on Obesity and Type 2 Diabetes Management. Nutrients 2023; 16:34. [PMID: 38201865 PMCID: PMC10780530 DOI: 10.3390/nu16010034] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Diabesity, the intersection of obesity and diabetes, presents a global health crisis with profound implications. Addressing diabesity requires multifaceted strategies, with diet playing a pivotal role. Over the last 15 years, clinical studies have intensified their exploration of various dietary approaches in diabesity management. This literature review aims to synthesize findings from clinical studies conducted in the last 15 years, shedding light on the efficacy, mechanisms, and nuances of different diet types in diabesity management with special focus on the Mediterranean diet (MD). METHODS Thorough research of academic databases yielded a collection of relevant clinical studies. These studies encompassed a range of dietary strategies, including the MD, low-carbohydrate diets, plant-based diets, high-protein diets, low-fat regimens, and intermittent fasting. Key findings, methodologies, and outcomes were thoroughly extracted and analyzed. RESULTS The last 15 years have witnessed considerable improvements in recognizing the role of human nutritional habits in diabesity management. The MD appears to be the most well-recognized diet, exerting favorable effects against both obesity and diabetes. Low-carbohydrate diets were found to enhance glycemic regulation and decrease insulin resistance. Plant-based diets demonstrated potential benefits in weight management and cardiometabolic health. High-protein, low-fat dietary models exhibited positive effects on satiety and body weight decline. Intermittent fasting regimens also exerted metabolic improvements and body weight decline. Personalization emerged as a crucial factor in dietary recommendations. CONCLUSIONS Clinical studies from the last 15 years underscore the intricate relationship between diet types and diabesity management. The above results contribute to an increasing body of evidence, emphasizing the need for tailored dietary approaches and especially the MD. Healthcare providers can utilize this knowledge to offer personalized dietary recommendations for individuals with diabesity, potentially curbing the rise of these twin epidemics and improving the well-being of affected populations.
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Affiliation(s)
- Eleni Pavlidou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (A.F.); (O.A.); (M.M.); (C.G.)
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Aristeidis Fasoulas
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (A.F.); (O.A.); (M.M.); (C.G.)
| | - Vasileios Papaliagkas
- Department of Biomedical Sciences, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (V.P.); (M.C.)
| | - Olga Alexatou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (A.F.); (O.A.); (M.M.); (C.G.)
| | - Maria Chatzidimitriou
- Department of Biomedical Sciences, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (V.P.); (M.C.)
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (A.F.); (O.A.); (M.M.); (C.G.)
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (A.F.); (O.A.); (M.M.); (C.G.)
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Chen Y, Wu J, Yu D, Liu M. Plant or Animal-Based or PLADO Diets: Which Should Chronic Kidney Disease Patients Choose? J Ren Nutr 2023; 33:228-235. [PMID: 35809890 DOI: 10.1053/j.jrn.2022.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/09/2022] [Accepted: 06/29/2022] [Indexed: 12/27/2022] Open
Abstract
Nutrition therapy is the cornerstone treatment for chronic kidney disease (CKD). Although much attention has been given to dietary protein intake in CKD patients, many findings now demonstrate that the type of dietary protein intake may be more critical for CKD patients. In protein bioavailability and malnutrition prevention, many physicians recommend that CKD patients adhere to a low protein diet and restrict their plant foods, such as vegetables, fruits, and soybeans. However, nephrologists should not ignore the potential benefits of plant foods for CKD patients. It is not advisable to restrict the intake of plant foods in the later stage of CKD simply to prevent the development of hyperkalemia and malnutrition. This article highlights the benefits and possible problems of a plant-dominant low protein diet (PLADO) diet, defined as an LPD with dietary protein intake of 0.6-0.8 g/kg/day with at least 50% plant-based source for CKD patients. We hope to provide new opinions for clinical work and CKD patients.
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Affiliation(s)
- Ye Chen
- Department of Nephrology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jinlan Wu
- Department of Nephrology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dan Yu
- Department of Clinical Nutrition, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Maodong Liu
- Department of Nephrology, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
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Raikou VD. Protein intake, chronic renal disease progression and cardiovascular morbidity. Nutr Health 2023; 29:21-23. [PMID: 35946110 DOI: 10.1177/02601060221118897] [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] [Indexed: 02/05/2023]
Abstract
It has been suggested that the lowering of dietary protein reduces the progression of CKD, despite it has been also reported that higher intake of total protein was associated with a lower risk of cardiovascular morbidity.The role of protein intake is equivocal in clinical outcomes including the renal and cardiovascular disease worsening, metabolic acidosis and bone abnormalities.The modification of both amount and sources of protein intake could influence the renal and cardiovascular deterioration.
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Affiliation(s)
- Vaia D Raikou
- Dpt of Nephrology, DOCTORS' Hospital, Athens, GREECE
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Alkhatib L, Velez Diaz LA, Varma S, Chowdhary A, Bapat P, Pan H, Kukreja G, Palabindela P, Selvam SA, Kalra K. Lifestyle Modifications and Nutritional and Therapeutic Interventions in Delaying the Progression of Chronic Kidney Disease: A Review. Cureus 2023; 15:e34572. [PMID: 36874334 PMCID: PMC9981552 DOI: 10.7759/cureus.34572] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Chronic kidney disease (CKD) is a debilitating progressive illness that affects more than 10% of the world's population. In this literature review, we discussed the roles of nutritional interventions, lifestyle modifications, hypertension (HTN) and diabetes mellitus (DM) control, and medications in delaying the progression of CKD. Walking, weight loss, low-protein diet (LPD), adherence to the alternate Mediterranean (aMed) diet, and Alternative Healthy Eating Index (AHEI)-2010 slow the progression of CKD. However, smoking and binge alcohol drinking increase the risk of CKD progression. In addition, hyperglycemia, altered lipid metabolism, low-grade inflammation, over-activation of the renin-angiotensin-aldosterone system (RAAS), and overhydration (OH) increase diabetic CKD progression. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend blood pressure (BP) control of <140/90 mmHg in patients without albuminuria and <130/80 mmHg in patients with albuminuria to prevent CKD progression. Medical therapies aim to target epigenetic alterations, fibrosis, and inflammation. Currently, RAAS blockade, sodium-glucose cotransporter-2 (SGLT2) inhibitors, pentoxifylline, and finerenone are approved for managing CKD. In addition, according to the completed Study of Diabetic Nephropathy with Atrasentan (SONAR), atrasentan, an endothelin receptor antagonist (ERA), decreased the risk of renal events in diabetic CKD patients. However, ongoing trials are studying the role of other agents in slowing the progression of CKD.
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Affiliation(s)
- Lean Alkhatib
- Internal Medicine, Royal Medical Services, Amman, JOR
| | | | - Samyukta Varma
- Internal Medicine, Madurai Medical College, Madurai, IND
| | - Arsh Chowdhary
- Nephrology, Smt. Kashibai Navale Medical College and General Hospital, Pune, IND
| | - Prachi Bapat
- General Medicine, Smt. Kashibai Navale Medical College and General Hospital, Pune, IND
| | - Hai Pan
- Pathology, Tianjin University of Chinese Medicine, Tianjin, CHN
| | - Geetika Kukreja
- Internal Medicine and Hematology/Oncology, Henry Ford Health System, Clinton Township, USA
| | | | | | - Kartik Kalra
- Nephrology, Geisinger Medical Center, Danville, USA
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11
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Mediterranean Diet and Chronic Kidney Disease (CKD): A Practical Approach. Nutrients 2022; 15:nu15010097. [PMID: 36615755 PMCID: PMC9824533 DOI: 10.3390/nu15010097] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/12/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Chronic kidney disease has become a serious public health issue, as well as others health problems such as hypertension, DM, and obesity. Mediterranean diet (MD) can reduce the risk of cardiovascular disease and cancer and can lead to weight loss in obesity. There are studies that suggest that MD could be the diet of choice for patients with CKD for its influence on endothelial function, inflammation, lipid profile and blood pressure. There are few studies that tell us how to adapt MD to this group of patients. This review aims to offer a practical approach to Mediterranean diet adaptation as nutritional treatment in CKD patients.
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12
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Cigarrán Guldris S, Latorre Catalá JA, Sanjurjo Amado A, Menéndez Granados N, Piñeiro Varela E. Fibre Intake in Chronic Kidney Disease: What Fibre Should We Recommend? Nutrients 2022; 14:nu14204419. [PMID: 36297103 PMCID: PMC9612304 DOI: 10.3390/nu14204419] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022] Open
Abstract
Chronic kidney disease (CKD) is a major global health problem that challenges all patients' healthcare needs. Fibre consumption benefits kidney patients by acting preventively on associated risk factors, improving intestinal microbiota composition or reducing metabolic acidosis and inflammation. In this review, we focus on increasing fibre consumption and the quality of fibre to recommend, in addition to increasing the consumption of foods that naturally have it in their design, that can resort to fortified foods or fibre supplements. The Western nutritional practice, which is low in fibre and rich in animal proteins, saturated fats, sodium, and sugar, increases the risk of mortality in these patients. On the contrary, patterns with higher consumption of fibre and vegetable proteins, such as the Mediterranean, vegetarian, or Plant dominant low protein diet (PLADO), seem to have a preventive effect on the associated risk factors and influence CKD progression. Until now, the use of fibre supplements has not achieved an evident impact on clinical results. Fibre-rich foods contain other nutrients that reduce cardiovascular risk. Promoting diets richer in vegetables and guaranteeing adequate energy and protein intake is a challenge for the multidisciplinary teams involved in the standard of care for CKD.
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Affiliation(s)
- Secundino Cigarrán Guldris
- Nephrology Service, Hospital Publico da Mariña, E-27880 Burela, Spain
- Nephrology Research Unit, Hospital Publico da Mariña, E-27880 Burela, Spain
- Correspondence:
| | | | | | - Nicolás Menéndez Granados
- Nephrology Service, Hospital Publico da Mariña, E-27880 Burela, Spain
- Nephrology Research Unit, Hospital Publico da Mariña, E-27880 Burela, Spain
| | - Eva Piñeiro Varela
- Nephrology Service, Hospital Publico da Mariña, E-27880 Burela, Spain
- Nephrology Research Unit, Hospital Publico da Mariña, E-27880 Burela, Spain
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13
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de Morais TLSA, de Souza KSC, de Lima MAF, Pereira MG, de Almeida JB, de Oliveira AMG, Sena-Evangelista KCM, de Rezende AA. Effects of an individualized nutritional intervention on kidney function, body composition, and quality of life in kidney transplant recipients: Study protocol for a randomized clinical trial. PLoS One 2022; 17:e0272484. [PMID: 35925872 PMCID: PMC9352089 DOI: 10.1371/journal.pone.0272484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 07/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Proteinuria after kidney transplantation (KTx) has been a frequent problem due to several factors, high protein intake being one of them. Individualized nutritional intervention in the late post-KTx period can promote the improvement or the reduction of risks associated with the parameters of evaluation of kidney function, body composition, and quality of life in individuals submitted to KTx.
Methods
This is a single-center, randomized and stratified clinical trial. The study will be conducted in a university hospital in northeastern Brazil with 174 individuals aged ≥19 years submitted to KTx and followed up for 12 months. Assessments will take place at 3-month intervals (T0, T3, T6, T9, and T12). The patients will be allocated to intervention and control groups by random allocation. The intervention group will receive individualized nutritional interventions with normoproteic diets (1.0 g/kg) after 60 days of KTx whereas the controls will receive the standard nutritional guidance for the post-KTx period. The primary efficacy variable is the change from baseline in log proteinuria assessed with the urinary albumin/creatinine ratio. Secondary efficacy variables include body composition, anthropometry, quality of life assessment and physical activity, lipid profile and glycemic control. Ninety-two subjects per group will afford 70% power to detect a difference of 25% between groups in log proteinuria. Primary efficacy analysis will be on the modified intention-to-treat population with between-groups comparison of the change from baseline in log proteinuria by analysis of covariance.
Discussion
The study will assess the effects of an individualized nutritional intervention on proteinuria 12 months after KTx.
Trial registration
REBEC (RBR-8XBQK5).
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Affiliation(s)
| | - Karla Simone Costa de Souza
- Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Mabelle Alves Ferreira de Lima
- Postgraduate Program in Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Maurício Galvão Pereira
- Division of Nephrology, Department of Integrated Medicine, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - José Bruno de Almeida
- Division of Nephrology, Department of Integrated Medicine, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Antônio Manuel Gouveia de Oliveira
- Postgraduate Program in Health Sciences, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Karine Cavalcanti Mauricio Sena-Evangelista
- Postgraduate Program in Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Adriana Augusto de Rezende
- Postgraduate Program in Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- * E-mail:
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14
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Kalantar-Zadeh K, Moore LW. Functional Nutrition, Naturopathic Nutrition, and Integrative and Holistic Renal Nutrition in Kidney Health and Value-Based Kidney Care Models. J Ren Nutr 2022; 32:493-497. [PMID: 35843458 DOI: 10.1053/j.jrn.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, CA, USA.
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
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15
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Kalantar-Zadeh K, Saville J, Moore LW. Unleashing the Power of Renal Nutrition in Value-Based Models of Kidney Care Choices: Leveraging Dietitians' Expertise and Medical Nutrition Therapy to Delay Dialysis Initiation. J Ren Nutr 2022; 32:367-370. [PMID: 35589046 DOI: 10.1053/j.jrn.2022.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, CA, USA.
| | | | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
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16
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De Mauri A, Carrera D, Vidali M, Bagnati M, Rolla R, Riso S, Torreggiani M, Chiarinotti D. Compliance, Adherence and Concordance Differently Predict the Improvement of Uremic and Microbial Toxins in Chronic Kidney Disease on Low Protein Diet. Nutrients 2022; 14:nu14030487. [PMID: 35276846 PMCID: PMC8839589 DOI: 10.3390/nu14030487] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 02/06/2023] Open
Abstract
Background. In medicine, “compliance” indicates that the patient complies with the prescriber’s recommendations, “adherence” means that “the patient matches the recommendations” and “concordance” means “therapeutic alliance” between patient and clinician. While a low protein diet (LPD) is a cornerstone treatment of chronic kidney disease (CKD), monitoring the actual performance of LPD is a challenge. Patients. Fifty-seven advanced CKD adult patients were enrolled and LPD prescribed. Compliance was evaluated through the normalized protein catabolic rate (nPCR), adherence by the dietitian by means of a 24-h dietary recall and concordance by the nephrologist during consultations. Traditional parameters as well as total p-Cresyl Sulphate (t-PCS), total Indoxyl Sulphate (t-IS) and Lipoprotein-associated phspholipase A2 (Lp-PLA2) were compared between adherent/not adherent and concordant/not concordant subjects at enrolment and after two months. Results. nPCR, blood urea nitrogen, cholesterol and triglycerides significantly decreased in all patients. t-PCS and t-IS decreased among adherent subjects. Lp-PLA2, t-PCS, free-PCS and t-IS decreased among concordant subjects, while these increased in non-concordant ones. Conclusion. This study demonstrates that LPD may improve the control of traditional uremic toxins and atherogenic toxins in “adherent” and “concordant” patients. A comprehensive and multidisciplinary approach is needed to evaluate the compliance/adherence/concordance to LPD for optimizing nutritional interventions.
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Affiliation(s)
- Andreana De Mauri
- Nephrology and Dialysis Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy;
- Correspondence:
| | - Deborah Carrera
- Nutritional Science and Dietetic, Maggiore della Carità University Hospital, 28100 Novara, Italy; (D.C.); (S.R.)
| | - Matteo Vidali
- Clinical Chemistry Unit, Fondazione IRCCS Ca’ Granda Maggiore Policlinico Hospital, 20122 Milano, Italy;
| | - Marco Bagnati
- Clinical Chemistry Laboratory, Maggiore della Carità University Hospital, 28100 Novara, Italy; (M.B.); (R.R.)
| | - Roberta Rolla
- Clinical Chemistry Laboratory, Maggiore della Carità University Hospital, 28100 Novara, Italy; (M.B.); (R.R.)
- Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, 28100 Novara, Italy
| | - Sergio Riso
- Nutritional Science and Dietetic, Maggiore della Carità University Hospital, 28100 Novara, Italy; (D.C.); (S.R.)
| | | | - Doriana Chiarinotti
- Nephrology and Dialysis Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy;
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17
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Kalantar-Zadeh K, Rhee CM, Joshi S, Brown-Tortorici A, Kramer HM. Medical nutrition therapy using plant-focused low-protein meal plans for management of chronic kidney disease in diabetes. Curr Opin Nephrol Hypertens 2022; 31:26-35. [PMID: 34750331 DOI: 10.1097/mnh.0000000000000761] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Nearly half of all Americans with chronic kidney disease (CKD) also have type-2-diabetes (T2D). Whereas traditional and emerging pharmacotherapies are increasingly frequently used for the management of CKD in diabetes (CKD/DM), the role of integrated or multimodal interventions including the potentially synergistic and additive effect of diet and lifestyle modifications in addition to pharmacotherapy has not been well examined, in sharp contrast to the well-known integrated approaches to heart disease. RECENT FINDINGS Low-carbohydrate low-fat diets are often recommended in T2D, whereas low-protein diets (LPD) are recommended by guidelines for nondiabetic CKD with increasing emphasis on plant-based protein sources. High-protein diets with greater animal protein lead to glomerular hyperfiltration, especially in patients with T2D, and faster decline in renal function. Guidelines provide differing recommendations regarding the amount (low vs high) and source (plant vs animal) of dietary protein intake (DPI) in CKD/DM. Some such as KDIGO recommend 0.8 g/kg/day based on insufficient evidence for DPI restriction in CKD/DM, whereas KDOQI and ISRNM recommend a DPI of 0.6 to <0.8 g/kg/day. A patient-centered plant-focused LPD for the nutritional management of CKD/DM (PLAFOND), a type of PLADO diet comprising DPI of 0.6 to <0.8 g/kg/day with >50% plant-based sources, high dietary fiber, low glycemic index, and 25-35 Cal/kg/day energy, can be implemented by renal dietitians under Medical Nutrition Therapy. SUMMARY Potential risks vs benefits of high vs low protein intake in CKD/DM is unknown, for which expert recommendations remain opinion based. Randomized controlled studies are needed to examine safety, acceptability and efficacy of PLAFOND.
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Affiliation(s)
- Kamyar Kalantar-Zadeh
- University of California Irvine (UCI), Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, Orange
- Tibor Rubin VA Long Beach Healthcare System, Long Beach, California
| | - Connie M Rhee
- University of California Irvine (UCI), Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, Orange
| | - Shivam Joshi
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Amanda Brown-Tortorici
- University of California Irvine (UCI), Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, Orange
| | - Holly M Kramer
- Loyola University Medical Center and Hines VA Medical Center, Hines, Illinois, USA
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Revisiting glomerular hyperfiltration and examining the concept of high dietary protein-related nephropathy in athletes and bodybuilders. Curr Opin Nephrol Hypertens 2022; 31:18-25. [PMID: 34846311 DOI: 10.1097/mnh.0000000000000755] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW High-protein diets (HPDs) are popular but their consequences for kidney health, especially among athletes and bodybuilders who typically maintain a high protein intake for a long time, have not been investigated. This review focused on recent studies of the association of HPD with long-term kidney health and the concept of high dietary protein-related nephropathy. RECENT FINDINGS Several long-term observational studies including large populations have reinforced the notion that HPDs are associated with a rapid decline of kidney function. An increase in renal blood flow and glomerular hyperfiltration caused by vasodilation, and increased levels of endocrine and paracrine factors (glucagon, IGF-1, prostanoids, and nitric oxide), facilitates the excretion of protein-derived nitrogenous waste. Inhibition of tubule-glomerular feedback and increased proximal tubular Na+ reabsorption after a HPD augment glomerular hyperfiltration and may trigger synthesis of proinflammatory cytokines and receptor for advanced glycation end-products (RAGE). Focal segmental glomerulosclerosis reported in association with anabolic steroid may indeed be a HPD nephropathy given that HPD results in progressive glomerulosclerosis, especially in remnant glomeruli or in diabetic kidney disease but can happen in any high-risk situation, such as solitary kidney and polycystic kidneys. SUMMARY HPD among athletes and bodybuilders in an extreme way across a long-term period may pose a risk to renal health including high incidence of HPD nephropathy.
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