{"title":"Role of Cell-Based Therapies in T2D","authors":"Sudipta Ashe PhD , Matthias Hebrok PhD","doi":"10.1016/j.semnephrol.2023.151432","DOIUrl":"10.1016/j.semnephrol.2023.151432","url":null,"abstract":"<div><p>Type 2 diabetes mellitus (T2D) has become a global epidemic affecting the health of millions of people. T2D is a complex and multifactorial metabolic disease<span>, largely characterized by a combination of impaired insulin secretion<span><span> from β cells residing within the islets of the pancreas and peripheral insulin resistance. In this article, we discuss the current state and risk factors for T2D, conventional treatment options, and upcoming strategies, including progress in the areas of allogeneic and xenogeneic </span>islet transplantation, with a major focus on stem cell–derived β cells and associated technologies.</span></span></p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 3","pages":"Article 151432"},"PeriodicalIF":3.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71426636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhammad Shahzeb Khan MD, MSc , Ahmed Mustafa Rashid MBBS , Tariq Shafi MD, MHS , Joao Pedro Ferreira MD , Javed Butler MD, MPH, MBA
{"title":"Management of Heart Failure With Reduced Ejection Fraction in Patients With Diabetes Mellitus and Chronic Kidney Disease","authors":"Muhammad Shahzeb Khan MD, MSc , Ahmed Mustafa Rashid MBBS , Tariq Shafi MD, MHS , Joao Pedro Ferreira MD , Javed Butler MD, MPH, MBA","doi":"10.1016/j.semnephrol.2023.151429","DOIUrl":"10.1016/j.semnephrol.2023.151429","url":null,"abstract":"<div><p><span>Heart failure (HF), diabetes, and chronic kidney disease (CKD) frequently coexist, with one comorbidity worsening the prognosis of another. β-blockers, angiotensin-receptor–neprilysin inhibitors, renin-angiotensin-aldosterone system inhibitors, mineralocorticoid-receptor antagonists, and sodium-glucose cotransporter-2 inhibitors all have been shown to reduce mortality </span>in patients<span> with HF with reduced ejection fraction. However, their uptake in real-world clinical practice remains low, especially among patients who have multiple other comorbidities such as CKD and diabetes. The management of HF in patients with diabetes and CKD can be especially challenging because these patients typically are older, frail, and have multiple other comorbidities, and guideline-directed medical therapy used in HF potentially can affect renal function acutely and chronically. In this article, we discuss the available evidence for each of the foundational HF therapies in patients with diabetes and CKD, emphasizing the current challenges and outlining future directions to optimize the management of HF among these high-risk patients.</span></p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 3","pages":"Article 151429"},"PeriodicalIF":3.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49692288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peter Rossing MD , Marie Frimodt-Møller MD , Frederik Persson MD
{"title":"Precision Medicine and/or Biomarker Based Therapy in T2DM: Ready for Prime Time?","authors":"Peter Rossing MD , Marie Frimodt-Møller MD , Frederik Persson MD","doi":"10.1016/j.semnephrol.2023.151430","DOIUrl":"10.1016/j.semnephrol.2023.151430","url":null,"abstract":"<div><p>Approximately 30–40% of people with type 2 diabetes mellitus develop chronic kidney disease. This is characterised by elevated blood pressure, declining kidney function and enhanced cardiovascular morbidity and mortality. Increased albuminuria and decreasing estimated glomerular function has to be evaluated regularly to diagsnose kidney disease. New biomarkers may facilitate early diagnosis and provide infomation on undlying pathology thereby supporting early precision intervention for the optimal benefit. A number of biomarkers have been suggested but are not yet implemented in clinical practice. iI the future such bimarkers may pave the way for personalized treatment.</p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 3","pages":"Article 151430"},"PeriodicalIF":3.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49682106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Is There a Need to “Modernize” and “Simplify” the Diagnostic Criteria of Protein-Energy Wasting?","authors":"Laetitia Koppe , Robert H. Mak","doi":"10.1016/j.semnephrol.2023.151403","DOIUrl":"10.1016/j.semnephrol.2023.151403","url":null,"abstract":"<div><p><em>Protein energy wasting</em>(PEW) is a term that most nephrologists used to define nutritional disorders in patients with acute kidney injury and chronic kidney disease. Although this nomenclature is well implemented in the field of nephrology, the use of other terms such as <em>cachexia</em> or <em>malnutrition</em>in the majority of chronic diseases can induce confusion regarding the definition and interpretation of these terms. There is ample evidence in the literature that the pathways involved in cachexia/malnutrition and PEW are common. However, in kidney diseases, there are pathophysiological conditions such as accumulation of uremic toxins, and the use of dialysis, which may induce a phenotypic specificity justifying the original term PEW. In light of the latest epidemiologic studies, the criteria for PEW used in 2008 probably need to be updated. The objective of this review is to summarize the main mechanisms involved in cachexia/malnutrition and PEW. We discuss the need to modernize and simplify the current definition and diagnostic criteria of PEW. We consider the interest of proposing a specific nomenclature of PEW for children and elderly patients with kidney diseases.</p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 2","pages":"Article 151403"},"PeriodicalIF":3.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9940051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Organ Crosstalk Contributes to Muscle Wasting in Chronic Kidney Disease","authors":"Xiaonan H. Wang MD , S. Russ Price PhD","doi":"10.1016/j.semnephrol.2023.151409","DOIUrl":"10.1016/j.semnephrol.2023.151409","url":null,"abstract":"<div><p>Muscle wasting (ie, atrophy) is a serious consequence of chronic kidney disease (CKD) that reduces muscle strength and function. It reduces the quality of life for CKD patients and increases the risks of comorbidities and mortality. Current treatment strategies to prevent or reverse skeletal muscle loss are limited owing to the broad and systemic nature of the initiating signals and the multifaceted catabolic mechanisms that accelerate muscle protein degradation and impair protein synthesis and repair pathways. Recent evidence has shown how organs such as muscle, adipose, and kidney communicate with each other through interorgan exchange of proteins and RNAs during CKD. This crosstalk changes cell functions in the recipient organs and represents an added dimension in the complex processes that are responsible for muscle atrophy in CKD. This complexity creates challenges for the development of effective therapies to ameliorate muscle wasting and weakness in patients with CKD.</p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 2","pages":"Article 151409"},"PeriodicalIF":3.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10414875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ban-Hock Khor PhD , Keiichi Sumida MD, MPH, PhD , Nicole Scholes-Robertson PhD , Maria Chan PhD , Kelly Lambert PhD , Holly Kramer MD, MPH , Siu-Fai Lui MD , Angela Yee-Moon Wang MD, PhD
{"title":"Nutrition Education Models for Patients With Chronic Kidney Disease","authors":"Ban-Hock Khor PhD , Keiichi Sumida MD, MPH, PhD , Nicole Scholes-Robertson PhD , Maria Chan PhD , Kelly Lambert PhD , Holly Kramer MD, MPH , Siu-Fai Lui MD , Angela Yee-Moon Wang MD, PhD","doi":"10.1016/j.semnephrol.2023.151404","DOIUrl":"10.1016/j.semnephrol.2023.151404","url":null,"abstract":"<div><p>Nutrition is an integral component in the management of chronic kidney disease (CKD), and kidney health professionals play a crucial role in educating patients on dietary interventions for CKD. Several dietary modifications are indicated for CKD that require frequent adaptations with CKD progression and with underlying metabolic disturbances. However, poor adherence to dietary interventions is not uncommon among patients with CKD. An effective education program on nutrition intervention consists of providing knowledge and developing skills that are necessary to support behavioral change. The application of theoretical models of behavioral change such as social cognitive theory and the transtheoretical model in nutrition intervention has been reported to be effective in promoting changes in dietary habits. This review summarizes the evidence supporting the application of theoretical models as strategies to enhance nutrition education for patients with CKD. In addition, digital technologies are gaining interest in empowering patients and facilitating nutrition management in patients with CKD. This review also examines the applications of the latest digital technologies guided by behavioral theory in facilitating patients’ changes in dietary intake patterns and lifestyle habits.</p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 2","pages":"Article 151404"},"PeriodicalIF":3.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10406285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Keiichi Sumida MD, MPH, PhD , Joseph F. Pierre PhD , Melana Yuzefpolskaya MD , Paolo C. Colombo MD , Ryan T. Demmer MPH, PhD , Csaba P. Kovesdy MD
{"title":"Gut Microbiota-Targeted Interventions in the Management of Chronic Kidney Disease","authors":"Keiichi Sumida MD, MPH, PhD , Joseph F. Pierre PhD , Melana Yuzefpolskaya MD , Paolo C. Colombo MD , Ryan T. Demmer MPH, PhD , Csaba P. Kovesdy MD","doi":"10.1016/j.semnephrol.2023.151408","DOIUrl":"10.1016/j.semnephrol.2023.151408","url":null,"abstract":"<div><p><strong><em>Summary:</em></strong> Recent advances in microbiome research have informed the potential role of the gut microbiota in the regulation of metabolic, cardiovascular, and renal systems, and, when altered, in the pathogenesis of various cardiometabolic disorders, including chronic kidney disease (CKD). The improved understanding of gut dysbiosis in cardiometabolic pathologies in turn has led to a vigorous quest for developing therapeutic strategies. These therapeutic strategies aim to investigate whether interventions targeting gut dysbiosis can shift the microbiota toward eubiosis and if these shifts, in turn, translate into improvements in (or prevention of) CKD and its related complications, such as premature cardiovascular disease. Existing evidence suggests that multiple interventions (eg, plant-based diets; prebiotic, probiotic, and synbiotic supplementation; constipation treatment; fecal microbiota transplantation; and intestinal dialysis) might result in favorable modulation of the gut microbiota in patients with CKD, and thereby potentially contribute to improving clinical outcomes in these patients. In this review, we summarize the current understanding of the characteristics and roles of the gut microbiota in CKD and discuss the potential of emerging gut microbiota–targeted interventions in the management of CKD.</p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 2","pages":"Article 151408"},"PeriodicalIF":3.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10123548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Olgert Bardhi MD , Deborah J. Clegg PhD , Biff F. Palmer MD
{"title":"The Role of Dietary Potassium in the Cardiovascular Protective Effects of Plant-Based Diets","authors":"Olgert Bardhi MD , Deborah J. Clegg PhD , Biff F. Palmer MD","doi":"10.1016/j.semnephrol.2023.151406","DOIUrl":"10.1016/j.semnephrol.2023.151406","url":null,"abstract":"<div><p><strong><em>Summary:</em></strong> Dietary intervention is an essential factor in managing a multitude of chronic health conditions such as cardiovascular and chronic kidney disease. In recent decades, there has been a host of research suggesting the potential benefit of plant-based diets in mitigating the health outcomes of these conditions. Plant-based diets are rich in vegetables and fruits, while limiting processed food and animal protein sources. The underlying physiological mechanism involves the interaction of several macronutrients and micronutrients such as plant protein, carbohydrates, and dietary potassium. Specifically, plant-based foods rich in potassium provide cardiorenal protective effects to include urinary alkalization and increased sodium excretion. These diets induce adaptive physiologic responses that improve kidney and cardiovascular hemodynamics and improve overall metabolic health. A shift toward consuming plant-based diets even in subjects with cardiorenal decrements may reduce their morbidity and mortality. Nonetheless, randomized controlled trials are needed to confirm the clinical benefits of plant-based diets.</p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 2","pages":"Article 151406"},"PeriodicalIF":3.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9937386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kelly Lambert PhD, RD, Adv APD , Robert Gardos BSc (Appl) , Helen Coolican BA, Dip Ed MA , Lauren Pickel BSc (Biol) , Hoon-Ki Sung PhD , Angela Yee-Moon Wang MD, PhD , Albert CM Ong DM, MA, FRCP
Anita Vincent-Johnson MD , Brenda Davy PhD, RDN , Julia J. Scialla MD, MHS
{"title":"Diet and Metabolism in CKD-Related Metabolic Acidosis","authors":"Anita Vincent-Johnson MD , Brenda Davy PhD, RDN , Julia J. Scialla MD, MHS","doi":"10.1016/j.semnephrol.2023.151425","DOIUrl":"10.1016/j.semnephrol.2023.151425","url":null,"abstract":"<div><p>Metabolic acidosis is a common complication in patients with chronic kidney disease that occurs when the daily nonvolatile acid load produced in metabolism cannot be excreted fully by the kidney. A reduction in urine net acid excretion coupled with a high nonvolatile acid load may play a role in its pathogenesis. Diet is important in generation of the nonvolatile acid load. Acids are produced from metabolism of dietary protein and from the endogenous production of organic anions from neutral precursors. Acids can be balanced by alkali precursors ingested in the diet in the form of combustible organic anions. These typically are reflected indirectly by the excess of mineral cations to mineral anions in a food or diet. These principles underscore widely used methods to estimate the nonvolatile acid load from dietary intake using formulas such as the net endogenous acid production equation and the potential renal acid load equation. Empiric data largely validate these paradigms with high net endogenous acid production and potential renal acid load contributed by foods such as protein, grains, and dairy, and low net endogenous acid production and potential renal acid load contributed by fruits and vegetables along with corresponding dietary patterns. Although further studies are needed to understand the health benefits of altering nonvolatile acid load via diet, this review provides a detailed assessment on our current understanding of the role of diet in chronic kidney disease–related acidosis, providing an updated resource for researchers and clinicians.</p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 2","pages":"Article 151425"},"PeriodicalIF":3.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0270929523001353/pdfft?md5=6c9f55d977ac23987a08aea39e573f5c&pid=1-s2.0-S0270929523001353-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66784282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}