Journal of Renal Nutrition最新文献

{"title":"Gastrointestinal Mucosal Cell Injury Caused by Sevelamer Crystals: Case Series and Literature Review","authors":"Ahmed Elkalashy MD ,&nbsp;Randall R. Rainwater BS ,&nbsp;Umair Ali MD ,&nbsp;Enas Elbahnasawy MD ,&nbsp;Manisha Singh MD ,&nbsp;Nithin Karakala MD","doi":"10.1053/j.jrn.2025.01.008","DOIUrl":"10.1053/j.jrn.2025.01.008","url":null,"abstract":"<div><div>In end-stage kidney disease (ESKD), hyperphosphatemia occurs secondary to decreased renal elimination with continued intestinal absorption of dietary phosphate. Even in chronic kidney disease, glomerular filtration rate lower than 30 mL/min markedly decreases the filtration of inorganic phosphate and increases its serum level. Sevelamer, a noncalcium phosphate binder, is commonly used to control hyperphosphatemia. Available in 2 forms, sevelamer hydrochloride and sevelamer carbonate, it absorbs phosphate in the gastrointestinal tract and is known to have minimal adverse effects. These are limited to nausea, vomiting, flatulence, and metabolic acidosis, with infrequent significant adverse outcomes. We present a series of 2 patients with ESKD on sevelamer, with lower gastrointestinal bleeding and endoscopic findings of colonic mucosal injuries with histopathological findings of sevelamer crystals deposition.</div><div>Although reported in gastrology literature, nephrology reports show a paucity of discussion around this increasingly common adverse effect and the need for vigilance in ESKD.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 628-635"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374700","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":"Computed Tomography-based Abdominal Myosteatosis Indicators and Handgrip Strength in Hemodialyzed Patients","authors":"Takahiro Yajima MD,&nbsp;Maiko Arao MD","doi":"10.1053/j.jrn.2025.04.001","DOIUrl":"10.1053/j.jrn.2025.04.001","url":null,"abstract":"<div><h3>Objective</h3><div>The relationship between myosteatosis and muscle quality in hemodialyzed patients remains unknown. This study aimed to investigate the relationship between computed tomography (CT)-based abdominal myosteatosis indicators and handgrip strength (HGS) in these patients.</div></div><div><h3>Methods</h3><div>This study enrolled 128 hemodialyzed patients who underwent CT, bioimpedance analysis (BIA), and HGS measurement. CT-based abdominal myosteatosis indicators were measured, including psoas muscle density (PMD), paraspinous muscle density (PSMD), and abdominal skeletal muscle density (ASMD), defined as the mean CT value of each muscle at the third lumbar vertebral level. The association between these indicators and HGS was analyzed, and the diagnostic abilities of these indicators to detect low muscle strength, as defined by HGS cutoff values (male, &lt;28 kg; female, &lt;18 kg), were investigated.</div></div><div><h3>Results</h3><div>The PMD, PSMD, and ASMD were independently correlated with HGS (β = 0.310, <em>P</em> = .0041; β = 0.210, <em>P</em> = .033; and β = 0.252, <em>P</em> = .011, respectively), but not with BIA-estimated skeletal muscle index. Sixty-two (48.4%) patients had low HGS. After adjusting for confounding factors, the adjusted C-statistics of PMD, PSMD, and ASMD for detecting low HGS were 0.845 (reference), 0.836 (<em>P</em> = .56), and 0.837 (<em>P</em> = .50), respectively. Moreover, an increase in the PMD alone was independently associated with a decrease in the risk of low HGS (adjusted odds ratio: 0.912 (95% confidence interval 0.841-0.982), <em>P</em> = .015).</div></div><div><h3>Conclusions</h3><div>CT-based abdominal myosteatosis indicators were independently associated with HGS, but not with BIA-estimated skeletal muscle index, and may aid in detecting clinically acceptable low HGS in hemodialyzed patients. The PMD may be the most recommended myosteatosis indicator for assessing muscle quality in this population.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 646-654"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025199","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":"Physical Exercise in Patients With Chronic Kidney Disease: A Call to Action","authors":"Giacomo Garibotto MD,&nbsp;Lucia Macciò MD, PhD,&nbsp;Linda W. Moore PhD, RDN","doi":"10.1053/j.jrn.2025.07.005","DOIUrl":"10.1053/j.jrn.2025.07.005","url":null,"abstract":"","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 565-567"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683958","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":"Comparison Between Global Leadership Initiative on Malnutrition Criteria and Protein-Energy Wasting in Patients With Kidney Failure Undergoing Peritoneal Dialysis","authors":"Gabriela Leal-Escobar MNA ,&nbsp;Annabel Biruete PhD ,&nbsp;Karla Berenice Cano-Escobar MD ,&nbsp;Magdalena Madero MD ,&nbsp;Ivan Armando Osuna-Padilla PhD","doi":"10.1053/j.jrn.2025.01.006","DOIUrl":"10.1053/j.jrn.2025.01.006","url":null,"abstract":"<div><h3>Objective</h3><div>Protein-energy wasting (PEW) is the chronic kidney disease-specific diagnosis encompassing malnutrition. PEW is associated with adverse outcomes<span>, including those receiving peritoneal dialysis (PD). Identifying PEW requires accurate methods to improve diagnosis. The Global Leadership Initiative on Malnutrition (GLIM) criteria is focused on validating a global consensus for malnutrition diagnosis in adults in clinical settings. While the GLIM criteria has been extensively studied in other clinical populations, there is limited evidence about the agreement with PEW in the PD setting. The aim of this study was to assess the agreement, accuracy, sensitivity, and specificity of GLIM criteria in comparison to the malnutrition inflammation score (MIS), a widely used tool to diagnose PEW in patients on dialysis.</span></div></div><div><h3>Methods</h3><div>This was a cross-sectional study of patients undergoing PD. PEW was diagnosed using MIS score. Nutritional assessment<span> was performed to identify malnutrition using GLIM criteria. Phenotypic criteria were assessed using low body mass index, low fat-free mass index, or low muscle strength. Etiology criteria were evaluated using high serum C-reactive protein or reduced food intake. The concordance between GLIM and MIS was evaluated by the Kappa test. A receiver operating characteristic curve was used for identifying area under curve, sensitivity, and specificity of GLIM.</span></div></div><div><h3>Results</h3><div><span>Patients undergoing PD (n = 154) were included in the study. Participants had a median age of 40 (29-51) years and 46.7% were male. PEW/malnutrition was diagnosed using MIS score in 35.3% and in 27.3% using the GLIM criteria. In comparison with MIS (used as the diagnostic reference), the sensitivity of GLIM was 65.8%, specificity 61.6%, and area under curve was 0.63. The weighted Kappa coefficient was (k 0.15, </span><em>P</em> = .02.).</div></div><div><h3>Conclusion</h3><div>GLIM criteria did not perform better than MIS in diagnosing PEW/malnutrition in patients in PD. Future research to assess the association of GLIM criteria with clinical outcomes is needed.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 682-689"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069215","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":"Correlation of Nutritional Risk Indicators and Cognitive Function on Mexican Hemodialysis Patients: Cross-Sectional Study","authors":"García-Cruz María Fernanda MSc ,&nbsp;Rios-Rios Brenda Daniela MSc ,&nbsp;Cárdenas Yolitzy PhD ,&nbsp;Ríos-Silva Mónica PhD ,&nbsp;Trujillo Xóchitl PhD ,&nbsp;Huerta Miguel PhD ,&nbsp;Bermúdez-Aceves Luis Antonio MD ,&nbsp;Sánchez-Meza Karmina PhD ,&nbsp;Bricio-Barrios Jaime Alberto PhD","doi":"10.1053/j.jrn.2025.04.006","DOIUrl":"10.1053/j.jrn.2025.04.006","url":null,"abstract":"<div><h3>Objective</h3><div>Deterioration of cognitive status and malnutrition are very common in patients with hemodialysis<span>; these patients usually have a greater decline in their cognitive performance than individuals of the same age in the general population. The objective of the study was to correlate cognitive function with nutritional risk indicators in adults receiving hemodialysis treatment in the state of Colima, Mexico.</span></div></div><div><h3>Methods</h3><div><span>Analytical, cross-sectional study, which included 63 people (aged &gt;18 years) of both sexes, who attended the Colima State Hemodialysis Center. Each patient who agreed to participate signed an informed consent. Nutritional risk was measured with the Nutritional Control Scale. To evaluate cognitive status, the Brief </span>Neuropsychological Test in Spanish was used.</div></div><div><h3>Results</h3><div>Overall, 38.1% of the participants were women and 61.9% were men, with a median age of 52 (interquartile range 24.5) years. In addition, 58.7% of the participants presented cognitive impairment, and 14.3% were at nutritional risk. Albumin presented a positive correlation with the recall and encoding domains, the latter being stronger in the group of patients with moderate to severe nutritional risk, and lymphocytes were strongly and negatively correlated with the encoding domain.</div></div><div><h3>Conclusion</h3><div>No association was found between cognitive status and nutritional status in this study. However, a positive correlation of albumin and lymphocytes with some domains of cognitive function was found, especially in patients with nutritional risk.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 663-671"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044769","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":"Declining Serum Albumin With Stable Body Mass Index: A Mortality Indicator in Predialysis Chronic Kidney Disease","authors":"Menaka Sarav MD ,&nbsp;Prabin Shrestha MD ,&nbsp;Adnan Naseer MD ,&nbsp;Fridtjof Thomas PhD ,&nbsp;Keiichi Sumida MD, MPH, PhD, FASN ,&nbsp;Kamyar Kalantar-Zadeh MD, MPH, PhD ,&nbsp;Csaba P. Kovesdy MD","doi":"10.1053/j.jrn.2025.04.005","DOIUrl":"10.1053/j.jrn.2025.04.005","url":null,"abstract":"<div><h3>Objective</h3><div><span>This study aimed to investigate changes in nutritional markers in patients with predialysis chronic kidney disease (CKD) and stable </span>body mass index (BMI).</div></div><div><h3>Methods</h3><div><span><span>We analyzed data from a nationwide cohort of US Veterans with advanced CKD who transitioned to kidney replacement therapy from October 1, 2007, through March 31, 2015. We identified 20,164 U.S. veterans with stable BMI and multiple </span>serum albumin<span> measurements. We calculated intraindividual slopes of serum albumin<span> using mixed effects models for 3 years preceding dialysis. We examined the association of serum albumin slope with mortality after dialysis initiation using Cox proportional hazards models adjusted for demographic characteristics, comorbidities, and baseline estimated </span></span></span>glomerular filtration rate and serum albumin.</div></div><div><h3>Results</h3><div>The cohort had a mean age of 64 years, with 98.3% male and 30% African American participants. Despite maintaining stable BMI, 81% of patients displayed a decline in serum albumin levels in the predialysis period (median slope: −0.09 g/dL/year, 25th and 75th percentile: −0.17, −0.02). A steeper decline in serum albumin over time was associated with significantly higher postdialysis mortality (multivariable-adjusted hazard ratio associated with −1 g/dL/year decline in serum albumin: 1.86, 95% confidence interval: 1.65-2.10, <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>A large proportion of patients with advanced CKD display a clinically relevant decline in serum albumin despite maintaining a stable BMI. Our study highlights the limitations of stable BMI as a marker of nutritional adequacy in advanced CKD, emphasizing the need for more comprehensive nutritional assessments in CKD management.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 598-606"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993899","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":"September Meeting Announcements","authors":"","doi":"10.1053/j.jrn.2025.07.001","DOIUrl":"10.1053/j.jrn.2025.07.001","url":null,"abstract":"","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Page 696"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109962","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":"Evaluation and Management of Obesity in Chronic Kidney Disease","authors":"Allon N. Friedman MD","doi":"10.1053/j.jrn.2025.07.004","DOIUrl":"10.1053/j.jrn.2025.07.004","url":null,"abstract":"<div><div>Obesity is arguably the premier global public health problem of our era. It is also an independent risk factor for the development and progression of chronic kidney disease (CKD) and adverse outcomes in persons with CKD. Fortunately, effective treatment options for obesity have proliferated in just the last few years. These newer therapies in conjunction with older treatments offer great potential in treating obesity and CKD, although many questions remain about their use, efficacy, and place within the overall therapeutic plan. This article will provide a discussion of the definition of obesity, its etiology, and its importance as a risk factor for CKD and other kidney-associated problems. It will then review current treatment options for obesity and the related evidence base. Finally, it will address major topics or controversies that remain unresolved and identify obstacles to effective treatment.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 578-588"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669280","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":"Dialysis-Friendly Snack and Sack Lunch Ideas for Skilled Nursing Facilities","authors":"Melissa Ann Mroz Planells DCN, RDN, CD ,&nbsp;Angel Planells MS, RDN","doi":"10.1053/j.jrn.2025.07.008","DOIUrl":"10.1053/j.jrn.2025.07.008","url":null,"abstract":"","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages e1-e3"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777681","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":"Combination of Clinical Frailty Score and Myostatin Concentrations as Mortality Predictor in Hemodialysis Patients","authors":"Sophie Cornet MD ,&nbsp;Kevin Quinonez MD ,&nbsp;Xavier Warling MD ,&nbsp;François Jouret MD, PhD ,&nbsp;Antoine Lanot MD, PhD ,&nbsp;Olivier Bruyère PhD ,&nbsp;Etienne Cavalier EuSpLM, PhD ,&nbsp;Pierre Delanaye MD, PhD","doi":"10.1053/j.jrn.2025.01.005","DOIUrl":"10.1053/j.jrn.2025.01.005","url":null,"abstract":"<div><h3>Objectives</h3><div><span><span>Frailty is common among </span>hemodialysis (HD) patients. Its assessment is usually based on clinical criteria. In the present work, we evaluated the interest of combining clinical frailty score and biomarkers to predict mortality of chronic HD patients. Four biomarkers were assessed: </span>myostatin<span>, insulin-like growth factor-1 (IGF-1), dehydroepiandrosterone sulfate (DHEA-S), and serum creatinine-to-cystatin C ratio (SCr/SCys).</span></div></div><div><h3>Methods</h3><div>Prevalent HD patients were enrolled from September 2016 to October 2017 in 2 centers in this observational prospective study and followed up for 5 years. Serum levels of myostatin<span>, IGF-1, DHEA-S, and SCr/SCys were measured at baseline. Frailty was assessed using Fried frailty score (≥ 3 indicates frailty). The ability to predict 5-year mortality was assessed by calculating Cox regression analyses and areas under the curve (AUCs).</span></div></div><div><h3>Results</h3><div><span><span>We included 125 HD patients with the following characteristics: median age of 67 (53; 78) years, 40% of women, 41% of diabetics, and median dialysis vintage of 30 (16; 54) months. Among them, 46% were classified as “Frail” according to Fried score. Mortality rate at 5 years was 56%. The median follow-up was 49 (19; 60) months. Cox </span>univariate analysis<span><span> showed that higher age, frailty phenotype, and decreased concentrations of myostatin, IGF-1, DHEA-S, and SCr/SCys were associated with higher mortality. In </span>multivariate analysis, only myostatin remained significant among the biomarkers. The AUC of Fried score and myostatin to predict mortality was significant and comparable: 0.72 (95% confidence interval [CI]: 0.63-0.80) and 0.72 (95% CI: 0.64-0.80), respectively. Combining myostatin with Fried score improved significantly the AUC (AUC = 0.79, 95% CI: 0.71-0.86) compared to Fried score alone or myostatin alone (</span></span><em>P =</em> .0049 and <em>P</em> = .0035, respectively).</div></div><div><h3>Conclusion</h3><div>Decreased concentrations of myostatin seem to be independently associated with higher risk of mortality. Combining Fried frailty score with myostatin concentration could improve the prediction of 5-year mortality in chronic HD patients.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 636-645"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054025","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}