Journal of Renal Nutrition最新文献

{"title":"Evaluation of Amino Acid Kinetics During Low-Dose Continuous Renal Replacement Therapy in Patients With Acute Kidney Injury: A Prospective Single-Center Study.","authors":"Hiroomi Tatsumi, Shinya Chihara, Masayuki Akatsuka, Hiromitsu Kuroda, Satoshi Kazuma, Miyuki Tani, Satoru Kamoshita, Akiyoshi Kuroda, Yoshiki Masuda","doi":"10.1053/j.jrn.2025.02.004","DOIUrl":"10.1053/j.jrn.2025.02.004","url":null,"abstract":"<p><strong>Objective: </strong>Amino acid and protein loss during continuous renal replacement therapy has been proposed to contribute to protein-energy wasting in patients with acute kidney injury (AKI); however, the actual amount removed remains unclear. We investigated the loss of amino acids and proteins in the filtrate during continuous renal replacement therapy in patients who did not receive nutritional supplementation.</p><p><strong>Methods: </strong>A total of 19 patients with AKI who received low-dose continuous venovenous hemofiltration (CVVH) were included. Blood samples were collected before CVVH initiation and at 30, 60, 120, and 240 minutes thereafter, and a filtrate sample was collected at 240 minutes. Changes in blood amino acid concentrations during 240-minute CVVH sessions were measured. The amino acid and protein concentrations in the filtrate were determined at the end of the 240-minute CVVH session, and the amounts of amino acids and proteins lost during 240-minute CVVH were calculated.</p><p><strong>Results: </strong>The median total amino acid blood concentrations did not decrease and were near the lower limits of the reference ranges. The median concentrations of 3-methyl histidine, a marker of skeletal muscle catabolism, were above the upper limits of the reference ranges throughout the CVVH session. The median total amino acidloss during the 240-minute CVVH session was 0.95 g. In 10 patients with detectable proteins in the filtrate, the median protein loss was 2.52 g.</p><p><strong>Conclusion: </strong>These results suggest that optimal nutritional management in patients with AKI who receive CVVH should take into account amino acid and protein loss and hypercatabolism.</p>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538019","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":"Low Plasma Marine N-3 Polyunsaturated Fatty Acids are Associated With Increased Risk of Cardiovascular Events in Patients Treated With Maintenance Hemodialysis.","authors":"Caroline Liboriussen, Louis Nygaard, Jens Dam Jensen, Erik Berg Schmidt, Rie Io Glerup, My Hanna Sofia Svensson","doi":"10.1053/j.jrn.2025.02.001","DOIUrl":"10.1053/j.jrn.2025.02.001","url":null,"abstract":"<p><strong>Objective: </strong>This study investigated the association between the plasma marine n-3 polyunsaturated fatty acids (n-3 PUFAs) eicosapentaenoic acid and docosahexaenoic acid and cardiovascular (CV) events and all-cause mortality in patients treated with hemodialysis.</p><p><strong>Methods: </strong>Prospective multicenter cohort study with 5 years of follow-up. Primary outcome was CV events and secondary outcomes were all-cause mortality and each component of CV events. The sum of plasma eicosapentaenoic acid and docosahexaenoic acid was expressed as marine n-3 PUFAs in weight percentage (wt%). The population was divided into tertiles according to plasma n-3 PUFA levels: lower tertile <5.06 wt%, middle tertile 5.06-6.52 wt%, and upper tertile >6.52 wt%.</p><p><strong>Results: </strong>In total, 336 patients were included. Median follow-up was 5.05 (5.02-5.07) years. Generally, the lower tertile was associated with a higher risk of CV events. Unadjusted, the middle tertile was associated with a 36% lower risk of CV events [hazard ratio (HR) 0.64 (95% confidence interval (CI) 0.43-0.96)], and the upper tertile was associated with a 34% lower risk of CV events [HR 0.66 (95% CI 0.44-0.98)]. After adjusting for confounders, the middle tertile was associated with a lower risk of CV events [HR 0.60 (95% CI 0.40-0.92)], peripheral arterial disease [HR 0.44 (95% CI 0.22-0.88)], and all-cause mortality [HR 0.61 (95% CI 0.42-0.86)]. A restricted cubic spline showed that the CV risk was higher in patients with levels below the median of 5.7 wt%, indicating a potential threshold effect.</p><p><strong>Conclusion: </strong>Low plasma marine n-3 PUFA levels were associated with a higher risk of CV events, peripheral arterial disease, and all-cause mortality in patients treated with hemodialysis.</p>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532079","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":"Short Report: Influence of Dark Chocolate Intake on Magnesium Status in Hemodialysis Patients.","authors":"Julie Ann Kemp, Susane Fanton, Beatriz G Baptista, Marcia Ribeiro, Ludmila F M F Cardozo, Marcelo Ribeiro-Alves, Denise Mafra","doi":"10.1053/j.jrn.2025.02.002","DOIUrl":"10.1053/j.jrn.2025.02.002","url":null,"abstract":"<p><strong>Objective: </strong>Magnesium (Mg²⁺) deficiency can be observed in patients with chronic kidney disease (CKD) and is associated with increased inflammation, disease progression, and mortality. Dark chocolate is an excellent source of Mg²⁺. This study aimed to evaluate the effect of 70% cocoa chocolate intake on Mg²⁺ serum levels in patients with CKD on hemodialysis (HD).</p><p><strong>Methods: </strong>These are secondary analyses from a previous controlled pilot study. The study included 59 patients undergoing HD. Patients were allocated into 2 groups: dark chocolate and the control group. The dark chocolate group received 40 g of 70% cocoa chocolate for 2 months during HD sessions (3 times a week). The control group did not receive any intervention. Mg²⁺ was evaluated by a colorimetric test using a commercial kit (Bioclin®). NCT04600258 on March 1, 2020, retrospectively registered.</p><p><strong>Results: </strong>Thirty-five patients in the dark chocolate group (17 women, 53.4 ± 12.9 years) and 11 in the control group (4 women, 46.7 ± 10.9 years) completed the study. The median (interquartile range) overall Mg²⁺ serum levels were 2.4 (0.4) mg/dL, with no significant differences between the groups. After 2 months of supplementation, serum levels of Mg²⁺ increased significantly in the dark chocolate group from 2.5 (2.4-2.6) to 2.7 (2.6-2.8) mg/dL (P < .01). No change was observed in potassium and phosphorus plasma levels.</p><p><strong>Conclusions: </strong>Dark chocolate might be a promising nutritional strategy to improve Mg²⁺ levels in patients with CKD on HD. The offered dose was safe, not altering plasma phosphorus and potassium levels.</p>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532081","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":"A CENTER FOR NUTRITION CARE TO PROVIDE RENAL NUTRITION THERAPY TO CHRONIC KIDNEY DISEASE PATIENTS.","authors":"Abril Gutiérrez-Espinoza, Julia Nava-Hernández, Rocío Urbina-Arronte, Araceli Aguilar-Gamiño, Adriana Salinas-Rico, Nadia Aldana-Solís, Sara De La Rosa-Diez, Rafael Montufar-Cárdenas, Joel D Kopple","doi":"10.1053/j.jrn.2025.02.005","DOIUrl":"https://doi.org/10.1053/j.jrn.2025.02.005","url":null,"abstract":"<p><strong>Objective: </strong>This paper describes a novel program that provides nutritional care to people with chronic kidney disease (CKD).</p><p><strong>Design and methods: </strong>This is an observational study of the structure and function of CEAN (Centro de Atencion Nutricional - Center for Nutritional Care) Centers in metropolitan areas in Mexico that provide nutritional care to patients with CKD. Data on nutritional outcomes to treatment were obtained retrospectively from clinic records.</p><p><strong>Results: </strong>The centers consist of several offices that are staffed by licensed dietitians who have undergone training in renal nutrition and are experienced in treating CKD patients. Any licensed physician in Mexico can refer patients to these centers for nutritional assessment and counseling. At their initial visit, patients undergo a comprehensive nutritional assessment by a dietitian, which includes anthropometry, bioelectrical impedance and handgrip strength, and requests for laboratory measurements. A nutritional diagnosis and dietary treatment plan are developed. The patient's referring physician receives a typed consultation.. Almost 50% of the patients make four or more follow-up visits to the Center. Those patients who had an initial visit and a tenth visit displayed a reduced dietary protein intake with no reduction in serum albumin or handgrip strength. Body mass index, which averaged overweight, decreased slightly.</p><p><strong>Conclusions: </strong>CEAN Centers in Mexico can provide sophisticated nutritional assessment, dietary therapy and nutritional follow-up for patients with CKD. Preliminary data suggest good nutritional responses in these centers. Clinical trials are needed to examine more definitively whether these centers improve nutritional and clinical outcomes in patients with CKD.</p>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532076","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":"Gastrointestinal mucosal cell injury caused by sevelamer crystals- Case series and literature review.","authors":"Ahmed Elkalashy, Randall R Rainwater, Umair Ali, Enas Elbahnasawy, Manisha Singh, Nithin Karakala","doi":"10.1053/j.jrn.2025.01.008","DOIUrl":"https://doi.org/10.1053/j.jrn.2025.01.008","url":null,"abstract":"<p><p>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 non-calcium phosphate binder, is commonly used to control hyperphosphatemia. Available in two 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 two patients with ESKD on sevelamer, with lower gastrointestinal bleeding and endoscopic findings of colonic mucosal injuries with histopathologic findings of sevelamer crystals deposition. Though reported in gastrology literature, nephrology reports show a paucity of discussion around this increasingly common adverse effect and the need for vigilance in ESKD.</p>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-05","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":"Message From the Chair March 2025.","authors":"Jill Hoyt","doi":"10.1053/j.jrn.2025.01.007","DOIUrl":"10.1053/j.jrn.2025.01.007","url":null,"abstract":"","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374702","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, Annabel Biruete, Karla Berenice Cano-Escobar, Magdalena Madero, Ivan Armando Osuna-Padilla","doi":"10.1053/j.jrn.2025.01.006","DOIUrl":"https://doi.org/10.1053/j.jrn.2025.01.006","url":null,"abstract":"<p><strong>Background: </strong>Protein-energy wasting (PEW) is the chronic kidney disease (CKD)-specific diagnosis encompassing malnutrition. PEW is associated with adverse outcomes, 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.</p><p><strong>Methods: </strong>This was a cross-sectional study of patients undergoing PD. PEW was diagnosed using MIS score. Nutritional assessment 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 ROC-curve was used for identifying area under curve (AUC), sensitivity and specificity of GLIM.</p><p><strong>Results: </strong>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 AUC was 0.63. The weighted Kappa coefficient was (k 0.15, p=0.02.).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-27","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":"Combination of clinical frailty score and myostatin concentrations as mortality predictor in hemodialysis patients.","authors":"Sophie Cornet, Kevin Quinonez, Xavier Warling, François Jouret, Antoine Lanot, Olivier Bruyère, Etienne Cavalier, Pierre Delanaye","doi":"10.1053/j.jrn.2025.01.005","DOIUrl":"https://doi.org/10.1053/j.jrn.2025.01.005","url":null,"abstract":"<p><strong>Background and aims: </strong>Frailty is common among 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: myostatin, insulin-like growth factor-1 (IGF-1), dehydroepiandrosterone sulfate (DHEA-S) and serum creatinine-to-cystastin C ratio (SCr/SCys).</p><p><strong>Methods: </strong>Prevalent HD patients were enrolled from September 2016 to October 2017 in two centers in this observational prospective study and followed up for 5 years. Serum levels of myostatin, 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 (AUC).</p><p><strong>Results: </strong>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 univariate analysis showed that higher age, frailty phenotype and decreased concentrations of myostatin, IGF-1, DHEA-S and SCr/SCys were associated with higher mortality. In 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% CI: 0.63 to 0.80) and 0.72 (95% CI: 0.64 to 0.80), respectively. Combining myostatin with Fried score improved significantly the AUC (AUC = 0.79, 95% CI: 0.71 to 0.86) compared to Fried score alone or myostatin alone (p=0.0049 and p=0.0035 respectively).</p><p><strong>Conclusion: </strong>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 five-year mortality in chronic HD patients.</p>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-25","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}

{"title":"Diet Quality Components and Gut Microbiota of Patients on Peritoneal Dialysis.","authors":"Christiane Ishikawa Ramos, Laila Santos de Andrade, Renata Rodrigues Teixeira, Natália Barros Ferreira Pereira, Fabiana da Silva Lima, Christian Hoffmann, Lilian Cuppari","doi":"10.1053/j.jrn.2025.01.001","DOIUrl":"10.1053/j.jrn.2025.01.001","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the associations between the quality of the diet and its components and microbial diversity and composition in peritoneal dialysis (PD) patients.</p><p><strong>Design and methods: </strong>This cross-sectional study included PD patients for at least 3 months, aged 18-75 years and clinically stable. The Diet Quality Index (DQI), validated for the Brazilian population, is based on the energy density of 11 components (\"sugar and sweets;\" \"beef, pork, and processed meat;\" \"refined grains and breads;\" \"animal fat;\" \"poultry, fish, and eggs;\" \"whole cereals, tubers, and roots;\" \"fruits\"; \"nonstarch vegetables;\" \"legumes and nuts;\" \"milk and dairy products;\" and \"vegetable oil\"). A proportional score-based on the adequacy of the intake to Brazilian dietary guidelines-is calculated, and a final score ranged from 0 (worse) to 100 (better) is obtained. Fecal samples were collected at home, in a sterile material, kept refrigerated, and delivered to the clinic within 12 hours; α-diversity indices (Observed operational taxonomic units, Chao-1, Shannon's, Gini-Simpson's, Pielou eveness, and Faith phylogenetics) and microbial profile were determined by 16S ribosomal DNA with polymerase chain reaction-amplification and sequenced on an Illumina MiSeq platform.</p><p><strong>Results: </strong>Forty-three participants were included (53.5% men, 52.4 ± 14.1 years, body mass index: 25.9 ± 4.1 kg/m², 30.2% had diabetes mellitus). DQI score was 50.5 (41.9-54.9). The lowest energy density was for the components \"animal fat\" and \"whole cereals and breads, tubers, and roots,\" and the highest were for \"refined grains and bread\" and \"beef, pork, and processed meat.\" Diversity indices and Enterorhabdus genus were directly associated with the energy density of the components \"whole cereals and breads, tubers, and roots\" and inversely with \"refined grains and bread,\" after adjustments for age and diabetes.</p><p><strong>Conclusions: </strong>Even low, the intake of whole cereals, tubers, and roots has the potential to positively influence the microbiota profile in PD patients.</p>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048760","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":"Accuracy of Current Large Language Models and the Retrieval-Augmented Generation Model in Determining Dietary Principles in Chronic Kidney Disease.","authors":"Feray Gençer Bingöl, Duygu Ağagündüz, Mustafa Can Bingol","doi":"10.1053/j.jrn.2025.01.004","DOIUrl":"10.1053/j.jrn.2025.01.004","url":null,"abstract":"<p><strong>Objective: </strong>Large language models (LLMs) have emerged as powerful tools with significant potential for quickly accessing information in the nutrition and health, as in many fields. Retrieval-augmented generation (RAG) has been included among artificial intelligence (AI) powered chatbot structures as a framework developed to increase the accuracy and ability of LLMs. This study aimed to evaluate the accuracy of LLMs (Generative Pre-trained Transformer 4, Gemini, and Llama) and RAG in determining dietary principles in chronic kidney disease.</p><p><strong>Design and methods: </strong>The nutrition guideline published by the National Kidney Foundation in 2020 was used as an external information source in developed RAG model. Answers were obtained using 12 medical nutritional therapy prompts for chronic kidney disease by four chatbots. The accuracy of the 48 answers generated by the chatbots was evaluated with a 5-point Likert scale.</p><p><strong>Results: </strong>The results showed that Gemini and RAG had the highest accuracy scores (median: 4.0), followed by Generative Pre-trained Transformer 4 (median: 2.5) and Llama (median: 1.5), respectively. When the accuracy scores were examined between the two chatbots, a significant difference was detected between all groups except Gemini and RAG.</p><p><strong>Conclusion: </strong>These chatbots produced both completely correct answers and false information with potentially harmful clinical outcomes. Customization of LLMs in specific areas such as nutrition or the development of a nutrition-specific RAG framework by improving LLM structures with current guidelines and articles may be an important strategy to increase the accuracy of AI powered chatbots.</p>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048759","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}