Clinical Journal of the American Society of Nephrology最新文献_第8页

Dietary Phosphorus and Metabolic Health in CKD and ESKD. CKD和ESKD患者膳食磷与代谢健康

IF 8.5 1区医学

Clinical Journal of the American Society of Nephrology Pub Date : 2025-03-20 DOI: 10.2215/CJN.0000000715

Adamasco Cupisti, Domenico Giannese, Mario Cozzolino, Vincenzo Panichi, Claudia D'Alessandro, Maurizio Gallieni

{"title":"Dietary Phosphorus and Metabolic Health in CKD and ESKD.","authors":"Adamasco Cupisti, Domenico Giannese, Mario Cozzolino, Vincenzo Panichi, Claudia D'Alessandro, Maurizio Gallieni","doi":"10.2215/CJN.0000000715","DOIUrl":"10.2215/CJN.0000000715","url":null,"abstract":"The contribution of dietary phosphate (P) in the pathogenesis of CKD-associated mineral bone disease and the management of P intake in patients with CKD are essential to slow down disease progression and improve patient outcomes. In patients with CKD, and most likely in the general population, P retention and overload can affect four critical aspects of the cardiovascular system: increased arterial BP, vascular and valvular calcification, and left ventricular hypertrophy. All of these factors contribute to increased cardiovascular risk and mortality. Intestinal absorption of P from a mixed diet is approximately 60%-70% of the dietary P content, with lower rates for organic P from plant sources and higher rates for inorganic P from processed foods containing additives. The widespread use of phosphate additives in processed foods and the high consumption of animal protein in the Western diet have led to a steady increase in phosphate consumption in recent decades. Although it is unclear whether this high P intake has adverse effects in people with normal kidney function, several studies have found that increased dietary P contributes to the progression of CKD and cardiovascular damage. High P intake may be detrimental, but there is no clear evidence that it should be avoided in the general population. On the contrary, kidney function impairment is the setting in which modulation of P intake is justified and easy to implement by restricting/reducing protein intake. However, it is quite difficult to implement P restriction in patients on dialysis because of the conflicting recommendation of high protein intake. Educational approaches, together with solid motivation and adherence by patients and caregivers, are needed to achieve the goal of successful dietary phosphate management in patients with CKD.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Innovating Kidney Care in Patients with Cancer: Development of an Inpatient Onconephrology Service. 创新癌症患者肾脏护理：住院肿瘤学服务的发展。

IF 8.5 1区医学

Clinical Journal of the American Society of Nephrology Pub Date : 2025-03-19 DOI: 10.2215/CJN.0000000714

Raad B Chowdhury, Jessica L Ortega, Sophia L Wells, Marta Pirovano, Raphael Kim, Carolina S Lima, Mohit Madken, Sheikh B Khalid, Rania El Fekih, Firasat M Alikhan, Alexa C Peterkin, Gearoid M McMahon, David B Mount, Joseph V Bonventre, Shruti Gupta

引用次数: 0

Prescribing Physical Activity and Exercise for People with CKD: A Practical Guide by the Global Renal Exercise Network. 慢性肾脏疾病患者的身体活动和运动处方：全球肾脏运动网络的实用指南。

IF 8.5 1区医学

Clinical Journal of the American Society of Nephrology Pub Date : 2025-03-14 DOI: 10.2215/CJN.0000000708

Thomas J Wilkinson, Brett Tarca, Courtney J Lightfoot, João L Viana, Kenneth R Wilund, Heitor S Ribeiro, Sharlene Greenwood, Giorgos K Sakkas, Brandon M Kistler

{"title":"Prescribing Physical Activity and Exercise for People with CKD: A Practical Guide by the Global Renal Exercise Network.","authors":"Thomas J Wilkinson, Brett Tarca, Courtney J Lightfoot, João L Viana, Kenneth R Wilund, Heitor S Ribeiro, Sharlene Greenwood, Giorgos K Sakkas, Brandon M Kistler","doi":"10.2215/CJN.0000000708","DOIUrl":"10.2215/CJN.0000000708","url":null,"abstract":"Physical activity (PA) and exercise are fundamental to optimizing and maintaining health. The evidence on the benefits of PA and exercise in people with CKD is well-established. Yet patients remain inactive, partly driven by a lack of knowledge and confidence from the healthcare providers involved in their management. A potential key element in improving PA in CKD includes better provisions around education, tools, and training resources among nephrology healthcare providers on PA recommendations, counseling, prescription, and referral to appropriate professionals for assessment, implementation, and monitoring. Much like other pharmacologic therapies, an effective prescription should be prescribed at the correct dose, strength, and frequency to the individual, titrated (and progressed) to optimize adherence and safety, and reviewed regularly to ensure maximum effectiveness. Aside from a formal prescription of exercise, many people would benefit from modest improvements in daily PA, and an emphasis on reducing sedentary behavior is likely to confer beneficial effects on outcomes. The purpose of this article is to outline the key components of successful PA and exercise prescriptions, including understanding the barriers and facilitators individuals may have, taking a PA history, and how to tailor exercise \"dose\" to each patient with the ultimate goal of increasing accessibility of PA for all people living with CKD. To do this, we will use worked examples to demonstrate what an exercise prescription may consist of across each of the major CKD stages.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":"876-888"},"PeriodicalIF":8.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12160954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Autonomic Nervous System Dysregulation and Bone Health in Patients with CKD: Potential for Intervention. 慢性肾病患者的自主神经系统失调和骨骼健康：干预的潜力。

IF 8.5 1区医学

Clinical Journal of the American Society of Nephrology Pub Date : 2025-03-14 DOI: 10.2215/CJN.0000000709

Carmine Zoccali, Marc G Vervloet, Pieter Evenepoel, Ziad Massy, Mario Cozzolino, Francesca Mallamaci, Eleanor D Lederer, Jorge Cannata Andia, Tilman B Drueke

引用次数: 0

Do Overweight Status and Obesity Affect Progression to ESKD in Autosomal Dominant Polycystic Kidney Disease? 超重和肥胖是否影响常染色体显性多囊肾病的ESKD进展？

IF 9.8 1区医学

Clinical Journal of the American Society of Nephrology Pub Date : 2025-03-13 DOI: 10.2215/cjn.0000000690

Sol Carriazo, York Pei

引用次数: 0

Do Fast Foods Contribute to Food Insecurity in the In-Center Hemodialysis Population? 快餐会导致中心血液透析人群的食物不安全吗？

IF 9.8 1区医学

Clinical Journal of the American Society of Nephrology Pub Date : 2025-03-12 DOI: 10.2215/cjn.0000000686

David M. White

引用次数: 0

Plant-Based Diets across the Spectrum of Kidney Disease. 植物性饮食对肾脏疾病的影响。

IF 8.5 1区医学

Clinical Journal of the American Society of Nephrology Pub Date : 2025-03-12 DOI: 10.2215/CJN.0000000706

Nimrit Goraya, Donald E Wesson

引用次数: 0

Dietary Intake and Gut Microbiome in Chronic Kidney Disease. 慢性肾脏疾病的饮食摄入与肠道微生物组。

IF 8.5 1区医学

Clinical Journal of the American Society of Nephrology Pub Date : 2025-03-11 DOI: 10.2215/CJN.0000000705

Julie Ann Kemp, Marcia Ribeiro, Natália A Borges, Ludmila Cardozo, Denis Fouque, Denise Mafra

{"title":"Dietary Intake and Gut Microbiome in Chronic Kidney Disease.","authors":"Julie Ann Kemp, Marcia Ribeiro, Natália A Borges, Ludmila Cardozo, Denis Fouque, Denise Mafra","doi":"10.2215/CJN.0000000705","DOIUrl":"https://doi.org/10.2215/CJN.0000000705","url":null,"abstract":"Gut dysbiosis, characterized by an imbalance in the gut microbiota, has emerged as a potential factor influencing chronic kidney disease (CKD) progression. This condition plays a crucial role in the gut-kidney axis, where changes in microbial composition can contribute to systemic inflammation and uremic toxin production and ultimately exacerbate kidney damage. Understanding the dynamics of the gut-kidney axis provides new insights into potential therapeutic strategies to mitigate CKD progression. Diet is the primary driver of gut microbiota composition. Therefore, an approach emphasizing healthy nutritional patterns is recommended for improving overall health, cardiovascular disease, and profoundly altered metabolic patterns in CKD patients. Dietary modifications have been explored as therapeutic strategies targeting the microbiome to improve outcomes in CKD. An emerging therapeutic target is the production of dysmetabolites by the gut microbiota, which may help alleviate uremic and cardiovascular toxicity. Additionally, future research should broaden the scope to include other microorganisms, such as fungi, archaea, and viruses. This expanded focus will enable a more comprehensive understanding of the gut-kidney axis and pave the way for more personalized and effective treatment strategies for CKD patients. This review explores the role of lifestyle, particularly diet, in kidney health, highlights new gut microbiome therapies, and identifies research opportunities in CKD.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Dialysis Dependence in Standard Versus Accelerated Initiation of Kidney Replacement Therapy in Acute Kidney Injury: A Post-Hoc Analysis 急性肾损伤患者标准肾替代治疗与加速启动肾替代治疗的透析依赖性：事后分析

IF 9.8 1区医学

Clinical Journal of the American Society of Nephrology Pub Date : 2025-03-11 DOI: 10.2215/cjn.0000000672

Ian E. McCoy, Kathleen D. Liu, Ehsan Ghamarian, Jean-Pierre Quenot, Alex Zarbock, Azra Bihorac, Benjamin Khoo, Martin P. Gallagher, Bin Du, Michael Joannidis, Kianoush Kashani, Ashita Tolwani, Sean M. Bagshaw, Ron Wald, For the STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Investigators

{"title":"Dialysis Dependence in Standard Versus Accelerated Initiation of Kidney Replacement Therapy in Acute Kidney Injury: A Post-Hoc Analysis","authors":"Ian E. McCoy, Kathleen D. Liu, Ehsan Ghamarian, Jean-Pierre Quenot, Alex Zarbock, Azra Bihorac, Benjamin Khoo, Martin P. Gallagher, Bin Du, Michael Joannidis, Kianoush Kashani, Ashita Tolwani, Sean M. Bagshaw, Ron Wald, For the STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Investigators","doi":"10.2215/cjn.0000000672","DOIUrl":"https://doi.org/10.2215/cjn.0000000672","url":null,"abstract":"ompared to a standard strategy. However, it is unclear whether this difference exists among participants who likely would have been treated with KRT in usual practice. Methods: Secondary analysis of the STARRT-AKI randomized controlled trial, analyzing participants who received more than the median number of days of KRT, which served as a proxy for high probability of requiring KRT under usual practice. Two sensitivity analyses redefined the cohort as 1) those with ≥24 hours of oliguria who received KRT and 2) those who received any RT. Using the same statistical approach Kas the original trial, we calculated unadjusted relative risks with 95% confidence intervals (CI) for the exposure of randomized KRT initiation strategy (accelerated vs. standard) on the outcome of KRT dependence at 90 days among survivors. Results: Among the 1,184 participants who received ≥six days of KRT (670 and 514 in the accelerated and standard arms, respectively), baseline characteristics remained balanced between treatment arms. The relative risk of KRT dependence at 90 days was attenuated and non-significant: 1.21 (95% CI 0.84-1.78), compared to 1.74 (95% CI 1.24-2.43) in the overall trial. Results were similar in sensitivity analyses. Conclusions: Among patients who likely would have been treated with KRT in usual practice, there was no significant difference in 90-day KRT dependence among survivors between those randomized to the accelerated and standard KRT initiation strategies. These results suggest that the harm of long-term KRT dependence may be largely due to KRT initiation (vs never initiation) rather than earlier initiation. Copyright © 2025 by the American Society of Nephrology...","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"19 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Residual Risk of Adverse Kidney and Cardiovascular Outcomes in Patients with CKD. 慢性肾病患者肾脏和心血管不良结局的剩余风险

IF 8.5 1区医学

Clinical Journal of the American Society of Nephrology Pub Date : 2025-03-01 Epub Date: 2024-12-17 DOI: 10.2215/CJN.0000000588

Muhammad Shahzeb Khan, Ahmed Mustafa Rashid, Tariq Shafi, Janani Rangaswami, David Z I Cherney, Javed Butler

引用次数: 0