Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation最新文献

{"title":"Ultra-processed food consumption in people with chronic kidney disease.","authors":"Giacomo Garibotto, Francesca Cappadona, Haewook Han, Linda W Moore","doi":"10.1053/j.jrn.2026.10.001","DOIUrl":"https://doi.org/10.1053/j.jrn.2026.10.001","url":null,"abstract":"","PeriodicalId":520689,"journal":{"name":"Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Aspartate Aminotransferase and Aspartate Aminotransferase/Alanine Aminotransferase Ratio Exposure Reflects Risk of Low Skeletal Muscle Mass in Maintenance Hemodialysis: A Real-World Cohort Study.","authors":"Hai-Lian Deng, Shu-Ting He, Zhi-Yuan Chen, Liu-Tao Huang, Hong-Jiu Zhou, Chao Wu, Qin-Qi Qi, Hui-Wen Lin, Guang-Yan Liu, Cheng-Lin Yang, Yu Yang","doi":"10.1053/j.jrn.2026.09.001","DOIUrl":"10.1053/j.jrn.2026.09.001","url":null,"abstract":"<p><strong>Objective: </strong>Low skeletal muscle mass is highly prevalent among patients undergoing maintenance hemodialysis (MHD) and is closely linked to protein-energy wasting and adverse clinical outcomes. Aspartate aminotransferase (AST), a routinely measured enzyme involved in amino acid metabolism, is expressed in skeletal muscle and may reflect muscle metabolic status beyond hepatic injury. However, the association between long-term AST exposure and low skeletal muscle mass in the dialysis population remains unclear.</p><p><strong>Methods: </strong>In this single-center retrospective cohort study, 266 adult patients undergoing MHD were included. Five-year cumulative exposure to AST, alanine aminotransferase (ALT), and the AST/ALT ratio was quantified using time-weighted averages and median values. Skeletal muscle mass was assessed by bioelectrical impedance analysis. Low skeletal muscle mass was defined as skeletal muscle index < 7.0 kg/m² for men and <5.7 kg/m² for women, according to the Asian Working Group for Sarcopenia 2019 criteria. Multivariable logistic regression was performed to evaluate associations, adjusting for demographic, dialysis-related, and nutritional covariates. Nonlinear relationships were examined using restricted cubic spline models.</p><p><strong>Results: </strong>The study population consisted of 266 MHD patients (mean age 55.88 ± 14.82 years, 60.9% male). The prevalence of low skeletal muscle mass was 15.0%. Higher 5-year time-weighted average AST levels were independently associated with increased odds of low skeletal muscle mass (adjusted odds ratio [OR], 1.057; 95% confidence interval [CI], 1.009-1.107). Similar associations were observed for median AST levels (adjusted OR, 1.092; 95% CI, 1.024-1.164). The AST/ALT ratio demonstrated stronger associations, particularly for median values (adjusted OR, 3.720; 95% CI, 1.635-8.464). ALT-related metrics were not significantly associated with the outcome. Restricted cubic spline analysis showed no evidence of a nonlinear relationship between cumulative AST exposure and low skeletal muscle mass (P = .768 for nonlinearity), suggesting a linear dose-response relationship.</p><p><strong>Conclusions: </strong>Long-term elevated AST levels and a higher AST/ALT ratio were independently associated with low skeletal muscle mass in patients undergoing MHD. These routinely available biomarkers may provide additional insight into muscle metabolic status and help identify patients at increased nutritional risk.</p>","PeriodicalId":520689,"journal":{"name":"Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-Derived Quadriceps Muscle Measurements Are Independently Associated With Physical Frailty in Patients Undergoing Hemodialysis.","authors":"Ester Manuella de Moraes Zacarias, Camila Moura Batista Ferro, Roseane Maria Vogado Rodrigues, André Luís Oliveira Pacheco, Maria Aderuza Horst, Carla Maria Prado, Hellen Christina Neves Rodrigues, Nara Aline Costa","doi":"10.1053/j.jrn.2026.09.002","DOIUrl":"10.1053/j.jrn.2026.09.002","url":null,"abstract":"<p><strong>Objective: </strong>Patients undergoing hemodialysis (HD) frequently experience functional decline and a high prevalence of physical frailty. Ultrasound-derived muscle assessment enables objective bedside quantification of muscle mass and composition, while circulating biomarkers may provide additional insight into muscle-related physiology. This study examined the association of quadriceps muscle ultrasound measurements and serum biomarkers with physical frailty in HD patients.</p><p><strong>Design and methods: </strong>This is a subanalysis of a cohort study comprising adult patients on maintenance HD. Physical frailty was classified using the physical frailty phenotype (≥3 criteria). Blood samples were collected to measure serum concentrations of heat shock protein 72 and C-terminal agrin fragment using enzyme-linked immunosorbent assay kits. After the HD session, B-mode ultrasound was performed to assess thickness and echogenicity of the rectus femoris and vastus intermedius (RFVI), and vastus lateralis and vastus intermedius (VLVI).</p><p><strong>Results: </strong>Seventy-six patients were included, 45% with frailty. Multivariate logistic regression model adjusted for body mass index, age, and HD vintage, greater muscle thickness was associated with lower odds of frailty [RFVI (odds ratio [OR]: 0.340; 95% confidence interval [CI]: 0.150-0.774; P = .010); VLVI (OR: 0.244; 95% CI: 0.093-0.642; P = .004)], while higher muscle echogenicity was associated with higher odds [(RFVI (OR: 1.048; 95% CI: 1.007-1.090; P = .021); VLVI (OR: 1.108; 95% CI: 1.043-1.176; P = .001). No significant associations were found between C-terminal agrin fragment and heat shock protein 72 with frailty.</p><p><strong>Conclusion: </strong>Quadriceps muscle measurements were associated with physical frailty, reinforcing their use as a practical and clinically relevant tool for muscle assessment in hemodialysis patients.</p>","PeriodicalId":520689,"journal":{"name":"Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dietary Patterns for Obesity in Chronic Kidney Disease: Mediterranean, Low-Carbohydrate, and Plant-Forward Approaches-What Fits Best?","authors":"Fan Zhang, Liuyan Huang","doi":"10.1053/j.jrn.2026.08.011","DOIUrl":"10.1053/j.jrn.2026.08.011","url":null,"abstract":"<p><p>Obesity and chronic kidney disease (CKD) frequently coexist and mutually exacerbate metabolic, inflammatory, and hemodynamic disturbances that accelerate kidney function decline. Dietary therapy is central to weight management in CKD, yet traditional nutrient-restriction strategies may compromise diet quality and adherence. This review aims to evaluate the suitability of three major dietary patterns, the Mediterranean diet, plant-forward diets, and low-carbohydrate/ketogenic diets, for managing obesity in individuals with CKD. A narrative review of current literature was conducted, synthesizing evidence from observational studies, randomized controlled trials, and clinical guidelines that examined the metabolic, cardiovascular, and renal effects of these dietary patterns in CKD patients with obesity. Mediterranean and plant-dominant dietary patterns demonstrate consistent benefits in weight management, cardiovascular risk reduction, and kidney health. These diets are associated with improved insulin sensitivity, reduced dietary acid load, anti-inflammatory effects, and potential slowing of estimated glomerular filtration rate decline. Plant-forward diets may additionally improve gut microbiota composition and reduce uremic toxin generation. In contrast, low-carbohydrate and ketogenic diets can induce rapid short-term weight loss and glycemic improvements but raise concerns regarding metabolic acidosis, kidney stone risk, and uncertain long-term safety in CKD populations. Current evidence suggests that Mediterranean and well-planned plant-forward dietary patterns are reasonable first-line options for many patients with obesity and CKD, given their favorable cardio-metabolic profiles and generally acceptable safety. However, the certainty of evidence for long-term kidney outcomes remains limited, and dietary recommendations should be individualized according to CKD stage, comorbidities, nutritional status, and patient preferences.</p>","PeriodicalId":520689,"journal":{"name":"Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148932447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic Pathway Signatures of Amino Acids Across the Spectrum of Dialysis-Associated Fatigue.","authors":"Luxcia Kugathasan, Vikas S Sridhar, Nagarjunachary Ragi, Swetha Rani Kanduri, Ethan J Parikh, Ethan A Jackson, Carlos Lorenzo, Kumar Sharma, David Z I Cherney, Subrata Debnath","doi":"10.1053/j.jrn.2026.08.012","DOIUrl":"https://doi.org/10.1053/j.jrn.2026.08.012","url":null,"abstract":"<p><strong>Objective: </strong>Fatigue is among the most common and burdensome symptoms in patients with end-stage kidney disease (ESKD) undergoing maintenance hemodialysis, yet its metabolic drivers are not well defined. The aim of our study was to evaluate amino acid profiles in relation to dialysis-related fatigue.</p><p><strong>Methods: </strong>In a post hoc analysis of 115 adults with ESKD receiving hemodialysis, fatigue was measured on dialysis and non-dialysis day using the validated Brief Fatigue Inventory (BFI) test. Twenty-four plasma amino acid were measured pre- and post-dialysis. Differences in amino acid concentrations and metabolic pathways were evaluated across global BFI score categories (low, intermediate, high) on each day. Ordinal logistic regression examined associations between amino acids and shifts in global BFI score categories from dialysis to non-dialysis days.</p><p><strong>Results: </strong>On dialysis day, levels of tyrosine (p=0.01), asparagine (p=0.02), and ornithine (p=0.03) were lower in participants with high global BFI scores. Pathway-level analyses demonstrated lower branched-chain amino acid and essential amino acid pathway activity with high global BFI scores. On non-dialysis day, no differences in individual amino acids and metabolic pathways across global BFI score categories were observed. Aspartic acid (p=0.01), glycyl-histidine (p=0.04), and alanine, aspartate, and glutamate metabolism pathway (p=0.04) were associated with a shift toward lower global BFI score categories from dialysis to non-dialysis days.</p><p><strong>Conclusions: </strong>Fatigue in hemodialysis patients is linked to specific amino acid and metabolic changes on dialysis days, but not on non-dialysis days. These findings support exploring amino acid-targeted interventions, especially when fatigue is most severe.</p>","PeriodicalId":520689,"journal":{"name":"Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic Phenotype-Stratified Associations Between Obesity/Overweight and Mortality in Peritoneal Dialysis Patients.","authors":"Sijia Shang, Guowen Zhao, Na Tian, Xiaojiang Zhan, Fenfen Peng, Xiaoyang Wang, Yueqiang Wen, Qingdong Xu, Xiaoran Feng, Xingming Tang, Xianfeng Wu, Qian Zhou, Xing Zhang, Ning Su","doi":"10.1053/j.jrn.2026.07.007","DOIUrl":"10.1053/j.jrn.2026.07.007","url":null,"abstract":"<p><strong>Objective: </strong>Metabolic abnormalities and obesity/overweight are prevalent in peritoneal dialysis (PD) patients, and their interplay may significantly impact clinical outcomes. This study aimed to investigate the association between metabolic phenotypes (stratified by body mass index [BMI] and metabolic status) and all-cause mortality in PD patients.</p><p><strong>Methods: </strong>This multicenter cohort study was conducted from January 1, 2001, to May 31, 2023. Participants were categorized into four metabolic phenotypes based on their BMI and metabolic status: metabolically healthy overweight/obesity, metabolically healthy nonoverweight/obesity, metabolically unhealthy overweight/obesity, and metabolically unhealthy nonoverweight/obesity. The primary outcome is all-cause mortality. Cox regression analysis was employed to evaluate the association between metabolic phenotypes and all-cause mortality.</p><p><strong>Results: </strong>The study cohort comprised 4305 participants, with 1034 deaths during follow up. Compared with the metabolically healthy nonoverweight/obesity subgroup patients, those in the metabolically unhealthy nonoverweight/obesity subgroup (hazard ratio [HR], 1.169; 95% confidence interval [CI], 1.007-1.356), and the metabolically unhealthy overweight/obesity subgroup (HR, 1.206; 95% CI, 1.013-1.437) exhibited a higher risk of all-cause mortality, whereas patients in the metabolically healthy overweight/obesity group did not show an increased risk (HR, 0.921; 95% CI, 0.718-1.181). These results were consistent in subgroup and sensitivity analyses.</p><p><strong>Conclusion: </strong>In this cohort study, we found that patients with metabolic abnormalities showed a higher risk of all-cause mortality. The influence of BMI on all-cause mortality in PD patients varies with metabolic status; thus, metabolic status should be prioritized in risk stratification and personalized management for PD patients with overweight/obesity.</p>","PeriodicalId":520689,"journal":{"name":"Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Broccoli Sprout Extract for Glycemic Management in Patients with Chronic Kidney Disease and Type 2 Diabetes: A Randomized Double-Blind Placebo-Controlled Trial.","authors":"Carla Maria Avesani, Oskar Swartling, Anders H Rosengren, Olof Heimbürger, Maria K Svensson, Gregor Guron, Mårten Segelmark, Vaida Petrauskiene, Sigrid Lundberg, Andreas Jonsson, Josefin Mörtberg, Oscar Bratt, Ursa Bonnevier, Anders Fernstrom, Fredrik Uhlin, Maria Carlström, Babak Ghajavand, Anders Christensson, Roberta Fontanive Miyahira, Marie Evans, Peter Stenvinkel","doi":"10.1053/j.jrn.2026.08.009","DOIUrl":"10.1053/j.jrn.2026.08.009","url":null,"abstract":"<p><strong>Objective: </strong>Glucoraphanin, a precursor of sulforaphane (SFN), is found in high concentrations in broccoli sprout extract (BSE) and has been shown to have antioxidant effects and to improve glucose control in type 2 diabetes (T2D). This randomized controlled trial aimed to investigate whether BSE could improve glucose control in patients with chronic kidney disease (CKD) and T2D.</p><p><strong>Design and methods: </strong>This multicentre double-blind placebo-controlled randomized controlled trial included adult patients with T2D and CKD stages 3b-4. Participants were randomized to receive an incremental dose of BSE (maximum 150 μmol/day BSE (750 μmol SFN)) or placebo. The use BSE or placebo lasted 12 weeks (week 1 to 13) plus 8 weeks (week 14 to 21) with no intervention. The main outcome was improvement in glycemic control.</p><p><strong>Results: </strong>99 patients were included, and 91 completed the study. The mean age was 74±7 years, 69% were men, and mean estimated glomerular filtration rate was 28±7 mL/min/1.73 m². There were no significant differences in baseline characteristics between the groups. In an intention-to-treat analysis, there were no statistically significant differences between groups in fasting glucose, insulin, or HbA1c levels after 13 weeks or at 21 weeks of follow up (end of study). Similarly, no statistically significant differences were observed between both groups in these variables in a per protocol analysis.</p><p><strong>Conclusion: </strong>In patients with T2D and moderate CKD, 12 weeks of treatment with BSE with progressing dose (50 to 150 μmol/day BSE) did not result in statistically significant changes in measures related with glycemic control.</p>","PeriodicalId":520689,"journal":{"name":"Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma metabolomics improves prognostic prediction of chronic kidney disease: evidence from a large-scale population-based prospective cohort study.","authors":"Chen Jiang, Chengmiao Qiu, Dengren Li, Shasha Zhao, Miaomiao Fan, Hao Bai, Shujuan Lin, Lijuan Chai, Liyong Chen","doi":"10.1053/j.jrn.2026.08.004","DOIUrl":"https://doi.org/10.1053/j.jrn.2026.08.004","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a major global health concern associated with increased mortality and cardiovascular events. Traditional clinical models fail to capture the complex metabolic disturbances in CKD progression. This study aimed to assess the value of circulating Nuclear Magnetic Resonance (NMR) metabolic biomarkers in predicting all-cause and cardiovascular mortality in CKD patients.</p><p><strong>Methods: </strong>Using NMR-based metabolomic data from the UK Biobank, we analyzed baseline plasma samples from 16,306 participants. The multivariable-adjusted Cox proportional hazards models were applied to evaluate associations between NMR metabolic biomarkers and mortality in CKD. The full cohort was randomly assigned to a training set and test set to develop and validate the CKD prognostic risk prediction model using the least absolute shrinkage and selection operator (LASSO) regression and Cox proportional hazards regression analyses. Predictive performance was assessed using Harrell's C-index, with incremental value measured by continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI).</p><p><strong>Results: </strong>Of the 143 circulating metabolic biomarkers analyzed, 122 and 90 were significantly associated with all-cause and cardiovascular mortality, respectively, in patients with CKD (all FDR adjusted P value < 0.05). Very-low-density lipoprotein (VLDL) and low-density lipoprotein (LDL) particles, small high-density lipoprotein (HDL) sub-classes, polyunsaturated fatty acids, and branched-chain amino acids were negatively associated with mortality risk. Conversely, larger HDL particles, specific triglycerides, and the inflammatory marker glycoprotein acetylation (GlycA) were positively associated with mortality risk. Harrell's C-index of the conventional prediction model was 0.729 (95% CI: 0.707, 0.750) for all-cause mortality; after adding the circulating NMR metabolic biomarkers, the C-index increased to 0.750 (95% CI: 0.728, 0.771). For cardiovascular mortality, the C-index improved from 0.761 (95% CI: 0.724, 0.798) to 0.770 (95% CI: 0.733, 0.807). The continuous NRI and IDI were 0.097 (95% CI: 0.032, 0.158) and 0.043 (95% CI: 0.034, 0.051) for all-cause mortality, and 0.125 (95% CI: 0.007, 0.234) and 0.011 (95% CI: 0.005, 0.018) for cardiovascular mortality, respectively.</p><p><strong>Conclusion: </strong>This study identified multiple plasma metabolic biomarkers associated with all-cause and cardiovascular mortality in patients with CKD. Incorporating these biomarkers into conventional risk models significantly enhanced prediction accuracy.</p>","PeriodicalId":520689,"journal":{"name":"Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liberal Fruit and Vegetable Intake in Patients With Advanced Chronic Kidney Disease With or Without Sodium Zirconium Cyclosilicate.","authors":"Wouter T Moest, Brigitte Snoeker, Marko J K Mallat, Laurens A H Vermanen, Hidde T Kuipers, Martin H de Borst, Liffert Vogt, Ewout J Hoorn, Joris I Rotmans","doi":"10.1053/j.jrn.2026.08.005","DOIUrl":"10.1053/j.jrn.2026.08.005","url":null,"abstract":"<p><strong>Objectives: </strong>Higher dietary potassium intake is associated with lower blood pressure, better kidney outcomes and improved survival. However, the risk of hyperkalemia limits implementation of healthy potassium-rich diets in patients with chronic kidney disease (CKD). Novel potassium binders such as sodium zirconium cyclosilicate (SZC) may enable a more liberal intake of potassium-rich diets and thereby enable their cardiorenal benefits.</p><p><strong>Methods: </strong>This randomized, crossover, noninferiority clinical trial included 16 CKD patients receiving renin-angiotensin-aldosterone system (RAAS) inhibitors. Participants followed, in a randomized order, a potassium-rich diet for 6 weeks (adding 40 mmol potassium/day via extra fruits, vegetables, and nuts) or their regular diet. Hyperkalemia (>5.5 mmol/L) was managed with SZC, while continuing the diet. The primary endpoint was serum potassium after 6 weeks, with a noninferiority margin of 0.5 mmol/L.</p><p><strong>Results: </strong>At 6 weeks, there was no significant difference in serum potassium between the control and potassium-enriched diet phases (between-group difference 0.03 mmol/L, 95% confidence interval -0.32 to 0.27; P = .850). In contrast, 24-hour urinary potassium excretion increased significantly during the potassium-enriched diet (between-group difference 24.7 mmol/24h, 95% confidence interval 8.0 to 41.3; P = .005). Two patients developed hyperkalemia (5.9 and 6.1 mmol/L) and were treated with SZC, after which the diet was continued without recurrence.</p><p><strong>Conclusions: </strong>A potassium-rich diet was consistent with noninferior serum potassium levels compared with a regular diet at 6 weeks in patients with advanced CKD receiving RAAS inhibition. Hyperkalemia occurred in a minority of patients, and was effectively managed with SZC, allowing continuation of both the diet and RAAS inhibition. These findings suggest that a potassium-rich diet may be feasible in selected patients with advanced CKD, with careful monitoring and use of SZC when needed.</p>","PeriodicalId":520689,"journal":{"name":"Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malnutrition, Protein-Energy Wasting, Sarcopenia, and Sarcopenic Obesity in Hemodialysis Patients.","authors":"Manon de Geus, Andrea den Boeft, Manouk Dam, Elle Boersen, Anneke van Egmond-de Mik, Josje Schoufour, Peter Weijs, Hinke Kruizenga, Michael Tieland, Karin Ipema, Wesley Visser","doi":"10.1053/j.jrn.2026.08.008","DOIUrl":"10.1053/j.jrn.2026.08.008","url":null,"abstract":"<p><strong>Objective: </strong>Nutrition disorders and nutrition-related conditions contribute to increased morbidity, mortality, and poor quality of life in hemodialysis (HD) patients. This study investigates the prevalence and overlap between these conditions in HD patients.</p><p><strong>Methods: </strong>This cross-sectional multicenter study included adult HD patients from the Netherlands. Body composition was assessed using single-frequency bioimpedance analysis, multifrequency bioimpedance analysis, or bioimpedance spectroscopy. Muscle strength was estimated by handgrip strength. Nutrition disorders and nutrition-related conditions were assessed using: Global Leadership Initiative on Malnutrition (GLIM), protein-energy wasting (PEW), subjective global assessment (SGA), patient-generated SGA, European Working Group on Sarcopenia in Older People, and the Sarcopenic Obesity Global Leadership Initiative consensus. Overlap was identified using Venn diagrams.</p><p><strong>Results: </strong>Of the 128 HD patients included, 59% were classified as malnourished based on GLIM criteria, with reduced muscle mass being the most prevalent phenotypic indicator (83%). PEW was present in 38%, sarcopenia according to European Working Group on Sarcopenia in Older People in 23%, and sarcopenic obesity per Sarcopenic Obesity Global Leadership Initiative in 5%. Moderate-to-severe malnutrition was present in 47% of patients using the SGA (n = 89) and in 98% using patient-generated SGA (n = 39). GLIM showed the greatest overlap with other frameworks.</p><p><strong>Conclusion: </strong>This study reveals a high prevalence of malnutrition, PEW, and sarcopenia among HD patients. These results highlight the need for muscle-oriented screening and provide novel insight into the coexistence of nutrition disorders and nutrition-related conditions in this population. Given the overlap with other frameworks, GLIM appears to be a promising approach for diagnosing malnutrition in HD patients.</p>","PeriodicalId":520689,"journal":{"name":"Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}