scholarly journals Addressing Racial Disparity in the Progression of Chronic Kidney Disease: Prescribe More Fruits and Vegetables?

2018 ◽  
Vol 47 (3) ◽  
pp. 171-173 ◽  
Author(s):  
Wei Chen ◽  
David A. Bushinsky
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Racial Disparity ◽  
Fruits And Vegetables

scholarly journals The Serum Metabolome Identifies Biomarkers of Dietary Acid Load in 2 Studies of Adults with Chronic Kidney Disease

2019 ◽  
Vol 149 (4) ◽  
pp. 578-585 ◽  
Author(s):  
Casey M Rebholz ◽  
Aditya Surapaneni ◽  
Andrew S Levey ◽  
Mark J Sarnak ◽  
Lesley A Inker ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Fruits And Vegetables ◽  
Smoking Status ◽  
Cross Sectional ◽  
Dietary Acid Load ◽  
Nutrition Research ◽  
Net Endogenous Acid Production ◽  
Dietary Acid ◽  
Acid Load

ABSTRACT Background Dietary acid load is a clinically important aspect of the diet that reflects the balance between acid-producing foods, for example, meat and cheese, and base-producing foods, for example, fruits and vegetables. Methods We used metabolomics to identify blood biomarkers of dietary acid load in 2 independent studies of chronic kidney disease patients: the African American Study of Kidney Disease and Hypertension (AASK, n = 689) and the Modification of Diet in Renal Disease (MDRD, n = 356) study. Multivariable linear regression was used to assess the cross-sectional association between serum metabolites whose identity was known (outcome) and dietary acid load (exposure), estimated with net endogenous acid production (NEAP) based on 24-h urine urea nitrogen and potassium, and adjusted for age, sex, race, randomization group, measured glomerular filtration rate, log-transformed urine protein-to-creatinine ratio, history of cardiovascular disease, BMI, and smoking status. Results Out of the 757 known, nondrug metabolites identified in AASK, 26 were significantly associated with NEAP at the Bonferroni threshold for significance (P < 6.6 × 10−5). Twenty-three of the 26 metabolites were also identified in the MDRD study, and 13 of the 23 (57%) were significantly associated with NEAP (P < 2.2 × 10−3), including 5 amino acids (S-methylmethionine, indolepropionylglycine, indolepropionate, N-methylproline, N-δ-acetylornithine), 2 cofactors and vitamins (threonate, oxalate), 1 lipid (chiro-inositol), and 5 xenobiotics (methyl glucopyranoside, stachydrine, catechol sulfate, hippurate, and tartronate). Higher levels of all 13 replicated metabolites were associated with lower NEAP in both AASK and the MDRD study. Conclusion Metabolomic profiling of serum specimens from kidney disease patients in 2 study populations identified 13 replicated metabolites associated with dietary acid load. Additional studies are needed to validate these compounds in healthy populations. These 13 compounds may potentially be used as objective markers of dietary acid load in future nutrition research studies.

scholarly journals Higher estimated net endogenous acid production with lower intake of fruits and vegetables based on a dietary survey is associated with the progression of chronic kidney disease

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Koji Toba ◽  
Michihiro Hosojima ◽  
Hideyuki Kabasawa ◽  
Shoji Kuwahara ◽  
Toshiko Murayama ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Acid Production ◽  
Protein Intake ◽  
Fruits And Vegetables ◽  
Ckd Progression ◽  
Dietary Acid Load ◽  
Net Endogenous Acid Production ◽  
Dietary Acid ◽  
Acid Load

Abstract Background Dietary acid load has been suggested to mediate the progression of chronic kidney disease (CKD). However, it is unclear what kinds of foods are actually associated with dietary acid load in patients with CKD. The self-administered diet history questionnaire (DHQ), which semi-quantitatively assesses the dietary habits of Japanese individuals through 150 question items, can estimate average daily intake of various foods and nutrients during the previous month. Using the DHQ, we investigated the association of dietary acid load with CKD progression. We also analyzed the kinds of food that significantly affect dietary acid load. Methods Subjects were 96 outpatients with CKD (average estimated glomerular filtration rate [eGFR], 53.0 ± 18.1 ml/min/1.73 m2) at Niigata University Hospital, who had completed the DHQ in 2011. We calculated net endogenous acid production (NEAP) from potassium and protein intake evaluated by the DHQ in order to assess dietary acid load. CKD progression was assessed by comparing eGFR between 2008 and 2014. Results NEAP was not correlated with protein intake (r = 0.088, p = 0.398), but was negatively correlated with potassium intake (r = − 0.748, p < 0.001). Reduction in eGFR from 2008 to 2014 was estimated to be significantly greater in patients with higher NEAP (NEAP > 50.1 mEq/day, n = 45) than in those with lower NEAP (NEAP ≤50.1 mEq/day, n = 50) by 5.9 (95% confidence interval [95%CI], 0.1 to 11.6) ml/min/1.73 m2. According to multiple logistic regression analysis, higher NEAP was significantly associated with lower intake of fruits (odds ratio [OR], 6.454; 95%CI, 2.19 to 19.00), green and yellow vegetables (OR, 5.18; 95%CI, 1.83 to14.66), and other vegetables (OR, 3.87; 95%CI, 1.29 to 11.62). Conclusions Elevated NEAP could be a risk factor for CKD progression. Low intake of fruits and vegetables would increase dietary acid load and might affect the progression of renal dysfunction in Japanese CKD patients.

scholarly journals Is There a Racial Disparity in Coronavirus Disease 2019 Patients with Chronic Kidney Disease? An Experience in New York City

Authorea ◽  
2020 ◽  
Author(s):  
Takayuki Yamada ◽  
Takahisa Mikami ◽  
Nitin Chopra ◽  
Hirotaka Miyashita ◽  
Svetlana Chernyavsky ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
New York ◽  
New York City ◽  
Kidney Disease ◽  
York City ◽  
Racial Disparity

Abstract P038: Characterizing Patterns Of Fruits And Vegetables Intake In Adults With And Without Chronic Kidney Disease In The United States

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Shirin Pourafshar ◽  
Binu Sharma ◽  
Sibylle Kranz ◽  
Indika Mallawaarachchi ◽  
Elizabeth Kurland ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Fruits And Vegetables ◽  
Latent Class ◽  
Multinomial Logistic Regression ◽  
Starch Content ◽  
The United States ◽  
Nhanes Iii ◽  
The Us ◽  
High Starch

Background: Due to concerns about hyperkalemia, the recommendation for patients with chronic kidney disease (CKD) is to limit intakes of foods high in potassium, including certain types of nuts, fruits and vegetables (F&V). Detailed patterns of F&V intake have not been described in patients with CKD, limiting our ability to study higher or lower risk patterns. In this study, we aimed to characterize the patterns of F&V intake in adults with and without CKD in a nationally representative sample of the US. Methods: We included 16,183 adults, with (n= 3,225) and without (n= 12,958) CKD based on eGFR and albuminuria from the Third National Health and Nutrition Examination Survey (NHANES III). We calculated counts of different types of F&V consumed by the participants according to a 24-h recall interview reported in the NHANES III Individual Food File. Based on their phytonutrient and starch content, F&V were then categorized into: rich in polyphenols; rich in carotenoids; rich in glucosinolates, and high in starch. We also categorized consumption of legumes and nuts. Patterns of legumes, nuts, and F&V intake were identified using latent class analysis (LCA; LCCA package, R 3.0.1). We evaluated differences in serum carotenoids, vitamins A, E, and C as objective biomarkers to help validate patterns. Multinomial logistic regression incorporating survey weights was used to adjust association between CKD status and F&V patterns (SAS Institute, V.9.4). Results: LCA analysis classified the food consumption into 3 distinct patterns: low F&V/low starch; moderate F&V/high starch; and high F&V/moderate starch. Consumption of legumes and nuts was low in all three patterns. Pattern of higher F&V consumption had higher serum levels of carotenoids, vitamins A, E, and C (p for difference across patterns <0.0001). Unadjusted patterns of consumption were not different in patients with vs. without CKD (p=0.654). After adjustment for ethnicity, gender, body mass index, waist circumference, diabetes, and hypertension, patients with CKD were more likely to consume moderate F&V/ high starch (OR=1.23, p=0.0316) or low F&V/starch (OR=1.34, p=0.0001) compared to patients without CKD. Conclusions: Utilizing the LCA analysis and regression, we found higher likelihood of consuming low F&V patterns in patients with vs. without CKD in the US. Further studies are needed to evaluate outcomes to understand risks of benefits of F&V patterns for patients with CKD.

Direct association between high fat dietary pattern and risk of being in the higher stages of chronic kidney disease

2019 ◽  
Vol 89 (5-6) ◽  
pp. 261-270 ◽  
Author(s):  
Mohammad Hossein Rouhani ◽  
Mojgan Mortazavi Najafabadi ◽  
Ahmad Esmaillzadeh ◽  
Awat Feizi ◽  
Leila Azadbakht
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Dietary Patterns ◽  
Dietary Pattern ◽  
Fruits And Vegetables ◽  
Cross Sectional Study ◽  
High Fat ◽  
Cross Sectional ◽  
Simple Carbohydrate

Abstract. Background: Although there are some reports on the association of dietary patterns and chronic kidney disease (CKD), no data exists regarding the relation between dietary pattern and CKD from developing countries. Objective: To examine the association between major dietary patterns, renal function and progression of CKD. Methods: Two hundred twenty one subjects with diagnosed CKD were selected for this cross-sectional study. Dietary intake of patients was assessed by a validated food frequency questionnaire. Major dietary patterns were extracted by factor analysis. Renal function was measured by blood urea nitrogen (BUN) and serum creatinine (Cr) level as well as estimated glomerular filtration rate (eGFR). Results: Three major dietary patterns were identified: high fruits and vegetables, high simple carbohydrate and sugar and high fat. Subjects in the second quartile of high fat dietary pattern score had lower Cr and higher eGFR in compared with the first quartile after adjusting for covariates (P = 0.02 for both). After adjusting for confounders (age, physical activity, socioeconomic status, height, weight, systolic and diastolic blood pressure and energy intake), patients in the top quartile of high fat dietary pattern score were found to be at greater risk of being in the higher stages (stage 3 vs. stages 4 and 5) of CKD (odds ratio: 3.09; 95% CI: 1.23, 7.76; P for trend = 0.02). Conclusion: We observed that a high fat dietary pattern was directly associated with progression of CKD.

scholarly journals Diet and Chronic Kidney Disease

2019 ◽  
Vol 10 (Supplement_4) ◽  
pp. S367-S379 ◽  
Author(s):  
Holly Kramer
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Protein Intake ◽  
Fruits And Vegetables ◽  
Disease Incidence ◽  
Normal Serum ◽  
Western Diet ◽  
Animal Protein ◽  
Ammonium Excretion ◽  
High Animal

ABSTRACT Kidney disease affects almost 15% of the US population, and prevalence is anticipated to grow as the population ages and the obesity epidemic continues due to Western dietary practices. The densely caloric Western diet, characterized by high animal protein and low fruit and vegetable content, has fueled the growth of chronic diseases, including chronic kidney disease. The glomerulus or filtering unit of the kidney is very susceptible to barotrauma, and diets high in animal protein impede the glomerulus’ ability to protect itself from hemodynamic injury. High animal protein intake combined with low intake of fruits and vegetables also leads to a high net endogenous acid production requiring augmentation of ammonium excretion in order to prevent acidosis. This higher workload of the kidney to maintain a normal serum bicarbonate level may further exacerbate kidney disease progression. This article reviews the potential mechanisms whereby several key characteristics of the typical Western diet may impact kidney disease incidence and progression. Reducing animal protein intake and egg yolk and increasing intake of fruits and vegetables and fiber may prevent or delay end-stage renal disease, but few clinical trials have examined vegetarian diets for management of chronic kidney disease. More research is needed to determine optimal dietary patterns for the prevention of kidney disease and its progression.

scholarly journals Vegetable-Based Diets for Chronic Kidney Disease? It Is Time to Reconsider

Nutrients ◽  
2019 ◽  
Vol 11 (6) ◽  
pp. 1263 ◽  
Author(s):  
Aleix Cases ◽  
Secundino Cigarrán-Guldrís ◽  
Sebastián Mas ◽  
Emilio Gonzalez-Parra
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Fruits And Vegetables ◽  
Vegetarian Diet ◽  
Main Concern ◽  
Dietary Recommendations ◽  
High Potassium ◽  
Fatty Acid Production ◽  
High Fiber ◽  
Phosphorus Absorption

Traditional dietary recommendations to renal patients limited the intake of fruits and vegetables because of their high potassium content. However, this paradigm is rapidly changing due to the multiple benefits derived from a fundamentally vegetarian diet such as, improvement in gut dysbiosis, reducing the number of pathobionts and protein-fermenting species leading to a decreased production of the most harmful uremic toxins, while the high fiber content of these diets enhances intestinal motility and short-chain fatty acid production. Metabolic acidosis in chronic kidney disease (CKD) is aggravated by the high consumption of meat and refined cereals, increasing the dietary acid load, while the intake of fruit and vegetables is able to neutralize the acidosis and its deleterious consequences. Phosphorus absorption and bioavailability is also lower in a vegetarian diet, reducing hyperphosphatemia, a known cause of cardiovascular mortality in CKD. The richness of multiple plants in magnesium and vitamin K avoids their deficiency, which is common in these patients. These beneficial effects, together with the reduction of inflammation and oxidative stress observed with these diets, may explain the reduction in renal patients’ complications and mortality, and may slow CKD progression. Finally, although hyperkalemia is the main concern of these diets, the use of adequate cooking techniques can minimize the amount absorbed.

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