scholarly journals Chronic Dialysis Patients Are Depleted of Creatine: Review and Rationale for Intradialytic Creatine Supplementation

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2709
Author(s):  
Yvonne van der Veen ◽  
Adrian Post ◽  
Daan Kremer ◽  
Christa A. Koops ◽  
Erik Marsman ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Pilot Study ◽  
Kidney Disease ◽  
Energy Homeostasis ◽  
Creatine Supplementation ◽  
Daily Basis ◽  
Dietary Recommendations ◽  
Double Blind ◽  
Creatine Uptake ◽  
Related Quality

There is great need for the identification of new, potentially modifiable risk factors for the poor health-related quality of life (HRQoL) and of the excess risk of mortality in dialysis-dependent chronic kidney disease patients. Creatine is an essential contributor to cellular energy homeostasis, yet, on a daily basis, 1.6–1.7% of the total creatine pool is non-enzymatically degraded to creatinine and subsequently lost via urinary excretion, thereby necessitating a continuous supply of new creatine in order to remain in steady-state. Because of an insufficient ability to synthesize creatine, unopposed losses to the dialysis fluid, and insufficient intake due to dietary recommendations that are increasingly steered towards more plant-based diets, hemodialysis patients are prone to creatine deficiency, and may benefit from creatine supplementation. To avoid problems with compliance and fluid balance, and, furthermore, to prevent intradialytic losses of creatine to the dialysate, we aim to investigate the potential of intradialytic creatine supplementation in improving outcomes. Given the known physiological effects of creatine, intradialytic creatine supplementation may help to maintain creatine homeostasis among dialysis-dependent chronic kidney disease patients, and consequently improve muscle status, nutritional status, neurocognitive status, HRQoL. Additionally, we describe the rationale and design for a block-randomized, double-blind, placebo-controlled pilot study. The aim of the pilot study is to explore the creatine uptake in the circulation and tissues following different creatine supplementation dosages.

A randomized double-blind pilot study of serum phosphorus normalization in chronic kidney disease: A new paradigm for clinical outcomes studies in nephrology

2009 ◽  
Vol 13 (3) ◽  
pp. 360-362 ◽  
Author(s):  
Geoffrey A. BLOCK ◽  
Martha S. PERSKY ◽  
Markus KETTELER ◽  
Bryan KESTENBAUM ◽  
Ravi THADHANI ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Pilot Study ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Serum Phosphorus ◽  
New Paradigm ◽  
Double Blind

PP130 Oral Supplements For Protein-Energy Wasting In Chronic Kidney Disease

2019 ◽  
Vol 35 (S1) ◽  
pp. 61-62
Author(s):  
Noe Brito-Garcia ◽  
Ana Toledo-Chávarri ◽  
Maria Trujillo-Martin ◽  
Beatriz Leon-Salas ◽  
Pedro Serrano ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Nutritional Status ◽  
Comparative Studies ◽  
Nutritional Therapy ◽  
Serum Markers ◽  
Dietary Recommendations ◽  
Protein Energy Wasting ◽  
Protein Energy ◽  
Related Quality

IntroductionMalnutrition, specifically protein-energy wasting (PEW), is common in patients with chronic kidney disease (CKD), and its prevalence increases as CKD progresses. Oral nutritional supplementation (ONS) with complete formulas specific to this pathology, is a strategy aimed at meeting energy and protein requirements that are not possible with dietary recommendations and advice alone. This study systematically reviewed the available scientific literature on the safety and effectiveness of nutritional therapy with complete formulas specially designed for adults with CKD who have PEW that is not reversible through ordinary food consumption.MethodsWe systematically searched for articles published up to May 2018 in several electronic databases. We included comparative studies that evaluated the safety and effectiveness of complete nutritional formulas for malnourished adults with CKD. Relevant outcomes included rates of death, hospitalization, and adverse effects, and changes in nutritional status, anthropometrics, and health-related quality of life (HRQoL).ResultsThree systematic reviews and 22 primary studies were identified. The primary studies comprised nine randomized controlled trials, nine non-randomized comparative studies, and four before-after studies (the latter were only included in the safety review). The majority of studies were conducted in patients on hemodialysis. The studies exhibited methodological heterogeneity in terms of the methods used to measure nutritional status and the interventions and comparators evaluated. There was also inconsistency among the results. Adherence to ONS, especially in the long term, can be affected by taste fatigue produced by repeatedly taking the same formula. Some studies recommend supplementation during hemodialysis sessions.ConclusionsThe studies with less risk of bias indicated a trend toward improvements in rates of death and hospitalization, HRQoL and, to a lesser extent, some anthropometric variables and serum markers, such as albumin, when ONS was given to patients with CKD. High quality comparative studies are needed to make conclusive statements about the effectiveness of this intervention.

scholarly journals Creatine is a Conditionally Essential Nutrient in Chronic Kidney Disease: A Hypothesis and Narrative Literature Review

Nutrients ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 1044 ◽  
Author(s):  
Adrian Post ◽  
Dimitrios Tsikas ◽  
Stephan J.L. Bakker
Keyword(s):  
Chronic Kidney Disease ◽  
Fatty Acids ◽  
Kidney Disease ◽  
Energy Homeostasis ◽  
Saturated Fatty Acids ◽  
Dietary Recommendations ◽  
Creatine Deficiency ◽  
Essential Nutrient ◽  
Impaired Cognition ◽  
Protein Diets

To accommodate the loss of the plethora of functions of the kidneys, patients with chronic kidney disease require many dietary adjustments, including restrictions on the intake of protein, phosphorus, sodium and potassium. Plant-based foods are increasingly recommended as these foods contain smaller amounts of saturated fatty acids, protein and absorbable phosphorus than meat, generate less acid and are rich in fibers, polyunsaturated fatty acids, magnesium and potassium. Unfortunately, these dietary recommendations cannot prevent the occurrence of many symptoms, which typically include fatigue, impaired cognition, myalgia, muscle weakness, and muscle wasting. One threat coming with the recommendation of low-protein diets in patients with non-dialysis-dependent chronic kidney disease (CKD) and with high-protein diets in patients with dialysis-dependent CKD, particularly with current recommendations towards proteins coming from plant-based sources, is that of creatine deficiency. Creatine is an essential contributor in cellular energy homeostasis, yet on a daily basis 1.6–1.7% of the total creatine pool is degraded. As the average omnivorous diet cannot fully compensate for these losses, the endogenous synthesis of creatine is required for continuous replenishment. Endogenous creatine synthesis involves two enzymatic steps, of which the first step is a metabolic function of the kidney facilitated by the enzyme arginine:glycine amidinotransferase (AGAT). Recent findings strongly suggest that the capacity of renal AGAT, and thus endogenous creatine production, progressively decreases with the increasing degree of CKD, to become absent or virtually absent in dialysis patients. We hypothesize that with increasing degree of CKD, creatine coming from meat and dairy in food increasingly becomes an essential nutrient. This phenomenon will likely be present in patients with CKD stages 3, 4 and 5, but will likely be most pronouncedly present in patients with dialysis-dependent CKD, because of the combination of lowest endogenous production of creatine and unopposed losses of creatine into the dialysate. It is likely that these increased demands for dietary creatine are not sufficiently met. The result of which, may be a creatine deficiency with important contributions to the sarcopenia, fatigue, impaired quality of life, impaired cognition, and premature mortality seen in CKD.

scholarly journals Bicarbonate Supplement Restores Urinary Klotho Excretion in Chronic Kidney Disease: A Pilot Study

2019 ◽  
Vol 29 (4) ◽  
pp. 285-288 ◽  
Author(s):  
Valerie Hage ◽  
Cedric Villain ◽  
Solenne Pelletier ◽  
Maurice Laville ◽  
Jocelyne Drai ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Pilot Study ◽  
Kidney Disease
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