Kidney disease

Scientific studies on the relationship between diet/nutrients and kidney disease:
One swallow does not make a summer. A famous Dutch saying that could not be any more obvious. Just because one single scientific study about a certain topic makes certain claims, it does not necessarily mean it is true. On the other hand, a review article (a collection of scientific studies on a certain topic) of randomized, placebo-controlled double blind clinical trials (RCTs) will answer the following question:
"Do taking dietary supplements make sense?" Yes for a positive conclusion and no for a negative conclusion.

One swallow does not make a summer. A famous Dutch saying that could not be any more obvious. Just because one single scientific study about a certain topic makes certain claims, it does not necessarily mean it is true. On the other hand, a review article (a collection of scientific studies on a certain topic) of cohort studies or case-control studies will answer the following question:
"Should I change my diet?".

1. Cardiovascular reserve is improved after kidney-transplantation
2. L-carnitine supplementation should be supported in hemodialysis patients
3. Resistant starch type 2 improves residual renal function of patients under maintenance hemodialysis
4. Intravenous NAC administration decreases serum creatinine levels
5. Probiotic, prebiotic and synbiotic supplementation improve oxidative stress in patients with chronic kidney disease
6. Pneumococcal vaccine + influenza vaccine probably reduce all-cause mortality in dialysis patients
7. Mortality is more frequently in COVID-19 patients with chronic kidney diseases and cardiovascular disease
8. Hypertension, cardiovascular diseases, diabetes mellitus, smoking, COPD, malignancy and chronic kidney disease are risk factors for COVID-19 infection
9. Hepatitis B virus infection increases chronic kidney disease
10. Creatine supplementation does not induce renal damage
11. Exercise intervention in kidney transplant recipients improves quality of life
12. Subjects with end-stage renal disease benefit from a diet with 5.5 En% protein
13. Patients with diabetic kidney disease benefit from 0.8 g protein per kilogram body weight per day

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• Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine. When chronic kidney disease reaches an advanced stage, dangerous levels of fluid, electrolytes and wastes can build up in your body.
• Signs and symptoms of kidney disease may include:
  • Changes in how much you urinate
  • Chest pain, if fluid builds up around the lining of the heart
  • Decreased mental sharpness
  • Fatigue and weakness
  • High blood pressure (hypertension) that's difficult to control
  • Loss of appetite
  • Muscle twitches and cramps
  • Nausea
  • Persistent itching
  • Shortness of breath, if fluid builds up in the lungs
  • Sleep problems
  • Swelling of feet and ankles
  • Vomiting

• Chronic kidney disease (CKD) is divided into 5 stages based on the level of kidney function.

• You can find out what stage you’re in by testing:
  1. the blood pressure
  2. the eGFR number
  3. the urine’s ACR (albumin:creatinine ratio)
• Chronic kidney disease can progress to end-stage kidney failure, which is fatal without artificial filtering (dialysis) or a kidney transplant.
• Kidney failure is the last (most severe) stage of chronic kidney disease. This is why kidney failure is also called end-stage renal disease or ESRD for short.
• Diabetes is the most common cause of kidney failure. High blood pressure is the second most common cause of kidney failure. Other problems that can cause kidney failure include:
  • Autoimmune diseases, such as lupus and IgA nephropathy
  • Genetic diseases (diseases you are born with), such as polycystic kidney disease
  • Nephrotic syndrome
  • Urinary tract problems
  • Sepsis
• There are 2 ways the kidneys could be affected by sepsis.
  1. The first is if the infection that caused the sepsis begins in the kidney, through a kidney infection or a bladder infection that has spread to the kidney.
  2. The second is if the cascade of events from sepsis causes the kidney damage.
• If you have kidney failure (end-stage renal disease or ESRD), you will need dialysis or a kidney transplant to live. There is no cure for kidney failure, but many people live long lives while on dialysis or after having a kidney transplant.
• Before dialysis was available, total kidney failure meant death.
• Dialysis is a way of cleaning your blood when your kidneys can no longer do the job. It gets rid of your body's wastes, extra salt and water and helps to control your blood pressure.
• There are 2 kinds of dialysis:
  1. Hemodialysis
  2. Peritoneal dialysis
• In hemodialysis, blood is pumped out of your body to an artificial kidney machine and returned to your body by tubes that connect you to the machine.
  The procedure usually involves using a dialysis machine 3 times a week, with each session usually lasting about 4 hours. You'll need to plan your life around these sessions.
• Anemia (low red blood cells) is an inevitable complication of hemodialysis and the primary cause is erythropoietin deficiency.
• In peritoneal dialysis, the inside lining of your own belly acts as a natural filter. Wastes are taken out by means of a cleansing fluid called dialysate, which is washed in and out of your belly in cycles.
• Peritoneal dialysis (PD) and hemodialysis (HD) are dialysis options for end-stage renal disease patients in whom preemptive kidney transplantation is not possible.
• The selection of peritoneal dialysis or hemodialysis will usually be based on patient motivation, desire, geographic distance from a hemodialysis unit, physician and/or nurse bias and patient education.
• Peritoneal dialysis may be the better option if you:
  • Are 2 years or younger
  • Can't tolerate the rapid changes of fluid balance associated with hemodialysis
  • Have some residual kidney function
  • Want to minimize the disruption of your daily activities
  • Want to work or travel more easily
• Peritoneal dialysis might not work if you have:
  • A large area of weakened abdominal muscle (hernia)
  • Extensive surgical scars in your abdomen
  • Inflammatory bowel disease or frequent bouts of diverticulitis
  • Limited ability to care for yourself or a lack of caregiving support
• The benefits of peritoneal dialysis compared with hemodialysis include:
  • Greater lifestyle flexibility and independence. These can be especially important if you work, travel or live far from a hemodialysis center.
  • A less restricted diet. Peritoneal dialysis is done more continuously than hemodialysis, resulting in less accumulation of potassium, sodium and fluid. This allows you to have a more flexible diet than you could have on hemodialysis.
  • Longer lasting residual kidney function. People who use peritoneal dialysis might retain kidney function slightly longer than people who use hemodialysis.
• The main advantage of hemodialysis is that you have 4 dialysis-free days a week.
• One of the main disadvantages of peritoneal dialysis is that it needs to be carried out every day, which you may find very disruptive.
• Another major disadvantage of peritoneal dialysis is that you're at risk of developing peritonitis, an infection of the thin membrane that lines your abdomen.
• Estimated glomerular filtration rate (eGFR) is a test used to check how well the kidneys are working and therefore, determining the stage of kidney disease. Specifically, it estimates how much blood passes through the glomeruli each minute.
• In adults, the normal eGFR number is more than 90. eGFR declines with age, even in people without kidney disease.

• Healthy kidneys remove extra fluid and waste from your blood, but let proteins and other important nutrients pass through and return to your blood stream.
  When your kidneys are not working as well as they should, they can let some protein (albumin) escape through their filters, into your urine.
• When you have protein in your urine, it is called proteinuria (or albuminuria).
• Having protein in your urine can be a sign of nephrotic syndrome, or an early sign of kidney disease.
• The only way to know if you have protein in your urine is to have a urine test. The test for protein in the urine measures the amount of albumin in your urine, compared to the amount of creatinine in your urine. This is called the urine albumin-to-creatinine ratio (UACR).
• A UACR more than 30 mg/g can be a sign of kidney disease.
• Proteinuria is a strong marker for progression of chronic kidney disease.
• Most people live normal, healthy lives with one kidney.
• Most people with one healthy kidney do not need to follow a special diet.
• A dietary protein intake (DPI) of between 0.6 and 0.8 g protein per kilogram body weight per day (g/kg/day) is frequently recommended for adults with moderate-to-advanced chronic kidney disease (CKD).
  For example: you are a patient with moderate chronic kidney disease, you weigh 70 kg and you want to eat 2200 kcal every day. How should you meet a dietary protein intake of between 0.6 and 0.8 g protein per kilogram body weight per day (g/kg/day) in daily life?
  Every day you should take maximal 0.6-0.8 g protein x 70 kg = 42-56 g protein.
  42-56 g protein give 42-56x4 kcal = 168-224 kcal.
  168-224 kcal is around 7%-10% of 2200 kcal. Thus, you should eat products whose protein content contributes 7% to 10% to the total kcal of the product in question, meaning you should eat products with 7-10 En% protein. These products in the supermarket contain 7 to 10 En% protein.