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Kidney and Dialysis
Special Issues
Lifestyle Interventions to Prevent Kidney Diseases
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Lifestyle Interventions to Prevent Kidney Diseases

A special issue of Kidney and Dialysis (ISSN 2673-8236).

Deadline for manuscript submissions: closed (22 March 2022) | Viewed by 70123

Special Issue Editors

Prof. Dr. Roman-Ulrich Müller

E-Mail Website
Guest Editor
Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
Interests: acute kidney injury; kidney transplantation; autosomal dominant polycystic kidney disease; preconditioning; dietary interventions; RNA-binding proteins; non-coding RNAs
Dr. Sharlene A. Greenwood

E-Mail Website
Guest Editor
King’s College Hospital NHS Foundation Trust, Therapies Department, London SE5 9RS, UK
Interests: chronic kidney disease; transplantation; rehabilitation; prehabilitation; physical activity; exercise; wellbeing
Dr. Ellen M. Castle

E-Mail Website
Guest Editor
Physiotherapy Division, Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK
Interests: chronic kidney disease; transplantation; rehabilitation; prehabilitation; physical activity; exercise; wellbeing

Special Issue Information

Dear Colleagues,

Chronic kidney disease (CKD) affects around 10% of the global population and comes with a major burden to both individual CKD patients and healthcare systems. Particularly, CKD is one of the strongest independent risk factors for cardiovascular morbidity and mortality. Over the last few decades, strategies to prevent and treat CKD have largely focused on pharmacological interventions. However, while this approach has provided answers for individual disease settings, the general problem of CKD remains. Lifestyle interventions—including dietary recommendations and physical exercise—have been shown to harbor huge potential for beneficial effects on kidney health and the resulting co-morbidities. This great opportunity has not been fully exploited to date. This Special Issue on “Lifestyle interventions in Kidney Health and Disease” aims to provide an overview on the current knowledge in this field and an outlook towards new research questions. Increasing awareness of the power of lifestyle interventions and creating a setting in which these can be implemented in everyday life is an important goal to improve outcomes for kidney disease patients. To reach this aim, the following key aspects in the field of lifestyle interventions will be covered regarding their role in the prevention and treatment of acute kidney injury (AKI) and CKD, including optimal management of kidney transplant patients and treatment of complications of kidney disease (e.g., arterial hypertension):

- Dietary interventions in kidney disease and current recommendations regarding dietary habits in CKD and kidney transplantation;

- Dietary interventions for nephroprotection;

- An update on salt intake and kidney disease;

- The role of the microbiome and its modulation by dietary habits in kidney disease;

- Obesity, weight control, and kidney disease;

- Environmental factors (e.g., pollution, smoking) and kidney health;

- physical activity/sports in kidney health and disease;

- digital health for people living with kidney disease;

- pre-habilitation—pre-dialysis and kidney transplantation;

- self-management and patient activation;

- fatigue and mental/emotional wellbeing;

- identifying and managing frailty.

This Special Issue aims to integrate not only original articles and reviews by kidney experts from medicine and science. This endeavor will also include the patient view, e.g., by means of commentaries provided by patient advocacy groups, to account for the fact that optimal medical care goes beyond classical clinical endpoints. We look forward to your contributions to this important step towards an optimal management of lifestyle interventions in kidney disease.

Prof. Dr. Roman-Ulrich Müller
Dr. Sharlene A. Greenwood
Dr. Ellen M. Castle
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Kidney and Dialysis is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • kidney disease
  • kidney transplant
  • environment
  • complications
  • dietary
  • CKD
  • nephroprotection
  • salt intake
  • obesity
  • weight control
  • physical activity
  • sports
  • digital health
  • self-management
  • patient activation
  • lifestyle
  • interventions
  • exercise
  • rehabilitation
  • nephrology

Published Papers (15 papers)

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Editorial

Jump to: Research, Review, Other

4 pages, 214 KiB  
Editorial
The Importance of Lifestyle Interventions in the Prevention and Treatment of Chronic Kidney Disease
by Ellen M. Castle, Sharlene A. Greenwood and Roman-Ulrich Müller
Kidney Dial. 2023, 3(2), 192-195; https://doi.org/10.3390/kidneydial3020017 - 10 Apr 2023
Viewed by 2303
Abstract
Chronic kidney disease (CKD) is a global health problem, with a prevalence of approximately 13 [...] Full article
(This article belongs to the Special Issue Lifestyle Interventions to Prevent Kidney Diseases)

Research

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21 pages, 1661 KiB  
Article
Ren.Nu, a Dietary Program for Individuals with Autosomal-Dominant Polycystic Kidney Disease Implementing a Sustainable, Plant-Focused, Kidney-Safe, Ketogenic Approach with Avoidance of Renal Stressors
by Diana M. Bruen, Jacob J. Kingaard, Meg Munits, Clarissa S. Paimanta, Jacob A. Torres, Jessianna Saville and Thomas Weimbs
Kidney Dial. 2022, 2(2), 183-203; https://doi.org/10.3390/kidneydial2020020 - 13 Apr 2022
Cited by 11 | Viewed by 11896
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited cause of renal failure and has limited pharmacological treatment options. Disease progression is relentless, and regression is not a known feature of ADPKD even with pharmacological intervention. Recent research has uncovered underlying [...] Read more.
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited cause of renal failure and has limited pharmacological treatment options. Disease progression is relentless, and regression is not a known feature of ADPKD even with pharmacological intervention. Recent research has uncovered underlying pathogenic mechanisms that may be amenable to dietary interventions. Cyst cells in ADPKD are thought to depend on glucose for energy and are unable to metabolize fatty acids and ketones. High-carbohydrate diets and lifestyles leading to hyperglycemia appear to worsen progression of ADPKD. Additionally, renal stressors such as oxalate, phosphate and uric acid, that lead to renal tubular micro-crystal burden appear to accelerate disease progression. Based on these research findings, we have created a remote, dietitian-supervised training program to teach individuals with ADPKD the implementation of dietary and lifestyle changes to avoid factors that may worsen disease progression. Using web-based platforms, digital tools, one-on-one remote meetings, and video group meetings, participants learn to implement a plant-focused ketogenic diet that avoids renal stressors, the science behind these changes, how to self-measure health parameters, and track nutrient intake. Dietary changes are supplemented with a medical food containing the ketone beta-hydroxybutyrate and alkaline citrate, and mindfulness exercises. Here, we report the first experience with this program from a beta test with approximately 24 participants. Most participants completed the program and reported improvements in their health and well-being including pain levels, weight loss, hypertension, and eGFR. Adherence to the program was very high and the feasibility of the dietary and lifestyle changes was rated highly. The Ren.Nu program is now publicly available to individuals with ADPKD. Full article
(This article belongs to the Special Issue Lifestyle Interventions to Prevent Kidney Diseases)
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Review

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16 pages, 1062 KiB  
Review
Effects of Diet and Exercise on Metabolic Parameters and Health in Moderate to Advanced Kidney Disease
by Lale A. Ertuglu and Talat Alp Ikizler
Kidney Dial. 2022, 2(2), 330-345; https://doi.org/10.3390/kidneydial2020030 - 10 Jun 2022
Cited by 1 | Viewed by 2603
Abstract
Metabolic derangements such as obesity, dyslipidemia, chronic inflammation, and oxidative stress are commonly seen in patients with chronic kidney disease (CKD) and are implicated in the exaggerated cardiovascular disease (CVD) risk observed in this patient population. Lifestyle interventions including healthy dietary patterns and [...] Read more.
Metabolic derangements such as obesity, dyslipidemia, chronic inflammation, and oxidative stress are commonly seen in patients with chronic kidney disease (CKD) and are implicated in the exaggerated cardiovascular disease (CVD) risk observed in this patient population. Lifestyle interventions including healthy dietary patterns and exercise training have been proven effective in modifying these CVD risk factors in the general population. The efficacy and safety of these interventions in CKD patients remain elusive. This review article aims to provide a summary of the current evidence on the effects of different types of dietary and exercise interventions on metabolic biomarkers associated with cardiovascular disease in patients with moderate to advanced CKD. Full article
(This article belongs to the Special Issue Lifestyle Interventions to Prevent Kidney Diseases)
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32 pages, 1373 KiB  
Review
Physical Activity Behaviour in Solid Organ Transplant Recipients: Proposal of Theory-Driven Physical Activity Interventions
by Sofie Leunis, Marieke Vandecruys, Véronique Cornelissen, Amaryllis H. Van Craenenbroeck, Sabina De Geest, Diethard Monbaliu and Stefan De Smet
Kidney Dial. 2022, 2(2), 298-329; https://doi.org/10.3390/kidneydial2020029 - 07 Jun 2022
Cited by 7 | Viewed by 2822
Abstract
Physical inactivity is highly prevalent after solid organ transplantation and leads to unfavourable outcomes. This review aimed to understand posttransplant physical activity behaviour and propose physical activity interventions. Michie’s Behavioural Change Wheel was applied, in which the Context and Implementation of Complex Interventions [...] Read more.
Physical inactivity is highly prevalent after solid organ transplantation and leads to unfavourable outcomes. This review aimed to understand posttransplant physical activity behaviour and propose physical activity interventions. Michie’s Behavioural Change Wheel was applied, in which the Context and Implementation of Complex Interventions framework, the Capability-Opportunity-Motivation and Behaviour model, and the Theoretical Domains Framework were embedded. Various contextual factors were found to modulate physical activity behaviour. Promising strategies to promote long-term physical activity included (i) tailoring of physical activity programs to patients’ abilities and preferences; (ii) incitement of intrinsic and autonomous motivation to change; (iii) SMART goals setting (e.g., Specific, Measurable, Achievable, Realistic, Timebound), (iv) autonomy-supportive co-design of action plans; (v) foster new habit formation; (vi) self-monitoring of physical activity; (vii) follow-up opportunities for evaluation and adjustment; (viii) education of transplant recipients, healthcare providers, and the patients’ social network; (iv) improvement of self-efficacy through incremental successes, verbal persuasion, peer modelling, and awareness of exercise-related bodily signals; (x) providing physical activity opportunity within patients’ social and environmental setting; (xi) encouragement and support from patients’ social network and healthcare providers; and (xii) governmental action that alleviates financial barriers and restructures the physical environment to promote physical activity. These new insights may contribute to physical activity program development for transplantation recipients. Full article
(This article belongs to the Special Issue Lifestyle Interventions to Prevent Kidney Diseases)
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9 pages, 262 KiB  
Review
Next Steps for Intradialytic Cycling Research
by Alexis C. King and Kenneth R. Wilund
Kidney Dial. 2022, 2(2), 287-295; https://doi.org/10.3390/kidneydial2020027 - 02 Jun 2022
Cited by 1 | Viewed by 2004
Abstract
Hemodialysis patients typically have extremely low physical activity levels, which contributes to poor physical function and quality of life (QOL). Numerous studies show that exercise, intradialytic cycling in particular, may improve physical and cardiovascular function and QOL. But there are also significant inconsistencies [...] Read more.
Hemodialysis patients typically have extremely low physical activity levels, which contributes to poor physical function and quality of life (QOL). Numerous studies show that exercise, intradialytic cycling in particular, may improve physical and cardiovascular function and QOL. But there are also significant inconsistencies in the literature, and the benefits in many studies are modest. This may be due in part to methodological limitations in intradialytic cycling trials, including small sample sizes, short interventions, low volume, and intensity of exercise prescriptions, and/or low retention and protocol adherence rates. The goal of this review is twofold. First, we summarize the current literature on intradialytic cycling in HD patients, highlighting benefits and concerns noted in several recently published trials that were among the most robust and clinically relevant trials conducted to date. Second, we will consider strategies for moving forward with exercise and physical activity interventions in HD, including promoting intradialytic cycling as a core component of a more patient-centric and comprehensive strategy that helps progress patients towards standard physical activity guidelines. We urge researchers and exercise professionals to consider intradialytic cycling as a valuable component of a comprehensive patient-centered, lifestyle intervention, as opposed to a stand-alone exercise prescription. Full article
(This article belongs to the Special Issue Lifestyle Interventions to Prevent Kidney Diseases)
25 pages, 418 KiB  
Review
The Role of Exercise Training in Delaying Kidney Function Decline in Non-Dialysis-Dependent Chronic Kidney Disease
by Mark Davies, Aamer Sandoo and Jamie Macdonald
Kidney Dial. 2022, 2(2), 262-286; https://doi.org/10.3390/kidneydial2020026 - 25 May 2022
Cited by 2 | Viewed by 4105
Abstract
Chronic Kidney Disease (CKD) is a progressive condition characterised by declining eGFR and associated, particularly in advanced stages, with increased morbidity and cardiovascular mortality. Current treatment options for delaying disease progression are limited to a small number of pharmacological agents. Considering that rates [...] Read more.
Chronic Kidney Disease (CKD) is a progressive condition characterised by declining eGFR and associated, particularly in advanced stages, with increased morbidity and cardiovascular mortality. Current treatment options for delaying disease progression are limited to a small number of pharmacological agents. Considering that rates of kidney function decline are greater in patients with lower levels of habitual physical activity, there is interest in the potential benefits of structured exercise training in delaying CKD progression. This discursive review summarises the current state-of-play in this field of research by critically analysing the published systematic reviews of randomised controlled trials of structured exercise training in the non-dialysis CKD population. Several issues are highlighted that hamper definite conclusions as to the therapeutic effectiveness of exercise training for this purpose. However, following an overview of the pathophysiology and risk factors for kidney function decline, several potential mechanisms explaining how exercise training may benefit CKD progression are offered. Finally, suggestions for future research in this area are made. The review concludes that there is a need for further research on the effectiveness of exercise before it can be recommended as part of routine care for the purpose of delaying CKD progression. Exercise can be recommended, however, to individual patients because of a potential benefit to kidney function, and definite benefits to other outcomes such as quality of life, with no apparent evidence of harm. Full article
(This article belongs to the Special Issue Lifestyle Interventions to Prevent Kidney Diseases)
17 pages, 937 KiB  
Review
Targeted Non-Pharmacological Interventions for People Living with Frailty and Chronic Kidney Disease
by Juliet Mayes, Hannah M. L. Young, Rochelle M. Blacklock, Courtney J. Lightfoot, Joseph Chilcot and Andrew C. Nixon
Kidney Dial. 2022, 2(2), 245-261; https://doi.org/10.3390/kidneydial2020025 - 20 May 2022
Cited by 5 | Viewed by 4511
Abstract
Frailty is highly prevalent within people living with chronic kidney disease (CKD) and is associated with the increased risk of falls, hospitalisation, and mortality. Alongside this, individuals with CKD report a high incidence of depression and reduced quality of life. The identification of [...] Read more.
Frailty is highly prevalent within people living with chronic kidney disease (CKD) and is associated with the increased risk of falls, hospitalisation, and mortality. Alongside this, individuals with CKD report a high incidence of depression and reduced quality of life. The identification of frailty within nephrology clinics is needed to establish comprehensive management plans to improve clinical outcomes and quality of life for people with CKD. Current research exploring the role of non-pharmacological management has primarily focussed on exercise and physical activity interventions in the frail CKD population. However, there is a growing evidence base and interest in this area. This review provides an up-to-date overview of the literature into frailty assessment in CKD and subsequent non-pharmacological treatment approaches. Full article
(This article belongs to the Special Issue Lifestyle Interventions to Prevent Kidney Diseases)
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11 pages, 298 KiB  
Review
Assessment of Function Limitations in People with Chronic Kidney Disease for Implementation in Clinical Practice
by Pelagia Koufaki
Kidney Dial. 2022, 2(2), 234-244; https://doi.org/10.3390/kidneydial2020024 - 04 May 2022
Cited by 3 | Viewed by 2387
Abstract
Chronic Kidney Disease (CKD) is a global health problem and a significant contributor to mortality, morbidity and disability from non-communicable diseases (NCD). The current consensus amongst researchers in the field of renal rehabilitation and healthcare practitioners involved in the management of people with [...] Read more.
Chronic Kidney Disease (CKD) is a global health problem and a significant contributor to mortality, morbidity and disability from non-communicable diseases (NCD). The current consensus amongst researchers in the field of renal rehabilitation and healthcare practitioners involved in the management of people with CKD, is that physical dysfunction and inactivity are severe and prevalent in all ages and CKD stages compared to normative data. The negative impact of CKD on independence is cumulative, and health interventions and policies should target prevention of deterioration of kidney function and its consequences for physical frailty, disability and ultimately, quality of life. Accurate and feasible assessment of physical function is key for supporting the clinical implementation of current clinical care management guidelines. This overview, therefore, presents the rationale and some key scientific evidence to support the recommendation of physical function measurement tools that reflect function limitations for immediate implementation in clinical practice. Measurement property characteristics of the proposed measurement tools are also summarised in order to support health and exercise professionals in selecting the right tool and in interpreting and evaluating the measured outcomes. Full article
(This article belongs to the Special Issue Lifestyle Interventions to Prevent Kidney Diseases)
13 pages, 277 KiB  
Review
Constipation in Chronic Kidney Disease: It Is Time to Bridge the Gap
by Christiane Ishikawa Ramos, Fabiana Baggio Nerbass and Lilian Cuppari
Kidney Dial. 2022, 2(2), 221-233; https://doi.org/10.3390/kidneydial2020023 - 03 May 2022
Cited by 3 | Viewed by 9391
Abstract
In this narrative review, we briefly describe the general features of constipation, our understanding of its physiopathology, and its diagnosis and treatment, focusing on chronic kidney disease (CKD). Considering that constipation is poorly characterized in CKD, we referred to studies that used the [...] Read more.
In this narrative review, we briefly describe the general features of constipation, our understanding of its physiopathology, and its diagnosis and treatment, focusing on chronic kidney disease (CKD). Considering that constipation is poorly characterized in CKD, we referred to studies that used the Rome criteria to diagnose constipation in patients to describe a more realistic prevalence based on a standardized tool. A highly variable prevalence of the condition was reported, ranging from 4.5% to 71.7%. The main risk factors associated with constipation reported in these studies were advanced age, low fruit intake, presence of diabetes, and medication use, and the main consequence of constipation in CKD was a worse quality of life. We found a paucity of interventional studies for constipation treatment in CKD; however, in the general population, meta-analyses published in the last decade have reported the beneficial effects of non-pharmacological strategies, which may guide the management of constipated patients with CKD. These strategies include the consumption of fiber, prebiotics, and probiotics, as well as physical exercise and acupuncture. In conclusion, although constipation is a frequent complaint among patients with CKD, there remains a considerable knowledge gap regarding its epidemiology, prognosis, and treatment. Full article
(This article belongs to the Special Issue Lifestyle Interventions to Prevent Kidney Diseases)
17 pages, 1773 KiB  
Review
Obesity, Weight Loss, Lifestyle Interventions, and Autosomal Dominant Polycystic Kidney Disease
by Cortney Steele and Kristen Nowak
Kidney Dial. 2022, 2(1), 106-122; https://doi.org/10.3390/kidneydial2010013 - 04 Mar 2022
Cited by 3 | Viewed by 5660
Abstract
Obesity remains a growing public health concern in industrialized countries around the world. The prevalence of obesity has also continued to rise in those with chronic kidney disease. Epidemiological data suggests those with overweight and obesity, measured by body mass index, have an [...] Read more.
Obesity remains a growing public health concern in industrialized countries around the world. The prevalence of obesity has also continued to rise in those with chronic kidney disease. Epidemiological data suggests those with overweight and obesity, measured by body mass index, have an increased risk for rapid kidney disease progression. Autosomal dominant polycystic kidney disease causes growth and proliferation of kidney cysts resulting in a reduction in kidney function in the majority of adults. An accumulation of adipose tissue may further exacerbate the metabolic defects that have been associated with ADPKD by affecting various cell signaling pathways. Lifestyle interventions inducing weight loss might help delay disease progression by reducing adipose tissue and systematic inflammation. Further research is needed to determine the mechanistic influence of adipose tissue on disease progression. Full article
(This article belongs to the Special Issue Lifestyle Interventions to Prevent Kidney Diseases)
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15 pages, 1550 KiB  
Review
Patient Activation: The Cornerstone of Effective Self-Management in Chronic Kidney Disease?
by Courtney J. Lightfoot, Devika Nair, Paul N. Bennett, Alice C. Smith, Anthony D. Griffin, Madeleine Warren and Thomas J. Wilkinson
Kidney Dial. 2022, 2(1), 91-105; https://doi.org/10.3390/kidneydial2010012 - 03 Mar 2022
Cited by 17 | Viewed by 8301
Abstract
The importance of patient activation (i.e., the knowledge, skills, and confidence one has in managing one’s own healthcare) in people with long-term conditions, including kidney disease, is growing. Enabling and empowering patients to take a more active role in their health and healthcare [...] Read more.
The importance of patient activation (i.e., the knowledge, skills, and confidence one has in managing one’s own healthcare) in people with long-term conditions, including kidney disease, is growing. Enabling and empowering patients to take a more active role in their health and healthcare is the focus of person-centred care. Patient activation is recognised as a key construct of self-management, as to effectively self-manage a long-term condition, it is required to enable individuals to actively participate in treatment decisions, prevent complications, and manage risk factors. Identifying an individual’s level of activation can help guide and tailor care, and interventions aimed at increasing patient activation may improve patient engagement and health outcomes. In this review, we explore the concepts of patient activation and self-management, the relationship between patient activation and self-management, interventions aimed at improving these, and what these mean to people living with kidney disease. Full article
(This article belongs to the Special Issue Lifestyle Interventions to Prevent Kidney Diseases)
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Graphical abstract

11 pages, 6301 KiB  
Review
Peritoneal Dialysis and the Role of Exercise Training Interventions
by Osasuyi Iyasere, Hannah M. L. Young and James O. Burton
Kidney Dial. 2022, 2(1), 57-67; https://doi.org/10.3390/kidneydial2010007 - 11 Feb 2022
Cited by 1 | Viewed by 3283
Abstract
People receiving peritoneal dialysis (PrPD) tend to be physically inactive, with consequent adverse outcomes including increased mortality, reduced technique, and hospitalization free survival. Exercise is a form of planned physical activity which has the potential to improve these outcomes. Feasibility studies suggest that [...] Read more.
People receiving peritoneal dialysis (PrPD) tend to be physically inactive, with consequent adverse outcomes including increased mortality, reduced technique, and hospitalization free survival. Exercise is a form of planned physical activity which has the potential to improve these outcomes. Feasibility studies suggest that exercise interventions are safe in PrPD. However, the uptake of exercise is low. In this review, we explore the benefits of exercise in this population, noting the limitations in the existing evidence. We highlight the challenges and uncertainties associated with exercise, including the perceptions of patients and clinicians. Finally, the opportunities for increasing exercise uptake are discussed, alongside future research priorities. Full article
(This article belongs to the Special Issue Lifestyle Interventions to Prevent Kidney Diseases)
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Other

5 pages, 510 KiB  
Perspective
Lifestyle Interventions in Improving Health Outcomes and Enabling People to Live Well with Kidney Disease
by Tess Harris
Kidney Dial. 2022, 2(2), 204-208; https://doi.org/10.3390/kidneydial2020021 - 03 May 2022
Cited by 2 | Viewed by 3598
Abstract
Lifestyle interventions can play an important role in improving patients’ health outcomes and helping them to live well with chronic kidney disease (CKD). The key to living well is ‘life participation’, defined as ‘the ability to do meaningful activities of life including, but [...] Read more.
Lifestyle interventions can play an important role in improving patients’ health outcomes and helping them to live well with chronic kidney disease (CKD). The key to living well is ‘life participation’, defined as ‘the ability to do meaningful activities of life including, but not limited to, work, study, family responsibilities, travel, sport, social, and recreational activities’. Pharmaceutical, clinical, and surgical interventions such as dialysis and transplantation can deliver beneficial health outcomes for patients. Yet CKD patients say that the focus of renal appointments is ‘bloods, urine, blood pressure and kidney function’ and their treatment. Little time is provided to discuss non-clinical symptoms or concerns and recommend other treatments, such as lifestyle interventions. There are no highly ranked evidence-based guidelines for lifestyle interventions in CKD due to a historic lack of evidence. Diet advice, for example, is widely requested by patients on the internet and online forums but access to reliable information is highly variable. The lack of patient reported outcome measures (PROMs) is a barrier to monitoring and gathering evidence, but regulatory changes and the efforts of international organisations should soon deliver validated tools for research and guidelines which can be implemented in holistic care pathways. A global call to action to focus on lifestyle interventions is proposed. Full article
(This article belongs to the Special Issue Lifestyle Interventions to Prevent Kidney Diseases)
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7 pages, 210 KiB  
Commentary
Dietary Changes and Their Influence in the Development of Kidney Disease
by Artemis P. Simopoulos
Kidney Dial. 2022, 2(2), 131-137; https://doi.org/10.3390/kidneydial2020015 - 29 Mar 2022
Cited by 2 | Viewed by 1903
Abstract
Human beings evolved on a diet that was balanced in omega-6/omega-3 fatty acids, and was rich in fruits and vegetables with a ratio of animal to vegetable intake of 35:65. Such a diet is a base-producing anti-inflammatory diet and one in which our [...] Read more.
Human beings evolved on a diet that was balanced in omega-6/omega-3 fatty acids, and was rich in fruits and vegetables with a ratio of animal to vegetable intake of 35:65. Such a diet is a base-producing anti-inflammatory diet and one in which our genes have been programmed to respond. Current Western diets are acid-producing diets and are also high in omega-6 fatty acids, leading to a proinflammatory state. From an evolutionary perspective a mild systemic metabolic alkalosis, resulting from chronic net-base loading, is the natural and optimal systemic acid–base homeostasis of humans. Western diets that lead to a metabolic acidosis increase susceptibility to kidney disease as has been shown from the proinflammatory biomarkers that produce a cytokine storm. Healthy dietary patterns, including the Dietary Approach to Stop Hypertension (DASH) Study, and Mediterranean diets, such as the diet of Crete, both of which have a healthy dietary pattern, are associated with a lower incidence of chronic kidney disease and may prevent or decrease albuminuria and improve the estimated glomerular filtration rate (eGFR). Full article
(This article belongs to the Special Issue Lifestyle Interventions to Prevent Kidney Diseases)
21 pages, 2619 KiB  
Systematic Review
Do Exercise, Physical Activity, Dietetic, or Combined Interventions Improve Body Weight in New Kidney Transplant Recipients? A Narrative Systematic Review and Meta-Analysis
by Ellen M. Castle, Emily McBride, James Greenwood, Kate Bramham, Joseph Chilcot and Sharlene A. Greenwood
Kidney Dial. 2021, 1(2), 100-120; https://doi.org/10.3390/kidneydial1020014 - 02 Oct 2021
Cited by 3 | Viewed by 3267
Abstract
Weight gain within the first year of kidney transplantation is associated with adverse outcomes. This narrative systematic review and meta-analysis examines the effect of exercise, physical activity, dietary, and/or combined interventions on body weight and body mass index (BMI) within the first year [...] Read more.
Weight gain within the first year of kidney transplantation is associated with adverse outcomes. This narrative systematic review and meta-analysis examines the effect of exercise, physical activity, dietary, and/or combined interventions on body weight and body mass index (BMI) within the first year of kidney transplantation. Seven databases were searched from January 1985 to April 2021 (Prospero ID: CRD42019140865), using a ‘Population, Intervention, Controls, Outcome’ (PICO) framework. The risk-of-bias was assessed by two reviewers. A random-effects meta-analysis was conducted on randomized controlled trials (RCTs) that included post-intervention body weight or BMI values. Of the 1197 articles screened, sixteen met the search criteria. Ten were RCTs, and six were quasi-experimental studies, including a total of 1821 new kidney transplant recipients. The sample sizes ranged from 8 to 452. Interventions (duration and type) were variable. Random-effects meta-analysis revealed no significant difference in post-intervention body weight (−2.5 kg, 95% CI −5.22 to 0.22) or BMI (−0.4 kg/m2, 95% CI −1.33 to 0.54). Despite methodological variance, statistical heterogeneity was not significant. Sensitivity analysis suggests combined interventions warrant further investigation. Five RCTs were classified as ‘high-risk’, one as ‘some-concerns’, and four as ‘low-risk’ for bias. We did not find evidence that dietary, exercise, or combined interventions led to significant changes in body weight or BMI post kidney transplantation. The number and quality of intervention studies are low. Higher quality RCTs are needed to evaluate the immediate and longer-term effects of combined interventions on body weight in new kidney transplant recipients. Full article
(This article belongs to the Special Issue Lifestyle Interventions to Prevent Kidney Diseases)
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