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Hormonal and Nutritional Disorders in Kidney Failure

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (20 June 2023) | Viewed by 29997

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Special Issue Editors

Prof. Dr. Stanisław Niemczyk

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Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Szaserów Street 128, Warsaw, 04-141 Poland
Interests: nephrology; transplantology; endocrinology; geriatrics; hydration status; nutritional status; renal failure; ESRD; cardiovascular dysfunction; acute kidney injury; vasculitis; protein energy wasting; hormonal disorders in renal failure; hemodialysis; peritoneal dialysis
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Prof. Dr. Dorota Szostak-Węgierek

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Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, E. Ciołka Str. 7, 01-445 Warsaw, Poland
Interests: nutrition; dietetics; nutritional epidemiology; cardiovascular diseases; dyslipidemia; diabetes; obesity; pregnancy; aging
Special Issues, Collections and Topics in MDPI journals

Dr. Aleksandra Rymarz

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Guest Editor

Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, 04-141 Warsaw, Poland
Interests: nutritional status in chronic kidney disease; body composition; protein-energy-wasting; endocrinological disorders in chronic kidney disease; small-vessel vasculitis; immunosuppressive treatment

Special Issue Information

Dear Colleagues,

We are inviting researchers to submit original research or review papers concerning hormonal and nutritional disorders in chronic kidney disease (CKD). Publications may involve CKD patients over the course of maintenance treatment or those undergoing renal replacement therapy, including kidney transplantation.

Nutritional status is one of the most important prognostic factors in chronic kidney disease patients. The prevalence of protein-energy wasting (PEW) is relatively high among CKD patients, ranging from 11 to 54%. Therefore, research on PEW, its pathogenesis, prevention, diagnosis and treatment is crucial. Many etiologic factors contribute to PEW development, including hormonal disorders, which can potentially be treated.

PEW promotes and accelerates the development of atherosclerosis, resulting in excessive mortality in CKD patients due to cardiovascular disease. This process is especially exacerbated during dialysis treatment. Therefore, papers considering nutritional status evaluation and interventions in the context of cardiovascular disease are of particular interest for this Special Issue.

In patients with chronic kidney disease, diabetes is a leading cause of renal impairment and end-stage renal disease. Diabetes, as a very common concomitant disease and the main cause of both CKD and cardiovascular disease, also demands significant attention. Another challenge facing the treatment of CKD patients is the development of proper dietary interventions before and during hemodialysis treatment, especially regarding protein intake.There are many diagnostic procedures for PEW evaluation in CKD patients. In clinical trials, a great number of these are considered; however, strict recommendations are still lacking and there are significant discrepancies among obtained results, necessitating further study on this topic.

This Special Issue will present the latest studies presenting novel results and future perspectives for the abovementioned areas.

We welcome the submission of original research, reviews and expert opinions. We are primarily interested in papers focused on protein-energy wasting, sarcopenia, body composition, hormonal disorders such as testosterone deficiency, secondary and tertiary hyperparathyroidism and insulin resistance in chronic kidney disease patients.

Prof. Dr. Stanisław Niemczyk
Prof. Dr. Dorota Szostak-Węgierek
Dr. Aleksandra Rymarz
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. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). 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

protein-energy wasting (PEW)
malnutrition
dietary treatment
clinical nutrition
adipocytokines
hormonal disorders
testosterone
insulin resistance
parathormone (PTH)
hyperparathyroidism
renal failure
chronic kidney disease
body composition
sarcopenia
muscle mass
fat mass
lean tissue mass
nephrotic syndrome
diabetes
atherosclerosis
haemodialysis
peritoneal dialysis
kidney transplantation
bioimpedance
anthropometric measurements
biomarkers

Published Papers (13 papers)

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15 pages, 1365 KiB

Open AccessArticle

Inferior Nutritional Status Significantly Differentiates Dialysis Patients with Type 1 and Type 2 Diabetes

by Anna Grzywacz, Arkadiusz Lubas and Stanisław Niemczyk

Nutrients 2023, 15(7), 1549; https://doi.org/10.3390/nu15071549 - 23 Mar 2023

Viewed by 1296

Abstract

Diabetes mellitus is currently the leading cause of end-stage renal disease. Assessing nutritional status is an important component of care in this group. This prospective observational study aimed to assess the nutritional status of type 1 and type 2 diabetes patients on hemodialysis or peritoneal dialysis and its relationship with hospitalizations and all-cause death. Adult patients with end-stage renal disease, treated with dialysis, and suffering from type 1 or type 2 diabetes, being treated with insulin, were included in the study. Exclusion criteria comprised other types of diabetes, the patient’s refusal to participate in the study, and severe disorders impacting verbal-logical communication. The nutritional status based on the Nutritional Risk Index, the Geriatric Nutritional Risk Index, fat distribution measures, and the Charlson Comorbidity Index was estimated for 95 Caucasian dialysis patients with type 1 (n = 25) or type 2 (n = 70) diabetes. Patients with type 1 diabetes exhibited significantly inferior nutritional status and increased nutritional risk than those with type 2 diabetes. Lower values of nutritional indices significantly differentiated patients with type 1 from those with type 2 diabetes, with ≥84% sensitivity and specificity. Inferior nutritional status was related to all-cause hospitalizations, whereas higher comorbidity was associated with a greater likelihood of cardiovascular hospitalizations and all-cause death. The significant difference between patients with type 1 and type 2 diabetes being treated with dialysis indicates that these patients should not be considered as a homogeneous group, while also considering the greater age of patients with type 2 diabetes. Full article

(This article belongs to the Special Issue Hormonal and Nutritional Disorders in Kidney Failure)

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12 pages, 1008 KiB

Open AccessArticle

Higher Muscle Mass and Higher Serum Prealbumin Levels Are Associated with Better Survival in Hemodialysis Patients during a Five-Year Observation Period

by Anna Jeznach-Steinhagen, Iwona Boniecka, Aleksandra Rymarz, Monika Staszków, Jerzy Romaszko and Aneta Czerwonogrodzka-Senczyna

Nutrients 2023, 15(5), 1237; https://doi.org/10.3390/nu15051237 - 28 Feb 2023

Viewed by 1979

Abstract

Background: Dialysis is the most commonly used renal replacement therapy in patients with end-stage renal disease. The mortality rate of hemodialysis patients is 15–20%, with cardiovascular complications being the most common. There is an association between the severity of atherosclerosis and both the development of protein-calorie malnutrition and inflammatory mediators. The aim of this study was to assess the relationship between biochemical markers of nutritional status, body composition and survival in hemodialysis patients. Methods: Fifty-three hemodialysis patients were included in the study. Serum albumin, prealbumin, and IL-6 levels were measured, as well as body weight, body mass index, fat content and muscle mass. The five-year survival of patients was calculated using Kaplan–Meier estimators. The long-rank test was used for univariate comparison of survival curves, and the Cox proportional hazards model was used for multivariate analysis of survival predictors. Results: There were 47 deaths, 34 of which were due to cardiovascular disease. The hazard ratio (HR) for age in the middle-aged group (55–65 years) was 1.28 (confidence interval [CI] 0.58, 2.79) and 5.43 (CI 2.1, 14.07; statistically significant) for the oldest age group (over 65 years). A prealbumin level above 30 mg/dl was associated with an HR of 0.45 (CI 0.24, 0.84). Serum prealbumin (odds ratio [OR] = 5.23; CI 1.41, 19.43; p = 0.013) and muscle mass (OR = 7.5; CI 1.31, 43.03; p = 0.024) were significant predictors of all-cause mortality. Conclusions: Prealbumin level and muscle mass were associated with increased mortality risk. Identification of these factors may improve the survival of hemodialysis patients. Full article

(This article belongs to the Special Issue Hormonal and Nutritional Disorders in Kidney Failure)

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12 pages, 656 KiB

Open AccessArticle

Low Free Triiodothyronine as a More Sensitive Predictor of Survival Than Total Testosterone among Dialysis Men

by Ksymena Leśniak, Aleksandra Rymarz, Maria Sobol and Stanisław Niemczyk

Nutrients 2023, 15(3), 595; https://doi.org/10.3390/nu15030595 - 23 Jan 2023

Viewed by 1632

Abstract

Background: Some endocrine disorders, previously considered benign, may be related to a poorer prognosis for patients with renal failure. Both low serum free triiodothyronine (fT3) and low total testosterone (TT) concentrations have been considered as predictors of death in dialysis patients, but the results of studies are inconsistent. In our study, we evaluated the relationships of the serum thyroid hormone levels and the total testosterone levels with survival in male dialysis patients. Methods: Forty-eight male dialysis patients, 31 on hemodialysis (HD) and 17 on peritoneal dialysis (PD), aged 61.4 ± 10.0, 59.2 ± 12.2 years, respectively, were included in the study. Serum thyroid hormones and total testosterone were measured. Results: During the 12-month follow-up, nine all-cause deaths were recorded. The concentrations of fT3 were significantly lower in those who died than in the survivors (p = 0.001). We did not observe any statistically considerable differences between the group of men who died and the rest of the participants in terms of the total serum testosterone concentration (p = 0.350). Total testosterone positively correlated with fT3 (r = 0.463, p = 0.009) in the HD group. Conclusions: In the group of male dialysis patients, the serum concentration of fT3 had a better prognostic value in terms of survival than the total testosterone. A linear relationship between the fT3 levels and testosterone levels in men undergoing hemodialysis may confirm the hypothesis that some of the hormonal changes observed in chronic kidney disease (CKD) may have a common cause. Full article

(This article belongs to the Special Issue Hormonal and Nutritional Disorders in Kidney Failure)

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12 pages, 1293 KiB

Open AccessArticle

Comparable Hemodilution with Hypertonic Glucose in Patients with and without Type-2 Diabetes Mellitus during Hemodialysis

by Daniel Schneditz, Longin Niemczyk, Anna Wojtecka, Katarzyna Szamotulska and Stanisław Niemczyk

Nutrients 2023, 15(3), 536; https://doi.org/10.3390/nu15030536 - 19 Jan 2023

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Abstract

(1) Background: It was examined whether glucose-induced changes in the relative blood volume are suitable to identify subjects with and without type-2 diabetes mellitus (T2D) during hemodialysis. (2) Methods: The relative blood volume was continuously recorded during hemodialysis and perturbed by the infusion of glucose comparable to the dose used for intravenous glucose tolerance tests. Indices of glucose metabolism were determined by the homeostatic model assessment (HOMA). Body composition was measured by a bioimpedance analysis. The magnitude and the time course of hemodilution were described by a modified gamma variate model and five model parameters. (3) Results: A total of 34 subjects were studied, 14 with and 20 without T2D. The magnitude of the hemodilution and the selected model parameters correlated with measures of anthropometry, body mass index, absolute and relative fat mass, volume excess, baseline insulin concentration, and HOMA indices such as insulin resistance and glucose disposition in a continuous analysis, but were not different in a dichotomous analysis of patients with and without T2D. (4) Conclusions: Even though the parameters of the hemodilution curve were correlated with measures of impaired glucose metabolism and body composition, the distinction between subjects with and without T2D was not possible using glucose-induced changes in the relative blood volume during hemodialysis. Full article

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14 pages, 18517 KiB

Open AccessArticle

Usefulness of PET/CT with Carbon-11-Labeled Methionine in the Diagnosis of Tertiary Hyperparathyroidism

by Maciej Kołodziej, Marek Saracyn, Arkadiusz Lubas, Mirosław Dziuk, Adam Daniel Durma, Jerzy Smoszna, Grzegorz Zelichowski, Stanisław Niemczyk and Grzegorz Kamiński

Nutrients 2023, 15(1), 188; https://doi.org/10.3390/nu15010188 - 30 Dec 2022

Cited by 2 | Viewed by 1965

Abstract

Introduction: Tertiary hyperparathyroidism (tHP) may develop in patients treated with hemodialysis or peritoneal dialysis. Parathyroidectomy may result in a significant reduction in the severity of symptoms. For the effective surgical treatment of hyperparathyroidism, proper localization of the parathyroid glands prior to surgery is essential. The sensitivity of scintigraphy in the diagnosis of tHP is lower than in the diagnosis of primary hyperparathyroidism. In recent years, positron emission tomography (PET/CT) has been gaining importance, usually as a complementary technique. Aim: The aim of this study was to determine the usefulness of PET/CT with [¹¹C]MET in the preoperative localization diagnosis of patients with tertiary hyperparathyroidism caused by chronic kidney disease, in whom first-line diagnostic methods did not allow the localization of pathologically parathyroid glands. Material and methods: The study was conducted in a group of 19 adult patients with severe tHP who were resistant or intolerant to non-invasive treatment, with negative results of scintigraphy and ultrasonography of the neck. The study protocol included measurement of the concentration of calcium, phosphorus, and PTH in the blood serum and performing PET/CT with [¹¹C]MET. Results: A positive result of PET/CT was obtained in 89.5% of the patients (17/19). Parathyroidectomy was performed in 52.9% of the patients (9/17) with positive results of PET/CT with [¹¹C]MET, which were fully consistent with the results of the histopathological examinations of the removed parathyroid glands. On this basis, the sensitivity of PET/CT with [¹¹C]MET in the preoperative localization diagnosis of patients with tHP was found to be 100%. Multiple lesions were visualized in 57.9% of the patients (11/19). Ectopic lesions were visualized in 21.1% of the patients (4/19). Conclusions: PET/CT with [¹¹C]MET is a sensitive technique for the second-line preoperative imaging of parathyroid glands in patients with tertiary hyperparathyroidism in whom first-line examinations, such as ultrasound and scintigraphy, has failed. Full article

(This article belongs to the Special Issue Hormonal and Nutritional Disorders in Kidney Failure)

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11 pages, 288 KiB

Open AccessArticle

Long-Term Complications of Radioligand Therapy with Lutetium-177 and Yttrium-90 in Patients with Neuroendocrine Neoplasms

by Marek Saracyn, Adam Daniel Durma, Barbara Bober, Maciej Kołodziej, Arkadiusz Lubas, Waldemar Kapusta, Stanisław Niemczyk and Grzegorz Kamiński

Nutrients 2023, 15(1), 185; https://doi.org/10.3390/nu15010185 - 30 Dec 2022

Cited by 4 | Viewed by 1915

Abstract

Background: Neuroendocrine neoplasms are a group of tumors deriving from neural crest. They can be located in every tissue, but most commonly in gastrointestinal tract. Targeted therapy with use of radionuclides is an available and acceptable way of treatment, but its long-term safety is still to be determined, especially with sensitive methods. Methods: Study was performed on a group of 42 patients. They underwent full cycle (4 courses; 8–12 weekly intervals) of radioligand therapy with [¹⁷⁷Lu]Lu-DOTATATE alone or tandem therapy with [¹⁷⁷Lu]Lu-DOTATATE+[⁹⁰Y]Y-DOTATATE. Late and long-term marrow and renal complications were assessed. Analysis focused on comparing data before first, fourth, and one year after the last course of RLT. Results: Study showed decreasing of all blood parameters in long-term observation, especially in lymphocytes line. Type of radioisotope, other diseases, primary tumor location, BMI, gender or age did not affect results. The only factor that had influence on hemoglobin and erythrocytes was decreased renal filtration. In long-term observation almost 10% decrease of renal filtration was observed. Type of isotope, gender, age, BMI did not affect these results. Moreover, reduction of urine IL-18, KIM-1, and albumin concentration has been observed. Conclusions: Though low-grade complications of radioligand therapy are possible, it stay a safe method of NEN treatment where benefits outweigh the risk. Full article

(This article belongs to the Special Issue Hormonal and Nutritional Disorders in Kidney Failure)

14 pages, 510 KiB

Open AccessArticle

Malnutrition and Erythropoietin Resistance among Patients with End-Stage Kidney Disease: Where Is the Perpetrator of Disaster?

by Wiktoria Feret, Krzysztof Safranow, Ewa Kwiatkowska, Aleksandra Daniel and Kazimierz Ciechanowski

Nutrients 2022, 14(24), 5318; https://doi.org/10.3390/nu14245318 - 14 Dec 2022

Cited by 3 | Viewed by 2288

Abstract

Background: Hemodialyzed patients with poor erythropoietin response tend to have low volume of visceral adipose tissue and score high on malnutrition-inflammation score. This study investigates in-depth the role of leptin and chosen cytokines in the development of malnutrition-inflammation syndrome (MIS) and erythropoietin resistance. Methods: Eighty-one hemodialyzed patients with erythropoietin-treated anemia were enrolled in the study. Their body composition was measured. Erythropoietin resistance index was calculated. Blood samples for leptin, IL-6, IL-18, TNF-alpha, and IL-1-alpha serum levels were drawn. Results: Leptin showed negative correlation with erythropoietin resistance index (ERI), whilst IL-6 showed the opposite. IL-6 seemed to be linked more to HD parameters and vintage, while TNF-alpha and leptin were more dependent on body composition. IL-18 and IL-1-alpha did not affect nutritional parameters nor ERI. Conclusion: Modulation of adipokine- and cytokine-related signaling is a promising target in tempering malnutrition in hemodialyzed, and thus achieving better outcomes in anemia treatment. Large clinical studies that target the inflammatory response in hemodialysis, especially regarding IL-6, TNF-alpha, and leptin, would be of great worth. Full article

(This article belongs to the Special Issue Hormonal and Nutritional Disorders in Kidney Failure)

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9 pages, 280 KiB

Open AccessArticle

Vitamin K1 and K2 in the Diet of Patients in the Long Term after Kidney Transplantation

by Małgorzata Kluch, Patrycja Bednarkiewicz, Magdalena Orzechowska, Piotr Grzelak and Ilona Kurnatowska

Nutrients 2022, 14(23), 5070; https://doi.org/10.3390/nu14235070 - 29 Nov 2022

Cited by 1 | Viewed by 2265

Abstract

Vitamin K, especially its K2 form, is considered to be a protective factor against developing vascular changes and bone lesions that are common complications in kidney transplant (KTx) recipients. There is a growing number of studies showing that KTx patients are at risk of vitamin K deficiency. The aim of this study was to evaluate the intake of vitamin K1 and K2 in the diet of patients in the late period after KTx. During a routine visit at one outpatient transplantation clinic in Central Europe, a diet survey questionnaire was filled in by 151 clinically stable KTx recipients and compared with medical history, anthropometric measurements and laboratory tests. Mean vitamin K1 intake was 120.9 ± 49 μg/day and vitamin K2 (MK, menaquinone) intake 28.69 ± 11.36 μg/day, including: MK-4: 25.9 ± 9.9 μg/day; MK-5: 0.1 ± 0.2 μg/day; MK-6: 0.2 ± 0.4 μg/day; MK-7: 0.2 ± 0.23 μg/day; MK-8: 1 ± 1.9 μg/day; MK-9: 0.9 ± 2.3 μg/day; and MK-10: 0.2 ± 0.5 μg/day. Our study showed that KTx recipients’ diets contained adequate amounts of vitamin K1, whereas the intake of vitamin K2 seemed insufficient. Full article

(This article belongs to the Special Issue Hormonal and Nutritional Disorders in Kidney Failure)

14 pages, 1190 KiB

Open AccessArticle

Testosterone Deficiency and Nutritional Parameters as Predictors of All-Cause Mortality among Male Dialysis Patients

by Ksymena Leśniak, Aleksandra Rymarz, Maria Sobol, Jolanta Dymus, Agnieszka Woźniak-Kosek and Stanisław Niemczyk

Nutrients 2022, 14(21), 4461; https://doi.org/10.3390/nu14214461 - 24 Oct 2022

Cited by 3 | Viewed by 2109

Abstract

Background: Chronic kidney disease (CKD) is associated with an accelerated risk of cardiovascular mortality. Hormonal and metabolic disorders in CKD may constitute novel risk factors. Our objective was to characterize and evaluate prognostic implications of circulating sex steroids and selected nutritional parameters in patients at different stages of CKD. Methods: Studied groups were composed of 78 men: 31 on hemodialysis (HD), 17 on peritoneal dialysis (PD), 30 with CKD stage G3-G4. Total testosterone (TT), dehydroepiandrosterone sulphate (DHEA-S), androstenedione, luteinizing hormone (LH), prolactin (PRL), and biochemical parameters were measured; Free testosterone (FT) was calculated. Results: The lowest TT and FT were observed in HD, the highest- in CKD (p = 0.006 for TT, p = 0.005 for FT). TT positively correlated with total cholesterol in HD (p = 0.012), FT negatively correlated with BMI in CKD (p = 0.023). During the 12 months, 9 patients died (5 in the HD, 4 in the PD group). The deceased group had significantly lower concentrations of albumin (p = 0.006) and prealbumin (p = 0.001), and a significantly higher concentration of androstenedione (p = 0.019) than the surviving group. In the group of men on dialysis, a serum TT concentration <2.55 ng/mL (Q1-first quartile) was associated with a 3.7-fold higher risk of death, although statistical significance was not achieved (p = 0.198). After analysis of the ROC curves, the FT level was the best prognostic marker in HD (AUC = 0.788; 95% CI: 0.581–0.996; p = 0.006) Conclusions: Total and free testosterone levels were lower in the HD group than in the CKD group. The nutritional status undoubtedly affects the survival of dialysis patients but also the concentrations of testosterone significantly contributes to further worsening the prognosis. Full article

(This article belongs to the Special Issue Hormonal and Nutritional Disorders in Kidney Failure)

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12 pages, 920 KiB

Open AccessFeature PaperArticle

Testosterone Replacement Therapy in Chronic Kidney Disease Patients

by Ryszard Skiba, Aleksandra Rymarz, Anna Matyjek, Jolanta Dymus, Agnieszka Woźniak-Kosek, Tomasz Syryło, Henryk Zieliński and Stanisław Niemczyk

Nutrients 2022, 14(16), 3444; https://doi.org/10.3390/nu14163444 - 22 Aug 2022

Cited by 4 | Viewed by 2441

Abstract

(Background) The aim of our study was to evaluate the efficacy and safety of testosterone replacement therapy (TRT) in men with chronic kidney disease and hypogonadism on conservative and hemodialysis treatment. (Methods) The studied population consisted of 38 men on hemodialysis (HD), 46 men with CKD stages II-IV (predialysis group, PreD) and 35 men without kidney disease who were similar in age to others (control group). Serum total testosterone level (TT) was measured, and free testosterone level (fT) was calculated. Hypogonadism criteria according to the EAU definition were fulfilled by 26 men on HD (68.4%) and by 24 men from the PreD group (52%). Testosterone replacement therapy (TRT) with testosterone enanthate in intramuscular injections every 3 weeks was applied in 15 men from HD and in 14 men from PreD. The safety of TRT was monitored by measuring PSA and overhydration. (Results) A significant rise of TT and fT was observed after 3 months of TRT, but no significant changes were observed after 6 and 12 months in the HD and PreD group. An intensity of clinical symptoms of hypogonadism measured by ADAM (androgen deficiency in the ageing male) questionnaire gradually decreased, and the intensity of erectile dysfunction measured by the IIEF-5 (international index of erectile functioning) questionnaire also decreased after 3, 6 and 12 months of TRT in the HD and PreD group. (Conclusions) The applied model of TRT is effective in the correction of clinical signs of hypogonadism without a significant risk of overhydration or PSA changes. Full article

(This article belongs to the Special Issue Hormonal and Nutritional Disorders in Kidney Failure)

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14 pages, 2420 KiB

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Focusing on Phosphorus Loads: From Healthy People to Chronic Kidney Disease

by Mengjing Wang, Jiaying Zhang, Kamyar Kalantar-Zadeh and Jing Chen

Nutrients 2023, 15(5), 1236; https://doi.org/10.3390/nu15051236 - 28 Feb 2023

Cited by 4 | Viewed by 2629

Abstract

Phosphorus is an essential micromineral with a key role in cellular metabolism and tissue structure. Serum phosphorus is maintained in a homeostatic range by the intestines, bones, and kidneys. This process is coordinated by the endocrine system through the highly integrated actions of several hormones, including FGF23, PTH, Klotho, and 1,25D. The excretion kinetics of the kidney after diet phosphorus load or the serum phosphorus kinetics during hemodialysis support that there is a “pool” for temporary phosphorus storage, leading to the maintenance of stable serum phosphorus levels. Phosphorus overload refers to a state where the phosphorus load is higher than is physiologically necessary. It can be caused by a persistently high-phosphorus diet, renal function decline, bone disease, insufficient dialysis, and inappropriate medications, and includes but is not limited to hyperphosphatemia. Serum phosphorus is still the most commonly used indicator of phosphorus overload. Trending phosphorus levels to see if they are chronically elevated is recommended instead of a single test when judging phosphorus overload. Future studies are needed to validate the prognostic role of a new marker or markers of phosphorus overload. Full article

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12 pages, 340 KiB

Open AccessReview

Nutrition Disturbances and Metabolic Complications in Kidney Transplant Recipients: Etiology, Methods of Assessment and Prevention—A Review

by Monika Górska and Ilona Kurnatowska

Nutrients 2022, 14(23), 4996; https://doi.org/10.3390/nu14234996 - 24 Nov 2022

Cited by 5 | Viewed by 2978

Abstract

Nutrition disturbances occur at all stages of chronic kidney disease and progress with the decrease of the kidney filtration rate. Kidney transplantation (KTx) as the best form of kidney replacement therapy poses various nutritional challenges. Prior to transplantation, recipients often present with mild to advanced nutrition disturbances. A functioning allograft not only relieves uremia, acidosis, and electrolyte disturbances, but also resumes other kidney functions such as erythropoietin production and vitamin D3 metabolism. KTx recipients represent a whole spectrum of undernutrition and obesity. Since following transplantation, patients are relieved of most dietary restrictions and appetite disturbances; they resume old nutrition habits that result in weight gain. The immunosuppressive regimen often predisposes them to dyslipidemia, glucose intolerance, and hypertension. Moreover, most recipients present with chronic kidney graft disease at long-term follow-ups, usually in stages G2–G3T. Therefore, the nutritional status of KTx patients requires careful monitoring. Appropriate dietary and lifestyle habits prevent nutrition disturbances and may improve kidney graft function. Despite many nutritional guidelines and recommendations targeted at chronic kidney disease, there are few targeted at KTx recipients. We aimed to provide a brief review of nutrition disturbances and known nutritional recommendations for kidney transplant recipients based on the current literature and dietary trends. Full article

(This article belongs to the Special Issue Hormonal and Nutritional Disorders in Kidney Failure)

17 pages, 394 KiB

Open AccessReview

Testosterone Deficiency as One of the Major Endocrine Disorders in Chronic Kidney Disease

by Katarzyna Romejko, Aleksandra Rymarz, Hanna Sadownik and Stanisław Niemczyk

Nutrients 2022, 14(16), 3438; https://doi.org/10.3390/nu14163438 - 21 Aug 2022

Cited by 13 | Viewed by 3441

Abstract

Reduced testosterone concentration is nowadays thought to be one of the main endocrine disorders in chronic kidney disease (CKD). It is caused by the dysfunction of the hypothalamic-pituitary-gonadal axis. The role of testosterone is multifactorial. Testosterone is responsible not only for reproductive processes, but it is a hormone which increases bone and muscle mass, improves lipid profile, insulin sensitivity, erythropoiesis, reduces blood pressure, and ameliorates mood and perception. The implications of hypogonadism in CKD are infertility and loss of libido, reduction of muscle mass and strength, disorders in bone mineralization, the development of sarcopenia and protein energy wasting (PEW), progression of atherosclerosis, increased visceral adiposity, insulin resistance, and anaemia. Reduced testosterone serum concentrations in CKD are associated with increased mortality rate. Testosterone supplementation improves sexual functions, reduces the level of inflammatory markers and blood pressure, stimulates muscle protein synthesis, improves insulin sensitivity and lipid profile, and increases muscle mass, bone mineral density, and haemoglobin concentration. It positively affects mood and well-being. The modes of testosterone supplementation are intramuscular injections, subcutaneous pellets, and percutaneous methods—patches and gels. Successful kidney transplantation may improve gonadal function and testosterone production, however, half of men with low testosterone concentrations before kidney transplantation do not restore hormonal function. Full article

(This article belongs to the Special Issue Hormonal and Nutritional Disorders in Kidney Failure)

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