Browsing by Subject "chronic kidney disease"

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    Dietary Phosphorus in Chronic Kidney Disease: Effects of Amount, Source and Bioaccessibility on Intestinal Absorption and Health Outcomes
    (2023-05) Burstad, Kendal
    Phosphorus restriction is a key component to dietary recommendations for patients with chronic kidney disease (CKD) to aid in the prevention of CKD-mineral bone disorder (CKD-MBD). However, this is challenging and burdensome to follow, leading to bouts of non-adherence. How these bouts of non-adherence affect intestinal phosphorus absorption remains unclear. In addition, other approaches to manage dietary phosphorus intake are of growing interest such as the incorporation of plant-based protein. How these new dietary approaches to manage phosphorus intake affect intestinal phosphorus absorption or other health outcomes in CKD must be determined. In this dissertation, we aimed to evaluate how dietary phosphorus amount, source, and bioaccessibility affect intestinal phosphorus absorption and health outcomes in CKD. We first sought to determine the effect of acute high dietary phosphorus intake following acclimation to a low phosphorus diet on intestinal fractional phosphorus absorption using an in vivo oral gavage technique in a rodent model of CKD. Despite finding no difference in intestinal fractional phosphorus absorption between groups, plasma phosphorus, fibroblast growth factor-23, and parathyroid hormone were all significantly higher in rats in the low to high phosphorus and high phosphorus groups compared to the low phosphorus group. These findings support continued efforts to reduce phosphorus intake in patients with CKD. We then aimed to determine phosphorus bioaccessibility of emerging plant-based protein products as a new approach to manage dietary phosphorus intake. We found that average phosphorus bioaccessibility ranged from ~32% in pulse-based beef to ~100% in pulse-based milk. Despite this large range in percent bioaccessible phosphorus, most of the plant-based protein products evaluated had lower phosphorus bioaccessibility in mg per 100g serving compared with animal-based protein products. However, how this translates in vivo is still unknown. Additionally, we undertook a systematic review to summarize the available clinical trial evidence for the effect of plant-based protein on kidney function and MBD outcomes in adults with stage 3-5 CKD not on dialysis. Overall, results for both kidney function and CKD-MBD outcomes were heterogenous and most studies were of suboptimal methodological quality. Of the included studies, a subset of five investigated a change in protein source only (i.e., animal vs plant). No change in kidney function was reported in four studies, while one study, of longer duration, reported a decrease. Further, of the CKD-MBD outcomes only one short term study reported lower serum phosphorus following a vegetarian diet. While our results from the study of intestinal phosphorus absorption in rodents support continued efforts to reduce phosphorus intake in patients with CKD, it is evident that other approaches to help manage phosphorus intake in this population are required. Our findings for phosphorus bioaccessibility indicate that emerging plant-based proteins may be suitable options for patients with CKD as they offer lower phosphorus bioaccessibility compared with animal products. However, our systematic review results show that sparse data with heterogenous results are available for the effect of plant-based protein compared with animal protein on kidney function and CKD-MBD outcomes in adults with stage 3-5 CKD not on dialysis. Therefore, more research must be conducted to determine the health effects of plant-based protein consumption to manage phosphorus intake in patients with CKD.
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    Evaluation of Phosphorus Content Among Plant- and Animal-Based Protein Products: Implications for Dietary Recommendations in Chronic Kidney Disease
    (2022-05) Fons, Alexandria
    Kidney function is imperative for human health, especially due to its unique physiologic role in waste regulation. However, approximately 15% of American adults experience diminishing kidney function, which causes substances such as phosphorus (P) to accumulate in the blood, leading to cardiac and skeletal abnormalities. One primary treatment to mitigate elevated serum P levels is to restrict P consumption in the diet. However, this is a largely unsuccessful endeavor due to the ubiquitous nature of P in the food supply, lack of transparency of P content in foods, association of P with protein-rich sources, and economic barriers to acquiring and preparing low P foods. One proposed method for addressing these concerns is transitioning the focus away from P-restricted diets to adopting plant-based eating patterns. However, widespread interest in plant-based eating has generated an emerging industry of ultra-processed plant-based meat alternatives which have unknown health consequences, and it remains unclear whether these products would be beneficial for patients with chronic kidney disease. Therefore, the study described in this thesis sought to investigate the P content of plant- and animal-based protein products through laboratory analysis and exploration of a nutrient database. Laboratory analysis included preparation of food products, freeze drying, ashing, and measurement of mineral content via ICP-OES. Results from this research revealed wide variation in P content and P-to-protein ratios among products in addition to an underestimation of P content of foods in a nutrient database. Further, examining these products illuminated the immense use of phosphorus additives in the food supply and the great discrepancy of cost between plant and animal protein products. The work discussed in this thesis provides foundational knowledge on new-to-market plant protein products, which supplies the groundwork for future research on mineral analysis, bioaccessibility, and bioavailability of food products to ultimately understand the connection between consumption of these foods and the effect on serum P and health outcomes to modify and strengthen dietary recommendations for chronic kidney disease.
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    Life Course Evaluation of a Plant-Centered Diet and Risk of Type 2 Diabetes, Weight Gain, Cardiovascular Diseases, All-Cause Mortality, and Markers of Chronic Kidney Disease: The Coronary Artery Risk Development in Young Adults (CARDIA) Cohort
    (2021-01) Choi, Yuni
    OBJECTIVE: To examine the association of plant-centered diet quality with risk of type 2 diabetes (T2D), weight gain, cardiovascular disease (CVD), all-cause mortality, and markers of chronic kidney disease (CKD)−estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (ACR).METHODS: Data from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort were used. This US multicenter, community-based prospective study involved 5,115 Black and White men and women aged 18-30 years old at baseline assessment in 1985–1986 and followed through to 2018. Diet was assessed by an interviewer-administered, validated diet history questionnaire. Plant-centered diet quality was assessed using the A Priori Diet Quality Score (APDQS); higher index scores represent higher consumption of nutritionally-rich plant foods and limited consumption of high-fat meat products and unhealthy plant foods. Cox regression models were used to assess risk of T2D, CVD, and all-cause mortality, and linear regression models were used to examine change in body size, eGFR, ACR, and combination of eGFR and ACR. RESULTS: For every 1–SD increase in the APDQS (over a 20-year period for T2D and a 13-year period for CVD), there was a reduction in subsequent risk of T2D (Hazard Ratio [HR]= 0.71; 95% CI: 0.59–0.86) and CVD (HR=0.75; 95% CI: 0.57–1.00), independent of the baseline APDQS. In addition, each 1–SD increase in the APDQS over 20 years was associated with concurrent changes in body mass index (-0.39±0.14 kg/m2; P=0.004), waist circumference (-0.90±0.27 cm; P <0.001), and body weight (-1.14±0.33 kg; P <0.001). The time-updated average APDQS was associated with lower risk of CVD (HR=0.80; 95% CI: 0.67–0.95), lower ln(ACR) (β±SE at Y30: -0.09±0.02 mg/g; P<0.001), higher eGFR (1.64±0.47 mL/min/1.73m2; P<0.001), and lower the combined markers (for ln(ACR) z-score - eGFR z-score: -0.19±0.03; P<0.001). However, there was a suggestive, but not statistically significant, inverse association between the APDQS and risk of all-cause mortality. CONCLUSIONS: Consumption of a plant-centered, high-quality diet starting in young adulthood is associated with a lower risk of developing diet-related chronic disease by middle age.
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    Outpatient Acute Kidney Injury Increases Risk of Mortality and Chronic Kidney Disease
    (2017-05) Leither, Maxwell
    Introduction: Limited data exist regarding outcomes of patients with outpatient acute kidney injury (AKI). To determine whether outpatient AKI is associated with increased mortality and chronic kidney disease (CKD), we conducted a retrospective cohort study utilizing an electronic health record in Minnesota. Methods: All adult patients receiving primary care through Fairview Health Services were included. All outpatient Cr values during an 18 month exposure period were used to define five comparator groups as follows: No outpatient AKI (reference group), outpatient AKI with recovery, outpatient AKI without recovery, outpatient AKI without repeat Cr, or no Cr. A Cox proportional hazard model was utilized to assess whether outpatient AKI was associated with an increase in mortality, CKD stage 4 and secondary outcomes including hospitalization and recurrent AKI. Results: The cohort consisted of 384,869 patients and 51% had at least one Cr measured during the exposure period. Outpatient AKI occurred in 1.4% of patients during the 18 month exposure period and 37.8% recovered while 26.5% had no repeat Cr. Mortality was 3.2% over an average follow-up of 5.3 years. Outpatient AKI was associated with an increased risk of mortality (aHR 1.90, 95% CI 1.76-2.06) and CKD stage 4 (aHR 1.33, 95% CI 1.11-1.59) including those that recovered from their AKI (mortality aHR 2.15, 95% CI 1.91-2.41; CKD aHR 1.73, 95% CI 1.37-2.19) and in those with stage 1 AKI (mortality aHR 1.90, 95% CI 1.74-2.07; CKD aHR 1.34, 95% CI 1.10-1.62). Outpatient AKI was also associated with with an increased risk of hospitalization (aHR 1.71, 95% CI 1.63-1.79), hospital AKI (aHR 2.14, 95% CI 1.93-2.37), and recurrent outpatient AKI (aHR 2.75, 95% CI 2.57-2.93). Conclusion: Outpatient AKI is common and is a risk factor for death, CKD, hospitalization, and recurrent AKI, including those with stage 1 AKI and those that recover.