Assessing Global Kidney Nutrition Care.

BACKGROUND AND OBJECTIVES: Nutrition intervention is an essential component of kidney disease management. This study aimed to understand current global availability and capacity of kidney nutrition care services, interdisciplinary communication, and availability of oral nutrition supplements. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The International Society of Renal Nutrition and Metabolism (ISRNM), working in partnership with the International Society of Nephrology (ISN) Global Kidney Health Atlas Committee, developed this Global Kidney Nutrition Care Atlas. An electronic survey was administered among key kidney care stakeholders through 182 ISN-affiliated countries between July and September 2018. RESULTS: Overall, 160 of 182 countries (88%) responded, of which 155 countries (97%) answered the survey items related to kidney nutrition care. Only 48% of the 155 countries have dietitians/renal dietitians to provide this specialized service. Dietary counseling, provided by a person trained in nutrition, was generally not available in 65% of low-/lower middle-income countries and "never" available in 23% of low-income countries. Forty-one percent of the countries did not provide formal assessment of nutrition status for kidney nutrition care. The availability of oral nutrition supplements varied globally and, mostly, were not freely available in low-/lower middle-income countries for both inpatient and outpatient settings. Dietitians and nephrologists only communicated "sometimes" on kidney nutrition care in ≥60% of countries globally. CONCLUSIONS: This survey reveals significant gaps in global kidney nutrition care service capacity, availability, cost coverage, and deficiencies in interdisciplinary communication on kidney nutrition care delivery, especially in lower-income countries.

Sustainable Development Goals relevant to kidney health: an update on progress.

Globally, more than 5 million people die annually from lack of access to critical treatments for kidney disease - by 2040, chronic kidney disease is projected to be the fifth leading cause of death worldwide. Kidney diseases are particularly challenging to tackle because they are pathologically diverse and are often asymptomatic. As such, kidney disease is often diagnosed late, and the global burden of kidney disease continues to be underappreciated. When kidney disease is not detected and treated early, patient care requires specialized resources that drive up cost, place many people at risk of catastrophic health expenditure and pose high opportunity costs for health systems. Prevention of kidney disease is highly cost-effective but requires a multisectoral holistic approach. Each Sustainable Development Goal (SDG) has the potential to impact kidney disease risk or improve early diagnosis and treatment, and thus reduce the need for high-cost care. All countries have agreed to strive to achieve the SDGs, but progress is disjointed and uneven among and within countries. The six SDG Transformations framework can be used to examine SDGs with relevance to kidney health that require attention and reveal inter-linkages among the SDGs that should accelerate progress.

Strategic plan for integrated care of patients with kidney failure.

There is a huge gap between the number of patients worldwide requiring versus those actually receiving safe, sustainable, and equitable care for kidney failure. To address this, the International Society of Nephrology coordinated the development of a Strategic Plan for Integrated Care of Patients with Kidney Failure. Implementation of the plan will require engagement of the whole kidney community over the next 5-10 years.

Albizia chevalier based Ag nanoparticles: Anti-proliferation, bactericidal and pollutants degradation performance.

The eco-friendly biosynthesis of silver nanoparticles (AgNps) from bark extract of Albizia chevalier are reported here for their anti-proliferative, antibacterial and pollutant degradation potentials. The synthesized AgNps were characterized by FTIR spectroscopy, transmission electron microscopy (TEM), field emission scanning electron microscopy (FESEM), energy dispersive X-rays spectrometry (EDS) and X-ray diffraction studies. The TEM and FESEM images show a monodispersed spherical shaped particles of approximately 30 nm. Crystalline peaks were obtained for the synthesized AgNps in XRD spectrum. The AgNps were investigated for in vitro anticancer and antibacterial activities and its potential to degrade 4-nitrophenol (4-NP) and congo red dye (CR). The MTT results shows a significant dose-dependent antiproliferation effect of the AgNps on the cell lines HepG2, MDA-MB-231 and MFC7. The effect was found more pronounced in MDA-MB-231 as compared to MFC-7 cell lines. The antibacterial results indicated 99 and 95% killing of Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) respectively, after 24 h of incubation with the AgNps. The AgNps were found to speed up the reductive degradation of 4-NP and CR dye, which give an alternative route for the removal of toxic organic pollutants from the wastewater. The synthesized AgNps were not only used as a bactericidal and anticancer agent, but also effectively used for the reductive degradation of carcinogenic compounds which are listed as the priority pollutants. Therefore, AgNps have the potential for the treatment of various cancers, bacterial infections and for industrial detoxification of wastewater.

Antiproliferation and antibacterial effect of biosynthesized AgNps from leaves extract of Guiera senegalensis and its catalytic reduction on some persistent organic pollutants.

The study concentrate on the biosynthesis of silver nanoparticles (AgNps) from the leaves extract of Guiera senegalensis with focus on its; antiproliferation effect on prostate (PC3), breast (MCF7) and liver (HepG2) cancer cell lines, antibacterial effect on Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) and the degradation on 4-nitrophenol (4-NP) and congo red dye (CR). The synthesized AgNps were characterized by FTIR, TEM, FESEM, XRD and EDX analysis. The EDS spectrum revealed that the synthesized nanoparticles (Nps) were composed of 55.45% Ag atoms of spherical shape with approximately 50nm size, identified from TEM and FESEM data. The antiproliferation effect of the AgNps varies with cell lines in a concentration dependent manner. The result showed that the AgNps were more effective on PC3 (IC50 23.48µg/mL) than MCF7 (29.25µg/mL) and HepG2 (33.25µg/mL) by the virtue of their IC50 values. The AgNps were highly effective against E. coli and S. aureus by killing 99% colonies. The AgNps also shows a good catalytic reduction of the toxic organic pollutants in which only 3mg of the AgNps degraded 95% of both CR dye and 4-NP in 22 and 36min respectively. Therefore, the green synthesis of AgNps may have potential applications in pharmacology and industries for the treatment of cancers, bacterial infections and in degrading toxic organic pollutants in water.

Concentrations of Trace Elements in Hemodialysis Patients: A Prospective Cohort Study.

BACKGROUND: Low concentrations and excessive concentrations of trace elements have been commonly reported in hemodialysis patients, but available studies have several important limitations. STUDY DESIGN: Random sample of patients drawn from a prospective cohort. SETTING & PARTICIPANTS: 198 incident hemodialysis patients treated in 3 Canadian centers. MEASUREMENTS: We used mass spectrometry to measure plasma concentrations of the 25 elements at baseline, 6 months, 1 year, and 2 years following enrollment in the cohort. We focused on low concentrations of zinc, selenium, and manganese and excessive concentrations of lead, arsenic, and mercury; low and excessive concentrations of the other 19 trace elements were treated as exploratory analyses. Low and excessive concentrations were based on the 5th and 95th percentile plasma concentrations from healthy reference populations. RESULTS: At all 4 occasions, low zinc, selenium, and manganese concentrations were uncommon in study participants (≤5.1%, ≤1.8%, and ≤0.9% for zinc, selenium, and manganese, respectively) and a substantial proportion of participants had concentrations that exceeded the 95th percentile (≥65.2%, ≥74.2%, and ≥19.7%, respectively). Almost all participants had plasma lead concentrations above the 95th percentile at all time points. The proportion of participants with plasma arsenic concentrations exceeding the 95th percentile was relatively constant over time (9.1%-9.8%); the proportion with plasma mercury concentrations that exceeded the 95th percentile varied between 15.2% and 29.3%. Low arsenic, platinum, tungsten, and beryllium concentrations were common (>50%), as were excessive cobalt, manganese, zinc, vanadium, cadmium, selenium, barium, antimony, nickel, molybdenum, lead, and chromium concentrations. CONCLUSIONS: There was no evidence that low zinc, selenium, or manganese concentrations exist in most contemporary Canadian hemodialysis patients. Some patients have excessive plasma arsenic and mercury concentrations, and excessive lead concentrations were common. These findings require further investigation.

Anticancer, antibacterial and pollutant degradation potential of silver nanoparticles from Hyphaene thebaica.

We present here the biosynthesis of AgNps from the aqueous extract of H. thebaica fruit, and monitored through UV-Vis spectrophotometer. The functional group were characterized through ATR-FTIR spectroscopy, the particle size, morphologies and elemental composition of the nanoparticles were investigated by using TEM, FESEM and EDS respectively. The anti-proliferation activity of the synthesized AgNps was carried out using MTT assay on human prostate (PC3), breast (MCF7) and liver (HepG2) cancer cell lines. The anti-proliferation assay showed that the AgNps were able to inhibit the proliferation of the cancer cell lines in a dose depending manner. The effect was found more pronounced on prostate (IC50 2.6 mg/mL) followed by breast (IC50 4.8 mg/mL) and then liver cancer cell lines (IC50 6.8 mg/mL). The prepared AgNps were found to inhibit 99% growth of both E. coli and S. aureus after 24 h of incubation. The nanoparticles were used for the degradation of 4-nitrophenol (4-NP) and Congo red dyes (CR), which efficiently degrade CR, but make complex formation with 4-NP. Therefore, the AgNps synthesized from the aqueous fruit extract of H. thebaica have potential application in pharmacology and waste water treatment.

Integration of Care in Management of CKD in Resource-Limited Settings.

The prevalence of noncommunicable diseases, including chronic kidney disease (CKD), continues to increase worldwide, and mortality from noncommunicable diseases is projected to surpass communicable disease-related mortality in developing countries. Although the treatment of CKD is expensive, unaffordable, and unavailable in many developing countries, the current structure of the health care system in such countries is not set up to deliver comprehensive care for patients with chronic conditions, including CKD. The World Health Organization Innovative Care for Chronic Conditions framework could be leveraged to improve the care of CKD patients worldwide, especially in resource-limited countries where high cost, low infrastructure, limited workforce, and a dearth of effective health policies exist. Some developing countries already are using established health systems for communicable disease control to tackle noncommunicable diseases such as hypertension and diabetes, therefore existing systems could be leveraged to integrate CKD care. Decision makers in developing countries must realize that to improve outcomes for patients with CKD, important factors should be considered, including enhancing CKD prevention programs in their communities, managing the political environment through involvement of the political class, involving patients and their families in CKD care delivery, and effective use of health care personnel.

Trace element supplementation in hemodialysis patients: a randomized controlled trial.

BACKGROUND: People with kidney failure are often deficient in zinc and selenium, but little is known about the optimal way to correct such deficiency. METHODS: We did a double-blind randomized trial evaluating the effects of zinc (Zn), selenium (Se) and vitamin E added to the standard oral renal vitamin supplement (B and C vitamins) among hemodialysis patients in Alberta, Canada. We evaluated the effect of two daily doses of the new supplement (medium dose: 50 mg Zn, 75 mcg Se, 250 IU vitamin E; low dose: 25 mg Zn, 50 mcg Se, 250 IU vitamin E) compared to the standard supplement on blood concentrations of Se and Zn at 90 days (primary outcome) and 180 days (secondary outcome) as well as safety outcomes. RESULTS: We enrolled 150 participants. The proportion of participants with low zinc status (blood level <815 ug/L) did not differ between the control group and the two intervention groups at 90 days (control 23.9% vs combined intervention groups 23.9%, P > 0.99) or 180 days (18.6% vs 28.2%, P = 0.24). The proportion with low selenium status (blood level <121 ug/L) was similar for controls and the combined intervention groups at 90 days (32.6 vs 19.6%, P = 0.09) and 180 days (34.9% vs 23.5%, P = 0.17). There were no significant differences in the risk of adverse events between the groups. CONCLUSIONS: Supplementation with low or medium doses of zinc and selenium did not correct low zinc or selenium status in hemodialysis patients. Future studies should consider higher doses of zinc (≥75 mg/d) and selenium (≥100 mcg/d) with the standard supplement. TRIAL REGISTRATION: Registered with ClinicalTrials.gov (NCT01473914).