Effects of Cranberry Extract (Vaccinium macrocarpon) Supplementation on Lipid Peroxidation and Inflammation in Patients with Chronic Kidney Disease (Stages 3-4): A Randomized Controlled Trial.

Background: Growing evidence suggests that bioactive compounds in berry fruits may mitigate inflammation in patients with chronic kidney disease (CKD). Objectives: To evaluate cranberry (Vaccinium macrocarpon) supplementation effects on modulation of transcription factors involved in inflammation and oxidative stress in nondialysis (stages 3 and 4) patients with CKD. Design/Participants. A randomized, double-blind, placebo-controlled study was performed with 30 patients to receive capsules containing cranberry extract (1000 mg/day) or placebo (1000 mg/day of corn starch) for two months. Measurements. The mRNA expression of nuclear factor-erythroid 2-related factor-2 (Nrf2) and nuclear factor-kB (NF-kB) was evaluated in peripheral blood mononuclear cells (PBMCs) by quantitative real-time polymerase chain reaction. Thiobarbituric acid reactive substances (TBARS) were measured in the plasma to assess oxidative stress. Interleukin-6 (IL-6) plasma levels were assessed by enzyme-linked immunosorbent assay and C-reactive protein (CRP) by immunoturbidimetric method. Results: Twenty-five patients completed the study: 12 in the cranberry group (56.7 ± 7.5 years and body mass index (BMI) of 29.6 ± 5.5 kg/m2) and 13 in the placebo group (58.8 ± 5.1 years and BMI 29.8 ± 5.4 kg/m2). There were no differences in NF-kB or Nrf2 mRNA expressions (p = 0.99 and p = 0.89) or TBARS, CRP, and IL-6 plasma levels after cranberry supplementation. Conclusions: The cranberry extract administration (1000 mg/day) did not affect Nrf2 and NF-kB mRNA expression, oxidative stress, or inflammatory markers levels in nondialysis CKD patients. This trial is registered with NCT04377919.

Sulforaphane upregulates the mRNA expression of NRF2 and NQO1 in non-dialysis patients with chronic kidney disease.

Sulforaphane (SFN), found in cruciferous vegetables, is a known activator of NRF2 (master regulator of cellular antioxidant responses). Patients with chronic kidney disease (CKD) present an imbalance in the redox state, presenting reduced expression of NRF2 and increased expression of NF-κB. Therefore, this study aimed to evaluate the effects of SFN on the mRNA expression of NRF2, NF-κB and markers of oxidative stress in patients with CKD. Here, we observed a significant increase in the mRNA expression of NRF2 (p = 0.02) and NQO1 (p = 0.04) in the group that received 400 µg/day of SFN for 1 month. Furthermore, we observed an improvement in the levels of phosphate (p = 0.02), glucose (p = 0.05) and triglycerides (p = 0.02) also in this group. On the other hand, plasma levels of LDL-c (p = 0.04) and total cholesterol (p = 0.03) increased in the placebo group during the study period. In conclusion, 400 µg/day of SFN for one month improves the antioxidant system and serum glucose and phosphate levels in non-dialysis CKD patients.

Production of Toxins by the Gut Microbiota: The Role of Dietary Protein.

PURPOSE OF REVIEW: This narrative review will discuss how the intake of specific protein sources (animal and vegetable) providing specific amino acids can modulate the gut microbiota composition and generate toxins. A better understanding of these interactions could lead to more appropriate dietary recommendations to improve gut health and mitigate the risk of complications promoted by the toxic metabolites formed by the gut microbiota. RECENT FINDINGS: Gut microbiota is vital in maintaining human health by influencing immune function and key metabolic pathways. Under unfavorable conditions, the gut microbiota can produce excess toxins, which contribute to inflammation and the breakdown of the integrity of the intestinal barrier. Genetic and environmental factors influence gut microbiota diversity, with diet playing a crucial role. Emerging evidence indicates that the gut microbiota significantly metabolizes amino acids from dietary proteins, producing various metabolites with beneficial and harmful effects. Amino acids such as choline, betaine, l-carnitine, tyrosine, phenylalanine, and tryptophan can increase the production of uremic toxins when metabolized by intestinal bacteria. The type of food source that provides these amino acids affects the production of toxins. Plant-based diets and dietary fiber are associated with lower toxin formation than animal-based diets due to the high amino acid precursors in animal proteins.

Using the concept of food as medicine to mitigate inflammation in patients undergoing peritoneal dialysis.

The most common kidney replacement therapy (KRT) worldwide is hemodialysis (HD), and only 5%-10% of patients are prescribed peritoneal dialysis (PD) as KRT. Despite PD being a different method, these patients also present particular complications, such as oxidative stress, gut dysbiosis, premature aging, and mitochondrial dysfunction, leading to an inflammation process and high cardiovascular mortality risk. Although recent studies have reported nutritional strategies in patients undergoing HD with attempts to mitigate these complications, more information must be needed for PD patients. Therefore, this review provides a comprehensive analysis of recent studies of nutritional intervention to mitigate inflammation in PD patients.

Vitamin E and conflicting understandings in noncommunicable diseases: Is it worth supplementing?

Vitamin E is a lipid-soluble nutrient found mainly in vegetable oils and oilseeds. It is divided into eight homologous compounds; however, only α-tocopherol exhibits vitamin activity. Many advantages are related to these compounds, including cellular protection through antioxidant and anti-inflammatory activity, and improving lipid metabolism. Physiopathology of many diseases incepts with reduced antioxidant defense, characterized by an increased reactive oxygen species production and activation of transcription factors involved in inflammation, such as nuclear factor-kappa B (NF-κB), that can be linked to oxidative stress. Moreover, disorders of lipid metabolism can increase the risk of cardiovascular diseases. In addition, intestinal dysbiosis plays a vital role in developing chronic non-communicable diseases. In this regard, vitamin E can be considered to mitigate those disorders, but data still needs to be more conclusive. This narrative review aims to elucidate the mechanisms of action of vitamin E and if supplementation can be beneficial in a disease scenario regarding non-communicable diseases.

Can curcumin supplementation break the vicious cycle of inflammation, oxidative stress, and uremia in patients undergoing peritoneal dialysis?

BACKGROUND & AIMS: Turmeric (a source of curcumin) is an excellent food to modulate oxidative stress, inflammation, and gut dysbiosis in patients with chronic kidney disease (CKD). However, no studies report the benefits of curcumin in patients undergoing peritoneal dialysis (PD). This study aims to evaluate the effects of curcuminoid supplementation on oxidative stress, inflammatory markers, and uremic toxins originating from gut microbiota in patients with CKD undergoing PD. METHODS: This longitudinal, randomized, single-blind, placebo-controlled trial evaluated 48 patients who were randomized into two groups: Curcumin (three capsules of 500 mg of Curcuma longa extract, with 98.42 % total curcuminoids) or placebo (three capsules of 500 mg of starch) for twelve weeks. In the peripheral blood mononuclear cells (PBMCs), the transcriptional expression levels of Nrf2, HOX-1 and NF-κB were evaluated by quantitative real-time PCR. Oxidative stress was evaluated by malondialdehyde (MDA) and total Thiol (T-SH). TNF-α and IL-6 plasma levels were measured by ELISA. P-cresyl sulphate plasma level, a uremic toxin, was evaluated by high-performance liquid chromatography (HPLC) with fluorescent detection. RESULTS: Twenty-four patients finished the study: 10 in the curcumin group (57.5 ± 11.6 years) and 14 in the placebo group (56.5 ± 10.0 years). The plasma levels of MDA were reduced after 12 weeks in the curcumin group (p = 0.01), while the placebo group remained unchanged. However, regarding the difference between the groups at the endpoint, no change was observed in MDA. Still, there was a trend to reduce the p-CS plasma levels in the curcumin group compared to the placebo group (p = 0.07). Likewise, the concentrations of protein thiols, mRNA expression of Nrf2, HOX-1, NF-κB, and cytokines plasma levels did not show significant changes. CONCLUSION: Curcuminoid supplementation for twelve weeks attenuates lipid peroxidation and might reduce uremic toxin in patients with CKD undergoing PD. This study was registered on Clinicaltrials.gov as NCT04413266.

Efeitos a curto e longo prazos de ações de Educação Alimentar e Nutricional no perfil nutricional de pacientes em hemodiálise / Short-term and long-term effects of Food and Nutrition Education actions on the nutritional profile of hemodialysis patients

Introdução: A Doença Renal Crônica pode ser considerada como epidemia deste milênio, uma vez que há uma elevada prevalência mundial. O estágio dialítico da doença é considerado um problema de saúde mundial. Objetivos: Avaliar a influência de atividades de Educação Alimentar e Nutricional (EAN) sobre o perfil nutricional de indivíduos que realizam hemodiálise. Métodos: Estudo do tipo ensaio clínico controlado, nãorandomizado, desenvolvido no Centro de Hemodiálise do Hospital Universitário de Juiz de Fora (HU-UFJF). Os pacientes foram divididos em dois grupos: Grupo Intervenção (GI), que realizou as intervenções de EAN, e Grupo Controle (GC). Os dados dos prontuários foram coletados para ambos os grupos, na Linha de Base (LB), no Pós-Intervenção Imediato (PII), avaliação realizada logo após o término da última intervenção e no Pós-Intervenção Tardio (PIT), seis meses após a realização da última atividade. Resultados: Observou-se diminuição da mediana do fósforo sérico no GI, em curto e longo prazo, demonstrando resultado positivo das atividades de EAN. Não se observou influência das intervenções sobre o perfil antropométrico e alimentar dos pacientes em hemodiálise. Conclusões: As atividades de EAN podem provocar mudanças positivas sobre a hiperfosfatemia dos pacientes em hemodiálise. No entanto, essas ações devem ser contínuas e fazer parte da rotina dos indivíduos, para que os efeitos positivos sejam mais expressivos

Introduction: Chronic Kidney Disease (CKD) has being considered a Millennium epidemic, since there is a high prevalence worldwide. Currently, the final stage of the disease is considered a global health problem. Objectives: To evaluate the impact of interventions of Food and Nutrition Education (FNE) on the nutritional profile of individuals undergoing hemodialysis (HD). Methodology: Non-randomized controlled clinical study developed at the Hemodialysis Center of the University Hospital of the Federal University of Juiz de Fora (HU-UFJF). The patients were divided into two groups: Intervention Group (IG), who participated in the interventions of FNE, and the Control Group (CG). Data were collected for both groups at three moments: Baseline (BL), Post-Intervention Immediate (PII) (shortly after the end of the last intervention), and Post- Intervention Late (PIL) (six months after the last intervention). Results: It was observed a decrease in the median serum phosphorus in the GI, in the short and long term, demonstrating a positive result of the EAN activities. There was no influence of the interventions on the anthropometric and alimentary profile of hemodialysis patients. Conclusion: Interventions of FNE can lead to positive changes in hyperphosphatemia in hemodialysis patients. However, these actions must be continuous and part of the routine of individuals, so that the positive effects are more comprehensive

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Efeitos a curto e longo prazos de ações de Educação Alimentar e Nutricional no perfil nutricional de pacientes em hemodiálise / Short-term and long-term effects of Food and Nutrition Education actions on the nutritional profile of hemodialysis patients

Introdução: A Doença Renal Crônica pode ser considerada como epidemia deste milênio, uma vez que há uma elevada prevalência mundial. O estágio dialítico da doença é considerado um problema de saúde mundial. Objetivos: Avaliar a influência de atividades de Educação Alimentar e Nutricional (EAN) sobre o perfil nutricional de indivíduos que realizam hemodiálise. Métodos: Estudo do tipo ensaio clínico controlado, nãorandomizado, desenvolvido no Centro de Hemodiálise do Hospital Universitário de Juiz de Fora (HU-UFJF). Os pacientes foram divididos em dois grupos: Grupo Intervenção (GI), que realizou as intervenções de EAN, e Grupo Controle (GC). Os dados dos prontuários foram coletados para ambos os grupos, na Linha de Base (LB), no Pós-Intervenção Imediato (PII), avaliação realizada logo após o término da última intervenção e no Pós-Intervenção Tardio (PIT), seis meses após a realização da última atividade. Resultados: Observou-se diminuição da mediana do fósforo sérico no GI, em curto e longo prazo, demonstrando resultado positivo das atividades de EAN. Não se observou influência das intervenções sobre o perfil antropométrico e alimentar dos pacientes em hemodiálise. Conclusões: As atividades de EAN podem provocar mudanças positivas sobre a hiperfosfatemia dos pacientes em hemodiálise. No entanto, essas ações devem ser contínuas e fazer parte da rotina dos indivíduos, para que os efeitos positivos sejam mais expressivos

Introduction: Chronic Kidney Disease (CKD) has being considered a Millennium epidemic, since there is a high prevalence worldwide. Currently, the final stage of the disease is considered a global health problem. Objectives: To evaluate the impact of interventions of Food and Nutrition Education (FNE) on the nutritional profile of individuals undergoing hemodialysis (HD). Methodology: Non-randomized controlled clinical study developed at the Hemodialysis Center of the University Hospital of the Federal University of Juiz de Fora (HU-UFJF). The patients were divided into two groups: Intervention Group (IG), who participated in the interventions of FNE, and the Control Group (CG). Data were collected for both groups at three moments: Baseline (BL), Post-Intervention Immediate (PII) (shortly after the end of the last intervention), and Post-Intervention Late (PIL) (six months after the last intervention). Results: It was observed a decrease in the median serum phosphorus in the GI, in the short and long term, demonstrating a positive result of the EAN activities. There was no influence of the interventions on the anthropometric and alimentary profile of hemodialysis patients. Conclusion: Interventions of FNE can lead to positive changes in hyperphosphatemia in hemodialysis patients. However, these actions must be continuous and part of the routine of individuals, so that the positive effects are more comprehensive

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Nutritional profile of hemodialysis patients concerning treatment time / Análise do perfil nutricional de pacientes renais crônicos em hemodiálise em relação ao tempo de tratamento

Abstract Introduction: The mortality of the population with chronic kidney disease (CKD) on hemodialysis (HD) is very high and the protein-energy malnutrition stands out as one of the most common consequences in relation to this condition. Objective: To evaluate the association between time of hemodialysis and nutritional parameters of patients. Methods: It is a cross-sectional study with secondary data, developed of the University Hospital of the Federal University of Juiz de Fora (HU/UFJF). This study was approved by the Research Ethics Committee (Nº 1.233.142), a total of 36 patients. The medical records and collected data were analyzed for anthropometric markers, biochemical and diet, considering two groups: HD time less than three and greater than or equal to three years. Results: There was reduction of mass of somatic protein with increased duration of HD. In relation to food intake was observed that in patients with increased duration of dialysis, an increase in average consumption of protein / kg of weight, calories, phosphorus and potassium, with a significant difference from the mean protein intake / kg (p = 0.04) and phosphorus (p = 0.045). Increasing HD time has altered body composition of patients, indicating a decline in the nutritional status of these individuals. Conclusion: HD patients are a risk group for protein-energy malnutrition, where HD time interferes with the nutritional status and food profile of the patient. The group HD time greater than or equal to 3 years presented worsening nutritional status.

Resumo Introdução: Pacientes com doença renal crônica em hemodiálise (HD) apresentam risco elevado para mortalidade, sendo que a desnutrição protéico-energética se destaca como uma das causa mais comuns em relação a essa condição. Objetivo: Avaliar a associação entre o tempo de hemodiálise e parâmetros nutricionais dos pacientes. Métodos: É um estudo transversal com dados secundários, desenvolvido no Hospital Universitário Federal Universidade de Juiz de Fora (HU / UFJF). Este estudo foi aprovado pela pesquisa Comitê de Ética (nº 1.233.142), um Total de 36 pacientes. Os dados foram coletados por meio dos prontuários médicos, os quais foram analisados marcadores antropométricos, bioquímicos e dieta, considerando dois grupos: tempo HD menor do que três anos e tempo de HD maior ou igual atrês anos. Resultados: Houve redução de massa de proteína somática com aumento do tempo em HD. Em relação à avaliação alimentar, observou-se que em pacientes com maior tempo em diálise houve aumento no consumo médio de proteína/kg de peso, calorias, fósforo e Potássio, com diferença significativa da ingestão média de proteína/kg (p = 0,04) e fósforo (p = 0,045). O tempo em HD alterou a composição corporal dos pacientes, indicando um declínio doestado nutricional desses indivíduos. Conclusão: Pacientes com HD são um grupo de risco para desnutrição protéico-energética, onde o tempo em HD interfere no perfil antropométrico e alimentar do paciente.O grupo com tempo de HD superior ou igual a 3 anos apresentou piora do estado nutricional.

Pacientes em diálise peritoneal e em hemodiálise: Existe diferença em relação ao estado nutricional? / Patients in peritoneal dialysis and hemodialysis: Is there any difference in the nutritional status?

A hemodiálise (HD) e a diálise peritoneal (DP) são as terapias renais de substituição mais comumente utilizadas, sendo que o estado nutricional dos pacientes com Doença Renal Crônica (DRC) pode ser influenciado pela modalidade de diálise utilizada. Objetivo: Comparar o estado nutricional de pacientes em HD e em DP, por meio da avaliação antropométrica e bioquímica. Trata-se de um estudo transversal, realizado no setor de nefrologia do Hospital Universitário da Universidade Federal de Juiz de Fora. O estudo foi constituído por 29 pacientes em DP e 36 em HD, totalizando 65 pacientes. Os dados coletados foram: peso corporal seco, estatura, Índice de Massa Corporal (IMC), área muscular do braço (AMB), circunferência muscular do braço (CMB), prega cutânea tricipital (PCT) e circunferência do braço (CB); além dos exames bioquímicos: potássio, fósforo, uréia e albumina. Pode-se observar maior prevalência do sexo feminino na modalidade DP em relação a HD (75% X 44,4%, p = 0,01). Houve diferença nos tempos em diálise entre os grupos (DP: 41,86 ±33,2 meses X HD: 22,36 ±5,4 meses, p = 0,001). Em relação à classificação da CMB, 48,3% dos pacientes em DP e 22,2% em HD foram classificados como eutróficos (p = 0.001). Quanto à AMB, 72,5% dos pacientes em DP e 36,1% dos pacientes em HD foram classificados como eutróficos (p = 0.001). Em relação aos exames bioquímicos, somente o potássio apresentou diferença significante entre os grupos (DP: 4,9 ±0,73 mEq/L e HD: 5,64 ±0,78 mEq/L, p = 0,01). No presente estudo, os pacientes em DP apresentam melhor classificação em relação a CMB e AMB, além de melhor controle do potássio sérico, em relação aos pacientes em HD.

Hemodialysis (HD) and peritoneal dialysis (PD) are the most commonly used renal replacement therapy. The nutritional status of chronic kidney disease (CKD) patients can be influenced by the dialysis modality used. Objective: To compare the nutritional status of patients in HD and PD, through anthropometric and biochemical evaluation. This is a cross-sectional study carried out in the nephrology sector of the University Hospital of the Federal University of Juiz de Fora. The study consisted of 29 patients in PD and 36 in HD, totaling 65 patients. The data collected were: dry body weight, stature, body mass index (BMI), arm muscle area (BMA), arm muscle circumference (BMC), triceps skin fold and arm circumference. In addition, the biochemical tests: potassium, phosphorus, urea and albumin. It is possible to observe a higher prevalence of female sex in the PD modality in relation to HD (75% X 44.4%, p = 0.01). There was a difference in dialysis times between groups (SD: 41.86 ± 33.2 months X HD: 22.36 ± 5.4 months, p = 0.001). Regarding BMC classification, 48.3% of patients in PD and 22.2% in HD were classified as eutrophic (p = 0.001). As for BMA, 72.5% of patients in PD and 36.1% of patients in HD were classified as eutrophic (p = 0.001). In relation to the biochemical tests, only potassium had a significant difference between the groups (SD: 4.9 ± 0.73 mEq / L and HD: 5.64 ± 0.78 mEq / L, p = 0.01). In the present study, patients in PD present better classification in relation to BMC and BMA, in addition to better control of serum potassium, compared to patients in HD.

Relato de experiência: educação alimentar e nutricional com pacientes renais crônicos em hemodiálise / Experience report: food and nutrition education with chronic renal failure patients on hemodialysis

Introdução: Pacientes renais crônicos apresentam restrições alimentares em decorrência das alterações bioquímicas eminentes, como o desequilíbrio mineral, com elevação do nível sérico de fósforo e potássio. As atividades de Educação Alimentar e Nutricional (EAN) entram nesse contexto a fim de proporcionar melhora do conhecimento a respeito da própria doença e de práticas alimentares saudáveis para esse público. Objetivos: Descrever as atividades de Educação Alimentar e Nutricional realizadas com pacientes em Hemodiálise do Hospital Universitário da Universidade Federal de Juiz de Fora, Minas Gerais, Brasil. Métodos: Foram realizadas cinco atividades de EAN com os pacientes, sendo elas: 1. Leitura e interpretação dos rótulos de produtos industrializados; 2. Mitos e verdades sobre a alimentação e nutrição; 3. Sal, açúcar, óleo e doenças crônicas; 4. Potássio, Fósforo e ingestão de líquidos; e 5. Especial de Natal e Ano Novo: o que preferir e o que evitar. As atividades foram desenvolvidas por cerca de 60 a 90 minutos, antes do início do procedimento de hemodiálise. Resultados: A frequência nas intervenções nutricionais foi de sete a dez pacientes por atividade, o que significa 20% do grupo de convidados. As intervenções compreenderam atividades dinâmicas, visuais e lúdicas, que valorizaram a participação verbal dos pacientes, bem como a resolução de dúvidas relacionadas à alimentação e suas patologias. Discussão: Foi encontrada dificuldade em captar os pacientes para os encontros, provavelmente devido à disponibilidade de horários e a resistência, num primeiro momento, em relação às atividades propostas. Essa dificuldade pode-se relacionar a uma limitação deste estudo, já que as intervenções foram desenvolvidas fora do horário de hemodiálise, enquanto que, em muitos estudos, essas aconteceram durante o procedimento, no leito. Nas atividades descritas nesse relato, foram utilizadas técnicas educativas diversas que procuraram priorizar um maior contato entre os participantes e ministrantes, a partir do uso de materiais visuais e lúdicos. Segundo observação dos pesquisadores, estas se fizeram positivas para os pacientes. Conclusão: O acompanhamento nutricional e as atividades de EAN devem ser um processo contínuo da equipe de nutrição com os pacientes em hemodiálise. O uso de métodos lúdicos favorece o entendimento dos assuntos abordados (AU)

Introduction: Chronic renal patients have several dietary restrictions due to the eminent biochemical changes, such as mineral imbalance, with elevation of serum phosphorus and potassium. The interventions of Food and Nutrition Education are in this context to provide improved know ledge about the disease itself and healthy eating practices to the public. Objectives: Describe the interventions of Food and Nutrition Education held in hemodialysis patients at the University Hospital of the Federal University of Juiz de Fora. Methods: There were five distinct interventions of nutrition education with hemodialysis patients, as follows: 1. Reading and interpreting the labels of processed products; 2. Myths and truths about food and nutrition; 3. Salt, sugar, oil and chronic diseases; 4.Potassium, Phosphorus and liquid intake; and 5. Christmas and New Year’s Special: what to choose and what to avoid. The activities were developed for about 60 to 90 minutes before the beginning of the hemodialysis procedure. Results: The frequency on the nutritional interventions was seven to ten patients per activity, which means 20% of the group invited patients. The interventions realized were dynamic, visual and recreational, that valued the verbal participation of patients, as well as their solution of questions related to food and about their pathologies. Discussion: It was difficult the capture patients to the meetings, probably due to the availability of schedules and resistance, at first, in relation to proposed activities. This difficulty maybe related to a limitation of this study, since the interventions were developed out of the hemodialysis time, while in many studies the reoccurred during the procedure, in bed. In the activities described in this report, various educational techniques were used, that sought to prioritize greater contact between participants and worshipers and the presence of materials that are more visuals and recreational. According to observation of the researchers, the activities were extremely positive for the patients. Conclusion: The nutritional monitoring and EAN activities should be an ongoing process of the nutrition team with hemodialysis patients and the use of playing methods favors the understanding of the subjects (AU)