Plant-based diets in patients with chronic kidney disease.

Dietary protein restriction has been considered to be a nutritional-related strategy to reduce risk for end-stage kidney disease among patients with non-dialysis-dependent chronic kidney disease (CKD). However, there is insufficient evidence to recommend a particular type of protein to slow down the CKD progression. Recently, various plant-based diets could demonstrate some additional benefits such as a blood pressure-lowering effect, a reduction of metabolic acidosis as well as hyperphosphatemia, and gut-derived uremic toxins. Furthermore, the former concerns about the risk of undernutrition and hyperkalemia observed with plant-based diets may be inconsistent in real clinical practice. In this review, we summarize the current evidence of the proposed pleiotropic effects of plant-based diets and their associations with clinical outcomes among pre-dialysis CKD patients.

Association of fine particulate matter (PM2.5) exposure and chronic kidney disease outcomes: a systematic review and meta-analysis.

Several studies have reported an increased risk of chronic kidney disease (CKD) outcomes after long-term exposure (more than 1 year) to particulate matter with an aerodynamic diameter of ≤ 2.5 µm (PM2.5). However, the conclusions remain inconsistent. Therefore, we conducted this meta-analysis to examine the association between long-term PM2.5 exposure and CKD outcomes. A literature search was conducted in PubMed, Scopus, Cochrane Central Register of Controlled trials, and Embase for relevant studies published until August 10, 2023. The main outcomes were incidence and prevalence of CKD as well as incidence of end-stage kidney disease (ESKD). The random-effect model meta-analyses were used to estimate the risk of each outcome among studies. Twenty two studies were identified, including 14 cohort studies, and 8 cross-sectional studies, with a total of 7,967,388 participants. This meta-analysis revealed that each 10 µg/m3 increment in PM2.5 was significantly associated with increased risks of both incidence and prevalence of CKD [adjusted odds ratio (OR) 1.31 (95% confidence interval (CI) 1.24 to 1.40), adjusted OR 1.31 (95% CI 1.03 to 1.67), respectively]. In addition, the relationship with ESKD incidence is suggestive of increased risk but not conclusive (adjusted OR 1.16; 95% CI 1.00 to 1.36). The incidence and prevalence of CKD outcomes had a consistent association across all subgroups and adjustment variables. Our study observed an association between long-term PM2.5 exposure and the risks of CKD. However, more dedicated studies are required to show causation that warrants urgent action on PM2.5 to mitigate the global burden of CKD.

Prevalence of Sarcopenia and Its Impact on Cardiovascular Events and Mortality among Dialysis Patients: A Systematic Review and Meta-Analysis.

Sarcopenia in end-stage kidney disease patients requiring dialysis is a frequent complication but remains an under-recognized problem. This meta-analysis was conducted to determine the prevalence of sarcopenia and explored its impacts on clinical outcomes, especially cardiovascular events, and mortality in dialysis patients. The eligible studies were searched from PubMed, Scopus, and Cochrane Central Register of Controlled trials up to 31 March 2022. We included studies that reported the interested outcomes, and the random-effects model was used for analysis. Forty-one studies with 7576 patients were included. The pooled prevalence of sarcopenia in dialysis patients was 25.6% (95% CI 22.1 to 29.4%). Sarcopenia was significantly associated with higher mortality risk (adjusted OR 1.83 (95% CI 1.40 to 2.39)) and cardiovascular events (adjusted OR 3.80 (95% CI 1.79 to 8.09)). Additionally, both low muscle mass and low muscle strength were independently related to increased mortality risk in dialysis patients (OR 1.71; 95% CI (1.20 to 2.44), OR 2.15 (95% CI 1.51 to 3.07)), respectively. This meta-analysis revealed that sarcopenia was highly prevalent among dialysis patients and shown to be an important predictor of cardiovascular events and mortality. Future intervention research to alleviate this disease burden in dialysis patients is needed.

A Randomized Controlled Trial of Comparative Efficacy between Sodium Bicarbonate and Heparin as A Locking Solution for Tunneled Central Venous Catheters Among Patients Requiring Maintenance Hemodialysis.

BACKGROUND: Sodium bicarbonate (NaHCO3) is one of the promising solutions that has good safety profile and theoretical advantages regarding antimicrobial and antithrombotic properties but there are still limited reports. OBJECTIVE: To compare the efficacy in lowering rate of catheter loss due to catheter-related thrombosis (CRT) or catheter-related blood stream infection (CRBSI) between sodium bicarbonate and heparin lock in prevalent chronic hemodialysis (HD) patients. DESIGN: A multicenter, randomized, open-label study. SETTING: In a developing country, Thailand. PATIENTS: Chronic HD patients with tunneled central venous catheter. MEASUREMENTS: Catheter loss rate, rate of catheter-related blood stream infection, catheter-related thrombosis, and exit site or tunnel infection. METHODS: The prospective multicenter randomized controlled trial was conducted, we randomly assigned 118 patients undergoing HD with tunneled central venous catheter to receive a catheter locking solution of sodium bicarbonate or heparin. The primary outcome was a catheter loss rate due to CRT or CRBSI, while the secondary outcome was a composite outcome of CRT, CRBSI, or exit site/tunnel infection (ESI/TI). RESULTS: The present study was stopped early due to an excess of catheter-related thrombosis in the sodium bicarbonate group. From the first 6 weeks of follow-up, there were no catheter losses due to CRT or CRBSI in both groups. The sodium bicarbonate group had a significantly higher rate of the secondary composite outcomes and this was entirely caused by CRT with the median time to thrombosis of 23.6 days. Every CRT event could be successfully rescued by using a single dose of recombinant tissue plasminogen activator (rt-PA). LIMITATIONS: Short follow-up period. CONCLUSIONS: In prevalent HD patients with tunneled CVCs, use of a sodium bicarbonate locking solution for prevention of CRT is inferior to heparin and is associated with a high rate of catheter-related thrombosis. TRIAL REGISTRATION: The study was registered with the Thai Clinical Trials Registry TCTR 20200610003.

CONTEXTE: Le bicarbonate de sodium (NaHCO3) figure parmi les solutions prometteuses présentant un bon profil de tolérance et des bienfaits théoriques en matière de propriétés antimicrobiennes et antithrombotiques. Les rapports en faisant état demeurent toutefois limités. OBJECTIFS: Comparer l'efficacité du NaHCO3 par rapport à l'héparine en tant que solutions de verrouillage du cathéter dans la réduction du taux d'échec du cathéter en raison d'une thrombose due au cathéter (TDC) ou d'une septicémie due au cathéter (SDC) chez les patients suivant des traitements d'hémodialyse (HD) de façon chronique. TYPE D'ÉTUDE: Essai randomisé ouvert mené dans plusieurs centers. CADRE: Étude réalisée en Thaïlande, un pays en développement. SUJETS: Patients sous HD chronique par cathéter veineux central tunnelisé. MESURES: Le taux d'échec du cathéter, le taux de SDC, le taux de TDC et le taux d'infections au point d'émergence cutané ou de tunnelites. MÉTHODOLOGIE: Cet essai prospectif randomisé et contrôlé est multicentrique et porte sur 118 patients HD avec cathéter veineux central tunnelisé. Les sujets ont été répartis aléatoirement pour recevoir une solution de NaHCO3 ou d'héparine comme solution de verrouillage du cathéter. Le principal critère d'évaluation était l'échec du cathéter en raison d'une TDC ou d'une SDC. Le critère d'évaluation secondaire était un résultat combiné de TDC, de SDC ou d'une infection au point d'émergence/ tunnelite. RÉSULTATS: L'étude a été interrompue prématurément en raison d'un trop grand nombre de thromboses liées au cathéter dans le groupe recevant le NaHCO3. Dans les six premières semaines de suivi, aucun échec dû à une thrombose ou à une septicémie n'avait été observé dans les deux groupes. Le groupe NaHCO3 a montré un taux significativement plus élevé d'événements liés au critère d'évaluation secondaire, et cela était entièrement causé par TDC; le délai médian avant la thrombose était de 23,6 jours. Chaque TDC a pu être restaurée avec succès grâce à une seule dose d'activateur tissulaire du plasminogène (rt-PA). LIMITES: Courte période de suivi. CONCLUSION: Chez les patients prévalents suivant des traitements d'hémodialyse via un cathéter veineux central tunnelisé, l'utilization du NaHCO3 comme solution de verrouillage du cathéter a été associée à un taux élevé de thromboses dues au cathéter et s'est avérée moins efficace que l'héparine pour les prévenir. ENREGISTREMENT DE L'ESSAI: L'essai est enregistré au registre des essais cliniques thaïlandais TCTR 20200610003.