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  CKD »

  How does diet affect progression of CKD?

  Diets may impact CKD progression in several ways. A vegetarian diet lowers colon-derived uremic toxins such as indoxyl sulfate and p-cresol (Patel, J Am Soc Nephrol (Nov) 19:488A 2008). Diets high in advanced glycosylated end products are associated with evidence of glycation of body tissues. Phosphate restriction in CKD lowers serum FGF levels. A study is proposed using a 2 x 2 factorial design to study progression ...more »

  Diets may impact CKD progression in several ways. A vegetarian diet lowers colon-derived uremic toxins such as indoxyl sulfate and p-cresol (Patel, J Am Soc Nephrol (Nov) 19:488A 2008). Diets high in advanced glycosylated end products are associated with evidence of glycation of body tissues. Phosphate restriction in CKD lowers serum FGF levels. A study is proposed using a 2 x 2 factorial design to study progression of CKD in patients eating a vegetarian vs. meat-based diet, with or without restriction of phosphate and high-AGE foods. Outcomes would be 50% reduction of cystatin-estimated GFR or progression to dialysis/transplantation.

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  Submitted by John Daugirdas 2 years ago

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  CKD »

  BURNT-OUT DIABETES IN CKD

  Treatment of early diabetes mellitus, the most common cause of chronic kidney disease (CKD), may prevent or slow the progression of diabetic nephropathy and lower mortality and the incidence of cardiovascular disease in the general population and in patients with early stages of CKD. It is unclear if glycemic control in patients with advanced CKD, including those with end-stage renal disease (ESRD) who undergo maintenance ...more »

  Treatment of early diabetes mellitus, the most common cause of chronic kidney disease (CKD), may prevent or slow the progression of diabetic nephropathy and lower mortality and the incidence of cardiovascular disease in the general population and in patients with early stages of CKD. It is unclear if glycemic control in patients with advanced CKD, including those with end-stage renal disease (ESRD) who undergo maintenance dialysis treatment is beneficial. Aside from the uncertain benefits of treatment in ESRD, hypoglycemic interventions in this population are also complicated by the complex changes in glucose homeostasis related to decreased kidney function and to dialytic therapies, which may occasionally lead to spontaneous resolution of hyperglycemia and normalization of hemoglobin A1c levels, with a resultant picture of “burnt-out diabetes”. Further difficulties in ESRD are posed by the complicated pharmacokinetics of antidiabetic medications and the serious flaws in our available diagnostic tools used for monitoring long term glycemic control. Studies are needed ti examine the physiology and pathophysiology of glucose homeostasis in advanced CKD and ESRD, the available antidiabetic medications and their specifics related to kidney function, and the diagnostic tools used to monitor the severity of hyperglycemia and the therapeutic effects of available treatments, along with their deficiencies in ESRD. Studies need to investigate the concept of burnt-out diabetes and summarize the findings of studies that examined outcomes related to glycemic control in diabetic ESRD patients

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  Submitted by Kamyar Kalantar-Zadeh 2 years ago

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  DIABETIC NEPHROPATHY »

  It is easier to find genes in Type 1 diabetes DN than type 2

  It has been difficult to identify SNPs with even modest effects in studies of type 2 diabetic nephropathy. One possible explanation is that patients with kidney disease who have type 2 diabetes may not have a single disease. Indeed the old biopsy data suggest that there is a diversity of diseases in this population. Should gene finding efforts focus exclusively on type 1 diabetic nephropathy for the short term?

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  Submitted by rebekah rasooly 2 years ago

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