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Nutrients
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Nutritional Derangements and Sarcopenia in Chronic Kidney Disease
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Nutritional Derangements and Sarcopenia in Chronic Kidney Disease

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: 15 March 2025 | Viewed by 5514

Special Issue Editors

Dr. Simone Vettoretti

E-Mail Website1 Website2
Guest Editor
Division of Nephrology Dialysis and Renal Transplantation Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
Interests: uremic toxins; cardiovascular disease; chronic renal disease progression; malnutrition
Special Issues, Collections and Topics in MDPI journals
Dr. Claudia D'Alessandro

E-Mail Website
Guest Editor
Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
Interests: nutritional treatment; CKD patients; Crohn’s disease; diet in nepphology

Special Issue Information

Dear Colleagues,

Among the patients affected by chronic kidney disease (CKD), the prevalence of malnutrition and sarcopenia increases with the progression of renal disease. This may depend on the fact that malnutrition and sarcopenia are generally interconnected but also on the possibility that common pathophysiological pathways link these syndromes to CKD. Furthermore, recent evidence suggests that in CKD patients, malnutrition and sarcopenia are also strictly associated with mineral bone disorders, an association that may identify a new nosological entity recognized as “osteosarcopenia”. 

In this Special Issue of Nutrients, we would like to examine in depth the epidemiology linking malnutrition, sarcopenia and bone mineral disorders in the various stages of CKD. Furthermore, we will address the common pathophysiological pathways underlying these associations with special attention to dietary habits, uremic toxins, and inflammation.

We would also investigate the effects of different dietary interventions (such as: low protein, vegan/vegetarian, ketogenic, anti-inflammatory) on nutritional status, osteo and/or sarcopenia in the various stages of CKD. Finally, we would be interested in evaluating the possible benefits of enteral, parenteral or oral supplementations to prevent or improve malnutrition and osteosarcopenia in patients undergoing acute or chronic renal replacement treatments.

Dr. Simone Vettoretti
Dr. Claudia D'Alessandro
Guest Editors

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Keywords

  • chronic kidney disease
  • malnutrition
  • sarcopenia
  • osteosarcopenia
  • dietary habits
  • dietary interventions

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Published Papers (5 papers)

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Research

12 pages, 647 KiB  
Article
Intradialytic Parenteral Nutrition in Patients on Hemodialysis: A Multicenter Retrospective Study
by Marta Arias-Guillén, Juan Carlos González, Loreley Betancourt, Elisabeth Coll, Silvia Collado, Bárbara Romano-Andrioni, Ascensión Lupiañez-Barbero, Julia Garro, Verónica Duarte, Jordi Soler-Majoral and Jordi Calabia
Nutrients 2024, 16(23), 4018; https://doi.org/10.3390/nu16234018 - 24 Nov 2024
Viewed by 258
Abstract
Background and Objective: To evaluate the effectiveness and safety of intradialytic parenteral nutrition (IDPN) on different nutritional outcomes. Methods: This was a retrospective analysis for a “routinely collected data bank” in a multicenter cohort, conducted on consecutive malnourished or at-risk of malnutrition patients [...] Read more.
Background and Objective: To evaluate the effectiveness and safety of intradialytic parenteral nutrition (IDPN) on different nutritional outcomes. Methods: This was a retrospective analysis for a “routinely collected data bank” in a multicenter cohort, conducted on consecutive malnourished or at-risk of malnutrition patients with chronic kidney disease on hemodialysis who underwent IDPN with a three-in-one parenteral nutrition formula for a period ≥ 2 weeks. The primary endpoint was the mean change in the malnutrition inflammation score (MIS) score between baseline and the last follow-up visit on IDPN. Results: Fifty-six patients were included. The mean age was 72.4 ± 12.0 years, and 24 (42.9%) were women. In the overall study sample, MIS significantly decreased from 16.4 (95%CI: 15.3–17.65) at baseline to 14.3 (95%CI: 12.8–15.8) at the last follow-up visit on IDPN (p = 0.0019). Fifteen (26.8%) patients achieved a MIS reduction ≥ 5 points after IDPN. As compared to baseline, IDPN significantly reduced the proportion of patients with protein-energy wasting (PEW) (89.3% versus 66.1%, respectively, p = 0.0023). Regarding analytical parameters, serum albumin (p = 0.0003) and total proteins (p = 0.0024) significantly increased after IDPN administration. Throughout the study’s follow-up period, 45 (80.4%) patients reported experiencing some type of adverse event. Conclusions: IDPN was associated with a significant improvement in the nutritional profile. Notably, our research found that the administration of IDPN over a duration > 3 months significantly improved the nutritional status of patients evaluated by the MIS test. Full article
(This article belongs to the Special Issue Nutritional Derangements and Sarcopenia in Chronic Kidney Disease)
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10 pages, 624 KiB  
Communication
The Long-Term Effect of Kidney Transplantation on the Serum Fatty Acid Profile
by Maciej Śledziński, Justyna Gołębiewska and Adriana Mika
Nutrients 2024, 16(19), 3319; https://doi.org/10.3390/nu16193319 - 30 Sep 2024
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Abstract
Background: Epidemiologic evidence has demonstrated the prevalence of metabolic disorders and increased cardiovascular risk related to lipid metabolism disorders in kidney transplant recipients. Therefore, it is of great importance to understand lipid alterations and to look for ways to reduce cardiovascular risk in [...] Read more.
Background: Epidemiologic evidence has demonstrated the prevalence of metabolic disorders and increased cardiovascular risk related to lipid metabolism disorders in kidney transplant recipients. Therefore, it is of great importance to understand lipid alterations and to look for ways to reduce cardiovascular risk in this patient group. Methods: Our study included 25 patients with chronic kidney disease undergoing kidney transplantation (KTx). Three blood samples were taken from each patient: before KTx, 3 months after KTx and 6–12 months after KTx. A series of biochemical blood tests and a detailed analysis of the serum fatty acid profile were performed. Results: In our previous study, the effects of kidney transplantation on serum fatty acid (FA) profile 3 months after the procedure were investigated. The current study shows the longer-term (6–12 months) effects of the procedure on the serum FA profile. We found that although n-3 polyunsaturated FA levels started to decrease 3 months after surgery, they normalized over a longer period of time (6–12 months). Furthermore, we observed a strong decrease in ultra-long-chain FAs and an increase in odd-chain FAs over a longer time after kidney transplantation. All of the above FAs may have an important impact on human health, including inflammation, cardiovascular risk or cancer risk. Conclusions: The changes in serum FA profiles after kidney transplantation are a dynamic process and that more detailed studies could provide an accurate indication for supplementation with some FAs or diet modification. Full article
(This article belongs to the Special Issue Nutritional Derangements and Sarcopenia in Chronic Kidney Disease)
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14 pages, 875 KiB  
Article
Compliance with a Healthful Plant-Based Diet Is Associated with Kidney Function in Patients with Autosomal Dominant Polycystic Kidney Disease
by Sumin Heo, Miyeun Han, Hyunjin Ryu, Eunjeong Kang, Minsang Kim, Curie Ahn, Soo Jin Yang and Kook-Hwan Oh
Nutrients 2024, 16(16), 2749; https://doi.org/10.3390/nu16162749 - 17 Aug 2024
Viewed by 1399
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is a genetic kidney disorder with multiple cyst formation that progresses to chronic kidney disease (CKD) and end-stage kidney disease. Plant-based diets have attracted considerable attention because they may prevent CKD development. This study investigated whether adherence [...] Read more.
Autosomal dominant polycystic kidney disease (ADPKD) is a genetic kidney disorder with multiple cyst formation that progresses to chronic kidney disease (CKD) and end-stage kidney disease. Plant-based diets have attracted considerable attention because they may prevent CKD development. This study investigated whether adherence to a plant-based diet is associated with kidney function in patients with ADPKD. The overall plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI) were calculated using dietary intake data. Among 106 ADPKD patients, 37 (34.91%) were classified as having advanced CKD (eGFR < 60 mL/min/1.73 m2). The overall PDI and hPDI were lower, but the uPDI was higher in patients with advanced CKD than in those with early CKD. The hPDI was negatively correlated with the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio. Moreover, the hPDI was inversely associated with advanced CKD [odds ratio (OR): 0.117 (95% confidence interval (CI): 0.039–0.351), p < 0.001], and the uPDI was positively associated with advanced CKD [OR: 8.450 (95% CI: 2.810–25.409), p < 0.001]. The findings of the current study demonstrate that greater adherence to a healthful plant-based diet is associated with improved kidney function in ADPKD patients. Full article
(This article belongs to the Special Issue Nutritional Derangements and Sarcopenia in Chronic Kidney Disease)
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11 pages, 617 KiB  
Article
Frailty Is Associated with Malnutrition–Inflammation Syndrome in Older CKD Patients
by Paolo Molinari, Lara Caldiroli, Matteo Abinti, Luca Nardelli, Silvia Armelloni, Matteo Cesari, Giuseppe Castellano and Simone Vettoretti
Nutrients 2024, 16(16), 2626; https://doi.org/10.3390/nu16162626 - 9 Aug 2024
Viewed by 1002
Abstract
Patients affected by chronic kidney disease (CKD) are generally considered to be frailer than those with preserved renal function. We cross-sectionally evaluated the associations between frailty, malnutrition–inflammation syndrome and circulating inflammatory cytokines in 115 older individuals with advanced CKD. As for frailty definition, [...] Read more.
Patients affected by chronic kidney disease (CKD) are generally considered to be frailer than those with preserved renal function. We cross-sectionally evaluated the associations between frailty, malnutrition–inflammation syndrome and circulating inflammatory cytokines in 115 older individuals with advanced CKD. As for frailty definition, we adopted Fried’s frailty phenotype (FP), while malnutrition–inflammation syndrome was assessed using the Malnutrition–Inflammation Score (MIS) and circulating inflammatory cytokines (IL-6; TNFα; MCP-1). A total of 48 patients were frail, and mean eGFR was comparable in both frail and non-frail patients (24 ± 10 vs. 25 ± 11 mL/min/1.73 m2; p = 0.63). Frail patients had higher MIS (6 [4–11] vs. 4 [3–5]; p < 0.0001) but cytokine concentrations were comparable in both groups. At multivariate regression, FP was independently associated with MIS, age, gender and pre-albumin but not with cytokines. However, we found some associations between inflammatory cytokines and some specific frailty criteria: weight loss and slowness were associated with MCP-1 (respectively p = 0.049 and p < 0.0001) and weakness with IL-6 (p = 0.005); in conclusion, in older patients with advanced CKD, frailty is strictly associated with malnutrition–inflammation syndrome but not with circulating inflammatory cytokines. Full article
(This article belongs to the Special Issue Nutritional Derangements and Sarcopenia in Chronic Kidney Disease)
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20 pages, 1833 KiB  
Article
Adipokines and Myokines as Markers of Malnutrition and Sarcopenia in Patients Receiving Kidney Replacement Therapy: An Observational, Cross-Sectional Study
by Sylwia Czaja-Stolc, Antoine Chatrenet, Marta Potrykus, Jakub Ruszkowski, Massimo Torreggiani, Monika Lichodziejewska-Niemierko, Alicja Dębska-Ślizień, Giorgina Barbara Piccoli and Sylwia Małgorzewicz
Nutrients 2024, 16(15), 2480; https://doi.org/10.3390/nu16152480 - 31 Jul 2024
Viewed by 1654
Abstract
Chronic kidney disease (CKD) is linked to an elevated risk of malnutrition and sarcopenia, contributing to the intricate network of CKD-related metabolic disorders. Adipokines and myokines are markers and effectors of sarcopenia and nutritional status. The aim of this study was to assess [...] Read more.
Chronic kidney disease (CKD) is linked to an elevated risk of malnutrition and sarcopenia, contributing to the intricate network of CKD-related metabolic disorders. Adipokines and myokines are markers and effectors of sarcopenia and nutritional status. The aim of this study was to assess whether the adipokine–myokine signature in patients on kidney replacement therapy could help identify malnutrition and sarcopenia. The study involved three groups: 84 hemodialysis (HD) patients, 44 peritoneal dialysis (PD) patients, and 52 kidney transplant recipients (KTR). Mean age was 56.1 ± 16.3 years. Malnutrition was defined using the 7-Point Subjective Global Assessment (SGA) and the Malnutrition-Inflammation Score (MIS). Sarcopenia was diagnosed based on reduced handgrip strength (HGS) and diminished muscle mass. Concentrations of adipokines and myokines were determined using the enzyme-linked immunosorbent assay (ELISA). 32.8% of all study participants were identified as malnourished and 20.6% had sarcopenia. For malnutrition, assessed using the 7-Point SGA, in ROC analysis albumin (area under the curve (AUC) 0.67 was the best single biomarker identified. In dialysis patients, myostatin (AUC 0.79) and IL-6 (AUC 0.67) had a high discrimination value for sarcopenia, and we were able to develop a prediction model for sarcopenia, including age, albumin, adiponectin, and myostatin levels, with an AUC of 0.806 (95% CI: 0.721–0.891). Adipokines and myokines appear to be useful laboratory markers for assessing malnutrition and sarcopenia. The formula we propose could contribute to a better understanding of sarcopenia and potentially lead to more effective interventions and management strategies for dialysis patients. Full article
(This article belongs to the Special Issue Nutritional Derangements and Sarcopenia in Chronic Kidney Disease)
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