Browsing by Author "Kalantar-Zadeh, Kamyar"
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Item Assessing Global Kidney Nutrition Care(Wolters Kluwer, 2022) Wang, Angela Yee-Moon; Okpechi, Ikechi G.; Ye, Feng; Kovesdy, Csaba P.; Brunori, Giuliano; Burrowes, Jerrilynn D.; Campbell, Katrina; Damster, Sandrine; Fouque, Denis; Friedman, Allon N.; Garibotto, Giacomo; Guebre-Egziabher, Fitsum; Harris, David; Iseki, Kunitoshi; Jha, Vivekanand; Jindal, Kailash; Kalantar-Zadeh, Kamyar; Kistler, Brandon; Kopple, Joel D.; Kuhlmann, Martin; Lunney, Meaghan; Mafra, Denise; Malik, Charu; Moore, Linda W.; Price, S. Russ; Steiber, Alison; Wanner, Christoph; Wee, Pieter Ter; Levin, Adeera; Johnson, David W.; Bello, Aminu K.; Medicine, School of MedicineBackground 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.Item The International Society of Renal Nutrition and Metabolism Commentary on the National Kidney Foundation and Academy of Nutrition and Dietetics KDOQI Clinical Practice Guideline for Nutrition in Chronic Kidney Disease(Elsevier, 2021) Kistler, Brandon M.; Moore, Linda W.; Benner, Debbie; Biruete, Annabel; Boaz, Mona; Brunori, Giuliano; Chen, Jing; Drechsler, Christiane; Guebre-Egziabher, Fitsum; Hensley, Mary Kay; Iseki, Kunitoshi; Kovesdy, Csaba P.; Kuhlmann, Martin K.; Saxena, Anita; Wee, Pieter Ter; Brown-Tortorici, Amanda; Garibotto, Giacomo; Price, S. Russ; Wang, Angela Yee-Moon; Kalantar-Zadeh, Kamyar; Medicine, School of MedicineThe Academy of Nutrition and Dietetics and the National Kidney Foundation collaborated to provide an update to the Clinical Practice Guidelines (CPG) for nutrition in chronic kidney disease (CKD). These guidelines provide a valuable update to many aspects of the nutrition care process. They include changes in the recommendations for nutrition screening and assessment, macronutrients, and targets for electrolytes and minerals. The International Society of Renal Nutrition and Metabolism assembled a special review panel of experts and evaluated these recommendations prior to public review. As one of the highlights of the CPG, the recommended dietary protein intake range for patients with diabetic kidney disease is 0.6-0.8 g/kg/day, whereas for CKD patients without diabetes it is 0.55-0.6 g/kg/day. The International Society of Renal Nutrition and Metabolism endorses the CPG with the suggestion that clinicians may consider a more streamlined target of 0.6-0.8 g/kg/day, regardless of CKD etiology, while striving to achieve intakes closer to 0.6 g/kg/day. For implementation of these guidelines, it will be important that all stakeholders work to detect kidney disease early to ensure effective primary and secondary prevention. Once identified, patients should be referred to registered dietitians or the region-specific equivalent, for individualized medical nutrition therapy to slow the progression of CKD. As we turn our attention to the new CPG, we as the renal nutrition community should come together to strengthen the evidence base by standardizing outcomes, increasing collaboration, and funding well-designed observational studies and randomized controlled trials with nutritional and dietary interventions in patients with CKD.Item Kidney Health for Everyone Everywhere - From Prevention to Detection and Equitable Access to Care(Medknow Publications, 2020-03) Li, Philip Kam-Tao; Garcia-Garcia, Guillermo; Lui, Siu-Fai; Andreoli, Sharon; Fung, Winston Wing-Shing; Hradsky, Anne; Kumaraswami, Latha; Liakopoulos, Vassilios; Rakhimova, Ziyoda; Saadi, Gamal; Strani, Luisa; Ulasi, Ifeoma; Kalantar-Zadeh, Kamyar; World Kidney Day Steering Committee; Medicine, School of MedicineThe global burden of chronic kidney disease (CKD) is rapidly increasing with a projection of becoming the 5th most common cause of years of life lost globally by 2040. Aggravatingly, CKD is a major cause of catastrophic health expenditure. The costs of dialysis and transplantation consume up to 3% of the annual healthcare budget in high-income countries. Crucially, however, the onset and progression of CKD is often preventable. In 2020, the World Kidney Day campaign highlights the importance of preventive interventions - be it primary, secondary or tertiary. This complementing article focuses on outlining and analyzing measures that can be implemented in every country to promote and advance CKD prevention. Primary prevention of kidney disease should focus on the modification of risk factors and addressing structural abnormalities of the kidney and urinary tracts, as well as exposure to environmental risk factors and nephrotoxins. In persons with pre-existing kidney disease, secondary prevention, including blood pressure optimization and glycemic control, should be the main goal of education and clinical interventions. In patients with advanced CKD, management of co-morbidities such as uremia and cardiovascular disease is a highly recommended preventative intervention to avoid or delay dialysis or kidney transplantation. Political efforts are needed to proliferate the preventive approach. While national policies and strategies for non-communicable diseases might be present in a country, specific policies directed toward education and awareness about CKD screening, management and treatment are often lacking. Hence, there is an urgent need to increase the awareness of the importance of preventive measures throughout populations, professionals and policy makers.Item Kidney Nutrition in the Era of Social Media: Bridging the Gap of Nutrition Education and Kidney Health Literacy by Leveraging Resources of Social Networking(Elsevier, 2022) Biruete, Annabel; Kistler, Brandon M.; Kalantar-Zadeh, Kamyar; Moore, Linda W.; Medicine, School of MedicineItem Living well with kidney disease by patient and care partner empowerment: kidney health for everyone everywhere(Oxford, 2021-02) Kalantar-Zadeh, Kamyar; Li, Philip Kam-Tao; Tantisattamo, Ekamol; Kumaraswami, Latha; Liakopoulos, Vassilios; Lui, Siu-Fai; Ulasi, Ifeoma; Andreoli, Sharon; Balducci, Alessandro; Dupuis, Sophie; Harris, Tess; Hradsky, Anne; Knight, Richard; Kumar, Sajay; Ng, Maggie; Poidevin, Alice; Saadi, Gamal; Tong, Allison; Pediatrics, School of MedicineLiving with chronic kidney disease (CKD) is associated with hardships for patients and their care partners. Empowering patients and their care partners, including family members or friends involved in their care, may help minimize the burden and consequences of CKD-related symptoms to enable life participation. There is a need to broaden the focus on living well with kidney disease and re-engagement in life, including an emphasis on patients being in control. The World Kidney Day (WKD) Joint Steering Committee has declared 2021 the year of ‘Living Well with Kidney Disease’ in an effort to increase education and awareness on the important goal of patient empowerment and life participation. This calls for the development and implementation of validated patient-reported outcome measures to assess and address areas of life participation in routine care. It could be supported by regulatory agencies as a metric for quality care or to support labeling claims for medicines and devices. Funding agencies could establish targeted calls for research that address the priorities of patients. Patients with kidney disease and their care partners should feel supported to live well through concerted efforts by kidney care communities including during pandemics. In the overall wellness program for kidney disease patients, the need for prevention should be reiterated. Early detection with a prolonged course of wellness despite kidney disease, after effective secondary and tertiary prevention programs, should be promoted. WKD 2021 continues to call for increased awareness of the importance of preventive measures throughout populations, professionals and policymakers, applicable to both developed and developing countries.Item Living Well with Kidney Disease by Patient and Care-Partner Empowerment: Kidney Health for Everyone Everywhere(Oxford, 2021-02) Kalantar-Zadeh, Kamyar; Li, Philip Kam-Tao; Tantisattamo, Ekamol; Kumaraswami, Latha; Liakopoulos, Vassilios; Lui, Siu-Fai; Ulasi, Ifeoma; Andreoli, Sharon; Balducci, Alessandro; Dupuis, Sophie; Harris, Tess; Hradsky, Anne; Knight, Richard; Kumar, Sajay; Ng, Maggie; Poidevin, Alice; Saadi, Gamal; Tong, Allison; Pediatrics, School of MedicineLiving with CKD is associated with hardships for patients and their care-partners. Empowering patients and care-partners may help minimize the burden and consequences of CKD related symptoms to enable life participation. There is a need to broaden the focus on living well with kidney disease and re-engagement in life. The World Kidney Day (WKD) Joint Steering Committee has declared 2021 the year of “Living Well with Kidney Disease” in an effort to increase education and awareness on the important goal of patient empowerment and life participation. This calls for the development and implementation of validated patient-reported outcome measures to address areas of life participation in routine care. It could be supported by regulatory agencies as a metric for quality care. Funding agencies could establish targeted calls for research that address the priorities of patients. Patients with kidney disease and their care-partners should feel supported to live well through concerted efforts by kidney care communities including during pandemics. In the overall wellness program for kidney disease patients, the need for prevention should be reiterated. WKD 2021 continues to call for increased awareness of the importance of preventive measures throughout populations, professionals, and policy makers, applicable to both developed and developing countries.Item Managing Phosphate Burden in Patients Receiving Dialysis: Beyond Phosphate Binders and Diet(Wolters Kluwer, 2023) Kalantar-Zadeh, Kamyar; Forfang, Derek; Bakris, George; Martin, Kevin J.; Moe, Sharon M.; Sprague, Stuart M.; Medicine, School of MedicineMost patients receiving dialysis rely on dietary restriction and phosphate binders to minimize the risk of hyperphosphatemia, which is associated with increased mortality. However, dietary restriction is difficult because of hidden phosphate additives in processed foods and medications. Restriction of dietary phosphate sources such as protein may increase the risk of malnutrition. Phosphate binders, the only pharmacologic option for phosphate management since aluminum salts were introduced several decades ago, are often insufficient for binding the 1400–2500 mg of phosphate potentially consumed daily. Over the last decade, serum phosphate levels in the United States have risen, and >69% of patients receiving dialysis exhibited a most recent phosphate level >4.5 mg/dl (above the normal range), indicating an urgent need for new, more effective therapies to manage phosphate burden. Novel, nonbinder therapies such as transcellular and paracellular phosphate absorption inhibitors may be used for phosphate management, and future studies should examine whether they allow fewer dietary restrictions for patients receiving dialysis, potentially improving patient quality of life and nutritional status. It is imperative that we collaborate to move beyond the restrictive approaches available today and provide patients and clinicians with an array of strategies so that they may choose the most appropriate patient-centered therapy.Item Nutritional and Dietary Management of Chronic Kidney Disease Under Conservative and Preservative Kidney Care Without Dialysis(Elsevier, 2023) Rhee, Connie M.; Wang, Angela Yee-Moon; Biruete, Annabel; Kistler, Brandon; Kovesdy, Csaba P.; Zarantonello, Diana; Ko, Gang Jee; Piccoli, Giorgina Barbara; Garibotto, Giacomo; Brunori, Giuliano; Sumida, Keiichi; Lambert, Kelly; Moore, Linda W.; Han, Seung Hyeok; Narasaki, Yoko; Kalantar-Zadeh, Kamyar; Medicine, School of MedicineWhile dialysis has been the prevailing treatment paradigm for patients with advanced chronic kidney disease (CKD), emphasis on conservative and preservative management in which dietary interventions are a major cornerstone have emerged. Based on high-quality evidence, international guidelines support the utilization of low-protein diets as an intervention to reduce CKD progression and mortality risk, although the precise thresholds (if any) for dietary protein intake vary across recommendations. There is also increasing evidence demonstrating that plant-dominant low-protein diets reduce the risk of developing incident CKD, CKD progression, and its related complications including cardiometabolic disease, metabolic acidosis, mineral and bone disorders, and uremic toxin generation. In this review, we discuss the premise for conservative and preservative dietary interventions, specific dietary approaches used in conservative and preservative care, potential benefits of a plant-dominant low-protein diet, and practical implementation of these nutritional strategies without dialysis.