Browsing by Author "Lambert, Kelly"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    New Insights Into Dietary Approaches to Potassium Management in Chronic Kidney Disease
    (Elsevier, 2023) Sumida, Keiichi; Biruete, Annabel; Kistler, Brandon M.; Khor, Ban-Hock; Ebrahim, Zarina; Giannini, Rossella; Sussman-Dabach, Elizabeth J.; Avesani, Carla Maria; Chan, Maria; Lambert, Kelly; Wang, Angela Yee-Moon; Clegg, Deborah J.; Burrowes, Jerrilynn D.; Palmer, Biff F.; Carrero, Juan-Jesus; Kovesdy, Csaba P.; Nutrition and Dietetics, School of Health and Human Sciences
    Potassium disorders are one of the most common electrolyte abnormalities in patients with chronic kidney disease (CKD), contributing to poor clinical outcomes. Maintaining serum potassium levels within the physiologically normal range is critically important in these patients. Dietary potassium restriction has long been considered a core strategy for the management of chronic hyperkalemia in patients with CKD. However, this has been challenged by recent evidence suggesting a paradigm shift toward fostering more liberalized, plant-based dietary patterns. The advent of novel potassium binders and an improved understanding of gastrointestinal processes involved in potassium homeostasis (e.g., gastrointestinal potassium wasting) may facilitate a paradigm shift and incorporation of heart-healthy potassium-enriched food sources. Nevertheless, uncertainty regarding the risk-benefit of plant-based diets in the context of potassium management in CKD remains, requiring well-designed clinical trials to determine the efficacy of dietary potassium manipulation toward improvement of clinical outcomes in patients with CKD.
  • Thumbnail Image
    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 Medicine
    While 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.
  • Thumbnail Image
    Item
    Targeting the Gut Microbiota in Kidney Disease: The Future in Renal Nutrition and Metabolism
    (Elsevier, 2023) Lambert, Kelly; Rinninella, Emanuele; Biruete, Annabel; Sumida, Keiichi; Stanford, Jordan; Raoul, Pauline; Mele, Maria Cristina; Wang, Angela Yee-Moon; Mafra, Denise; Medicine, School of Medicine
    There is increasing interest in the therapeutic potential of manipulating the gut microbiome of patients with chronic kidney disease (CKD). This is because there is a substantial deviation from a balanced gut microbiota profile in CKD, with many deleterious downstream effects. Nutritional interventions such as plant-based diets with reduced animal protein intake and the use of probiotics, prebiotics, and synbiotics may alter the microbiome. This article aims to briefly describe what is known about the gut microbiome in patients with CKD, factors contributing to gut dysbiosis, and outline important evidence gaps. Future potential therapies, including restoring the microbiota with food and microbiota-based and metabolomic-based therapies, are also discussed.