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Browsing by Author "Meade, Anthony"
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Item Deconstructing Disease-Related Malnutrition: A New Assessment Framework for Clinical Practice(Elsevier, 2023-04-27) St-Jules, David E.; Lloyd, Lyn; Meade, Anthony; Biruete, Annabel; Kistler, Brandon; Carrero, Juan-Jesus; Medicine, School of MedicineProtein-energy wasting (PEW) is a key cause of functional impairment and poor health outcomes in people with chronic kidney disease. While PEW can be mitigated with nutrition therapy, it is a complex myriad of disorders with numerous interacting etiologies and corresponding presentations, which make it difficult to diagnose and manage in practice. A variety of scoring rubrics have been developed to facilitate malnutrition assessment. Although these tools have greatly benefited the recognition and treatment of PEW, the typical format of grading specified PEW indicators has the potential to overlook or overstate highly relevant individual-specific factors. This review presents a simple framework for malnutrition assessment that can be used to complement and evaluate conventional assessment tools. Unlike standard tools, which are designed to identify and rate malnutrition risk and severity, the malnutrition framework is conceptual model that organizes PEW assessment into three distinct, but interacting facets of PEW risk: nutrient balance, nutrition status, and malnutrition risk. The new framework encourages critical thinking about PEW risk that may help clinicians plan and interpret assessments to efficiently and effectively manage this condition.Item Global Policy Barriers and Enablers to Exercise and Physical Activity in Kidney Care(Elsevier, 2022-07) Bennett, Paul N.; Kohzuki, Masahiro; Bohm, Clara; Roshanravan, Baback; Bakker, Stephan J. L.; Viana, Joao L.; MacRae, Jennifer M.; Wilkinson, Thomas J.; Wilund, Kenneth R.; Van Craenenbroeck, Amaryllis H.; Sakkas, Giorgos K.; Mustata, Stefan; Fowler, Kevin; McDonald, Jamie; Aleamany, Geovana Martin; Anding, Kirsten; Avin, Keith G.; Escobar, Gabriela Leal; Gabrys, Iwona; Goth, Jill; Isnard, Myriam; Jhamb, Manisha; Kim, Jun Chul; Li, John Wing; Lightfoot, Courtney J.; McAdams-DeMarco, Mara; Manfredini, Fabio; Meade, Anthony; Molsted, Stig; Parker, Kristen; Seguri-Orti, Eva; Smith, Alice C.; Verdin, Nancy; Zheng, Jing; Zimmerman, Deb; Thompson, Stephanie; Global Renal Exercise Network (GREX); Medicine, School of MedicineObjective Impairment in physical function and physical performance leads to decreased independence and health-related quality of life in people living with chronic kidney disease and end-stage kidney disease. Physical activity and exercise in kidney care are not priorities in policy development. We aimed to identify global policy-related enablers, barriers, and strategies to increase exercise participation and physical activity behavior for people living with kidney disease. Design and Methods Guided by the Behavior Change Wheel theoretical framework, 50 global renal exercise experts developed policy barriers and enablers to exercise program implementation and physical activity promotion in kidney care. The consensus process consisted of developing themes from renal experts from North America, South America, Continental Europe, United Kingdom, Asia, and Oceania. Strategies to address enablers and barriers were identified by the group, and consensus was achieved. Results We found that policies addressing funding, service provision, legislation, regulations, guidelines, the environment, communication, and marketing are required to support people with kidney disease to be physically active, participate in exercise, and improve health-related quality of life. We provide a global perspective and highlight Japanese, Canadian, and other regional examples where policies have been developed to increase renal physical activity and rehabilitation. We present recommendations targeting multiple stakeholders including nephrologists, nurses, allied health clinicians, organizations providing renal care and education, and renal program funders. Conclusions We strongly recommend the nephrology community and people living with kidney disease take action to change policy now, rather than idly waiting for indisputable clinical trial evidence that increasing physical activity, strength, fitness, and function improves the lives of people living with kidney disease.Item 'Phos'tering a Clear Message: The Evolution of Dietary Phosphorus Management in Chronic Kidney Disease(Elsevier, 2023) Biruete, Annabel; Hill Gallant, Kathleen M.; Lloyd, Lyn; Meade, Anthony; Moe, Sharon M.; St-Jules, David; Kistler, Brandon M.; Nutrition and Dietetics, School of Health and Human SciencesPhosphorus is a vital nutrient, but disturbances in phosphorus homeostasis are central to chronic kidney disease-mineral and bone disorder. To minimize disturbances, traditional dietary guidance focused on a numerical phosphorus target leading to the exclusion of many healthy foods and implementation challenges. Contemporary phosphorus guidance focuses on dietary source, avoiding additives, and emphasizing low-phosphorus bioaccessibility foods, leading to a more liberal approach. Additional work is needed to demonstrate the efficacy of these contemporary approaches and understand the influence of specific foods, processing, and cooking methods. Unfortunately, patient education using traditional and contemporary strategies may give mixed messages, particularly related to plant-based foods. Thus, greater clarity on the effects of specific foods and dietary patterns may improve phosphorus education. This review aims to discuss the evolution of dietary phosphorus management while highlighting areas for future research that can help move the field toward stronger evidence-based guidance to prevent and treat hyperphosphatemia.