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Serum uric acid and mortality risk among maintenance hemodialysis patients
허인경,최수정,Kamyar Kalantar-Zadeh 대한신장학회 2017 Kidney Research and Clinical Practice Vol.36 No.4
Our understanding of the role of serum uric acid in the general population has changed since the 1950s [1]. Hyperuricemia was originally considered to be a consequence of renal insufficiency and associated with a variety of cardiovascular diseases, and several studies suggested that hyperuricemia can cause hypertension, renal insufficiency and metabolic syndrome. However, the role of serum uric acid remains unclear in the maintenance hemodialysis (MHD) patient population.
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( Gang-jee Ko ),( Kamyar Kalantar-zadeh ) 대한내과학회 2021 The Korean Journal of Internal Medicine Vol.36 No.4
High dietary protein intake may lead to increased intraglomerular pressure and glomerular hyperfiltration, which in the long-term can lead to de novo or aggra vating preexisting chronic kidney disease (CKD). Hence, a low protein diet (LPD, 0.6 to 0.8 g/kg/day) is recommended for the management of CKD. There are ev idences that dietary protein restriction mitigate progression of CKD and retard the initiation of dialysis or facilitate incremental dialysis. LPD is also helpful to control metabolic derangements in CKD such as metabolic acidosis and hyper phosphatemia. Recently, a growing body of evidence has emerged on the benefits of plant-dominant low-protein diet (PLADO), which composed of > 50% plant-based sources. PLADO is considered to be helpful for relieving uremic burden and metabolic complications in CKD compared to animal protein dominant con sumption. It may also lead to favorable alterations in the gut microbiome, which can modulate uremic toxin generation along with reducing cardiovascular risk. Alleviation of constipation in PLADO may minimize the risk of hyperkalemia. A balanced and individualized dietary approach for good adherence to LPD utiliz ing various plant-based sources as patients’ preference should be elaborated for the optimal care in CKD. Periodic nutritional assessment under supervision of trained dietitians should be warranted to avoid protein-energy wasting.
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Cardiorenal syndrome and vitamin D receptor activation in chronic kidney disease
( Sirous Darabian ),( Manoch Rattanasompattiku ),( Parta Hatamizadeh ),( Suphamai Bunnapradist ),( Matthew J. Budoff ),( Csaba P. Kovesdy ),( Kamyar Kalantar Zadeh ) 대한신장학회 2012 Kidney Research and Clinical Practice Vol.31 No.1
Cardiorenal syndrome (CRS) refers to a constellation of conditions whereby heart and kidney diseases are pathophysiologically connected. For clinical purposes, it would be more appropriate to emphasize the pathophysiological pathways to classify CRS into: (1) hemodynamic, (2) atherosclerotic, (3) uremic, (4) neurohumoral, (5) anemic·hematologic, (6) inflammatory·oxidative, (7) vitamin D receptor (VDR) and/or FGF23-, and (8) multifactorial CRS. In recent years, there have been a preponderance data indicating that vitamin D and VDR play an important role in the combination of renal and cardiac diseases. This review focuses on some important findings about VDR activation and its role in CRS, which exists frequently in chronic kidney disease patients and is a main cause of morbidity and mortality. Pathophysiological pathways related to suboptimal or defective VDR activation may play a role in causing or aggravating CRS. VDR activation using newer agents including vitamin D mimetics (such as paricalcitol and maxacalcitol) are promising agents, which may be related to their selectivity in activating VDR by means of attracting different post-D-complex cofactors. Some, but not all, studies have confirmed the survival advantages of D-mimetics as compared to non-selective VDR activators. Higher doses of D-mimetic per unit of parathyroid hormone (paricalcitol to parathyroid hormone ratio) is associated with greater survival, and the survival advantages of African American dialysis patients could be explained by higher doses of paricalcitol (410 mg/week). More studies are needed to verify these data and to explore additional avenues for CRS management via modulating VDR pathway.
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