As we delve deep into countless medical journals to uncover the latest on Integrative Medicine’s approach to kidney health, we are always reminded of the value of your time. Our commitment remains steadfast in curating and succinctly summarizing these vital studies for you. Welcome to the October Research and News.
Adding urinary biomarkers may improve the prediction of CKD progression
Published in July 2023 edition of The Lancet, this study evaluated the potential of urinary biomarkers in predicting the progression of chronic kidney disease (CKD).
Researchers rigorously tested 30 commercial ELISA assays, focusing on their ability to detect target analytes in urine based on FDA-approved validation criteria.
From these, 16 assays met the approval standards. Using LASSO logistic regression analysis on a subsample of 229 CKD patients, a combination of five specific biomarkers (CCL2, EGF, KIM1, NGAL, and TGF-α) was found to enhance the prediction of a rapid decline in mGFR, offering a superior prediction compared to just using traditional variables such as age, gender, mGFR, and albuminuria.
Why is this important?
Accurate prediction of CKD progression is pivotal for timely medical interventions. This research underscores the enhanced accuracy achieved by combining multiple urinary biomarkers.
Such a comprehensive approach could lead to better therapeutic strategies, improved patient outcomes, and potential cost savings in CKD treatments.
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Inflammatory bowel disease is associated with an increased risk of kidney disease
A study published in August of 2023 sought to determine if there was a connection between inflammatory bowel disease (IBD) and an increased risk of chronic kidney disease (CKD) and acute kidney injury (AKI) within the general population.
For this investigation, data from the UK Biobank, encompassing 417,302 participants (spanning 2006-2010), was analyzed. This included individuals with ulcerative colitis and Crohn’s disease but excluded those with prior CKD and AKI.
Over a median duration of 12.5 years, results revealed that participants with IBD had elevated hazard ratios for both CKD and AKI, even after adjusting for a variety of factors, including age, sex, race, biological factors, behavioral tendencies, socioeconomic status, mental health, and self-rated health.
Notably, this association was evident regardless of genetic risks for kidney diseases. Moreover, younger IBD patients exhibited a stronger association with the risks of developing CKD and AKI than their older counterparts.
Why is this important?
This study highlights the role of gut health in the development of kidney disease. This is what we describe as the gut-kidney connection.
Identifying the links between IBD and the risks of CKD and AKI is vital for patient care. Recognizing this association enables healthcare providers to monitor and intervene earlier, potentially preventing or mitigating kidney-related complications in IBD patients. This can significantly improve the prognosis and quality of life for these individuals.
Calprotectin may contribute to vascular calcification in CKD
Calprotectin is a protein found in the white blood cells, primarily neutrophils. This protein is released during inflammation and serves as a marker for several conditions, like inflammatory bowel disease.
Recently, the role of calprotectin in the context of vascular health, especially in patients with chronic kidney disease (CKD), has garnered significant attention.
Chronic kidney disease (CKD) has been linked to enhanced vascular calcification, a factor known to raise the risk of cardiovascular mortality in these patients. However, the precise mechanisms behind this association remained elusive.
In a detailed study led by Amaya-Garrido and her team, they embarked on a proteomic analysis of two sets of patients: those with moderate CKD (stage 3-4) and severe CKD patients on dialysis (stage 5). Their findings spotlighted increased levels of calprotectin as being correlated with a heightened risk of cardiovascular complications and mortality.
They further explored the effects of calprotectin on vascular smooth muscle cells (VSMCs), wherein its presence exacerbated calcification.
Interestingly, when treated with a calprotectin inhibitor called paquinimod, this calcification could be staved off. This inhibitory effect extended to mice with CKD induced by nephrectomy and even aged mice deficient in apolipoprotein E.
This extensive research underscores the pivotal role of calprotectin in driving vascular calcification, with its levels in the bloodstream being strongly linked to calcification severity, cardiovascular outcomes, and mortality in CKD patients.
Why is this important?
The discovery of calprotectin’s role in vascular calcification in CKD patients presents a new avenue for potential therapeutic interventions.
With vascular calcification being a significant contributor to cardiovascular mortality in CKD patients, strategies inhibiting calprotectin may offer a promising approach to curb this risk, improving the overall prognosis for these individuals.
Simple, low-cost intervention proves effective in reducing salt intake in CKD patients
Managing dietary habits, specifically salt intake, is crucial for people diagnosed with CKD. High salt intake can exacerbate blood pressure issues and potentially accelerate kidney damage in these patients.
In a recent multicenter randomized controlled trial, O’Callaghan and his team delved into the effectiveness of a simple, inexpensive intervention to empower CKD patients to reduce their salt intake. This initiative termed the OxSalt care bundle intervention, was tested against standard care over a month.
The study participants were CKD patients with an eGFR greater than 20 ml/min per 1.73 m^2, enlisted from primary and secondary care facilities.
The primary objective was to measure the reduction in salt consumption, gauged by a 24-hour urinary sodium excretion test after a month of the intervention. Out of the 201 participants, those in the intervention group witnessed a notable drop in their salt intake by 1.9 (±2.9) g/d, a stark contrast to the 0.4 (±2.7) g/d decline in the control group.
Interestingly, the intervention group still demonstrated a decrease, though marginal, in their salt intake in the subsequent year.
Why is this important?
Dietary salt reduction plays a role in the management and progression of CKD. The findings from this study underline the potential of a basic, cost-effective intervention in instigating a positive dietary change among CKD patients.
Such scalable and easy-to-implement interventions can have far-reaching benefits in improving the health and well-being of CKD patients across diverse care settings.
The persistent effect observed even after the intervention ended adds further weight to the potential long-term impact of the OxSalt initiative. You can download the OxSalt intervention here.
Review Article of the Month
Subtle changes in platelet count and volume may indicate risk of bleeding or clotting in CKD
A perspective article in JASN noted that subtle changes in platelet count and platelet volume may indicate which patients with CKD are at risk of bleeding or thrombosis.
It recommends complete blood counts for predicting such risk to optimize the use of anti-platelet drugs in this patient population.
You can download the full PDF here.
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