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 September Research and News.
Provitamin A Carotenoids, Not Retinol, May Support Fetal Kidney Development
This prospective cohort study from Nebraska examined the relationship between maternal levels of vitamin A (retinol) and provitamin A carotenoids (α- and β-carotene) with fetal and infant kidney development.
Among 120 pregnant women, maternal retinol levels showed no significant association with fetal or infant kidney size. However, higher levels of α- and β-carotene during gestation were positively correlated with longer fetal kidney lengths, and cord blood α-carotene levels were linked to larger infant kidneys.
Changes in maternal carotenoid levels over pregnancy were also associated with kidney growth.
Why is this important?
Kidney development in utero plays a key role in long-term renal health, and impaired nephrogenesis is linked to a higher risk of chronic kidney disease later in life.
While vitamin A has been recognized as essential for fetal organogenesis, this study highlights that provitamin A carotenoids, commonly found in fruits and vegetables, may be more influential than retinol in supporting kidney development.
These findings suggest dietary carotenoid intake during pregnancy may be a modifiable factor to promote renal health in offspring.
Enteric Hyperoxaluria: Different Gut Disorders, Different Risks for Kidney Stones and ESKD
This retrospective cohort study examined 814 adult patients with enteric hyperoxaluria (EH)—a condition marked by high urinary oxalate excretion due to underlying gastrointestinal disorders.
The cohort included individuals with inflammatory bowel disease, celiac disease, exocrine pancreatic insufficiency (EPI), structural intestinal malabsorption (SIM), and bariatric surgery.
The researchers assessed kidney stone event rates and end-stage kidney disease (ESKD) incidence. Patients with SIM and EPI had the highest rates of kidney stone formation, while SIM patients also had the highest five-year ESKD risk (17.8%).
In contrast, patients with a history of bariatric surgery had the lowest stone event rates.
Why is this important?
Enteric hyperoxaluria is a well-known risk factor for calcium oxalate kidney stones and kidney disease, but this study emphasizes that not all gut-related causes carry equal risk.
Structural intestinal malabsorption and pancreatic insufficiency appear particularly dangerous, with significantly higher rates of stone formation and progression to kidney failure.
By identifying subgroups with greater metabolic risk and worse outcomes, this study supports a more personalized approach to monitoring and managing EH, especially as interventions to reduce oxalate absorption or stone risk are developed.
High BMI and Aging Jointly Drive the Rising Global Burden of Chronic Kidney Disease
Using data from the Global Burden of Disease Study 2021, this study examined trends in chronic kidney disease (CKD) attributable to high body mass index (BMI) from 1990 to 2021 and projected burden through 2050.
In 2021 alone, high BMI contributed to over 418,000 CKD-related deaths and 1.04 million disability-adjusted life years (DALYs).
Both age-standardized mortality and DALY rates showed a steady increase over time, with the burden disproportionately affecting males and varying significantly by region and socio-demographic index.
A decomposition analysis revealed that population aging plays a key role in the growing CKD burden.
Why is this important?
This study highlights the dual impact of obesity and aging on kidney health, with projections suggesting continued increases in CKD burden globally. Addressing high BMI through prevention and intervention strategies, especially in aging populations, may be critical to reducing CKD-related disability and death in the decades ahead.
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Phosphorus Content in Plant-Based Milks: Implications for Advanced CKD
This UK-based study used UV spectrophotometric analysis to evaluate phosphorus content and phosphorus-to-protein ratios (PPR) in 14 plant-based milk alternatives (PBMAs).
It found that PBMAs with phosphate additives contained significantly more phosphorus (mean 58.47 mg/100g) and had much higher PPRs (mean 197.76 mg/g protein) than additive-free options (7.38 mg/100g and 16.25 mg/g, respectively).
Some PBMAs with additives even exceeded the phosphorus content and PPR of cow’s milk. These findings suggest that phosphate additives contribute substantially to phosphorus burden in commonly consumed PBMAs.
Why is this important?
For patients with advanced chronic kidney disease, controlling dietary phosphorus is essential to prevent complications like vascular calcifications, cardiovascular disease, and mineral bone disorders.
This study highlights a previously unappreciated source of high phosphorus intake, phosphate additives in PBMAs, which are often not readily apparent from product labeling. Choosing additive-free alternatives may help patients and providers better manage phosphorus load.
Hemodialysis Depletes Protective Metabolites and Disrupts Mitochondrial Health
This metabolomics study analyzed pre- and post-dialysis plasma from 43 hemodialysis patients using UPLC-QToF-MS and found that hemodialysis significantly alters the plasma metabolome.
While harmful solutes such as 3-indoxyl sulfate and D-galactonic acid were effectively reduced, protective metabolites, including L-carnitine, quinic acid, and homocarnosine, were also depleted.
Concurrently, levels of lipotoxic intermediates, such as myristic and linoleic acids, increased. Enrichment analysis revealed disruptions across amino acid, lipid, and energy metabolism pathways.
Why is this important?
These findings reveal a hidden cost of hemodialysis: while it clears toxins, it also removes beneficial compounds, contributing to metabolic imbalance and mitochondrial dysfunction.
This may negatively affect patient outcomes and underscores the urgent need for therapies that support metabolic resilience and preserve protective metabolites during dialysis.
Review article of the month
Citrate in Autosomal Dominant Polycystic Kidney Disease: Biomarker or Therapeutic Agent?
This review examines the role of urinary citrate in autosomal dominant polycystic kidney disease (ADPKD), with a focus on its potential as both a prognostic biomarker and a therapeutic target.
Evidence from experimental and clinical studies suggests that hypocitraturia in early ADPKD may contribute to calcium microcrystal deposition, promoting cyst formation and accelerated kidney function decline.
Animal models show that citrate supplementation may help preserve glomerular filtration rate and slow cyst growth. The authors propose that urinary citrate may aid in risk stratification and potentially serve as an adjunctive therapy, although further clinical research is needed.
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