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 January Research and News.
Happy New Year!
Varied Treatment Effects of Intensive Glycemic Control in ACCORD
A post-hoc analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial by Charu et al. examines the variable effects of intensive glycemic control on kidney microvascular outcomes and mortality in patients with type II diabetes.
The study utilized the kidney failure risk equation (KFRE) to stratify the ACCORD trial population into quartiles based on their 5-year kidney failure risk.
The analysis revealed that the benefits and risks of intensive glycemic control varied with the baseline risk of kidney failure. Patients with a higher baseline risk derived more benefit in terms of reducing kidney microvascular outcomes (with a 7-year restricted-mean-survival-time [RMST] difference of 114.8 days) compared to the overall trial population (48.4 days).
However, this group also experienced a significantly shorter time to death (7-year RMST difference of -56.7 days) compared to the overall effect in the trial (-23.6 days).
Why is this important
This study highlights the importance of individualizing glycemic targets in patients with type II diabetes, especially those with varying risks of kidney failure.
The findings suggest that while intensive glycemic control can be more beneficial for patients at higher risk of kidney microvascular complications, it may also increase their risk of mortality.
This underscores the need for careful patient selection and risk stratification when considering intensive glycemic control strategies.
Understanding the heterogeneous effects of such treatments can guide clinicians in balancing the benefits and risks, ultimately leading to more personalized and effective diabetes management.
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Vitamin K2 Supplementation in Dialysis Patients Did Not Lead to Increased Coagulation
This study is coming from the dialysis world. It was published ahead of print in the Journal of Renal Nutrition.
The study focused on the effects of vitamin K (MK-7) supplementation on patients undergoing dialysis, who typically exhibit poor functional vitamin K status, and aimed to assess the potential procoagulant effects of such supplementation.
The double-blinded, placebo-controlled trial involved 123 dialysis patients randomized to receive either vitamin K (MK-7, 360 ug/daily, n=61) or a placebo (n=62) for a period of 52 weeks.
Various biomarkers of coagulation, including thrombin generation and clot activities of vitamin K-dependent coagulation factors, were measured at the beginning and end of the intervention. Additionally, vascular adverse events (AE) and serious adverse events (SAE) were monitored.
The results showed a significant decrease in PIVKA-II, a marker of vitamin K deficiency, in the vitamin K group compared to the placebo group after one year.
However, no significant between-group differences or within-group changes were observed for other biomarkers of coagulation. Importantly, there were no differences in AE and SAE, including vascular events or death, between the two groups.
Why is this important
This study’s findings are significant as they indicate that a one-year regimen of vitamin K2 supplementation does not lead to detectable effects on coagulation activation or increase the risk of vascular events or death in patients on dialysis.
This addresses a crucial concern about the potential procoagulant effects of vitamin K2 supplementation in this vulnerable patient group. By demonstrating the safety of vitamin K2 supplementation, this research could pave the way for its wider use in managing functional vitamin K deficiency in dialysis patients, potentially helping to mitigate the risk of vascular calcification associated with this condition.
We believe that supplementing vitamin K2 should go hand in hand with adequate supplementation of vitamin D3 and starts earlier in chronic kidney disease (as early as stage 2).
D-Alanine’s Impacts the Circadian Clock and Glucose Metabolism in the Kidneys
Sakai et al.’s study investigates the role of d-alanine in regulating glucose metabolism through the circadian clock in kidneys.
Using high-performance liquid chromatography, the study measured d-alanine in mice blood and urine, discovering a clear intrinsic circadian rhythm. This rhythm was regulated by the kidney through urinary excretion.
In the kidneys, d-alanine-induced genes that are involved in gluconeogenesis and circadian rhythm, notably stimulating glucose production in mice, especially in kidney proximal tubular cells, but not in liver cells.
The study also explored the intraday variation in the gluconeogenetic effect of d-alanine, partially mediated through the circadian transcriptional network. Under constant darkness, d-alanine normalized the circadian cycle of behavior and kidney gene expressions.
Why this is important
This research is significant as it sheds light on a novel aspect of kidney physiology and its impact on systemic glucose metabolism.
The findings that d-alanine influences gluconeogenesis and circadian rhythm in the kidney provide new insights into how circadian rhythms regulate metabolic processes, especially in conditions like diabetes where glucose regulation is disrupted.
Understanding the role of d-alanine could lead to innovative therapeutic strategies for managing glucose metabolism in lifestyle-related diseases and benefiting shift workers, whose natural circadian rhythms are often disrupted.
This study also opens up new avenues for exploring dietary and pharmacological interventions targeting circadian rhythms to improve metabolic health.
The Clinical and Pathological Characteristics of Patients with Oxalate Nephropathy
In a study conducted at the Cleveland Clinic from January 2015 to March 2023, Llanos et al. examined the clinical and pathological characteristics of oxalate nephropathy (ON), a condition marked by the deposition of calcium oxalate crystals in the kidneys.
The study, one of the largest of its kind, analyzed 60 native kidney biopsies, ultimately focusing on 31 patients after excluding those with clinically insignificant biopsies or lacking data.
The mean age of patients at diagnosis was 66.2 years, with a slight female majority. Common comorbidities included hypertension (87.1%), diabetes (58.1%), nephrolithiasis (42%), and chronic kidney disease (77.4%).
The biopsies revealed abundant calcium oxalate crystal deposits, with acute tubular injury and diabetic glomerulosclerosis being the most frequent additional diagnoses. Notably, interstitial fibrosis was present in a significant number of cases.
The study observed that oxalate nephropathy often presented as acute kidney injury (AKI) or acute on chronic kidney disease (CKD), with a poor prognosis.
Most patients required dialysis at presentation, and the mortality rate was high. The study also noted an increase in vitamin C intake post-COVID pandemic, which might contribute to the condition.
Why this is important
This study is crucial as it provides a detailed understanding of oxalate nephropathy, a condition that is often underrecognized yet has significant implications.
The findings highlight the severity of ON, with high rates of dialysis dependency and mortality, stressing the need for early recognition and management.
Understanding the risk factors and clinical course of ON can aid clinicians in prompt diagnosis and tailored treatment strategies, potentially improving patient outcomes.
Additionally, the study’s insight into the potential role of dietary factors, such as increased vitamin C intake, in the development of ON is particularly relevant in the context of changing dietary habits and the post-COVID-19 pandemic era.
Review article of the month
Exercise and Kidney Disease
While there is still a need for further research in this field, there is a tremendous body of evidence supporting the role of exercise in slowing the progression of kidney disease.
This review article summarizes all the studies about the benefits of exercise in kidney disease.
You can download the full PDF here.
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