Diet Choices May Help Diabetics Stave Off Kidney Disease

Fruit, protein and moderate alcohol intake tied to lower risk of chronic disease in study.A healthy diet and moderate alcohol consumption may help people with type 2 diabetes reduce their risk of chronic kidney disease or slow its progression, a new study indicates.
Researchers looked at more than 6,200 diabetes patients, and found that nearly 32 percent of them developed chronic kidney disease and about 8 percent died during 5.5 years of follow-up.
Patients with the healthiest diets had a lower risk of kidney disease and of dying than those with the least healthy diets. Patients who ate more than three servings of fruit per week were less likely to develop chronic kidney disease than those who ate less fruit.
The study was published online Aug. 12 in the journalJAMA Internal Medicine.
Patients with the lowest intake of total and animal protein were more likely to develop kidney disease than those with the highest intake, the researchers also found. Moderate alcohol intake was associated with a lower risk of kidney disease and death. Sodium intake was not associated with kidney disease risk, according to a journal news release.
"A healthy diet and moderate intake of alcohol may decrease the incidence or progression of [chronic kidney disease] among individuals with type 2 diabetes. Sodium intake, within a wide range, and normal protein intake are not associated with [chronic kidney disease]," concluded Daniela Dunkler, of McMaster University in Ontario, Canada, and colleagues.
Could the new findings place an added burden on people who already have to be careful of their food choices?
"Patients with both type 2 diabetes and kidney disease may be frustrated by the numerous dietary restrictions that are recommended by their health care team," Dr. Holly Kramer, of Loyola University, and Dr. Alex Chang, of Johns Hopkins University, wrote in an accompanying commentary.
"Patients may even ask 'What can I eat?'" they added. "Perhaps the best dietary advice we can give to patients with type 2 diabetes and kidney disease is the same as the advice for those who want to avoid chronic kidney disease, and the same advice for preventing and treating hypertension, and the same dietary advice for everyone: Eat a diet rich in fruits and vegetables, low-fat dairy products, and whole grains while minimizing saturated and total fat."

HEALTHY DIET, MODERATE ALCOHOL LOWERS RISK OF KIDNEY DISEASE

 healthy diet and moderate alcohol consumption is linked to a decreased risk or progression of chronic kidney disease (CKD) in patients with type 2 diabetes, according to a study published by JAMA Internal Medicine.

Type 2 diabetes-related CKD has become a major public health issue. Researchers at McMaster University in Ontario, Canada examined the association of a healthy diet, alcohol, protein and sodium intake with incident or progression of CKD in patients with type 2 diabetes. The observational study included 6,213 patients with type 2 diabetes in the ONTARGET trial.

Results showed that 31.7% of patients developed CKD and 8.3% of patients died after 5.5 years of follow-up. In comparison to patients in the least healthy scoring group on an index that assessed diet quality, patients in the healthiest group showed a lower risk of developing CKD as well as mortality. Those patients that ate more than three servings of fruits per week had a lower risk of CKD, compared to those who ate fruit less frequently. Patients in the lowest group of total and animal protein intake had an increased risk of CKD compared with patients in the highest group. Also, sodium intake was not associated with CKD, but moderate alcohol intake reduced the risk of developing CKD and mortality. Findings from the study showed that a healthy diet as well as moderate alcohol intake can decrease the risk or progression of CKD among those with type 2 diabetes.

How Does Acute Pain Become Chronic?

Chronic pain is a major medical problem, affecting as many as 100 million Americans, robbing them of a full sense of well-being, disrupting their ability to work and earn a living, and causing untold suffering for the patient and family. This condition costs the country an estimated $560-635 billion annually—a staggering economic burden [1]. Worst of all, chronic pain is often resistant to treatment. NIH launched the Grand Challenge on Chronic Pain [2] to investigate how acute pain (which is part of daily experience) evolves into a chronic condition and what biological factors contribute to this transition.

But you may wonder: what, exactly, is the difference between acute and chronic pain?

Acute pain is an intensely unpleasant sensation transmitted by the nervous system to alert you to a real or impending injury—like a bruise, cut, or burn—or an infection like a toothache. It’s a warning that something’s wrong with your body, and that you need to take action. It can trigger you to remove your hand from a hot stove or to get rid of that pair of shoes that make your feet hurt every time you wear them. Pain is a powerful protective mechanism: those who cannot feel it, whether from a genetic condition or from an acquired disease of peripheral nerves like leprosy, suffer very serious consequences. But normally, acute pain is short lived—when the injury has healed, the pain is gone.

But in some situations, this acute pain becomes chronic, persisting for months or even years. In many instances that happens because the physiological condition is ongoing and unresolved—as in cancer or arthritis. But in some instances, the pain doesn’t appear to be caused by any disease, injury, or detectable damage to the nervous system [3]. That pain is just as real to the person suffering from it, though it is referred to as psychogenic pain.

We currently treat chronic pain with a variety of therapies, including medications, electrical stimulation, and surgery. Medications range from relatively mild over-the-counter drugs like aspirin to more powerful prescription drugs like Vicodin™ or Percocet™, which act on the brain and spinal cord to relieve pain. But these powerful narcotic drugs can cause serious side effects. They also carry the risk of addiction.

We believe that one key to developing better treatments is to identify signs that acute pain is likely to become chronic. By discovering such markers, we can personalize the treatment of pain. We could provide more aggressive treatments for those at high risk for chronic pain and minimal treatment for those likely to bounce back quickly. This would also help to reduce the risk of abuse and addiction to painkillers.

Here’s one example. We’re funding efforts to understand how the brain perceives a very common problem: back pain. Are there are biological markers that signal which patients’ pain will evolve into a more chronic form? Already, promising new fMRI brain imaging studies can predict which people will suffer from chronic pain after the acute phase [4].

We’re also looking into whether acute pain causes brain changes in certain people that might enhance pain sensitivity and lead to chronic pain. People coping with chronic pain often suffer from several conditions simultaneously—fibromyalgia and temporomandibular joint disorders or irritable bowel syndrome, for example. Is there some common mechanism?

We know there’s a significant difference in the way children, adults, and the elderly react to pain. A paper cut, for example, might cause your 6 year old to erupt in a fountain of tears, whereas most adults would just brush the injury aside. Is that because our wiring changes as we age? It’s an intriguing question, and one that we hope to answer.

We’re also investigating the use of complementary and alternative methods—like massage, acupuncture, herbal remedies, meditation, and yoga—to treat pain separately, or in addition to traditional analgesic treatments [5, 6]. As part of the Grand Challenge on Chronic Pain, we hope to understand the causes of chronic pain better—and ultimately to alleviate the suffering of millions.

References:

[1] Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research

[2] Grand Challenge on Chronic Pain

[3] NINDS Chronic Pain Information Page

4] Corticostriatal functional connectivity predicts transition to chronic back pain. Baliki MN, Petre B, Torbey S, Herrmann KM, Huang L, Schnitzer TJ, Fields HL, Apkarian AV. Nat Neurosci. 2012 Jul 1;15(8):1117-9.

[5] NINDS Hope Through Research

[6] Chronic Pain and Complementary and Alternative Medicine

Watch and Wait Works for Small Kidney Tumors For tumors less than 4 cm, no increase in risk for kidney cancer death

“Surveillance of small kidney tumors did not increase the risk of dying of kidney cancer,” said William Huang, MD, a surgical oncologist at New York University Langone Medical Center in New York City. In contrast, “surgical treatment, particularly removal of the entire kidney, was associated with cardiovascular complications and poorer survival over time.” He presented the study at the 2013 Genitourinary Cancers Symposium (abstract 343).

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In the current study, researchers set out to identify the effect of surveillance of small renal tumors on morbidity and mortality compared with surgery. They used the Surveillance, Epidemiology, and End Results cancer registry data linked to Medicare claims data, to capture patient comorbidities, for diagnoses between 2000 and 2007. The retrospective cohort study included 8,300 patients who were aged 66 years or older with kidney tumors less than 4 cm. Of these patients, 78% had surgery and 22% received surveillance.

During a median follow-up of five years, patients in the surveillance group had a 16% lower risk for death from any cause compared with the surgical group (hazard ratio [HR], 0.84; 95% confidence interval, 0.75-0.94). Kidney cancer–specific mortality did not differ significantly between the groups.

“Surveillance is a reasonable option, particularly for patients who are older or have a limited life expectancy,” said Dr. Huang. He added that a small number of small tumors can become lethal over a period of time, and therefore if a patient has a normal life expectancy, surgery should still remain the treatment of choice for these patients.

Bruce Roth, MD, a professor of medicine in the Oncology Division at Washington University in St. Louis, who was not involved in the study, said the findings were important in showing that surveillance does not have a negative influence on kidney cancer mortality. He pointed out that today, more small lesions are being identified. “In 2013, it is difficult to go to an emergency room with chest pain or abdominal pain and not come out with a CAT [computed axial tomography] scan,” he said. “The more CAT scans you do, the more kidney masses you are going to find.”

Obesity May Raise Kidney Stone Risk

According to a trial published in the Journal Of Urology obesity may raise your risk of developing Kidney stones. Obese people included in the trial were almost twice as likely to suffer kidney stones, in comparison with people of a normal weight. This applied whether they were morbidly obese, or just obese. In the UK standard obesity counts as having a body mass index (BMI) of over 30 while morbid obesity is a BMI of over 40.

Before this study it had commonly been believed that as weight increases, the threat to kidney health rises. This study refutes that idea, however, and shows that if you are obese, you may face a higher threat of kidney stones – regardless of how severe that obesity is. Kidney stones are small, solid masses that may build up inside the kidneys, causing pain and possible liver damage. Men are significantly more likely to develop kidney stones than women.

The exact reason for the link between kidney stones and obesity is not made clear by the study. Could it be that being overweight causes kidney stones? Although we cannot ascertain this from the results, the possibility cannot be excluded. What we do know is that obesity is linked to a variety of health problems, many of which can cause serious damage to your body. The major concern in terms of obesity is heart disease, a condition that kills 17 million people every year. Obesity is a common cause of heart disease. Other conditions that result from obesity include diabetes, musculoskeletal disorders and some cancers.

Globally the World Health Organisation believes that obesity is responsible for 1.6 billion deaths each year. As the global shift towards fast-food and high-calorie, high-fat snacks continues, keeping vigilant about your weight is more important than ever before.

Age is not a barrier in kidney transplant

A study shows that older recipients of kidneys have as good a chance as those who are younger, even if they get an organ from an older donor.
It is more common these days to use kidneys from older donors, even if they are in less than optimum health. This is to make up a shortfall between those requiring a new kidney and the actual supply of new organs.

There is reassuring news from Wake Forest University where researchers have studied a group of 144 patients having a new kidney. Age of the donor and recipient were not a factor in survival of the patient or the graft. The older patients tended to receive organs from older donors. At least one year after transplant, survival rates for transplanted kidneys were 86 per cent in the older group, who were over 60, and 87 per cent in those under 60. Patient survival was 92 per cent in the older group and 98 per cent in the younger group. These positive results probably arise because there are now new, more advanced ways of matching donor organs to their recipients.

Diet Can Cut the Recurrence of Kidney Stones

People who experience recurrent bouts of kidney stones are often told to limit their intake of calcium. That’s because calcium is a component of the most common type of kidney stones, called calcium oxalate stones.

But new research indicates that limiting animal protein and salt, instead of calcium, may actually be more effective in preventing calcium oxalate stones.

Researchers from University of Parma, Italy studied 120 men who had a history of kidney stones and randomly divided them into two groups of 60 each. In one group, the men were instructed to eat a low-calcium diet (400 milligrams calcium), by strictly limiting their intake of milk, yogurt, and cheese. The other group was instructed to eat a diet containing a normal amount of calcium (1,200 milligrams), but to keep their intake of animal protein to approximately 52 grams per day (roughly the amount in 2 cups of milk and 5 oz of meat) and their salt intake to 3 grams per day.

Men in both groups were instructed to drink adequate amounts of water (2-3 liters a day) and to limit their consumption of oxalate-containing foods, such as spinach, rhubarb, parsley, and chocolate, because oxalate is another component of kidney stones.

At the end of five years, nearly twice as many men following the low-calcium diet developed kidney stones as those who followed the normal-calcium diet. Twelve of the men in the low-protein, low-salt, normal-calcium group experienced relapses, whereas 23 men in the low-calcium group did.

The researchers speculate that the reason for the difference in the effects of the two diets has to do with how much oxalate accumulated in the men’s urine on each. While a low-calcium diet may be effective in reducing the amount of calcium in the urine, the researchers say this diet may actually increases the amount of oxalate in the urine. This is because less calcium in the intestinal tract allows more absorption of oxalate into the system, which has to be excreted in the urine.

The low-protein, low-salt, normal-calcium diet, however, reduced amounts of both calcium and oxalate in the urine, thereby reducing the risk for formation of calcium oxalate stones.

While the results of this study are promising, further studies of larger groups of people are needed to confirm them. The researchers point out that their results were only obtained after five years of study, so it is not know whether this diet would be effective in a shorter period. Also, the current study included only men, so it is unclear if the results would have been the same in women.

A diet that can prevent the recurrence of kidney stones is an attractive concept, but most consumers would need some diet-planning help to be able to follow the calcium, protein, and salt intake guidelines that produced positive results in this study. Those who suffer from recurrent kidney stones and are currently following a low-calcium diet, however, may want to discuss other diet options with their physician.

Study shows that gastric bypass raises kidney stone risk

People who have had gastric bypass surgery seem to be at increased risk of kidney stones because of changes in their urine composition.
Gastric bypass surgery can improve the health of people with severe obesity through rapid weight loss. However, the operation is not without risk. A team at the Mayo Clinic reveals that those undergoing gastric bypass may be more likely to develop kidney stones.

They took urine samples from 21 patients who had had gastric bypass surgery six to 12 months previously. The same measurements were made on 20 patients who were awaiting surgery. The first group had several biochemical changes in their urine which rendered them at increased risk of kidney stones, compared with the second group. These changes included increased levels of oxalate and reduced levels of citrate. Those patients who had had their bypass six months previously did not yet have significant changes in urine composition. There were no changes in kidney function after gastric bypass. These findings suggest that people having gastric bypass could be at increased risk of kidney stones and therefore might need to discuss steps, such as dietary changes, that they can take to avoid this complication.

Treatment of Elevated Intracranial Pressure with Hyperosmolar Therapy in Patients with Renal Failure

BACKGROUND: To evaluate the use of hyperosmolar therapy in the management of elevated intracranial pressure (ICP) and transtentorial herniation (TTH) in patients with renal failure and supratentorial lesions.
METHODS: Patients with renal failure undergoing renal replacement therapy treated with 23.4% saline (30-60 mL) and/or mannitol for high ICP or clinical evidence of TTH were analyzed in a retrospective cohort.
RESULTS: The primary outcome measure was reversal of TTH or ICP crisis. Secondary outcome measures were modified Rankin scale on hospital discharge, survival to hospital discharge, and adverse effects. Of 254 subjects over 7 years, 6 patients with end-stage renal disease had 11 events. All patients received a 23.4% saline bolus, along with mannitol (91%), hypertonic saline (HS) maintenance fluids (82%), and surgical interventions (n = 2). Reversal occurred in 6/11 events (55%); 2 of 6 patients survived to discharge. ICP recording of 6 TTH events showed a reduction from ICP of 41 ± 3.8 mmHg (mean ± SEM) with TTH to 20.8 ± 3.9 mmHg (p = 0.05) 1 h after the 23.4% saline bolus. Serum sodium increased from 141.4 to 151.1 mmol/L 24 h after 23.4% saline bolus (p = 0.001). No patients were undergoing hemodialysis at the time of the event. There were no cases of pulmonary edema, clinical volume overload, or arrhythmia after HS.
CONCLUSIONS: Treatment with hyperosmolar therapy, primarily 23.4% saline solution, was associated with clinical reversal of TTH and reduction in ICP and had few adverse effects in this cohort. Hyperosmolar therapy may be safe and effective in patients with renal failure and these initial findings should be validated in a prospective study.