New Agents May Improve Hyperkalemia Management in CKD

Hyperkalemia in patients with chronic kidney disease (CKD) remains a challenging condition to treat, but two new oral potassium-exchanging compounds may provide clinicians with more effective therapeutic options, according to researchers.

Importantly, the investigators noted, the new agents, patiromer and sodium zirconium cyclosilicate, could enable continued use of medications that inhibit the renin-angiotensin-aldosterone system (RAAS), which interfere with potassium homeostasis. One of the most complicated issues in CKD patient management is balancing the beneficial effects of RAAS inhibitors on the cardiovascular system and kidneys with the increased risk of hyperkalemia, a team led by George L. Bakris, MD, of the University of Chicago, wrote in Expert Opinion on Pharmacotherapy(2015;published online ahead of print).

Today, therapeutic options are limited to dietary potassium restriction, correction of metabolic acidosis using bicarbonate solutions, administration of cation exchange resins to bind potassium in the large intestines, and increasing the doses of loop diuretics to enhance potassium secretion by the kidneys.

The only currently available potassium binder in every-day clinical practice is sodium polystyrene sulfonate, a resin that exchanges 1 mEq of potassium to 1 or 2 mEq of sodium in the in the large intestines, Dr. Bakris' group observed. The authors noted that long-term administration of this compound is problematic and linked to serious adverse effects, especially involving the gastrointestinal (GI) tract.

In recent randomized clinical trials, patiromer and sodium zirconium cyclosilicate effectively normalized elevated serum potassium levels and maintained potassium homeostasis in hyperkalemic patients treated with RAAS inhibitors. The drugs were well tolerated and were not associated with serious adverse events.

These trials compared patiromer and sodium zirconium cyclosilicate with placebo and not sodium polystyrene sulfonate, so the comparative effectiveness of the new agents and existing potassium binders for managing hyperkalemia is not known, Dr. Bakris and his collaborators stated. They pointed out that sodium polystyrene sulfonate has been associated with an increased likelihood of colonic necrosis, which is a potentially life-threatening adverse event, and other GI complications, making the drug an unsuitable comparator due to serious safety issues.

The incidence of hyperkalemia in large-scaled outcome trials involving patients with stage 3 or higher CKD who were treated with RAAS inhibitor monotherapy generally is reported to be less than 3%, the authors stated. Initiation of RAAS inhibition in these studies was largely associated with a mean serum potassium rise of 0.4–0.6 mmol/L. They pointed out, however, that these data reflect hyperkalemia recorded in clinical trials, a setting with strict enrollment criteria and monitoring of patients during follow-up visits is very close. “Thus, these low rates of hyperkalemia could substantially underestimate the true frequency of hyperkalemia associated with the use of RAAS blockers in daily clinical practice, which has been reported to be as high as 10%.”

TOP 10 COMMON HABITS THAT DAMAGE YOUR KIDNEYS

Here are the top 10 common habits that damage your kidneys.

1. Not Emptying Your Bladder Timely

Maintaining a full bladder for a long time or delaying the urge to urinate is one of the main reasons behind kidney damage.

When urine remains in the bladder for a long time, it can cause the bacteria breeding in urine to multiply. In turn, these harmful bacteria can cause a urinary tract infection or kidney infection. Moreover, retaining urine increases pressure on the kidneys and can lead to renal failure and incontinence.

If you habitually delay responding to the call of nature, it’s time to rectify it for the benefit of your kidneys. No matter how busy you are, listen to the nature call signals and follow them.

2. Insufficient Water Intake

Not drinking an ample amount of water can also cause huge damage to your kidneys. The main function of the kidneys is to flush out metabolic waste from the body and regulate erythrocyte production.

When the body lacks sufficient water, there is less blood flow to the kidneys because the blood becomes concentrated. This hampers the kidneys’ ability to eliminate toxins from the body, and more toxins in the body means more health problems.

According to the National Kidney Foundation, a healthy adult must drink at least 10 to 12 glasses of fluid daily to keep the kidneys healthy and the body well hydrated. However, keep in mind that drinking too much water can also be hard on your kidneys. So, do not overdo it.

3. High Salt Consumption

Regularly eating too much salt can also cause huge damage to your kidneys as well as other health problems. The kidneys metabolize 95 percent of the sodium consumed through food.

When salt intake is high, the kidneys need to work harder to excrete the excess salt. This in turn can lead to decreased kidney functioning, causing water retention in the body. Water retention can cause a hike in blood pressure and increase the risk of developing kidney disease.

Studies have also shown that salt intake increases the amount of urinary protein, one of the major risk factors for developing kidney disease.

The recommended amount of salt is no more than 5 grams a day. More than this amount is harmful for your kidneys as well as your overall health. 1 teaspoon of salt is about 6 grams.

4. Regular Use of Analgesics

Many of us have the habit of taking analgesics (over-the-counter painkillers) to control pain and reduce fever and inflammation. But this can damage different body organs, including the kidneys.

Research shows that analgesics may reduce blood flow to the kidneys and deteriorate kidney functioning. Moreover, heavy or long-term use of over-the-counter analgesics can cause acute renal failure or chronic kidney disease known as chronic interstitial nephritis.

If you have decreased kidney function, do not take painkillers without asking your doctor. Even with normal kidney function, analgesics should be used as directed, at the lowest dose possible and for the shortest time.

5. High Protein Diet

Protein is good for your health, but excessive consumption of red meat and other protein-based foods can increase the risk of developing kidney disease.

One of the roles of the kidneys is to metabolize and excrete nitrogen by products from protein digestion. High protein intake increases the metabolic load of the kidneys by chronically increasing glomerular pressure and hyperfiltration. This in turn increases the risk of kidney problems.

So, limit your intake of red meat for the overall health of your kidneys. Moreover, those who have kidney problems must avoid eating red meat as it can worsen the condition.

6. Drinking Excessive Alcohol

Drinking in moderation is fine, but excessive drinking can cause significant damage to your kidneys. Alcohol is a toxin that puts a lot of stress on your kidneys and liver.

When you drink alcoholic beverages in high amounts, it causes uric acid to be deposited in renal tubules, leading to tubular obstruction. This in turn increases the risk of kidney failure. Moreover, alcohol causes dehydration and disrupts the normal functioning of the kidneys.

If you like to drink, then do it in moderation. A healthy amount is generally considered 2 drinks a day for men and 1 drink a day for women and older people.

7. Smoking Cigarettes

According to the Centers for Disease Control and Prevention, smoking is bad for almost every organ of the body, including the kidneys. Several studies have shown the connection between smoking and kidney disease.

In fact, smoking is a leading factor behind end stage renal disease (ESRD), according to the American Association of Kidney Patients (AAKP).

Smoking increases blood pressure and heart rate as well as reduces blood flow and narrows the blood vessels in the kidneys. It can even accelerate loss of kidney functions and worsen existing kidney diseases.

As smoking is not good for any part of your body, it is time to quit. Take help from friends, family members or professionals to help quit smoking.

8. Consuming Too Much Caffeine

Too much caffeine consumption can cause high blood pressure, which in turn will put a strain on your kidneys. Over time, this can damage your kidneys.

In fact, according to a 2002 study published in Kidney International, caffeine consumption has a strong connection with kidney stones. Caffeine can increase calcium excretion in urine.

Caffeine in moderate amounts will not cause health problems for most people. You can drink 1 to 2 cups of coffee, 3 cups of tea per day. Also, limit your intake of other sources of caffeine like soft drinks, energy drinks, chocolate, cocoa and some medications.

9. Ignoring Common Infections

Ignoring common infections like colds, the flu, coughs, pharyngitis, tonsillitis and others can also cause huge damage to your kidneys.

In fact, people who have kidney disease often have a history of not resting when they are sick. Moreover, people with kidney disease are more sensitive to weather changes and often get sick.

The bacteria or viruses that cause common infections can damage your kidneys if treatment is not carried out timely.

Next time you suffer from a common infection, get it treated quickly and properly. Take your antibiotics properly and rest your body until you feel better.

10. Lack of Sleep

Due to busy lifestyles, many people ignore the importance of sleep. Sound sleep of 6 to 8 hours daily is important for your overall health.

During the night when you sleep, renewal of organ tissues occurs. Therefore, when you do not get sound sleep, this interrupts the renewal process, resulting in damage to the kidneys and other organs.

Studies also suggest that sleepless nights may cause high blood pressure and more atherosclerosis (clogging of the arteries). This in turn increases your risk of kidney disease.

Try to adopt healthy sleeping habits and maintain a good balance between work and rest. This will greatly help protect your kidneys from health issues and allow you to live a healthy life.

Six Steps to Control Your Blood Pressure

A routine doctor’s appointment often involves a health professional checking your blood pressure. The screening is not painful or stressful and typically takes less than a minute to measure. However, the results of this simple test may identify a condition that, when managed, could help reduce your chances for stroke, heart attack and kidney disease.  

High blood pressure, often referred to as the “silent killer,” does not have any symptoms, but can cause serious damage to arteries, leading to heart disease and stroke. High blood pressure can also cause irreversible damage to kidneys .  Nearly one in three adults in the United States has high blood pressure, and because there are no symptoms, many remain unaware of the condition for years, according to the American Medical Group Foundation (AMGF). A blood pressure screening in a doctor’s office can determine if you have healthy or high blood pressure. Doctors, nurses, pharmacists and other health professionals can help patients understand the risk factors for high blood pressure and its health problems, and recommend lifestyle modifications and/or medicines to control the disease.

The Measure Up/Pressure Down® national high blood pressure campaign is an initiative of AMGF to encourage adults to get in control by using lifestyle changes, including:

• Know your numbers. Understanding what blood pressure is and what your numbers are is an important first step. At its simplest, blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps blood. Work with your health care team to determine your individual blood pressure goals and treatment plan if your numbers are too high.
• Eat right. A diet with excessive sodium (salt) may cause a person to retain fluid, which can lead to higher blood pressure. Potassium can help the body balance this sodium. Foods high in potassium include bananas, plain baked potatoes, avocados and cooked white beans.  [Note: people with chronic kidney disease should consult with a renal dietitian to understand how much potassium is recommended in their meal plan.]
• Stay active. On average, people who are more active tend to have lower heart rates, which means the heart does less work each time it contracts, reducing the pressure on arteries. Adults should be active at least 30 minutes each day.
• Reduce stress. Many Americans respond to stressful situations by eating more, getting less exercise, drinking or smoking. Plus, a stressful situation can also increase blood pressure for a short period of time. Try to reduce the occurrence of these situations and look for healthy ways—like meditation or walking— to help you deal with stress.
• Set alcohol limits and eliminate tobacco. Over time, consuming a high amount of alcohol can damage the heart. Recommendations are for women to limit themselves to one drink a day and for men to two drinks to avoid seeing an increase in blood pressure. Tobacco use and secondhand smoke can immediately raise blood pressure levels and cause damage to the lining of arteries. If you’re interested in quitting your tobacco use, call1-800-QUIT-NOW.
• Take medication. Your doctor may recommend taking a blood pressure medication to keep levels steady. Be sure to follow the directions provided for taking the medications to ensure you’re getting the most benefit from them.

Undiagnosed Kidney Disease Is A Serious Threat To People With Type 2 Diabetes

Diabetes is the most prevalent primary cause of kidney failure, according to statistics from the National Kidney and Urologic Diseases Information Clearinghouse, which is a service of the National Institute of Diabetes and Digestive and Kidney Diseases. Unfortunately for type 2 diabetics, a mere 12 percent of people with this form of diabetes who are plagued by chronic kidney disease (CKD) are actually properly diagnosed with this kidney disease, according to a recent study from the National Kidney Foundation.

The cross-sectional study from the Kidney Foundation was published in PLOS Medicine.

The study involved over nine thousand patients with type 2 diabetes in the United States. Just over five thousand patients had “urine protein excretion and eGFR,” according to Medical News Today, and therefore should have been diagnosed with some stage of kidney disease. Unfortunately, the researchers learned that only 12.1 percent of them had ever been diagnosed with CKD by their own doctors.

“This research underscores the urgency of testing at-risk populations for kidney disease,” Dr. Joseph Vassalotti said. Vassalotti is the Chief Medical Officer of the National Kidney Foundation. “We are missing important opportunities to prevent kidney failure, dialysis and cardiovascular events in those most at risk.”

According to the researchers, as the kidney disease in people progressed, the likelihood of being properly diagnosed went up, but the correct diagnosis was still missed in 47.1 percent of patients that had already developed stage-four CKD.

The research team even examined the details of the clinicians that were responsible for diagnosing the CKD in the type 2 diabetes sufferers, but according to Medical News Today, no differences were noted. There was no noticeable difference between experiences, patient caseloads or the settings of the medical practices.

“This shows we need clearer and simpler messages for both primary care clinicians and patients regarding the importance of screening for chronic kidney disease in people with diabetes,” the University at Buffalo’s Dr. Chester Fox explained of the type 2 diabetes study. “We want to use these data to draw attention to the simple fact that recognizing kidney disease and performing simple steps may keep people off dialysis.”

“We can increase the awareness, prevention and management of chronic kidney disease in people living with diabetes by identifying CKD in its earliest stages,” Dr. Vassalotti explained, according to the National Kidney Foundation. “Only by working closely with primary care clinicians to understand their workflow, can we enhance care for people with CKD.”

Because of these findings, officials at the National Kidney Foundation is launching two initiatives. All patients involved with the KEEP Healthy screening program will now have access to urine tests which will point out early warning signs of kidney disease. In addition, the National Kidney Foundation’s Primary Care Initiative will help doctors be of greater help to patients with type 2 diabetes. With this program, doctors will help patients with type 2 diabetes who show early signs of kidney disease make lifestyle changes and learn which medications they will need to avoid in order to best protect their kidneys.

Induction immunosuppressive therapy in renal transplantation in adults

In general, induction immunosuppressive strategies utilized by kidney transplant centers fall into one of two categories (table 1). One strategy relies upon high doses of conventional immunosuppressive agents, while the other utilizes antibodies directed against T-cell antigens in combination with lower doses of conventional agents.

The optimal prophylactic induction immunosuppressive therapy to prevent kidney transplant rejection remains controversial [1,2]. What follows in this topic review is a summary of the current data and our approach to induction therapy in adults. Maintenance immunosuppressive therapy is discussed separately.

OVERVIEW OF OUR APPROACH TO INDUCTION THERAPY

Practically all kidney allograft recipients require immunosuppressive therapy to prevent rejection and loss of the allograft. The optimal regimen, including induction therapy, is not clear. A large number of controlled, randomized trials and meta-analyses indicate that induction therapy consisting of biologic antibodies plus conventional immunosuppressive agent therapy is superior to conventional agent therapy alone in reducing kidney allograft rejection and allograft failure

Among patients undergoing kidney transplantation, we therefore recommend induction therapy consisting of antibody therapy plus conventional immunosuppressive therapy. One exception is Caucasian recipients of two-haplotype-identical, living, related allografts. Such patients do not generally require induction therapy with antibodies, given their markedly decreased immunologic risk of acute rejection.

Immunosuppressive antibody therapy — Currently available antibodies include the following specific antilymphocyte or interleukin-2 (IL-2) receptor antibodies [5-7]

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Kidney failure linked to silent stroke in people with diabetes

Kidney failure is one of the major health problems that people with type 2 diabetes may face as their disease progresses. A study shows that so-called silent cerebral infarctions (SCIs), otherwise known as ‘silent strokes,’ could be an indicator of kidney failure among diabetics. The study, from researchers at Shiga University School of Medicine, Japan, involved 608 patients with type 2 diabetes who had no obvious symptoms of kidney failure like protein in the urine. Nor did they have complications like stroke or heart disease. They underwent magnetic resonance imaging of the brain which showed that about 29% had SCI.

In long term follow up, those with SCI had a higher risk of kidney failure. Compared to those with normal scans, those with SCI were two and a half times more likely to die or develop end-stage kidney disease. Their risk of declining kidney function or need for dialysis was five times greater. The researchers agree that protein in the urine is the most common marker of kidney failure in diabetes. But some patients get decreased kidney function without having protein in the urine. This study suggests that subtle brain damage, SCI, detectable on a magnetic resonance image scan can detect those at risk of kidney failure independent of protein in the urine. It may be that small vessel disease in the brain is indicative of a similar problem in the kidneys.

Even modest gain in weight increases the risk of kidney disease

Gaining weight is a risk factor for development of chronic kidney disease. And, according to a study, this is so even if the person is not actually overweight or obese.

Healthy individuals who gain weight are at risk of developing chronic kidney disease, even if they stay within the so-called normal weight range. The findings come from annual health exams carried out on men in Korea. They show how those whose weight fluctuated the least had the lowest risk of kidney disease.

Increasing numbers of people are developing end stage renal disease (ESRD) and it is preceded by a condition known as chronic kidney disease (CKD). If we could diagnose, and deal with, CKD at an early stage, then progression to ESRD could be slowed or even halted. We already know that obesity is a risk factor for both ESRD and CKD but not much is known of the risk, if any, associated with modest weight gain that still leaves the individual within a ‘healthy’ weight range. This study comes from Korea and refers to the World Health Organization’s definition of BMI (body mass index) ranges for Asians. A healthy weight is BMI between 18.5 and 23, overweight from 23 to 25, and BMI over 25 is considered obese. Since the healthy range is quite wide, people may think it’s OK to put on a bit of weight as they age, so long as their BMI doesn’t go over 23.

Researchers at the Kangbuk Samsung Hospital in Seoul, took data – including BMI – from 8,792 healthy men undergoing a worksite health check in 2002 and followed up for the next few years. During this time, there were 427 new cases of CKD.

In both the normal weight and overweight groups, a U-shaped curve was found between weight change and risk of CKD. That is, minimal weight change was associated with lowest risk. Those who either lost or gained weight had a higher risk of CKD.

This is the first study to show a link between weight gain within the normal range and the risk of CKD. Weight loss was linked with increased risk too, but the researchers believe this result needs to be treated with caution – the weight loss could be a symptom of ill health that itself contributes to CKD. They are not sure just why weight gain increases the risk of CKD – but it may be because of increases in body fat. We also know that weight gain increases the risk of hypertension (high blood pressure) and diabetes which can, in turn, increase the risk of kidney disease. But the current findings suggest that weight gain is an independent risk factor of kidney disease. The take-home message seems to be that it is important to keep your weight steady as you age if you want to avoid kidney disease and its complications.

Preventing kidney stones through a healthy diet

Kidney stones are from through accumulation of salts in the urinary system. Having a kidney stone can be extremely painful but new research now suggests that a healthy diet can help avoid developing one.

The dietary approaches to hypertension (DASH) diet has previously been investigated for preventing high blood pressure, diabetes, and heart disease but not, till now, for kidney stones. However, a team at Maine Medical Center has looked at the impact of DASH on kidney stones, using data from three well known clinical studies. The Health Professionals Follow-up Study, the Nurses’ Health Study I and the Nurses’ Health Study II have run for many years and look at the impact of factors such as diet on chronic health conditions.

Kidney stones have previously been linked to higher rates of high blood pressure, obesity, diabetes and other heart disease risk factors. So there was already speculation that the DASH diet could, perhaps, also prevent kidney stones. In the study, participants were given a score linked to the main components of the DASH diet: fruit, vegetables, nuts and legumes, low fat dairy, whole grains, and lower intakes of salt, sweetened drinks, red meat and processed meat, like bacon and sausages. The study participants were followed up for several years, during which time there were 5,646 cases of kidney stones.

Those with the highest DASH scores were around 40% less likely to develop a kidney stone compared to those with the lowest scores. Kidney stones can be extremely painful and the medications used to treat them are far from ideal. This study suggests an alternative approach – prevention with a healthy DASH style diet. And there are other good reasons for adopting a diet based on fresh produce, low fat dairy and whole grains – namely, prevention of heart disease. The study is interesting also because it highlights the link between kidney stones and other health conditions – with the DASH diet, you may be able to reduce your risk of any of these, is the take home message.

Male and female rats show different patterns of kidney gene expression throughout their lives

Male and female rats show different patterns of kidney gene expression throughout their lives, a study in the open access journal Biology of Sex Differences reveals. The finding could help explain some of the gender differences observed in human renal disease, and lead to improved biomarkers of kidney function. 

Our kidneys play many important physiological roles. They filter waste products from the blood, produce urine, regulate blood pressure and make hormones. It's accepted that men and women experience renal disease differently - sex differences have been spotted in acute, chronic and diabetic kidney disease and in response to renal toxins - but the mechanisms responsible for these differences are unclear.

James C. Fuscoe and colleagues at the National Center for Toxicological Research, USFDA, Jefferson, AR studied gene expression  in the kidneys of male and female rats from 2 weeks to 2 years old, and identified over 800 genes that were expressed at different levels between the sexes. The findings help to explain what's happening at the molecular level, inside the kidney, as the rats age. Many of the differentially expressed genes were involved in pathways linked to renal injury, drug metabolism, and immune cell and inflammatory responses.

Expression levels of many of these genes also varied across the lifecycle. 'Middle-aged' females expressed higher levels of genes involved in xenobiotic metabolism and endocrine function, whilst males of the same age expressed higher levels of genes related to oxidative stress and renal cell death. So together, the findings may help explain some of the gender differences seen in human patients.

There are currently half a dozen urinary biomarkers of kidney injury qualified by the FDA. Dramatic sex differences were also spotted in the expression of genes encoding thesebiomarker proteins, a finding that should be taken into account as current biomarkers are used, and new biomarkers are developed.

Study: Ultrasound treatments may prevent acute kidney injury

Ultrasound treatments may prevent acute kidney injury that commonly arises after major surgery, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings suggest that this simple and noninvasive therapy may be an effective precaution for patients at risk.

Acute kidney injury, an abrupt decline in kidney function, is an increasingly prevalent and potentially serious condition in hospitalized patients. Sometimes acute kidney injury arises after major surgery because the kidneys can be deprived of normal blood flow during the procedure. Once the injury develops, patients have few established treatment options besides supportive care.

Mark Okusa, MD, Joseph Gigliotti, PhD (University of Virginia), and their colleagues found that a drug-free, noninvasive, ultrasound-based treatment could prevent acute kidney injury in mice. When they exposed anesthetized mice to ultrasound with a routine clinical imaging system 24 hours prior to blood disruption to the kidneys, the mice exhibited preserved kidney health after blood flow was restored. In contrast, sham-treated mice exhibited significant kidney injury. Further analyses revealed that the ultrasound treatment likely stimulated an anti-inflammatory response that originated from the spleen and was responsible for protecting the kidneys.

"Our studies using noninvasive ultrasound now provide us with an active treatment that appears to be simple, effective, and nontoxic for the prevention of acute kidney injury," said Dr. Okusa. "To our knowledge this has never been described for the prevention of tissue or organ injury. Interestingly, we suspect that similar mechanisms that lead to kidney injury may also lead to lung, heart, and liver damage and that this form of therapy might be effective for prevention of injury in other organs as well."

In an accompanying editorial, Alain Le Moine, MD, PhD (Erasme Hospital, in Belgium) and his colleagues noted that opportunities arising from the work are numerous and promising because many procedures that carry a very high risk of AKI are planned. "In searching for novel approaches to prevent and even cure AKI, we believe that splenicultrasound stimulation has a bright future ahead," they wrote.

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