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Carbonated Beverages and Chronic Kidney Disease
Abstract
Carbonated beverage consumption has been linked with diabetes, hypertension, and kidney stones, all risk factors for chronic kidney disease. Cola beverages, in particular, contain phosphoric acid and have been associated with urinary changes that promote kidney stones.
We examined the relationship between carbonated beverages (including cola) and chronic kidney disease, using data from 465 patients with newly diagnosed chronic kidney disease and 467 community controls recruited in North Carolina between 1980 and 1982.
Drinking 2 or more colas per day was associated with increased risk of chronic kidney disease (adjusted odds ratio = 2.3; 95% confidence interval = 1.4-3.7). Results were the same for regular colas (2.1; 1.3-3.4) and artificially sweetened colas (2.1; 0.7-2.5). Noncola carbonated beverages were not associated with chronic kidney disease (0.94; 0.4-2.2).
These preliminary results suggest that cola consumption may increase the risk of chronic kidney disease.
... The overall characteristics of the included studies are reported in Supplementary Table 4: fourteen employed a cohort design [17, 21, 40, 42, 43, 46, 48, 51-54, 58-60, 62, 65], thirteen were cross-sectional [18, 20, 38, 39, 41, 44, 45, 47, 49, 50, 55-57, 61, 63, 64] and one was casecontrol [37]. These studies were conducted between 2007 and 2024, and spanned multiple nations: United States [17,21,37,40,42,46,54,60,61,65], United Kingdom [59], China [20,43,44,50,58,64], Iran [18,41,47,49], Taiwan [38,45,48,56], the Netherlands [53], Spain [51,52,62], Croatia [57], Korea [55], Japan [63] and Thailand [39]. ...
... The overall characteristics of the included studies are reported in Supplementary Table 4: fourteen employed a cohort design [17, 21, 40, 42, 43, 46, 48, 51-54, 58-60, 62, 65], thirteen were cross-sectional [18, 20, 38, 39, 41, 44, 45, 47, 49, 50, 55-57, 61, 63, 64] and one was casecontrol [37]. These studies were conducted between 2007 and 2024, and spanned multiple nations: United States [17,21,37,40,42,46,54,60,61,65], United Kingdom [59], China [20,43,44,50,58,64], Iran [18,41,47,49], Taiwan [38,45,48,56], the Netherlands [53], Spain [51,52,62], Croatia [57], Korea [55], Japan [63] and Thailand [39]. The maximally adjusted RR specific to each study was recorded for a total of 786,216 individuals across the included publications and was subsequently pooled for a meta-analysis aimed at evaluating the relationship between UPFs and CKD risk. ...
... The maximally adjusted RR specific to each study was recorded for a total of 786,216 individuals across the included publications and was subsequently pooled for a meta-analysis aimed at evaluating the relationship between UPFs and CKD risk. In the quality assessment, the Newcastle-Ottawa scale designated 23 articles as high [17, 18, 20, 21, 39-46, 49-56, 58-65] and 5 as medium [37,38,47,48,57] quality. Inter-rater consistency for data collection and quality assessment was appropriate (Kappa = 0.881). ...
Objectives
Earlier investigations have documented an association between elevated consumption of Ultra-Processed Foods (UPFs) and adverse renal outcomes. To explore this relationship further, we executed a comprehensive dose–response meta-analysis to examine the link between UPFs intake and the risk of declined renal function.
Setting.
A systematic search was completed utilizing the ISI Web of Science, Scopus, Embase as well as PubMed/MEDLINE databases (without any restrictions), up until September 5, 2024. Effect sizes of declined renal function were recalculated by applying a random effects model. The GRADE tool was adopted to assess the certainty of the evidence, while study quality and potential publication bias were examined via validated methods such as the Newcastle–Ottawa Scale, Egger’s regression asymmetry and Begg’s rank correlation test.
Results
Thirty-three studies (comprising 786,216 participants) were incorporated in the quantitative analysis. The results demonstrated that a greater UPFs intake was significantly associated with an enhanced risk of declined renal function (RR = 1.16; 95% CI: 1.09, 1.23; I² = 68.8%; p < 0.001; n = 37). Additionally, we observed that each 1-serving-per-day increase in UPFs consumption was associated to a 5% greater risk of reduced renal function (RR = 1.05; 95% CI: 1.02, 1.09; I² = 80.9%; p = 0.013; n = 9). A positive, linear association between UPF intake and the risk of declined renal function (Pnonlinearity = 0.107, Pdose–response < 0.001) was further displayed in the non-linear dose–response analysis.
Conclusion
Greater exposure to UPFs is positively associated with the risk of declined renal function. The information emphasizes the importance of considering UPFs in the prevention and management of adverse renal outcomes.
... Thus, the dietary policies of the American Heart Association [10] recommend both restricting additional sugar intake by avoiding sugar-sweetened beverage consumption in order to reduce the occurrence of the aforementioned diseases, and circulating health-promoting information [11]. In addition to widely known adverse outcomes, such as metabolic syndrome and CVDs, recent studies have reported the relationship between SASB consumption and chronic kidney disease (CKD) [12], which comprises albuminuria [13] and decline in kidney function [14,15]. These SASBs, acidified with phosphoric acid, are associated with crystallized urinary solutes, leading to kidney stones [16]. ...
... Furthermore, with regard to sensitivity analysis, by excluding the studies with small sample size or short follow-up duration (i.e. Saldana et al. [14], and Yuzbashian et al. [22]), no significant association between SASB consumption (high versus low intake) and risk of CKD was found (Supplementary Figure S4). On the other hand, when different knots of cubic spline model were chosen, the conclusion of nonlinear dose-response analysis remained the same (Supplementary Table S3). ...
... Exposure/outcome Saldana et al. [14] Case-control study U L L Shoham et al. [13] Cross-sectional analysis L L L Bomback et al. [24] Prospective cohort study U L L Bomback et al. [17] Prospective cohort study L L L Lin and Curhan [15] Prospective cohort study U L L Chang et al. [45] Prospective cohort study L L L Rebholz et al. [46] Prospective cohort study L L L Rebholz et al. [47] Prospective cohort study L L L Yuzbashian et al. [22] Prospective cohort study L L U Asghari et al. [48] Prospective cohort study L L L Rebholz et al. [23] Prospective cohort study L L L Lew et al. [50] Prospective cohort study L L L Rebholz et al. [49] Prospective cohort study L L L nutrients or food in relation to CKD [40]. However, these investigations of a single type of food or nutrition in relation to disease have not always shown definitive positive results, and the findings are difficult to implement in public health programs [41]. ...
Background
Consumption of sugar or artificially-sweetened beverages (SASBs) has been linked to albuminuria, decline in kidney function, and risk of chronic kidney disease (CKD). However, the results are controversial. We therefore aim to evaluate the effects of sugar or artificially-sweetened beverage consumption on CKD risk.Methods
Original observational studies reporting relative risks (RRs) with 95% confidence intervals (CIs) for the association between sugar or artificially-sweetened beverage consumption and impaired renal function or CKD risk in adults were identified using a systematic search of PubMed and EMBASE from inception to 20 February, 2019. Random effects model was applied to derive summary RRs and 95% CIs. Linear and non-linear dose–response relationships were estimated using data from sugar or artificially-sweetened beverage consumption categories in each study.ResultsThe summary RR of CKD for high versus low sugar-sweetened beverage consumption was 1.30 (95% CI 0.88–1.94) according to six included studies with a total of 25,455 participants, while the pooled RR of CKD for high versus low artificially sweetened beverage consumption was 1.40 (95% CI 0.65–3.02) according to three studies with a total of 19,995 participants. For dose–response analysis, a significant, increased risk of CKD was observed with the sugar or artificially-sweetened beverage consumption above seven servings per week (P < 0.001).Conclusion
Our study found a positive association between consumption of sugar or artificially-sweetened beverage consumption and CKD, though it did not reach statistical significance. However, the dose–response results suggest that more than seven servings per week should be avoided.Graphic abstract
... Consuming carbonated drinks in excess, especially those containing phosphoric acid, such as Coca-Cola, is associated with diseases such as hypertension and diabetes. Daily consumption of this type of beverages also has a real impact on the increased risk of developing chronic kidney diseases 25,26 . ...
... A detailed description of the formation of struvite and PCaAP in infected urine is presented, for example, in Refs. 3,25,26,29 . Artificial urine was prepared by dissolving reagent grade chemicals (Sigma Aldrich) in deionized water. ...
In recent years, there has been a continuous increase in the incidence of urolithiasis, especially in highly developed countries. Therefore, the question arises which factors specific to these countries may be responsible for the increase in the incidence of this disease. In this article, we try to assess the effect of phosphoric acid, a component of various carbonated drinks, including Coca-Cola, on the nucleation and growth of struvite crystals, which are the main component of infectious urinary stones. The research was carried out in the environment of artificial urine with and without the presence of Proteus mirabilis bacteria. In the latter case, the activity of bacterial urease was simulated by adding an aqueous ammonia solution. The obtained results indicate that phosphoric acid present in artificial urine causes the nucleation of struvite to shift towards a lower pH, which means that struvite nucleates earlier in artificial urine compared to the control test. The amount of struvite formed is the greater the higher the concentration of phosphoric acid. At the same time, as the concentration of phosphoric acid increases, the growing struvite crystals are larger, which is disadvantageous because they are more difficult to remove from the urinary tract along with the urine. For the highest levels of phosphoric acid tested, large dendrites are formed, which are particularly undesirable as they can damage the epithelium of the urinary tract. The effect of phosphoric acid on the nucleation and growth of struvite is explained in base of chemical speciation analysis. This analysis indicates that the MgHCit and MgCit− complexes have the main influence on the nucleation and growth of struvite in artificial urine in the presence of phosphoric acid. It should be keep in mind that all these effects of phosphoric acid are possible when the urinary tract is infected with urease-positive bacteria. In the absence of infection, phosphoric acid will not cause struvite to crystallize.
... Consumption of two or more soda drinks daily was related to an increased risk of chronic kidney diseases thanks to high levels of orthophosphoric acid within the body [20]. A study of over 3,000 women concluded consuming two servings or more of artificially sweetened soft drinks each day was significantly connected to more rapid renal function decline in older women and doubled the danger of kidney function decline [21]. ...
... It has become an essential need in household, basic need in different events and nutritional need in different canteens of offices and educational institutes. The consumption has risen to a threatening level that it is affecting our health, decreasing quality of our life and slowly leading us to different diseases [18,20,30]. ...
Background: Soft Drink is a non-alcoholic beverage, mainly composed of carbonated water and high amount of sugar. From the studies, it is concluded that people who consumed soft drinks frequently have more chances to develop different diseases.
... Third, we could not distinguish the origin of water intake in detail. In other studies, the association between water intake and renal outcome appears to be modified by the source of water [27][28][29]. There is some evidence that fructose can cause kidney damage, and excessive sweetener intake may increase the risk of obesity or diabetes, an established risk factor for CKD [27]. ...
... There is some evidence that fructose can cause kidney damage, and excessive sweetener intake may increase the risk of obesity or diabetes, an established risk factor for CKD [27]. Several large observational studies have demonstrated that high intake of sugar or carbonated beverages is linked to albuminuria and CKD [28,29]. Further studies about the difference in the effect of water intake according to the source of food are warranted. ...
Background
The renoprotective effect of water intake remains unclear. We aimed to investigate the relationship between water intake and renal impairment in the Korean general population, focusing on individual differences in body fluid distribution and risk of chronic dehydration.
Methods
We conducted a cross-sectional analysis of the 2008–2017 Korea National Health and Nutrition Examination Survey (KNHANES). Adult participants who had body weight and serum creatinine data and had answered 24-h recall nutritional survey were included. Four water intake groups were defined by daily total water intake per body weight: lowest (< 20 mL/kg/day), low-moderate (20–29.9 mL/kg/day), high-moderate (30–49.9 mL/kg/day), and highest (≥ 50 mL/kg/day). We assessed the risk of renal impairment (estimated glomerular filtration rate ≤ 60 mL/min/1.73 m ² ) according to water intake.
Results
In total of 50,113 participants, 3.9% had renal impairment. The risk of renal impairment gradually decreased as water intake increased. After adjustment of sodium intake, the trend of renoprotective effect was remained in low-moderate and high-moderate water intake group compared to low intake group, whereas no significant impact was observed with the highest water intake due to concurrent intake of high sodium. In subgroup analysis, the renoprotective effect of water intake was significant in the participants with elderly, male and daily sodium intake over 2 g/day.
Conclusions
High daily water intake is renoprotective. Our data may provide an important basis for determining the amount of water intake needed to prevent renal impairment, considering variations in body weight, body composition and risk of chronic dehydration.
... The intake of soft drinks has increased in the past two decades [2], and several health conditions have been associated with steady or regular intake of soft drinks [3]. There is some evidence that consumption of two bottles of soft drinks per day can cause kidney disease [4]. The consumption of sugary sweetened beverages has been found to increase the rate of insulin resistance in adolescent [5]. ...
... In addition to the high sugar content, Cola beverages also contain phosphoric acid which is a colorless, odorless crystalline liquid. It gives the soft drink a sharp flavor and prevents the growth of mold and bacteria, which can multiply easily in sugary solution [4], phosphorous may have an effect on the kidney causing kidney dysfunction, laboratory studies have shown that high phosphorous diets can cause nephrocalciosis in rats [20]. It has also been associated with urinary changes that promote kidney stones [21]. ...
The effect of a daily consumption of soft drink was evaluated using 24 albino male rats divided into two groups viz:control and treatment. The experiment was carried out for four (4) weeks. The treatment (a brand of soft drink) was administered to the test group for three weeks while on the fourth week no treatment was given to the test group. The parameters analysed include; Sperm count, kidney function test, liver test, red blood cell, pack cell volume, haemoglobin, white blood cell, platelets, lymphocytes. The results showed that: The mean serum electrolyte for Na (mmol/l) was low for week 1, 2, 3 and 4 having 142, 140, 133.6 and 141.66 respectively when compared to the average control (147.3) with a significant difference (P<0.05) in week 1 and 4, K (mmol/l) were all lower than the average control (5.4) across the week with no significant difference (P>0.05) but had the least mean value of 4.8 in week 2. Bicarbonate (mmol/l) was also significantly lower (P<0.05) in the treated group when compared to the average control (24.3) with the least mean value in week 4 (18.67) and Cl (mmol/l) had a mean of 93.0 in week 1, 94.67 in week 2, 108.66 in week 3 and 107.67 in week 4 with an average control of 99.33. AST (U/L) mean value was 20.67 in week 1 which increased to 31.67 in week 4 while ALT (U/L) mean value was 10 in week 1 which also increased to 13 in week 4. The mean serum protein (g/dL) reduced from 81.83 in week 1 to 73.24 in week 4. Mean PCV (%) reduced from 33.67 in week 1 to 32.7 in week 4, Hb (g/dL) increased from 11.2 in week 1 to 13.4 in week 4 with a significant difference (P<0.05) when comparing the test with the average control, WBC (X109) increased from a mean 5.26 in week 1 to 11.9 in week 4 with a significant difference (P<0.05), Platelet (X109) mean value was 315 on week 1 and 419 in week 4 with significant difference (P<0.05) in week 3 and 4 when compared with its control, RBC (X1012) increased from a mean of 4.23 in week 1 to 6.90 in week 4 with significant difference (P<0.05). Lymphocyte (X109) mean value for week 1 was 70 and 82.26 in week 4 with significant difference (P<0.05) across the week. While the mean sperm count (X106) reduced significantly (P<0.05) from 425 in week 1 to 400 in week 4 when compared to the average control (566). These findings demonstrate that regular consumption of soft drink had a detrimental effect on the sperm count, liver, kidney and on the haematological parameters.
... Clinical studies have reported that drinking at least two beverages containing sugar daily causes high level of urinary albumin excretion [1] and is related to an increased incidence of kidney diseases [2]. It is well known that an excess amount of fructose could cause hyperuricemia [3]. ...
Background/Objectives: High fructose has been implicated as an important trigger of kidney inflammation in patients and experimental models. Magnolol, isolated from Magnolia officinalis, has an anti-inflammatory effect, but its protective role in podocytes remains underexplored. This study explored the protective effects and underlying mechanism of magnolol against high fructose-induced podocyte inflammation. Methods: The effects of magnolol on high fructose-induced podocyte inflammation were assessed in male Sprague Dawley rats administered 10% (w/v) fructose water for 12 weeks and heat-sensitive human podocyte cell lines (HPCs) exposed to 5 mM fructose. Podocyte foot processes were examined using transmission electron microscopy. The expression levels of nephrin, podocin, tumor necrosis factor-α (TNF-α), Notch1 intracellular domain (NICD1), triokinase/FMN cyclase (TKFC), specificity protein 1 (Sp1) and histone deacetylase 4 (HDAC4) were determined by Western blot, immunofluorescence and real-time quantitative polymerase chain reaction (qRT-PCR). The chromatin immunoprecipitation (ChIP) assay was performed to evaluate the interaction between Sp1 and the promoter region of HDAC4. Results: Magnolol mitigated the impairment of glomerular filtration function in high fructose-fed rats. Besides, it significantly alleviated the inflammatory responses in glomeruli and HPCs, evidenced by decreased protein levels of TNF-α and NICD1. Increased protein levels of TKFC, Sp1 and HDAC4 were observed in high fructose-stimulated HPCs and rat glomeruli. TMP195, an HDAC4 inhibitor, reduced TNF-α and NICD1 protein levels in high fructose-exposed HPCs. The increased Sp1 was shown to associate with the promoter region of HDAC4, promoting HDAC4 protein expression in high fructose-exposed HPCs. The knockdown of TKFC in HPCs by TKFC siRNA decreased Sp1, HDAC4 and NICD1 protein levels, alleviating podocyte inflammatory response. Furthermore, magnolol inhibited TKFC/Sp1/HDAC4/Notch1 activation in vivo and in vitro. Conclusions: Magnolol attenuated high fructose-induced podocyte inflammation possibly through the suppression of TKFC/Sp1/HDAC4/Notch1 activation, providing new evidence for its potential role in podocyte protection.
... 26 Similarly, we excluded a primary casecontrol study from the meta-analysis on CKD. 27 We found duplicate primary publications of the same population with longer follow-up periods for obesity-related cancer outcome; thus, the study with the smaller sample size was excluded 28 ; finally, 1 primary cohort study remained. 29 One primary cohort study considered composite CVD outcomes; therefore, we could not include this study in the meta-analyses on either stroke or CHD. ...
Context
Several effects of non–sugar-sweetened beverage (NSSBs) intake on health outcomes have been reported; however, the evidence on the association between NSSBs intake and chronic diseases and mortality risk is still inconclusive.
Objective
This umbrella review aimed to summarize the evidence on the association between NSSBs intake and the risk of chronic diseases and mortality.
Data Sources
Embase, ISI Web of Science, Cochrane Central, and PubMed were searched up to September 2023 for relevant meta-analyses of observational prospective cohort studies.
Data Extraction
Two groups of researchers independently extracted study data and assessed the risk of bias for meta-analyses and primary studies.
Data Analysis
Six meta-analyses, reporting 74 summary hazard ratios (HRs) for different outcomes obtained from 50 primary studies, were included. The summary HRs, 95% CIs, and certainty of evidence on the association of NSSBs intake with risk of chronic diseases and mortality were as follows: all-cause mortality (per 355 mL/d: 1.06 [1.01 to 1.10]; moderate certainty); stroke (per 250 mL/d: 1.09 [1.04 to 1.13]; high certainty); coronary heart disease (CHD) (per 250 mL/d: 1.06 [1.02 to 1.11]; high certainty); hypertension (HTN) (high vs low intake: 1.14 [1.09 to 1.18]; moderate certainty); type 2 diabetes (T2D) (high vs low intake: 1.16 [1.08 to 1.26]; low certainty); metabolic syndrome (MetS) (high vs low intake: 1.32 [1.22 to 1.43]; low certainty); colorectal cancer (high vs low intake: 0.78 [0.62 to 0.99]; moderate certainty); and leukemia (high vs low intake: 1.35 [1.03 to 1.77]; moderate certainty). For other outcomes, including the risk of cardiovascular and cancer mortality, chronic kidney diseases, breast cancer, prostate cancer, endometrial cancer, pancreatic cancer, multiple myeloma, and non-Hodgkin lymphoma, no association was found.
Conclusion
This study provides further evidence that NSSBs are associated with increased risk of all-cause mortality, stroke, CHD, HTN, T2D, MetS, and leukemia. Moreover, a higher intake of NSSBs was associated with a lower risk of colorectal cancer. However, it should be noted that the magnitudes of the associations are not large. Further studies are needed to clarify the long-term effects of different NSSBs intakes on health.
Systematic Review Registration
PROSPERO no. CRD42023429981.
... Phosphoric acid, employed as an acidulant in cola soft drinks, has been implicated in disrupting calcium levels and inducing hypocalcemia that results in kidney stones [9,10]. Higher phosphate concentration can suppress 1,25dihydroxy vitamin D activation and can trigger the release of parathyroid hormone (PTH), leading to decreased intestinal calcium absorption resulting in excessive urinary phosphate loss. ...
The research is aimed at addressing concerns regarding the health implications of increased cola consumption by developing a healthier alternative. This was achieved by replacing phosphoric acid with organic acidulants (citric acid (CA), lactic acid (LA), and tartaric acid (TA)) and enriching the drink with calcium gluconate salt. Response surface methodology (RSM) was employed as a statistical optimization tool to ensure the formulation met predefined criteria for physicochemical and sensory parameters. The optimized cola drink formulation consisted of 0.07% CA, 0.05% TA, and 0.04% LA, along with calcium gluconate. The physicochemical analysis revealed a pH of 3.36, an acidity of 7.72%, a reducing sugar (glucose) content of 4.46%, and a Brix value of 12.7°. Sensory evaluation indicated high overall acceptability with a hedonic score of 7.08, suggesting that the optimized cola drink with improved qualitative characteristics could serve as a desirable option for consumers seeking healthier beverage choices. Further studies could explore its long-term health effects and market feasibility.
... Phosphoric acid, employed as an acidulant in cola soft drinks, has been implicated in disrupting calcium levels and inducing hypocalcemia that results in kidney stones [9,10]. Higher phosphate concentration can suppress 1,25dihydroxy vitamin D activation and can trigger the release of parathyroid hormone (PTH), leading to decreased intestinal calcium absorption resulting in excessive urinary phosphate loss. ...
The research is aimed at addressing concerns regarding the health implications of increased cola consumption by developing a healthier alternative. This was achieved by replacing phosphoric acid with organic acidulants (citric acid (CA), lactic acid (LA), and tartaric acid (TA)) and enriching the drink with calcium gluconate salt. Response surface methodology (RSM) was employed as a statistical optimization tool to ensure the formulation met predefined criteria for physicochemical and sensory parameters. The optimized cola drink formulation consisted of 0.07% CA, 0.05% TA, and 0.04% LA, along with calcium gluconate. The physicochemical analysis revealed a pH of 3.36, an acidity of 7.72%, a reducing sugar (glucose) content of 4.46%, and a Brix value of 12.7°. Sensory evaluation indicated high overall acceptability with a hedonic score of 7.08, suggesting that the optimized cola drink with improved qualitative characteristics could serve as a desirable option for consumers seeking healthier beverage choices. Further studies could explore its long-term health effects and market feasibility.
... 7 Finally, the patient's history highlighted excessive consumption of cola-flavoured drinks, which can lead to increased urine potassium excretion. 8 Given the patient's history, and the normalisation of his potassium levels post-supplementation in association with a significant reduction in cola-flavoured drinks intake, hypokalaemia induced by excessive cola-flavoured drinks consumption was deemed the most probable diagnosis. Therefore, a comprehensive approach, considering all potential causes and dietary factors, was crucial to understand the cause of the patient's palpitations, muscle spasms, and restlessness. ...
We present a case involving a male patient in his 30s who was admitted to hospital due to recurrent episodes of hypokalaemia over the past 5 years. His medical history revealed hypertension, attention deficit hyperactivity disorder (ADHD), autism, and paranoia. He was taking citalopram, ramipril, amlodipine, and pramipexole. Tests indicated normal levels of aldosterone/renin ratio and plasma metanephrines. On reviewing his dietary history, it was noted that he consumed 3 to 3.5 L of cola-flavoured drinks on a daily basis. Normal potassium levels were achieved after a significant reduction in cola-flavoured drinks intake and potassium replacement. Subsequent outpatient clinic follow-up revealed that normal potassium levels were maintained even after the patient ceased taking potassium replacement tablets. Given the rarity of hypokalaemia associated with fizzy drinks, the underlying mechanism for this association remains unclear. In this case report, we attempt to provide a possible explanation for the involved mechanisms.
... Evidences supported that long-term consumption of sugar-sweetened beverages is not only related to hypertension, diabetes and cardiovascular diseases (1-4) but also increases the incidence rate of chronic kidney disease (CKD) (5), which proved to be one of the important diseases threatening human health (6). Consumption of 2 or more glasses of cola per day or more than 4 cups of sugary beverages a week, was associated with more than 2-fold risk of CKD (7,8). Even long-term consumption of sugarfree beverages with low calories is also associated with an increased incidence of end-stage renal disease (ESRD) (9). ...
... Studies have shown that increased consumption of drinks high in sugar was associated with an increased risk for DM2 and obesity which have been linked with the progression toward ESRD in patients with CKD (Schulze et al., 2004), two major risk factors for progression toward chronic kidney disease (Fox et al., 2004). Consumption of sugary drinks has been shown to be associated with chronic kidney disease in wellconducted studies (Saldana et al., 2007) (Shoham et al., 2008). With these established facts that DM2 has a direct correlation with CKD as well as its progression to ESRD, any intervention that helps in reducing the risk of DM2 and its complication can be logically thought to help in the incidence of ESRD too. ...
The study was carried out to measure the glycemic index (GI) of an oral food supplement for people with CKD as well as on patients on maintenance dialysis. The study was conducted as per international protocols for testing GI, was approved by the local institutional ethics committee, and was registered with the Clinical Trial Registry of India (CTRI). This was a crossover randomized controlled study which enrolled 15 participants between the ages of 18 and 45 years. The participants were randomly allotted to one group that consumed either the reference food (27.5 g of glucose monohydrate) or 118 g of the nutritional supplement which contained 25 g of available carbohydrates. Fasting capillary blood samples as well as blood samples at different time intervals as per the GI protocol, after consumption of either the supplement or the reference food were taken from the participants. Each testing day was separated by a 3‐day washout period. GI was calculated from the incremental area under the blood glucose response elicited by the nutritional supplement as a percentage of the response after the consumption of 25 g of glucose (27.5 g of glucose monohydrate) by the same participant using a standard formula. The GI of the nutritional supplement was calculated to be 10.3 ± 2.0 which is considered to be low as per international GI testing standards. The product was created to supplement the diet of people with CKD at different stages and to help prevent the progression from CKD to ESRD as well as the risk for CVD. This product was found to have a low GI which is desirable for people with CKD as well as diabetics in general who are at risk for developing CKD.
... An HFr may also have a relationship with chronic kidney disease (CKD) since metabolic syndrome is a significant cause for CKD [6]. Clinical trials have reported that consuming sugar-sweetened beverages is related with hypertension among healthy subjects [7] and patients with CKD [8]. In CKD patients, the low fructose diet lowered blood pressure [9]. ...
Chronic exercise (Ex) exerts antihypertensive and renoprotective effects in rats fed a high fructose diet (HFr). To elucidate the mechanisms, the impacts of an HFr and Ex on the nitric oxide (NO) system and oxidative stress in the kidney were examined. Rats were fed a control diet or an HFr, and a part of the HFr-fed rats underwent treadmill running for 12 weeks. The HFr did not affect nitrate/nitrite (NOx) levels in plasma and urine, and Ex increased the NOx levels. The HFr increased thiobarbituric acid reactive substance (TBARS) levels in plasma and urine, and Ex decreased the HFr-increased TBARS levels in plasma. The HFr increased the neuronal and endothelial NO synthase (nNOS and eNOS) expressions, and Ex enhanced the HFr-increased eNOS expression. The HFr inhibited the eNOS phosphorylation at serine 1177, and Ex restored the HFr-inhibited eNOS phosphorylation. The HFr increased xanthine oxidase and NADPH oxidase activities, and Ex restored the HFr-increased xanthine oxidase activity but enhanced the HFr-increased NADPH oxidase activity. The HFr increased the nitrotyrosine levels, and Ex attenuated the HFr-increased levels. These results indicate that although Ex enhances the HFr-increased eNOS expression and NADPH oxidase activity, an HFr inhibits renal eNOS phosphorylation and NO bioavailability, whereas Ex ameliorates them.
... Diabetes, hypertension and CVD are associated with a higher prevalence of chronic kidney disease (CKD) [20,21]. Besides, in addition to these well-known adverse consequences of SSB intake, recent clinical studies [22][23][24][25] showed that sugary soda intake was associated with kidney damage. The underlying renal lesions in CKD patients directly affect glycometabolism in vivo, which might cause further metabolic disorders and uncontrollable chronic inflammation and eventually lead to death from hypertonic non-ketoacidosis or ketoacidosis in CKD patients. ...
Background:
The relationship between intake of sugar-sweetened beverages (SSBs) and the risk of death in patients with chronic kidney disease (CKD) is unclear. We evaluated the association between SSB intake and subsequent overall mortality in CKD patients.
Methods:
We included data from 3996 CKD patients who participated in the 1999-2014 National Health and Nutrition Examination Survey (NHANES). SSB intake was assessed by a 24-h dietary recall, grouped as none, >0 to <1 serving/day, 1 to <2 servings/day and ≥2 servings/day. After adjusting for demographic variables, lifestyle, diet and comorbidities, Cox proportional risk regressions were applied to analyze the associations between the daily intake of SSBs as well as added sugar from beverages and all-cause mortality.
Results:
In the whole research population, the median age at baseline was 67 years, 22% were Black and 54% were female. A total of 42% had stage 3 CKD. During an average follow-up period of 8.3 years, a sum of 1137 (28%) deaths from all causes was recorded. The confounder-adjusted risk of mortality was associated with an increase of 1 serving/day of SSBs, with all-cause mortality of 1.18 [95% confidence interval (95% CI)1.08-1.28], and intakes of increased 20-g added sugar/1000 kcal of total energy per day were associated with all-cause mortality of 1.14 (1.05-1.24). Equivalently substituting 1 serving/day of SSBs with unsweetened coffee [HR (95% CI) 0.82 (0.74-0.91)], unsweetened tea [HR (95% CI) 0.86 (0.76-0.98)], plain water [HR (95% CI) 0.79 (0.71-0.88)], or non- or low-fat milk [HR (95% CI) 0.75 (0.60-0.93)] were related to a 14-25% reduced risk of all-cause mortality.
Conclusion:
Findings suggest that in the CKD population, increased SSB intake was associated with a higher risk of mortality and indicated a stratified association with dose. Plain water and unsweetened coffee/tea might be possible alternatives for SSBs to avert untimely deaths.
... С этой точки зрения особое неблагоприятное значение могут иметь напитки на основе колы: установлено, что употребление более 2 стандартных доз колы ассоциировано с увеличением вероятности ХБП в 2,3 раза. Данная взаимосвязь сохраняла свое значение при употреблении колы как с искусственными заменителями сахара, так и без них [17]. Среди возможных механизмов, объясняющих связь употребления сладких газированных напитков, в том числе содержащих фруктозу, с развитием ХБП, называют гиперурикемию, что подтверждают результаты ряда эпидемиологических исследований [18]. ...
Traditional and new risk factors of chronic kidney disease are discussed. The importance of risk factors for chronic kidney disease in Russian clinical guidelines 2021 was demonstrated.
... High level of oxalate excretion in urine [44] In the present chapter we are discussing in detail about the role of diet in KSD, so that we could summarise important preventive dietary habits for the urolithiasis ( Table 1). ...
Kidney stone disease is an oldest known and widespread medical condition characterised by its high prevalence in all over the world. Literature suggests that around 9–12% of population in industrialised countries have kidney stone disease in their lives with the 30–50% of reoccurrence rate. Because of high prevalence, recurrent and unpredictable nature of stone formation and its predominance mainly in adults contributes to the substantial impact on society, individual and health care system. In light of these trends, it’s imperative to use optimum preventive strategies to reduce the burden of kidney stone disease on individual and society. The aetiology of kidney stone disease is a multifactorial and it’s related to diet, environmental factors, genetics, metabolic syndromes and various life style factors. Its noteworthy that dietary and life style modification are the major contributors in the prevention of kidney stone reoccurrence. Dietary interventions aim to reduce the urinary abnormalities known to promote lithogenesis. Therefore, modification in the dietary factors is appealing way to patients and physicians in the treatment and prevention of stone recurrence as it is relatively inexpensive and safe. So, the present chapter is focusing on the role of dietary supplements in prevention of renal stones.
... Likewise, several clinical studies have sought the role of fructose in the kidney, but the issue remains controversial. Interestingly, more than two SSB per day is associated with an incidence and a prevalence of chronic kidney disease (CKD) [9,10], but less than one SSB per day was not [11,12]. Fructose may therefore impair renal function in a dose-dependent manner. ...
The Warburg effect is a unique property of cancer cells, in which glycolysis is activated instead of mitochondrial respiration despite oxygen availability. However, recent studies found that the Warburg effect also mediates non-cancer disorders, including kidney disease. Currently, diabetes or glucose has been postulated to mediate the Warburg effect in the kidney, but it is of importance that the Warburg effect can be induced under nondiabetic conditions. Fructose is endogenously produced in several organs, including the kidney, under both physiological and pathological conditions. In the kidney, fructose is predominantly metabolized in the proximal tubules; under normal physiologic conditions, fructose is utilized as a substrate for gluconeogenesis and contributes to maintain systemic glucose concentration under starvation conditions. However, when present in excess, fructose likely becomes deleterious, possibly due in part to excessive uric acid, which is a by-product of fructose metabolism. A potential mechanism is that uric acid suppresses aconitase in the Krebs cycle and therefore reduces mitochondrial oxidation. Consequently, fructose favors glycolysis over mitochondrial respiration, a process that is similar to the Warburg effect in cancer cells. Activation of glycolysis also links to several side pathways, including the pentose phosphate pathway, hexosamine pathway, and lipid synthesis, to provide biosynthetic precursors as fuel for renal inflammation and fibrosis. We now hypothesize that fructose could be the mediator for the Warburg effect in the kidney and a potential mechanism for chronic kidney disease.
... De igual forma, Saldana et al. [22] realizaron un estudio de casos y controles que contó con 465 pacientes con ERC recién diagnosticada y un grupo de control de 467 para evaluar la relación entre las bebidas carbonatadas y la ERC y encontraron que beber 2 o más bebidas con cola regulares por día se asoció a un mayor riesgo de ERC, con resultados similares para las bebidas con cola endulzadas arti cialmente, que tuvo un OR=2,1 (IC95 %: 0,7-2.5); sin embargo, las bebidas sin cola no se asociaron a ERC, por lo que los autores sugieren que el factor común para el aumento de ERC sería el consumo de cola. ...
Los edulcorantes artificiales no calóricos han surgido para ofrecer una opción segura y saludable en el marco de la alimentación. Han abarcado especial atención en las ultimas décadas, precisamente por la cultura de alimentación adquirida en la actualidad, donde ha tomado especial fuerza la alimentación con la comida rápida y el alto consumo de azúcar, lo que repercute negativamente en la incidencia de enfermedades metabólicas. En ese orden de ideas los edulcorantes artificiales no calóricos, proponen una mejor salud sin la necesidad de un cambio drástico en el estilo de vida. Empero, sus beneficios no han sido estudiados a profundidad, además de que no ha habido un cambio significativo en el desarrollo de enfermedades metabólicas asociadas al consumo de azúcar, por el contrario, se han relacionado con enfermedades como la obesidad, diabetes mellitus tipo 2 y síndrome metabólico. Así mismo, provocan una serie de cambios metabólicos por distintos mecanismos que terminan en proteinuria progresiva y el descenso de la tasa de filtrado glomerular. En orden con lo anterior, se hace necesario un análisis del riesgo al que se está sometido al elegir esta opción alimenticia, y no dejarse ensordecer ni mucho menos deslumbrar por los procesos mediáticos, si no mas bien, regirse por los hallazgos científicos.
... [8] Drinking two or more colas that are high in phosphoric acid not only increases one"s chance of developing kidney stones but also chronic kidney disease. [73] The study was conducted by Shuster J., et al (1992), [74] on 1009 men between the ages 18 to 75 who had already suffered from kidney stones and consumed 160 ml of soft drinks per day. Half of the subjects refrained from having aerated drinks, and the other half was monitored closely for their soft drink intake. ...
potential adverse effects of soft drinks
... Normal renal function is of great importance as this includes filtration and excretion process of the metabolic waste product such as urea and ammonium; regulation of electrolytes; fluid and acid-base balance; aids in production of red blood cells which is used to maintain the blood pressure through the renin-angiotensin-aldosterone system and to control water resorption; maintain the volume of blood in vessels. (Saldana et al., 2007) Chronic kidney disease is a term for heterogeneous disorders affecting the anatomy and physiology of the kidney and is based on the presence of kidney damage (i.e., albuminuria) or decreased kidney function (i.e., glomerular filtration rate) [GFR] < 60 ml/min per 1.73 m 2 for three months or more. (Levey and Coresh, 2012)There are basically two subtypes of renal disease, vascular and parenchymal. ...
Background: Chronic Renal Failure (CRF) is a terminology used for heterogeneous disorders affecting the anatomy and physiology of the kidney. The variation in disease expression is related partly to cause and pathology, severity, and rate of progression Chronic Renal Failure (CRF) being recognized as a life-threatening disorder. Objective: The aim of this study was to assess the correlation of cortical thickness and echogenicity among patients suffering from chronic renal failure using ultrasound. Methodology: Cross-sectional prospective study 138 patients were included in the study. All the patients had been collected from indoor, outdoor, and emergency department of Mayo Hospital, Lahore. After informed consent, data were collected through ultrasound machine Toshiba Nimo 7. Results: Findings revealed that 138 CRF patients, 82 patients were male and 56 patients were female, and 56 patient belongs to the age group 15-35, 42 patient belongs to age group 36-55 and 40 patient belong to age group 56-75. P value is .131, which is greater than the significance level .05, which shows that there is no significant relation between both variables. Conclusion: It is concluded that there is no ultrasonographic correlation of cortical thickness and echogenicity among patient suffering from chronic renal failure
... Normal renal function is of great importance as this includes filtration and excretion process of the metabolic waste product such as urea and ammonium; regulation of electrolytes; fluid and acid-base balance; aids in production of red blood cells which is used to maintain the blood pressure through the renin-angiotensin-aldosterone system and to control water resorption; maintain the volume of blood in vessels. (Saldana et al., 2007) Chronic kidney disease is a term for heterogeneous disorders affecting the anatomy and physiology of the kidney and is based on the presence of kidney damage (i.e., albuminuria) or decreased kidney function (i.e., glomerular filtration rate) [GFR] < 60 ml/min per 1.73 m 2 for three months or more. (Levey and Coresh, 2012)There are basically two subtypes of renal disease, vascular and parenchymal. ...
Background: Chronic Renal Failure (CRF) is a terminology used for heterogeneous disorders affecting the anatomy and physiology of the kidney. The variation in disease expression is related partly to cause and pathology, severity, and rate of progression Chronic Renal Failure (CRF) being recognized as a life-threatening disorder. Objective: The aim of this study was to assess the correlation of cortical thickness and echogenicity among patients suffering from chronic renal failure using ultrasound. Methodology: Cross-sectional prospective study 138 patients were included in the study. All the patients had been collected from indoor, outdoor, and emergency department of Mayo Hospital, Lahore. After informed consent, data were collected through ultrasound machine Toshiba Nimo 7. Results: Findings revealed that 138 CRF patients, 82 patients were male and 56 patients were female, and 56 patient belongs to the age group 15-35, 42 patient belongs to age group 36-55 and 40 patient belong to age group 56-75. P value is .131, which is greater than the significance level .05, which shows that there is no significant relation between both variables. Conclusion: It is concluded that there is no ultrasonographic correlation of cortical thickness and echogenicity among patient suffering from chronic renal failure
... The cross-sectional and caseÀcontrol studies exploited a variety of definitions of the intake and effect. For example, Saldana [27] and his group defined intake of two or more regular size colas per day and the effect as diagnosed kidney disease in their caseÀcontrol study. An odds ratio of 2.51 was reported by this study considering the response of self-respondents. ...
... Los puntos de corte para definir el consumo alto de bebidas azucaradas (>7 veces/semana), 20 de sodio (≥2 000 mg/día) 21 y proteínas (>75 gr/día) 22 se determinaron considerando su asociación con los riesgos metabólico, cardiovascular y renal. Los puntos de corte para definir la presión arterial sistólica (PAS, >110 mmHg) y la presión arterial diastólica (PAD, >80 mmHg) elevadas se basaron en las recomendaciones de la Organización Mundial de la Salud para obtener beneficios cardiovasculares. ...
Objetivo. Examinar prospectivamente los predictores de alteraciones subclínicas de la función renal en adultos sin diagnóstico previo de enfermedad renal crónica. Material y métodos. Se analizaron datos de una cohorte de adultos mexicanos (n=757). La función renal (2010) se midió mediante la tasa de filtración glomerular estimada (TFGE-Cr), creatinina y ácido úrico séricos. Los predictores (2004) se identificaron con modelos de regresión lineal y logística. Resultados. Se clasificó 33% con TFGE-Cr disminuida. La TFGE-Cr fue menor en hombres, en >40 años y en usuarios de antihipertensivos; y fue mayor en aquellos con consumo proteico alto. Los predictores de la creatinina fueron similares a los de la TFGE-Cr. El ácido úrico disminuyó en participantes hombres, con obesidad, hipertensión e hipercolesterolemia. Conclusión. Los biomarcadores séricos convencionales son útiles para identificar alteraciones subclínicas de la función renal. Algunos predictores de la función renal son potencialmente modificables, por tanto susceptibles de intervención.
... En 2007, Saldana, et al. realizaron un estudio con diseño de casos y controles, en el que evaluaron la asociación entre la ingesta del consumo de bebidas carbonatadas y la presencia de enfermedad renal crónica 30 . Se incluyeron 465 participantes con diagnóstico reciente de enfermedad renal crónica y 467 controles sanos. ...
Artículo de revisión resumen Los edulcorantes no calóricos (ENC) son aditivos alimentarios cuyo uso como herramienta para reducir el consumo de azúcares y la ingesta energética está a debate. Hay una controversia científica en torno a posibles riesgos de su consumo. Los ENC son sustancias evaluadas extensamente por la literatura científica. Su seguridad es monitoreada por agencias internacionales. Estos edulcorantes se han utilizado como sustitutos de sacarosa, con mayor frecuencia por personas con diabetes mellitus y obesidad, que son factores de riesgo muy relevantes para la enfermedad renal crónica. Por ello es ne-cesaria una revisión crítica de la literatura. Este documento pretende revisar tópicos y cuestionamientos que los profesiona-les de la salud y el público pueden hacerse acerca de si la salud renal pudiese verse afectada de una u otra manera por estos aditivos en los alimentos. Un grupo de trabajo convocado por el Instituto Mexicano de Investigaciones Nefrológicas (IMIN) condensó y clasificó una diversidad de publicaciones científicas bajo el método de la medicina basada en evidencia, para analizar si el uso de ENC puede o no afectar la función renal y presentar opiniones técnicas sustentadas en dicho análisis. Los escasos estudios que evalúan el impacto agudo de los ENC sobre biomarcadores de la función renal en hu-manos arrojan ausencia de un efecto apreciable; sin embargo, los estudios observacionales de largo plazo muestran resul-tados contradictorios sobre desenlaces de la función renal, que podrían ser explicados por causalidad inversa o factores de confusión. El metaanálisis más comprehensivo encontró resultados estadísticos no significativos. A la luz de la evidencia disponible, la plausibilidad biológica y epidemiológica de que los ENC representen un riesgo directo o indirecto para el desarrollo de ERC en humanos parece improbable. Abstract Non-caloric sweeteners (NCS) are food additives with sweet taste used as a tool to substitute sugar consumption and reduce energy intake. There is scientific controversy surrounding possible risks of its use, which is under continuous discussion in correspondencia:
... En 2007, Saldana, et al. realizaron un estudio con diseño de casos y controles, en el que evaluaron la asociación entre la ingesta del consumo de bebidas carbonatadas y la presencia de enfermedad renal crónica 30 . Se incluyeron 465 participantes con diagnóstico reciente de enfermedad renal crónica y 467 controles sanos. ...
Artículo de revisión resumen Los edulcorantes no calóricos (ENC) son aditivos alimentarios cuyo uso como herramienta para reducir el consumo de azúcares y la ingesta energética está a debate. Hay una controversia científica en torno a posibles riesgos de su consumo. Los ENC son sustancias evaluadas extensamente por la literatura científica. Su seguridad es monitoreada por agencias internacionales. Estos edulcorantes se han utilizado como sustitutos de sacarosa, con mayor frecuencia por personas con diabetes mellitus y obesidad, que son factores de riesgo muy relevantes para la enfermedad renal crónica. Por ello es ne-cesaria una revisión crítica de la literatura. Este documento pretende revisar tópicos y cuestionamientos que los profesiona-les de la salud y el público pueden hacerse acerca de si la salud renal pudiese verse afectada de una u otra manera por estos aditivos en los alimentos. Un grupo de trabajo convocado por el Instituto Mexicano de Investigaciones Nefrológicas (IMIN) condensó y clasificó una diversidad de publicaciones científicas bajo el método de la medicina basada en evidencia, para analizar si el uso de ENC puede o no afectar la función renal y presentar opiniones técnicas sustentadas en dicho análisis. Los escasos estudios que evalúan el impacto agudo de los ENC sobre biomarcadores de la función renal en hu-manos arrojan ausencia de un efecto apreciable; sin embargo, los estudios observacionales de largo plazo muestran resultados contradictorios sobre desenlaces de la función renal, que podrían ser explicados por causalidad inversa o factores de confusión. El metaanálisis más comprehensivo encontró resultados estadísticos no significativos. A la luz de la evidencia disponible, la plausibilidad biológica y epidemiológica de que los ENC representen un riesgo directo o indirecto para el desarrollo de ERC en humanos parece improbable.
... Normal renal function is of great importance as this includes filtration and excretion process of the metabolic waste product such as urea and ammonium; regulation of electrolytes; fluid and acid-base balance; aids in production of red blood cells which is used to maintain the blood pressure through the renin-angiotensin-aldosterone system and to control water resorption; maintain the volume of blood in vessels. (Saldana et al., 2007) Chronic kidney disease is a term for heterogeneous disorders affecting the anatomy and physiology of the kidney and is based on the presence of kidney damage (i.e., albuminuria) or decreased kidney function (i.e., glomerular filtration rate) [GFR] < 60 ml/min per 1.73 m 2 for three months or more. (Levey and Coresh, 2012)There are basically two subtypes of renal disease, vascular and parenchymal. ...
Background: Chronic Renal Failure (CRF) is a terminology used for heterogeneous disorders affecting the anatomy and physiology of the kidney. The variation in disease expression is related partly to cause and pathology, severity, and rate of progression Chronic Renal Failure (CRF) being recognized as a life-threatening disorder. Objective: The aim of this study was to assess the correlation of cortical thickness and echogenicity among patients suffering from chronic renal failure using ultrasound. Methodology: Cross-sectional prospective study 138 patients were included in the study. All the patients had been collected from indoor, outdoor, and emergency department of Mayo Hospital, Lahore. After informed consent, data were collected through ultrasound machine Toshiba Nimo 7. Results: Findings revealed that 138 CRF patients, 82 patients were male and 56 patients were female, and 56 patient belongs to the age group 15-35, 42 patient belongs to age group 36-55 and 40 patient belong to age group 56-75. P value is .131, which is greater than the significance level .05, which shows that there is no significant relation between both variables. Conclusion: It is concluded that there is no ultrasonographic correlation of cortical thickness and echogenicity among patient suffering from chronic renal failure
... Brown colas, which have inorganic phosphorus and high fructose corn syrup, have been found to have negative effects to the kidneys (Vieira et al, 2014). Drinking two or more colas a day has been associated with an increased risk of chronic kidney disease (Saldana et al, 2007). Increased fructose consumption has also been associated with increased serum uric acid levels (Kedar and Simkin, 2012). ...
Kidney transplantation is an excellent treatment option for many patients, providing a quality of life that is superior to that experienced by patients on dialysis. Despite its advantages, there are certain health implications that transplant recipients must face. In this article, Susie Lew et al review the nutritional factors that need to be considered to prevent health issues after kidney transplant
... These observations provide another, evidence supporting the plausibility of a link between cola beverages, kidney disease, as cola beverages are generally acidified using phosphoric acid. Phosphorus may have an effect on the risk of kidney disease [ 32] . ...
... About 15.38 per cent of male patients and 7.69 per cent of female patients were taking cold drinks on alternative days which may be a reason of stone formation in them. Saldana et al. (2007) reported that drinking two or more colas per day is associated with diabetes, hypertension and kidney stones. ...
Dietary habits of one hundred and thirty kidney stone patients from various hospitals of Palampur of Kangra District in Himachal Pradesh, North India were studied. Majority of the patients were non-vegetarian (60 per cent) and many of them (40 per cent) were consuming more salted foods. Water consumption amount revealed that majority (59.23 per cent) of the patients were consuming 1000 ml of water per day. Frequency of consumption of foodstuffs revealed that it varied from weekly to rarely for most of the items from various selected categories.
The proximal tubule of the kidney is programmed to reabsorb all filtered glucose and fructose. Glucose is taken up by apical sodium‐glucose cotransporters SGLT2 and SGLT1 whereas SGLT5 and potentially SGLT4 and GLUT5 have been implicated in apical fructose uptake. The glucose taken up by the proximal tubule is typically not metabolized but leaves via the basolateral facilitative glucose transporter GLUT2 and is returned to the systemic circulation or used as an energy source by distal tubular segments after basolateral uptake via GLUT1. The proximal tubule generates new glucose in metabolic acidosis and the postabsorptive phase, and fructose serves as an important substrate. In fact, under physiological conditions and intake, fructose taken up by proximal tubules is primarily utilized for gluconeogenesis. In the diabetic kidney, glucose is retained and gluconeogenesis enhanced, the latter in part driven by fructose. This is maladaptive as it sustains hyperglycemia. Moreover, renal glucose retention is coupled to sodium retention through SGLT2 and SGLT1, which induces secondary deleterious effects. SGLT2 inhibitors are new anti‐hyperglycemic drugs that can protect the kidneys and heart from failing independent of kidney function and diabetes. Dietary excess of fructose also induces tubular injury. This can be magnified by kidney formation of fructose under pathological conditions. Fructose metabolism is linked to urate formation, which partially accounts for fructose‐induced tubular injury, inflammation, and hemodynamic alterations. Fructose metabolism favors glycolysis over mitochondrial respiration as urate suppresses aconitase in the tricarboxylic acid cycle, and has been linked to potentially detrimental aerobic glycolysis (Warburg effect). © 2022 American Physiological Society. Compr Physiol 12:2995‐3044, 2022.
Background
Dietary risks are increasingly reported as a cause of chronic kidney disease (CKD). However, the trends in the burden of CKD attributable to dietary risks have yet to be fully elucidated.
Methods
This study extracted two major indicators related to CKD caused by dietary risks from the Global Burden of Disease (GBD) database for the years 1990 to 2021, including deaths and disability-adjusted life years (DALYs). It used estimated annual percentage change (EAPC) and percentage change to assess the trends in the burden of CKD caused by dietary risks. The relationship between Socio-demographic Index (SDI) and disease burden was also further analyzed. Additionally, we utilized the contemporary age-period-cohort model from NORDPRED to project future burden of CKD attributable to dietary risks.
Results
In 2021, globally, the number of deaths due to CKD caused by dietary risks was 317,010, and the number of DALYs was 7,971,281, approximately 2–3 times that of 1990, and it was expected to continue to rise before 2040. The global death rates and DALY rates of CKD related to dietary risks had increased, with EAPCs of 0.63 (95% CI: 0.57 to 0.69) and 0.39 (95% CI: 0.35 to 0.42), respectively. From a gender perspective, men were more likely to suffer from CKD due to dietary risks. From an age pattern perspective, in 2021, the number of deaths due to CKD caused by dietary risks peaked among men aged 70–74 and women aged 85–89. Additionally, the highest number of DALYs due to CKD caused by dietary risks was observed among men and women aged 65–69. In terms of socioeconomic factors, from 1990 to 2021, as the SDI increased, the age-standardized death rates and DALY rates due to CKD caused by dietary risks generally decreased. Among the seven dietary habits related to dietary risks, low vegetable intake, low fruit intake, and high sodium intake had the greatest impact.
Conclusion
In summary, over the past 32 years, the burden of CKD attributable to dietary risks has rapidly increased globally, and it is expected to continue rising until 2040. Therefore, interdisciplinary actions involving education, policy, and healthcare should be taken to mitigate this growing trend.
In this chapter we explain:
Normal acid-base chemistry and homeostasis
How the kidneys regulate serum bicarbonate and acid excretion
How to interpret acid-base laboratory results
Different types of acidosis
Renal tubular acidosis
Acidosis in chronic kidney disease
Metabolic alkalosis
Taking into account that in recent decades there has been an increase in the incidence of urinary stones, especially in highly developed countries, from a wide range of potentially harmful substances commonly available in such countries, we chose zinc for the research presented in this article, which is classified by some sources as a heavy metal. In this article, we present the results of research on the influence of Zn2+ ion on the nucleation and growth of struvite crystals—the main component of infection urinary stones. The tests were carried out in an artificial urine environment with and without the presence of Proteus mirabilis bacteria. In the latter case, the activity of bacterial urease was simulated chemically, by systematic addition of an aqueous ammonia solution. The obtained results indicate that Zn2+ ions compete with Mg2+ ions, which leads to the gradual replacement of Mg2+ ions in the struvite crystal lattice with Zn2+ ions to some extent. This means co-precipitation of Mg-struvite (MgNH4PO4 ∙ 6H2O) and Znx-struvite (Mg1-xZnxNH4PO4·6H2O). Speciation analysis of chemical complexes showed that Znx-struvite precipitates at slightly lower pH values than Mg-struvite. This means that Zn2+ ions shift the nucleation point of crystalline solids towards a lower pH. Additionally, the conducted research shows that Zn2+ ions, in the range of tested concentrations, does not have a toxic effect on bacteria; on the contrary, it has a positive effect on cellular metabolism, enabling bacteria to develop better. It means that Zn2+ ions in artificial urine, in vitro, slightly increase the risk of developing infection urinary stones.
Importance
An increasing body of evidence indicates an association between consuming sugar or its alternatives and cardiometabolic diseases. However, the effects of the consumption of sugar-sweetened beverages, artificially sweetened beverages, and natural juices on kidney health remain unclear.
Objective
To investigate the association of the intake of sugar-sweetened beverages, artificially sweetened beverages, and natural juices with the risk of chronic kidney disease (CKD), and the effect of substituting these beverage types for one another on this association.
Design, Setting, and Participants
This prospective, population-based cohort study analyzed data from the UK Biobank. Participants without a history of CKD who completed at least 1 dietary questionnaire were included. The follow-up period was from the date of the last dietary questionnaire until October 31, 2022, in England; July 31, 2021, in Scotland; and February 28, 2018, in Wales. Data were analyzed from May 1 to August 1, 2023.
Exposures
Consumption of sugar-sweetened beverages, artificially sweetened beverages, and natural juices.
Main Outcomes and Measures
The primary outcome was incident CKD. Multivariable Cox proportional hazards models were used to estimate the associations between the 3 beverage types and incident CKD. A substitution analysis was used to evaluate the effect on the associations of substituting one beverage type for another.
Results
A total of 127 830 participants (mean [SD] age, 55.2 [8.0] years; 66 180 female [51.8%]) were included in the primary analysis. During a median (IQR) follow-up of 10.5 (10.4-11.2) years, 4459 (3.5%) cases of incident CKD occurred. The consumption of more than 1 serving per day of sugar-sweetened beverages was associated with higher risk of incident CKD (adjusted hazard ratio [AHR], 1.19 [95% CI, 1.05-1.34]) compared with not consuming sugar-sweetened beverages. The AHR for participants consuming more than 0 to 1 serving per day of artificially sweetened beverages was 1.10 (95% CI, 1.01-1.20) and for consuming more than 1 serving per day was 1.26 (95% CI, 1.12-1.43) compared with consuming no artificially sweetened beverages. By contrast, there was no significant association between natural juice intake and incident CKD (eg, for >1 serving per day: HR, 0.99 [95% CI, 0.87-1.11]; P = .10). Substituting sugar-sweetened beverages with artificially sweetened beverages did not show any significant difference in the risk of CKD (HR, 1.03 [95% CI, 0.96-1.10]). Conversely, replacing 1 serving per day of sugar-sweetened beverage with natural juice (HR, 0.93 [95% CI, 0.87-0.97]) or water (HR, 0.93 [95% CI, 0.88-0.99]) or replacing 1 serving per day of artificially sweetened beverage with natural juice (HR, 0.90 [95% CI, 0.84-0.96]) or water (HR, 0.91 [95% CI, 0.86-0.96]) was associated with a reduced risk of incident CKD.
Conclusions and Relevance
Findings from this cohort study suggest that lower consumption of sugar-sweetened beverages or artificially sweetened beverages may reduce the risk of developing CKD.
Background
The impact of the Nutri-Score labelling system on renal function is unknown.
Objective
To assess the association between food consumption based on the nutrient profile system underlying the Nutri-Score and renal function decline in older adults.
Methods
We used data from the Spain-based Seniors-ENRICA cohort, a study with 1,312 community-dwelling adults aged ≥60 years recruited during 2008–2010 and followed up to December 2015. At baseline, a validated dietary history was obtained. Based on their nutritional quality, foods consumed were categorized into five labels (A/Green–best quality, B, C, D, E/Red–worst quality) using the established Nutri-Score algorithm. For each participant, a Nutri-Score dietary index (DI) was calculated in g/day/kg of weight. At baseline and at follow-up, measured serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) levels were obtained, and time changes were calculated. A combined outcome for renal decline was defined as: any increase in SCr or any decrease in eGFR beyond expected-for-age. Statistical analyses were performed with logistic regression adjusting for socioeconomic, lifestyle, total energy intake, fresh foods, and comorbidity confounders.
Results
A total of 183 cases of renal-function decline occurred over a mean 6-year follow-up. Participants with a higher (less favorable) Nutri-Score DI (interquartile range (IQR)13.2–17.7 (g/day/kg of weight); 46 cases) had higher probability of renal decline than those with a lower Nutri-Score DI (IQR 36.6–46.2; 44 cases); the corresponding odds ratios (95% confidence interval) across increasing quartiles of Nutri-Score DI were 1 (reference), 1.26 (0.78-2.04), 1.55 (0.92-2.62), and 1.82 (1.01-3.30), P-trend=0.045. Per each 10-point increase in the Nutri-Score DI the odds of renal decline increased by 27% (6%-52%).
Conclusions
Higher Nutri-Score DI, reflecting the consumption of foods with less favourable Nutri-Score rating, was associated with higher kidney function decline in older adults. Consequently, Nutri-Score labeling might be a useful policy tool for preventing kidney function decline, adding to the potential health benefits of this front-of-pack labelling system.
The proximal tubule of the kidney is programmed to reabsorb all filtered glucose and fructose. Glucose is taken up by apical sodium-glucose cotransporters SGLT2 and SGLT1 whereas SGLT5 and potentially SGLT4 and GLUT5 have been implicated in apical fructose uptake. The glucose taken up by the proximal tubule is typically not metabolized but leaves via the basolateral facilitative glucose transporter GLUT2 and is returned to the systemic circulation or used as an energy source by distal tubular segments after basolateral uptake via GLUT1. The proximal tubule generates new glucose in metabolic acidosis and the postabsorptive phase, and fructose serves as an important substrate. In fact, under physiological conditions and intake, fructose taken up by proximal tubules is primarily utilized for gluconeogenesis. In the diabetic kidney, glucose is retained and gluconeogenesis enhanced, the latter in part driven by fructose. This is maladaptive as it sustains hyperglycemia. Moreover, renal glucose retention is coupled to sodium retention through SGLT2 and SGLT1, which induces secondary deleterious effects. SGLT2 inhibitors are new anti-hyperglycemic drugs that can protect the kidneys and heart from failing independent of kidney function and diabetes. Dietary excess of fructose also induces tubular injury. This can be magnified by kidney formation of fructose under pathological conditions. Fructose metabolism is linked to urate formation, which partially accounts for fructose-induced tubular injury, inflammation, and hemodynamic alterations. Fructose metabolism favors glycolysis over mitochondrial respiration as urate suppresses aconitase in the tricarboxylic acid cycle, and has been linked to potentially detrimental aerobic glycolysis (Warburg effect). © 2022 American Physiological Society. Compr Physiol 12:2995-3044, 2022.
This study provides experimental evidence on consumers’ inattention in a beverage choice setting and estimates the degree of inattention under a theoretical framework. In the field experiment, the shelf placement of the beverage varied exogenously. Displaying less (more) sugary beverages at eye height (the farthest position from eye height) increases (decreases) consumers’ demand by 24.8% (25.3%). The estimated consumers’ degree of inattention to the farthest position from eye height was around 20%. Changing the display reduced consumers’ sugar intake from beverages by 5,573g during the intervention, about 6.86g per consumption (about 13.7% of the World Health Organization's (WHO) daily sugar intake recommendation). Our findings support the idea that the limited attention in beverage choice can be harnessed as a nudge policy to reduce consumers’ intake of sugar from sugar-sweetened beverages.
Fructose is a simple sugar that is the primary nutrient in fruits and honey, which are classically considered healthy foods. Fructose is also a major component of refined sugar, which has classically been viewed as a nonnutritional food or “empty calorie.” In the last decades the viewpoint that fructose is simply a caloric source of nutrition has shifted to one that places it at the top of the list for driving diseases such as obesity and diabetes. The new studies have raised important questions related to the optimal diet for subjects with chronic or end-stage kidney disease, in which historic recommendations focused primarily on a restriction of proteins (especially red meats) and high-fat diets. Here we both review the role of fructose in the subject with chronic kidney disease and also make recommendations for management.
Objective: To determine the association between the consumption of carbonated drinks and development of kidney stones. Study Design: Matched Case-control study. Setting: Liaquat National Hospital Karachi, Pakistan. Period: June 2017 to December 2017. Material & Methods: We recruited patients of nephrolithiasis admitted in Nephrology ward at Liaquat National Hospital as cases and controls from General Surgery ward. The sample size calculated was 186, with 93 cases and 93 controls, matched for age. Descriptive statistics of socio-demographic variables were computed. Multivariate logistic regression analysis was applied to determine the association between predictor and outcome variables. Results: A total of 186 patients participated in the study. Mean ages of the cases and controls were 34.92 (SD: 16.81) years and 31.76 (SD: 14.49) years, respectively. Around 66% of the cases and 75% of the controls had formal education. Approximately 16% of the cases and 10% of the controls were consuming soft drinks daily. Of them 77% were taking for more than 5 years. In multivariate analysis, we were unable to find significant associations between intake of carbonated drinks and kidney stones. However, the adjusted matched odds ratio (adj. mOR) for calcium intake was 6.36 (CI: 1.81- 22.33) and for caffeine intake was 7.9 (CI: 2.12 – 30.04). Those who had a past history of kidney diseases were at higher risk of developing kidney stones (mOR14.5; CI: 3.20- 65.76). Conclusion: The Study did not show any significant association of kidney stones with the intake of carbonated drinks. However, further longitudinal studies are required in order to confirm or refute any association between intake of carbonated drinks and nephrolithiasis.
Kidney disease, especially when it is associated with a reduction in estimated glomerular filtration rate, can be associated with an increase in serum urate (uric acid), suggesting that hyperuricemia in subjects with kidney disease may be a strictly secondary phenomenon. Mendelian randomization studies that evaluate genetic scores regulating serum urate also generally have not found evidence that serum urate is a causal risk factor in chronic kidney disease. Nevertheless, this is countered by a large number of epidemiologic, experimental, and clinical studies that have suggested a potentially important role for uric acid in kidney disease and cardiovascular disease. Here, we review the topic in detail. Overall, the studies strongly suggest that hyperuricemia does have an important pathogenic role that likely is driven by intracellular urate levels. An exception may be the role of extracellular uric acid in atherosclerosis and vascular calcification. One of the more striking findings on reviewing the literature is that the primary benefit of lowering serum urate in subjects with CKD is not by slowing the progression of renal disease, but rather by reducing the incidence of cardiovascular events and mortality. We recommend large-scale clinical trials to determine if there is a benefit in lowering serum urate in hyperuricemic subjects in acute and chronic kidney disease and in the reduction of cardiovascular morbidity and mortality in subjects with end-stage chronic kidney disease.
Objective
Although consumption of vegetable and 100% fruit juices are an acceptable alternative for vegetables and fruits intake, information about their actual effects on kidney function is sparse. The present study aimed to determine associations between the consumption of vegetable and fruit juices and changes in kidney function in a Japanese population over a five-year period.
Methods
A total of 2,755 Japanese (742 men and 2,013 women) who participated in both the baseline and the follow-up surveys in the Daiko study (a study within the Japan Multi-Institutional Collaborative Cohort (J-MICC) study), were analyzed in this prospective study. Estimate glomerular filtration rate (eGFR) was calculated by age, sex, and serum creatinine level. For each beverage, we categorized all participants into four consumption groups that rare (rarely consumed), low (≤2 cups/week), moderate (3–4 cups/week), or frequent (≥5 cups/week) based on a food frequency questionnaire.
Results
The mean baseline and follow-up eGFR (standard deviation) were 82.4 (14.6) and 72.2 (12.6), respectively. In fully-adjusted regression analyses, moderate consumption of vegetable juice was associated a lower decline in eGFR compared with the rare consumption group (β = –1.30, p = 0.01). Moreover, stratified analyses revealed that this significant association remained in those who were young, female, non-obese, normotensive, smoked cigarettes, consumed alcohol, or exercised. However, no significant association was found in analyses for fruit juices.
Conclusions
This five-year prospective study suggested an association between self-reported moderate consumption of vegetable juice and changes (possibly smaller decline) in kidney function in a relatively healthy Japanese population.
In this chapter we explain:Normal acid-base chemistry and homeostasisHow the kidneys regulate serum bicarbonate and acid excretionHow to interpret acid-base laboratory resultsDifferent types of acidosisRenal tubular acidosisAcidosis in chronic kidney diseaseMetabolic alkalosis Normal acid-base chemistry and homeostasis How the kidneys regulate serum bicarbonate and acid excretion How to interpret acid-base laboratory results Different types of acidosis Renal tubular acidosis Acidosis in chronic kidney disease Metabolic alkalosis
Understanding fructose metabolism might provide insights to renal pathophysiology. To support systemic glucose concentration, the proximal tubular cells reabsorb fructose as a substrate for gluconeogenesis. However, in instances when fructose intake is excessive, fructose metabolism is costly, resulting in energy depletion, uric acid generation, inflammation, and fibrosis in the kidney. A recent scientific advance is the discovery that fructose can be endogenously produced from glucose under pathologic conditions, not only in kidney diseases, but also in diabetes, in cardiac hypertrophy, and with dehydration. Why humans have such a deleterious mechanism to produce fructose is unknown, but it may relate to an evolutionary benefit in the past. In this article, we aim to illuminate the roles of fructose as it relates to gluconeogenesis and fructoneogenesis in the kidney.
Objective: To describe the epidemiologic characteristics of patients hospitalized due to urolithiasis in the State of Yucatán, Mexico, compared with official state and national references. Methodological design: A retrospective, descriptive, observational, cross-sectional study was conducted. It included the hospitalizations due to urolithiasis in the public health sector, within the time frame of 2014 to 2016 in Yucatán, comparing them with the official state and national references through hypothesis contrast tests for independent samples adjusted to population size. Results: A total of 1078 hospitalizations due to urolithiasis in Yucatán were registered and 52.8% corresponded to male patients. The mean age at hospitalization was significantly lower in the female patients at both the state and national levels. The prevalence of obesity in the hospitalized patients was 33.33, which was not statistically different from that reported by the state. The number of hospitalizations of patients residing in the capital was significantly lower than expected (31.9 versus 52.9). Limitations: The present study was restricted to public health sector hospitalization data, and therefore, private sector registers were excluded. Originality and value: The present analysis is the first epidemiologic study to compare and evaluate the epidemiologic factors of the registered cases of hospitalizations due to urolithiasis in the State of Yucatán. Conclusions: There was a higher number of hospitalizations in the State of Yucatán than those registered nationally, resulting in the highest hospitalization rate in the country. Prevalence was slightly higher in men, whereas age was lower in women. The prevalence of obesity and the number of hospitalized patients of Mayan ancestry did not differ from the state registers. The number of hospitalized patients residing in the capital was lower than expected.
Clinical Vignette Poster
The question was addressed whether dietary phosphorus-induced nephrocalcinosis in rats is associated with impaired kidney function. Weanling female rats were fed purified diets containing either 0.4 or 0.6% (wt/wt) phosphorus for 28 d. The diet containing 0.6% phosphorus produced marked kidney calcification, as determined both by chemical analysis of kidney calcium and histological examination in kidney sections. Histological examination did not show calcification in stomach, lung, heart or thoracic aorta, which are predisposition sites of metastatic calcification in secondary renal hyperparathyroidism. In rats fed the 0.6% phosphorus diet, phosphorus retention and urinary excretion were greater compared with rats fed the 0.4% phosphorus diet. The following indicators of kidney function were examined: water intake, urinary volume, urine and plasma osmolality, urine and plasma creatinine, urine and plasma urea, urea and creatinine clearance and urinary albumin excretion. Of these indicators, only urinary albumin excretion was significantly increased in rats fed the nephrocalcinogenic diet. In a further experiment, the increase of urinary albumin was reproduced. After pooling the results of the two experiments, in individual rats fed the 0.6% phosphorus diet, the concentration of kidney calcium was found to be positively related with kidney weight expressed relative to body weight (r = 0.82, n = 22) and with albumin excretion in urine (r = 0.79, n = 28). The increased weight of calcinotic kidneys was mainly due to both calcium deposition and tubular hyperplasia. It is concluded that dietary phosphorus-induced nephrocalcinosis is associated with impaired kidney function in rats.
Acute renal failure (ARF) is rarely reported after bowel preparation with sodium phosphate. We report a patient with mild Crohn disease (in remission), without history of renal disease, and with normal baseline renal function, who developed ARF 14 days after bowel preparation for colonoscopy with oral sodium phosphate. A renal biopsy showed multifocal calcium phosphate deposition in the renal tubules against a background of diffuse chronic tubulointerstitial injury. Review of the literature suggested 2 distinct patterns of ARF in the context of sodium phosphate bowel cleansing. One pattern is characterized by ARF, which develops a few hours or days after sodium phosphate administration, as a component of a systemic syndrome associated with severe hyperphosphatemia and hypocalcemia. Correction of these electrolyte abnormalities was frequently associated with rapid recovery of renal function. The cause of ARF in this context was not clear because the favorable outcome negated the need for renal biopsy. In the second pattern, exemplified by the current patient, ARF was identified incidentally. These patients did not have any features of an acute syndrome immediately after sodium phosphate administration and presented much later (usually weeks) with mild, nonspecific symptoms. At the time of presentation, the serum calcium and phosphate levels were normal. The renal biopsies in each of these patients showed nephrocalcinosis as the possible cause of ARF. The renal failure improved at least partially in most of these patients, but persisted in rare cases.
Acute renal failure (ARF) is rarely reported after bowel preparation with sodium phosphate. We report a patient with mild Crohn disease (in remission), without history of renal disease, and with normal baseline renal function, who developed ARF 14 days after bowel preparation for colonoscopy with oral sodium phosphate. A renal biopsy showed multifocal calcium phosphate deposition in the renal tubules against a background of diffuse chronic tubulointerstitial injury. Review of the literature suggested 2 distinct patterns of ARF in the context of sodium phosphate bowel cleansing. One pattern is characterized by ARF, which develops a few hours or days after sodium phosphate administration, as a component of a systemic syndrome associated with severe hyperphosphatemia and hypocalcemia. Correction of these electrolyte abnormalities was frequently associated with rapid recovery of renal function. The cause of ARF in this context was not clear because the favorable outcome negated the need for renal biopsy. In the second pattern, exemplified by the current patient, ARF was identified incidentally. These patients did not have any features of an acute syndrome immediately after sodium phosphate administration and presented much later (usually weeks) with mild, nonspecific symptoms. At the time of presentation, the serum calcium and phosphate levels were normal. The renal biopsies in each of these patients showed nephrocalcinosis as the possible cause of ARF. The renal failure improved at least partially in most of these patients, but persisted in rare cases.
... 8. Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar - sweetened drinks and childhood obesity : a prospective, observational analysis. Lancet. 2001;357:505-508.pmid:11229668. ...
The development of nephrocalcinosis and the time course of changes in kidney function, especially proximal tubular function, were studied in young male rats fed a high-phosphorus diet. The animals were fed a purified diet with a phosphorus content of either 0.5% (normal phosphorus diet) or 1.5% (high-phosphorus diet). In the group fed the high-phosphorus diet, nephrocalcinosis was found in 4 of 42 rats after 1 d of feeding and in all rats of this group at 3 d. The degree of nephrocalcinosis gradually increased with time. Upon histological observation by electron microscopy, vacuoles, lysosomes and swelling of microvilli in the proximal tubules were observed in rats fed the high-phosphorus diet after 1 d of feeding. Giant lysosomes with deposition of calcium and deposition of hydroxyapatite in mitochondria were observed in the proximal tubules of rats fed the high-phosphorus diet at 3 d. Albumin concentration in the urine of these rats was significantly increased at 3 d. The activity of N-acetyl-beta-D-glucosaminidase in the urine was also significantly increased after 1 d of feeding the high-phosphorus diet, and then reached a plateau. The beta 2-microglobulin concentration in the urine of rats fed the high-phosphorus diet was significantly increased at 14 d, and increased more toward 21 d. We concluded that nephrocalcinosis and injury to the proximal tubules are rapidly induced in rats fed a high-phosphorus diet.
The serum concentration and urinary excretion of four potential stone constituents: calcium, oxalate, phosphate, and uric acid; and of two potential inhibitors of urinary stone formation, citrate and magnesium, were studied before and during ingestion of a carbonated cola beverage. Four participants, after baseline serum determinations, abstained for forty-eight hours from cola consumption and then attempted to drink 3 quarts per day of cola in the following forty-eight hours. One participant failed to drink more than two quarts per day of cola. In all 4 participants twenty-four-hour urinary excretion of magnesium decreased by an average of 2.6 mg. In the 3 participants who succeeded in drinking 3 quarts of cola per day, twenty-four-hour urinary excretion of oxalate increased an average of 8.3 mg and excretion of citrate decreased an average of 122 mg. These results demonstrate changes in urine constituents which could contribute to enhanced kidney stone formation in patients who drink large quantities of cola-flavored carbonated beverages.
The object of this study was to determine if a strong association between soft drink (soda) consumption and recurrence of urinary stone disease, found in an earlier case-control study of adult males, had a causal component. The study sample consisted of 1009 male subjects, who completed an episode of urinary stone disease, who were aged 18-75 at that time, and who reported consuming at least 160 ml per day of soft drinks. Half of the subjects were randomized to refrain from consuming soft drinks, while the remaining subjects served as controls. The intervention group had an observed 6.4% advantage in actuarial 3 yr freedom from recurrence (p = 0.023 one-sided) over the control group. One important secondary finding was that for those who reported at the time of the index stone that their most consumed drink was acidified by phosphoric acid but not citric acid, the experimental group had a 15% higher 3 yr recurrence-free rate than the controls, p = 0.002, while for those who reported at the time of the index stone that their most consumed drink was acidified by citric acid with or without phosphoric acid, the experimental group had a similar 3 yr recurrence-free rate to the controls, p = 0.55. This interaction was significant, p = 0.019.
To examine the use of analgesics as a cause of chronic renal disease, we performed a multicenter case-control study of 554 adults with newly diagnosed kidney disease (serum creatinine, greater than or equal to 130 mumol per liter [1.5 mg per deciliter]) and 516 matched control subjects selected randomly from the same area of North Carolina. Histories of use of analgesics (phenacetin, acetaminophen, and aspirin) were obtained by telephone interview with the patients or their proxies. Daily users of analgesics had significantly more renal disease than infrequent users (odds ratio, 2.79; 95 percent confidence interval, 1.85 to 4.21). The risk of renal disease was highest in daily users of phenacetin (odds ratio, 5.11; confidence interval, 1.76 to 14.9, after adjustment for the effects of other analgesics). The risk of renal disease was also increased in daily users of acetaminophen; after adjustment for the use of aspirin and phenacetin, the odds ratio was 3.21 (confidence interval, 1.05 to 9.80). There was no increased risk in daily aspirin users (adjusted odds ratio, 1.32; confidence interval, 0.69 to 2.51). The risks with daily use of either phenacetin or acetaminophen changed little after adjustment for diabetes, hypertension, and the indication for analgesic use. We conclude that the long-term, regular use of phenacetin may increase the risk of chronic renal disease. The long-term, daily use of acetaminophen, the major metabolite of phenacetin, is associated independently with an increased risk of chronic renal disease. We could find no increased risk in daily users of aspirin.
The effect of simple carbohydrate intake on the state of urine saturation was studied in 44 patients with calcium kidney stones and in 28 healthy subjects. Renal excretion of calcium, magnesium and oxalate significantly increased and pH of urine decreased after an intake of 100 g glucose in stone formers and healthy subjects. In the basic conditions (before glucose administration) urine was supersaturated with calcium oxalate in stone formers (median 0.55) and healthy subjects (0.24; p less than 0.05). Carbohydrate intake caused a significant increase of the degree of urine saturation with calcium oxalate and uric acid. The degree of urine saturation with brushite and sodium urate after glucose administration did not change. These data suggest that excess of simple carbohydrate consumption may increase the degree of urine saturation with some of the compounds important in stone formation.
This investigation indicates that there are important associations between urinary stone disease and a person's primary liquid intake. Based on data collected from 2295 caucasian male patients from two geographical regions, the Carolinas (both North and South) and the Rockies (including Colorado, Idaho, Nevada, Montana, Utah and Wyoming) an important (p less than 0.01) positive association was found between urinary stone disease and soda (carbonated beverage) consumption within both geographical regions. It was also found that negative associations exist between urinary stone disease and both beer consumption and coffee consumption in the Rockies and that no important associations exist between urinary stone disease and any of milk, water, or tea, when these beverages represent a person's primary liquid intake. Moreover, soda can be viewed almost synonymously as sugared cola, since few subjects had diet sodas or sugared non-cola soda as primary fluid. No cause/effect relationships are implied in this paper.
The calciuric response and the changes of plasma glucose and insulin produced by a 75-gram oral glucose tolerance test were determined in 27 male patients with idiopathic calcium renal stones (6 with dietary hypercalciuria, 5 with nondietary hypercalciuria and 16 with normocalciuria) and 22 healthy male subjects. The subjects were classified as obese (> or = 120% ideal weight) and nonobese. The incidence of an abnormal response to glucose loading was similar in the stone patients and the healthy subjects. In addition, the plasma glucose and insulin levels after oral glucose load did not differ between the stone patients and control subjects and were affected by the individual degree of obesity. Urinary calcium excretion increased significantly after glucose ingestion in both the stone patients and the control subjects. Urinary calcium excretion was greater in the stone patients than in the control subjects due to the presence of patients with nondietary hypercalciuria, and the increment in urinary calcium excretion in the dietary hypercalciuric and normocalciuric stone patients was indistinguishable from that in the control subjects. The degree of obesity did not affect the increment in urinary calcium excretion. These results suggest that overconsumption of refined carbohydrates such as sugar-sweetened soft drinks, soda and cakes may be a risk factor for stone formation, especially in the patients with nondietary hypercalciuria.
To determine whether geographic variability in rates of kidney stones in the United States was attributable to differences in personal and environmental exposures, the authors examined cross-sectional data that included information on self-reported, physician-diagnosed kidney stones collected from 1,167,009 men and women, aged > or = 30 years, recruited nationally in 1982. Information on risk factors for stones including age, race, education, body mass, hypertension, and diuretic and vitamin C supplement use was obtained by self administered questionnaire. Consumption of milk, coffee, tea, soft drinks, and alcohol was based on food frequency data. Indices of ambient temperature and sunlight level were assigned to subjects based on state of residence. Stones were nearly twice as prevalent in the Southeast as in the Northwest among men and women. Ambient temperature and sunlight indices were independently associated with stones prevalence after controlling for other risk factors for stones. Regional variation was eliminated for men and greatly reduced for women after adjustment for temperature, sunlight, and beverage consumption. Other factors appeared to not contribute to regional variation. These results provide evidence that ambient temperature and sunlight levels are important risk factors for stones and that differences in exposure to temperature and sunlight and beverages may contribute to geographic variability.
The Modification of Diet in Renal Disease (MDRD) Study examined the effects of dietary protein restriction and strict blood pressure control on the decline in glomerular filtration rate (GFR) in 840 patients with diverse renal diseases. We describe a systematic analysis to determine baseline factors that predict the decline in GFR, or which alter the efficacy of the diet or blood pressure interventions. Univariate analysis identified 18 of 41 investigated baseline factors as significant (P < 0.05) predictors of GFR decline. In multivariate analysis, six factors--greater urine protein excretion, diagnosis of polycystic kidney disease (PKD), lower serum transferrin, higher mean arterial pressure, black race, and lower serum HDL cholesterol--independently predicted a faster decline in GFR. Together with the study interventions, these six factors accounted for 34.5% and 33.9% of the variance between patients in GFR slopes in Studies A and B, respectively, with proteinuria and PKD playing the predominant role. The mean rate of GFR decline was not significantly related to baseline GFR, suggesting an approximately linear mean GFR decline as renal disease progresses. The 41 baseline predictors were also assessed for their interactions with the diet and blood pressure interventions. A greater benefit of the low blood pressure intervention was found in patients with higher baseline urine protein. None of the 41 baseline factors were shown to predict a greater or lesser effect of dietary protein restriction.
Phosphate intoxication, manifested by hypocalcemic tetany and acute renal failure, may complicate bowel-cleansing preparations which contain phosphate. These preparations are commonly used to prepare patients for various gastrointestinal procedures. Often, patients who receive these regimens are at increased risk of phosphate intoxication from diseases which slow gastrointestinal transit or decrease renal excretion (renal insufficiency). We present a patient who developed oliguric acute renal failure from severe phosphate intoxication associated with a phosphate-containing bowel-cleansing regimen.
Since stone formers are advised to increase their intake of fluid, the present study was undertaken to determine the effect of cola beverage consumption on calcium oxalate kidney stone risk factors. Fourteen males and 31 females provided 24-h urines before and after an acute load of cola. Relative supersaturations, activity products and empirical risk indices, ratios and quotients were calculated from urinary biochemical data to assess calcium oxalate crystal and stone formation risk. Several risk factors changed unfavourably following consumption of cola. In males, oxalate excretion, the Tiselius risk index and modified activity product increased significantly (P < 0.05). In females, oxalate excretion increased significantly while magnesium excretion and pH decreased significantly (P < 0.05). Scanning electron microscopy showed that urines obtained from both sexes after cola consumption supported calcium oxalate crystallization to a greater extent than the control urines. It is concluded that consumption of cola causes unfavourable changes in the risk factors associated with calcium oxalate stone formation and that therefore patients should possibly avoid this soft drink in their efforts to increase their fluid intake.
As the United States end-stage renal disease (ESRD) program enters the new millennium, the continued growth of the ESRD population poses a challenge for policy makers, health care providers, and financial planners. To assist in future planning for the ESRD program, the growth of patient numbers and Medicare costs was forecasted to the year 2010 by modeling of historical data from 1982 through 1997. A stepwise autoregressive method and exponential smoothing models were used. The forecasting models for ESRD patient numbers demonstrated mean errors of -0.03 to 1.03%, relative to the observed values. The model for Medicare payments demonstrated -0.12% mean error. The R(2) values for the forecasting models ranged from 99.09 to 99.98%. On the basis of trends in patient numbers, this forecast projects average annual growth of the ESRD populations of approximately 4.1% for new patients, 6.4% for long-term ESRD patients, 7.1% for dialysis patients, 6.1% for patients with functioning transplants, and 8.2% for patients on waiting lists for transplants, as well as 7.7% for Medicare expenditures. The numbers of patients with ESRD in 2010 are forecasted to be 129,200 +/- 7742 (95% confidence limits) new patients, 651,330 +/- 15,874 long-term ESRD patients, 520,240 +/- 25,609 dialysis patients, 178,806 +/- 4349 patients with functioning transplants, and 95,550 +/- 5478 patients on waiting lists. The forecasted Medicare expenditures are projected to increase to $28.3 +/- 1.7 billion by 2010. These projections are subject to many factors that may alter the actual growth, compared with the historical patterns. They do, however, provide a basis for discussing the future growth of the ESRD program and how the ESRD community can meet the challenges ahead.
Elevated serum phosphorus is a major, preventable etiologic factor associated with the increased cardiovascular morbidity and mortality of dialysis patients. An important determinant of serum phosphorus is the dietary intake of this mineral; this makes dietary restriction of phosphorus a cornerstone for the prevention and treatment of hyperphosphatemia. The average daily dietary intake of phosphorus is about 1550 mg for males and 1000 mg for females. In general, foods high in protein are also high in phosphorus. These figures, however, are changing as phosphates are currently being added to a large number of processed foods including meats, cheeses, dressings, beverages, and bakery products. As a result, and depending on the food choices, such additives may increase the phosphorus intake by as a much as 1 g/day. Moreover, nutrient composition tables usually do not include the phosphorus from these additives, resulting in an underestimate of the dietary intake of phosphorus in our patients. Our goal is to convey an understanding of the phosphorus content of the current American diet to better equip nephrologists in their attempt to control hyperphosphatemia.
The incidence of treated end-stage renal disease has increased progressively in the United States over the past several decades. It has been suggested that kidney stones may be a contributing factor for a small percentage of these patients.
We conducted a case-control study utilizing 548 hospital cases and 514 age, race and gender-matched community controls. The main outcome measure was diagnosis of chronic kidney disease, assessed by comprehensive chart review. History of kidney stones and other co-variables were obtained during telephone interviews.
This study revealed 16.8% of cases and 6.4% of controls with reported history of kidney stones. The odds ratios (adjusted for confounding variables) for chronic kidney disease (overall), diabetic nephropathy and interstitial nephritis for patients with kidney stones were 1.9 (95% CI: 1.1, 3.3), 2.5 (95% CI: 0.87, 7.0) and 3.4 (95% CI: 1.5, 7.4), respectively. After stratifying by hypertensive status this increased risk persisted only for study participants reporting no history of hypertension.
Kidney stones may play a role in the development of chronic kidney disease. Our study suggests that the prevention of kidney stones may be a means of delaying the onset of chronic kidney disease, however, further studies are needed to make conclusive recommendations.
Nephrocalcinosis is a chronic tubulointerstitial nephropathy characterized by tubular calcium phosphate deposition and slowly progressive renal insufficiency. We report a novel association of acute nephrocalcinosis and acute renal failure (ARF) with colonoscopy preceded by a bowel-cleansing regimen consisting of oral sodium phosphate solution (OSPS). A cohort of 5 patients (mean age, 69.2 years) had normal renal function (mean serum creatininem 0.9 mg/dL) before colonoscopy and presented with ARF (mean serum creatinine, 4.9 mg/dL) from 3 days to 2 months postcolonoscopy. Past medical history included hypertension in all 5 patients. Medications included an angiotensin-converting enzyme (ACE) inhibitor (ACE-I) or angiotensin receptor blocker (ARB) in 4 patients and diuretics in 2 patients. In all patients, colonoscopy was preceded by bowel cleansing with OSPS; OSPS was contraindicated in a single patient with hyperparathyroidism and was used at excessive doses in another. Renal biopsy specimens obtained from all 5 patients revealed diffuse tubular injury and abundant tubular deposition of calcium phosphate. Although the tubular injury involved all tubular segments, lectin and immunohistochemical staining disclosed calcium phosphate deposition confined to distal tubules and collecting ducts. At a mean of 5.8 weeks of postbiopsy follow-up, renal function was unchanged in 4 patients and mildly improved in 1 patient. We conclude that acute nephrocalcinosis is a seemingly rare complication of bowel cleansing with OSPS. The pathophysiology of acute nephrocalcinosis after treatment with OSPS likely involves transient hyperphosphatemia; volume depletion exacerbated by intercurrent ACE-I, ARB, and diuretic use; and elevated distal tubular phosphate and calcium concentrations. Greater awareness of this entity is needed to identify potential risk factors.
Sugar-sweetened beverages like soft drinks and fruit punches contain large amounts of readily absorbable sugars and may contribute to weight gain and an increased risk of type 2 diabetes, but these relationships have been minimally addressed in adults.
To examine the association between consumption of sugar-sweetened beverages and weight change and risk of type 2 diabetes in women.
Prospective cohort analyses conducted from 1991 to 1999 among women in the Nurses' Health Study II. The diabetes analysis included 91,249 women free of diabetes and other major chronic diseases at baseline in 1991. The weight change analysis included 51,603 women for whom complete dietary information and body weight were ascertained in 1991, 1995, and 1999. We identified 741 incident cases of confirmed type 2 diabetes during 716,300 person-years of follow-up.
Weight gain and incidence of type 2 diabetes.
Those with stable consumption patterns had no difference in weight gain, but weight gain over a 4-year period was highest among women who increased their sugar-sweetened soft drink consumption from 1 or fewer drinks per week to 1 or more drinks per day (multivariate-adjusted means, 4.69 kg for 1991 to 1995 and 4.20 kg for 1995 to 1999) and was smallest among women who decreased their intake (1.34 and 0.15 kg for the 2 periods, respectively) after adjusting for lifestyle and dietary confounders. Increased consumption of fruit punch was also associated with greater weight gain compared with decreased consumption. After adjustment for potential confounders, women consuming 1 or more sugar-sweetened soft drinks per day had a relative risk [RR] of type 2 diabetes of 1.83 (95% confidence interval [CI], 1.42-2.36; P<.001 for trend) compared with those who consumed less than 1 of these beverages per month. Similarly, consumption of fruit punch was associated with increased diabetes risk (RR for > or =1 drink per day compared with <1 drink per month, 2.00; 95% CI, 1.33-3.03; P =.001).
Higher consumption of sugar-sweetened beverages is associated with a greater magnitude of weight gain and an increased risk for development of type 2 diabetes in women, possibly by providing excessive calories and large amounts of rapidly absorbable sugars.
The findings of diffuse tubular injury with abundant tubular calcium phosphate deposits on renal biopsy are referred to as nephrocalcinosis, a condition typically associated with hypercalcemia. During the period from 2000 to 2004, 31 cases of nephrocalcinosis were identified among the 7349 native renal biopsies processed at Columbia University. Among the 31 patients, 21 presented with acute renal failure (ARF), were normocalcemic, and had a history of recent colonoscopy preceded by bowel cleansing with oral sodium phosphate solution (OSPS) or Visicol. Because the precipitant was OSPS rather than hypercalcemia, these cases are best termed acute phosphate nephropathy. The cohort of 21 patients with APhN was predominantly female (81.0%) and white (81.0%), with a mean age of 64.0 yr. Sixteen of the 21 patients had a history of hypertension, 14 (87.5%) of whom were receiving an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. The mean baseline serum creatinine was 1.0 mg/dl, available within 4 mo of colonoscopy in 19 (90.5%) patients. Patients presented with ARF and a mean creatinine of 3.9 mg/dl at a median of 1 mo after colonoscopy. In a few patients, ARF was discovered within 3 d of colonoscopy, at which time hyperphosphatemia was documented. Patients had minimal proteinuria, normocalcemia, and bland urinary sediment. At follow-up (mean 16.7 mo), four patients had gone on to require permanent hemodialysis. The remaining 17 patients all have developed chronic renal insufficiency (mean serum creatinine, 2.4 mg/dl). Acute phosphate nephropathy is an underrecognized cause of acute and chronic renal failure. Potential etiologic factors include inadequate hydration (while receiving OSPS), increased patient age, a history of hypertension, and concurrent use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker.
Caffeine acutely increases blood pressure, but the association between habitual consumption of caffeinated beverages and incident hypertension is uncertain.
To examine the association between caffeine intake and incident hypertension in women.
Prospective cohort study conducted in the Nurses' Health Studies (NHSs) I and II of 155,594 US women free from physician-diagnosed hypertension followed up over 12 years (1990-1991 to 2002-2003 questionnaires). Caffeine intake and possible confounders were ascertained from regularly administered questionnaires. We also tested the associations with types of caffeinated beverages.
Incident physician-diagnosed hypertension.
During follow-up, 19,541 incident cases of physician-diagnosed hypertension were reported in NHS I and 13,536 in NHS II. In both cohorts, no linear association between caffeine consumption and risk of incident hypertension was observed after multivariate adjustment (NHS I, P for trend = .29; NHS II, P for trend = .53). Using categorical analysis, an inverse U-shaped association between caffeine consumption and incident hypertension was found. Compared with participants in the lowest quintile of caffeine consumption, those in the third quintile had a 13% and 12% increased risk of hypertension, respectively (95% confidence interval in NHS I, 8%-18%; in NHS II, 6%-18%). When studying individual classes of caffeinated beverages, habitual coffee consumption was not associated with increased risk of hypertension. By contrast, consumption of cola beverages was associated with an increased risk of hypertension, independent of whether it was sugared or diet cola (P for trend <.001).
No linear association between caffeine consumption and incident hypertension was found. Even though habitual coffee consumption was not associated with an increased risk of hypertension, consumption of sugared or diet cola was associated with it. Further research to elucidate the role of cola beverages in hypertension is warranted.
State-specific trends in chronic kidney failure-United States
- Disease Centers
- Control
- Prevention
Centers for Disease Control and Prevention. State-specific trends in chronic kidney failure-United
States, 1990-2001. MMWR Morb Mortal Wkly Rep. 2004; 53:918-920. [PubMed: 15470324]
United States Renal Data System
United States Renal Data System. 2004 USRDS Annual Data Report. USRDS Coordinating Center;
National Kidney Foundation K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification
National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease:
evaluation, classification, and stratification. Am J Kidney Dis. 2002; 39(2 suppl 1):S1-S266.
[PubMed: 11904577]
National Institute of Diabetes and Digestive and Kidney Diseases Kidney and Urologic Diseases Statistics for the United States. National Kidney and Urologic Diseases Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases
National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health.
Kidney and Urologic Diseases Statistics for the United States. National Kidney and Urologic
Diseases Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney
Diseases; Bethesda, MD: 2004. NIH Publication no. 04-3895
Nutritional Aspects of Bone Health.
- Calvo
Relation between geographic variability in kidney stones prevalence and risk factors for stones.
- Soucie