Yoko Narasaki's research while affiliated with University of California, Irvine and other places

Publications (69)

Article
Dialysis has been the dominant treatment regimen in end-stage kidney disease as a means to remove uremic waste products and to maintain electrolyte, acid base, and fluid balance. However, given that dialysis may not always provide a survival benefit nor improved quality of life in certain subpopulations, there is growing recognition of the need for...
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There is rising interest globally with respect to the health implications of vegetarian or plant-based diets. A growing body of evidence has demonstrated that higher consumption of plant-based foods and the nutrients found in vegetarian and plant-based diets are associated with numerous health benefits, including improved blood pressure, glycemic c...
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Introduction: While Asians and Native Hawaiian and other Pacific Islanders (NHOPIs) have a high prevalence of kidney disease risk factors, there are sparse data examining their end-stage kidney disease (ESKD) outcomes. As Hawaii has high representation of Asians and NHOPIs, we compared their ESKD outcomes based on residence in the Mainland US vs....
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While dialysis has been the prevailing treatment paradigm for patients with advanced chronic kidney disease (CKD), emphasis on conservative and preservative management in which dietary interventions are a major cornerstone have emerged. Based on high-quality evidence, international guidelines support the utilization of low-protein diets as an inter...
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Context: Hypothyroidism is a common yet under-recognized condition in chronic kidney disease (CKD) patients, which may lead to end-organ complications if left untreated. Objective: We developed a prediction tool to identify CKD patients at-risk for incident hypothyroidism. Methods: Among 15,642 patients with stages 4-5 CKD without evidence of...
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Chronic kidney disease (CKD) and its downstream complications (i.e., cardiovascular) are a major source of morbidity worldwide. Additionally, deaths due to CKD or CKD-attributable cardiovascular disease account for a sizeable proportion of global mortality. However, the advent of new pharmacotherapies, diagnostic tools, and global initiatives are d...
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Background: Several studies suggest that Asian-American and Native Hawaiian and Other Pacific Islander (NHOPI) racial/ethnic groups have a heightened risk of chronic kidney disease (CKD), but provide limited inference due to the aggregation of these groups into a single racial/ethnic category. We thus examined the association of granularly defined...
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Background Emerging data suggest that sodium disarrays including hyponatremia are potential risk factors for infection ensuing from impairments in host immunity, which may be exacerbated by co-existing conditions (i.e. mucosal membrane and cellular edema leading to breakdown of microbial barrier function). While dysnatremia and infection-related mo...
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Background In healthy adults, higher dietary potassium intake is recommended given that potassium-rich foods are major sources of micronutrients, antioxidants, and fiber. Yet among patients with advanced kidney dysfunction, guidelines recommend dietary potassium restriction given concerns about hyperkalemia leading to malignant arrhythmias and mort...
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(1) Background: Current dietary recommendations for dialysis patients suggest that high phosphorus diets may be associated with adverse outcomes such as hyperphosphatemia and death. However, there has been concern that excess dietary phosphorus restriction may occur at the expense of adequate dietary protein intake in this population. We hypothesiz...
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BACKGROUND AND AIMS While dialysis has been the prevailing treatment paradigm in advanced CKD patients progressing to ESRD, this treatment approach may lead to a decline in physical function, loss of independence, and greater healthcare utilization among certain subgroups. We sought to compare the impact of dialysis versus conservative dialysis-fre...
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BACKGROUND AND AIMS Within the Veterans Health Administration, the largest integrated healthcare system in the USA, 1.1 million Veterans (16.4%) have been identified as having chronic kidney disease (CKD). Annual spending on US Veterans with non-dialysis dependent CKD is estimated at $19 billion/year, and each year ∼10% of US Veterans with advanced...
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BACKGROUND AND AIMS Low physical activity is common in hemodialysis (HD) patients and is associated with adverse outcomes in this population (poor health-related quality of life, cardiovascular [CV] disease, death). Prior studies show that hypothyroidism is highly prevalent in HD patients, and is associated with worse self-reported physical functio...
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Background Dialysis patients experience a high symptom burden, which may adversely impact their quality of life. Whereas other specialties emphasize routine symptom assessment, symptom burden is not well-characterized in dialysis patients. We sought to examine the prevalence and severity of unpleasant symptoms in a prospective hemodialysis cohort....
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Nutritional management and dietary intake have a major impact on kidney health and longevity. Among the macronutrients a large body of evidence has shown that increased dietary protein engenders changes in renal hemodynamics, kidney function, and kidney morphology. It has also been shown that various individual amino acids may have differential eff...
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Background: Chronic kidney disease (CKD) patients have displayed a paradoxical association between total cholesterol (TC) and mortality, where CKD patients with elevated TC did not display an increased mortality risk. However, this TC-mortality relationship amongst CKD patients requires further study using large databases to assess the impact CKD s...
Article
Diabetes is the leading cause of end‐stage renal disease (ESRD) and contributes to heightened morbidity and mortality in dialysis patients. Given that ESRD patients are susceptible to hypoglycemia and hyperglycemia via multiple pathways, adequate glycemic monitoring and control is a cornerstone in diabetic kidney disease management. In ESRD, existi...
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Intradialytic hypotension (IDH) is a major complication of hemodialysis, leading to myocardial stunning, cerebral hypoperfusion, gut ischemia, loss of residual kidney function, high symptom burden, and death. This study by Keane et al. provides new data on the incidence of IDH over well-defined time intervals during the hemodialysis treatment sessi...
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Background High-protein diets (e.g., Paleo, Atkins, South Beach, ketogenic) have gained popularity as a means to promote weight loss and avoid excess carbohydrate consumption. Yet in chronic kidney disease (CKD) patients, evidence suggests low dietary protein intake (DPI) leads to attenuation of kidney function decline, although concerns remain for...
Article
Hypothyroidism is a highly prevalent endocrine complication in chronic kidney disease (CKD) patients. A large body of evidence has shown that there is a bidirectional relationship between thyroid dysfunction and kidney disease, yet there are many remaining gaps in knowledge in regards to the clinical management of CKD patients with hypothyroidism,...
Article
Purpose of review: Chronic kidney disease (CKD) is highly prevalent in elderly patients. There is growing recognition of the importance of attention to dietary protein intake (DPI) in this population given their predisposition to age-related changes in kidney function and coexisting comorbidities (i.e., hypertension). We reviewed the impact of DPI...
Article
Objectives: Among hemodialysis patients, clinical practice guidelines recommend dietary potassium restriction given concerns about potential hyperkalemia leading to malignant arrhythmias and mortality. However, there are sparse data informing recommendations for dietary potassium intake in this population. We thus sought to examine the relationshi...
Article
Objective Dietary phosphorus (P) restriction is crucial to treat hyperphosphatemia and reduce cardiovascular disease risk and mortality in patients with chronic kidney disease (CKD) and the wider population. Various methods for dietary P restriction exist, but the bioavailability of P in food should also be considered when making appropriate food c...

Citations

... Considering this, much recent scientific evidence seems to recommend plant-based diets for both primary and secondary prevention of CKD [49][50][51][52]. Regarding salt intake, extensive research has shown that salt restriction has great potential to slow the progression of kidney disease and mitigate serious complications of CKD, such as high blood pressure [40]. ...
... Observational studies in patients with thyroid dysfunction have also shown a link with CKD, 2 although it is not yet clear if the thyroid is responsible for renal failure. In the study by You et al., 5 the authors set out to investigate whether hypothyroidism and hyperthyroidism are associated with higher CKD incidence and progression. ...
... This rate is 2.5 times higher than that of patients without diabetes (1). In diabetes, fluctuations with hyperglycemia and hypoglycemia occur (2). Hemodialysis treatment can cause glycemic fluctuations due to decreased plasma glucose concentrations and insulin levels. ...
... However, it is crucial to supplement protein intake with high-quality protein to prevent proteinuria. 72,73 Patients with osteoporosis may require additional calcium and vitamin D supplementation. 13,74 Meanwhile, maintaining proper hydration is vital to avoid dehydration and fluid overload. ...
... cardiovascular disease, cancer, chronic obstructive pulmonary disease) has declined over the past two decades, a similar reduction in age-standardized deaths has not been observed for CKD. 13 Understanding genetic and environmental factors influencing kidney function in healthy and diseased conditions and the interaction between genetic susceptibility factors and the environment can provide important insights into renal physiology and pathophysiology. It can reveal previously unknown or unexpected mechanisms, and consequently, research of genetic and environmental factors associated with chronic kidney disease (CKD) has the potential to identify novel therapeutic or preventive targets. ...
... Specifically, the risk of reaching kidney failure has been estimated to be significantly higher among Black and Hispanic patients by 3.4 and 1.3 times, respectively [5]. In addition, Asian Americans and Pacific Islanders have been shown to present a higher risk of early stage kidney disease, while native Hawaiian individuals have been proposed to be at greater risk of severe kidney disease forms [6]. Racial discrimination may be associated with kidney disease progression through its potential effects on social determinants of health, such as access to education and healthcare, while it may exert biological impact by contributing to increased allostatic load and epigenetic changes that may be implicated in altered hormone metabolism, albuminuria and kidney function decline [7,8]. ...
... Later on, the patient developed clinical presentations of CLABSI and was put on ciprofloxacin however her blood culture turned out negative. A growing body of literature documented that dialysis as a result of kidney disease and electrolytes imbalance increases the risk of BSI [26,27]. A combination of electrolyte imbalance and BSI accelerates patient's condition towards confusion and death [28][29][30]. ...
... Due to complexity of food components, the bioavailability of minerals varies greatly depending on their food sources [22]. Current evidences indicated that in addition to the quantity, food sources and forms of minerals were also of great importance in clarifying their associations with the risks of chronic diseases [23,24]. ...
... However, reducing dietary phosphorus without exacerbating protein-energy wasting can be challenging (Gutiérrez and Wolf, 2010). Protein-energy wasting, in turn, is known to increase the risk of mortality (Brown-Tortorici et al., 2022). Therefore, phosphate binders appeared to be more feasible clinical therapeutic options for ESRD patients with hyperphosphatemia. ...
... Such a diet is based on fruits, vegetables, seeds, nuts, tea, cocoa, and whole-grain cereals [97]. Among plant-based foods, Brazil nuts seem to have important benefits in CKD, even in end-stage kidney disease patients, due to their contents of proteins, selenium, omega-3 fatty acids, and fibers [98,99] (Figure 1). ...