Current Approaches to Treatment and Protein Intake Management in Pre-Dialysis Chronic Kidney Disease: Impact on Physical Exercise
DOI:
https://doi.org/10.12775/QS.2024.22.54956Keywords
chronic kidney disease, flozines, finerenone, angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, GLP-1 analog, protein intake in kidney diseaseAbstract
Chronic kidney disease (CKD) is the 8th most common condition in the modern world. Unfortunately, it becomes more and more frequent and constitutes a significant global health problem, affecting millions of people worldwide. Therefore, its treatment is an important topic among researchers all over the world. It has been the subject of many trials, so it will eventually be as effective, secure, and comfortable for patients as it possibly can be. That is why updating and assembling current knowledge is the key to organizing information. This paper focuses on pharmacological treatment and nutritional guidelines for CKD pre-dialysis patients, as well as physical activity outcomes. It aims to summarize this knowledge, educate, and help doctors in their daily clinical work.
References
Filev R, Rostaing L, Lyubomirova M, Bogov B, Kalinov K, Svinarov D. Renin-angiotensin-aldosterone system blockers in Bulgarian COVID-19 patients with or without chronic kidney disease. Medicine (Baltimore). 2022 Dec 2;101(48):e31988. doi: 10.1097/MD.0000000000031988. PMID: 36482641; PMCID: PMC9726321.
Xie X, Liu Y, Perkovic V, Li X, Ninomiya T, Hou W, Zhao N, Liu L, Lv J, Zhang H, Wang H. Renin-Angiotensin System Inhibitors and Kidney and Cardiovascular Outcomes in Patients With CKD: A Bayesian Network Meta-analysis of Randomized Clinical Trials. Am J Kidney Dis. 2016 May;67(5):728-41. doi: 10.1053/j.ajkd.2015.10.011. Epub 2015 Nov 18. PMID: 26597926.
Evans M, Lewis RD, Morgan AR, Whyte MB, Hanif W, Bain SC, Davies S, Dashora U, Yousef Z, Patel DC, Strain WD. A Narrative Review of Chronic Kidney Disease in Clinical Practice: Current Challenges and Future Perspectives. Adv Ther. 2022 Jan;39(1):33-43. doi: 10.1007/s12325-021-01927-z. Epub 2021 Nov 5. PMID: 34739697; PMCID: PMC8569052.
Tuegel C, Bansal N. Heart failure in patients with kidney disease. Heart. 2017 Dec;103(23):1848-1853. doi: 10.1136/heartjnl-2016-310794. Epub 2017 Jul 17. PMID: 28716974.
Kottgen A, Russell SD, Loehr LR, Crainiceanu CM, Rosamond WD, Chang PP, Chambless LE, Coresh J. Reduced kidney function as a risk factor for incident heart failure: the atherosclerosis risk in communities (ARIC) study. J Am Soc Nephrol. 2007 Apr;18(4):1307-15. doi: 10.1681/ASN.2006101159. Epub 2007 Mar 7. PMID: 17344421.
Singhania N, Bansal S, Mohandas S, Nimmatoori DP, Ejaz AA, Singhania G. Role of renin-angiotensin-aldosterone system inhibitors in heart failure and chronic kidney disease. Drugs Context. 2020 Nov 11;9:2020-7-3. doi: 10.7573/dic.2020-7-3. PMID: 33240389; PMCID: PMC7673621.
Goodfriend TL, Elliott ME, Catt KJ. Angiotensin receptors and their antagonists. N Engl J Med. 1996 Jun 20;334(25):1649-54. doi: 10.1056/NEJM199606203342507. PMID: 8628362.
Stoll M, Steckelings UM, Paul M, Bottari SP, Metzger R, Unger T. The angiotensin AT2-receptor mediates inhibition of cell proliferation in coronary endothelial cells. J Clin Invest. 1995 Feb;95(2):651-7. doi: 10.1172/JCI117710. PMID: 7860748; PMCID: PMC295531.
Hornig B, Kohler C, Drexler H. Role of bradykinin in mediating vascular effects of angiotensin-converting enzyme inhibitors in humans. Circulation. 1997 Mar 4;95(5):1115-8. doi: 10.1161/01.cir.95.5.1115. PMID: 9054837.
Tomiyama H, Kushiro T, Abeta H, Ishii T, Takahashi A, Furukawa L, Asagami T, Hino T, Saito F, Otsuka Y, et al. Kinins contribute to the improvement of insulin sensitivity during treatment with angiotensin converting enzyme inhibitor. Hypertension. 1994 Apr;23(4):450-5. doi: 10.1161/01.hyp.23.4.450. PMID: 8144214.
Chung EY, Ruospo M, Natale P, Bolignano D, Navaneethan SD, Palmer SC, Strippoli GF. Aldosterone antagonists in addition to renin angiotensin system antagonists for preventing the progression of chronic kidney disease. Cochrane Database Syst Rev. 2020 Oct 27;10(10):CD007004. doi: 10.1002/14651858.CD007004.pub4. PMID: 33107592; PMCID: PMC8094274.
Chertow GM, Vart P, Jongs N, Toto RD, Gorriz JL, Hou FF, McMurray JJV, Correa-Rotter R, Rossing P, Sjöström CD, Stefánsson BV, Langkilde AM, Wheeler DC, Heerspink HJL; DAPA-CKD Trial Committees and Investigators. Effects of Dapagliflozin in Stage 4 Chronic Kidney Disease. J Am Soc Nephrol. 2021 Sep;32(9):2352-2361. doi: 10.1681/ASN.2021020167. Epub 2021 Jul 16. PMID: 34272327; PMCID: PMC8729835.
Bailey CJ, Day C, Bellary S. Renal Protection with SGLT2 Inhibitors: Effects in Acute and Chronic Kidney Disease. Curr Diab Rep. 2022 Jan;22(1):39-52. doi: 10.1007/s11892-021-01442-z. Epub 2022 Feb 3. PMID: 35113333; PMCID: PMC8888485.
Mudaliar S, Polidori D, Zambrowicz B, Henry RR. Sodium-Glucose Cotransporter Inhibitors: Effects on Renal and Intestinal Glucose Transport: From Bench to Bedside. Diabetes Care. 2015 Dec;38(12):2344-53. doi: 10.2337/dc15-0642. PMID: 26604280.
Heerspink HJL, Stefánsson BV, Correa-Rotter R, Chertow GM, Greene T, Hou FF, Mann JFE, McMurray JJV, Lindberg M, Rossing P, Sjöström CD, Toto RD, Langkilde AM, Wheeler DC; DAPA-CKD Trial Committees and Investigators. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020 Oct 8;383(15):1436-1446. doi: 10.1056/NEJMoa2024816. Epub 2020 Sep 24. PMID: 32970396.
Perkovic V, Jardine MJ, Neal B, Bompoint S, Heerspink HJL, Charytan DM, Edwards R, Agarwal R, Bakris G, Bull S, Cannon CP, Capuano G, Chu PL, de Zeeuw D, Greene T, Levin A, Pollock C, Wheeler DC, Yavin Y, Zhang H, Zinman B, Meininger G, Brenner BM, Mahaffey KW; CREDENCE Trial Investigators. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. N Engl J Med. 2019 Jun 13;380(24):2295-2306. doi: 10.1056/NEJMoa1811744. Epub 2019 Apr 14. PMID: 30990260.
Aldrich S, Ashjian E. Use of GLP-1 receptor agonists in patients with T2DM and chronic kidney disease. Nurse Pract. 2019 Mar;44(3):20-28. doi: 10.1097/01.NPR.0000553396.65976.bb. PMID: 30695005.
The EMPA-KIDNEY Collaborative Group; Herrington WG, Staplin N, Wanner C, Green JB, Hauske SJ, Emberson JR, Preiss D, Judge P, Mayne KJ, Ng SYA, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu W, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Petrini M, Massey D, Eilbracht J, Brueckmann M, Landray MJ, Baigent C, Haynes R. Empagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2023 Jan 12;388(2):117-127. doi: 10.1056/NEJMoa2204233. Epub 2022 Nov 4. PMID: 36331190; PMCID: PMC7614055.
von Scholten BJ, Kreiner FF, Rasmussen S, Rossing P, Idorn T. The potential of GLP-1 receptor agonists in type 2 diabetes and chronic kidney disease: from randomised trials to clinical practice. Ther Adv Endocrinol Metab. 2022 Jul 19;13:20420188221112490. doi: 10.1177/20420188221112490. PMID: 35874312; PMCID: PMC9301118.
Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jódar E, Leiter LA, Lingvay I, Rosenstock J, Seufert J, Warren ML, Woo V, Hansen O, Holst AG, Pettersson J, Vilsbøll T; SUSTAIN-6 Investigators. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2016 Nov 10;375(19):1834-1844. doi: 10.1056/NEJMoa1607141. Epub 2016 Sep 15. PMID: 27633186.
Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, Nauck MA, Nissen SE, Pocock S, Poulter NR, Ravn LS, Steinberg WM, Stockner M, Zinman B, Bergenstal RM, Buse JB; LEADER Steering Committee; LEADER Trial Investigators. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2016 Jul 28;375(4):311-22. doi: 10.1056/NEJMoa1603827. Epub 2016 Jun 13. PMID: 27295427; PMCID: PMC4985288.
Rossing P, Baeres FMM, Bakris G, Bosch-Traberg H, Gislum M, Gough SCL, Idorn T, Lawson J, Mahaffey KW, Mann JFE, Mersebach H, Perkovic V, Tuttle K, Pratley R. The rationale, design and baseline data of FLOW, a kidney outcomes trial with once-weekly semaglutide in people with type 2 diabetes and chronic kidney disease. Nephrol Dial Transplant. 2023 Aug 31;38(9):2041-2051. doi: 10.1093/ndt/gfad009. Erratum in: Nephrol Dial Transplant. 2024 Mar 27;39(4):724. doi: 10.1093/ndt/gfad252. PMID: 36651820; PMCID: PMC10469096.
González-Juanatey JR, Górriz JL, Ortiz A, Valle A, Soler MJ, Facila L. Cardiorenal benefits of finerenone: protecting kidney and heart. Ann Med. 2023 Dec;55(1):502-513. doi: 10.1080/07853890.2023.2171110. PMID: 36719097; PMCID: PMC9891162.
Yasmin F, Aamir M, Najeeb H, Atif AR, Siddiqui AH, Ahsan MN, Moeed A, Ali SH, Tahir HM, Asghar MS. Efficacy and safety of finerenone in chronic kidney disease and type 2 diabetes patients: a systematic review and meta-analysis. Ann Med Surg (Lond). 2023 Aug 16;85(10):4973-4980. doi: 10.1097/MS9.0000000000001180. PMID: 37811017; PMCID: PMC10553111.
Pitt B, Kober L, Ponikowski P, Gheorghiade M, Filippatos G, Krum H, Nowack C, Kolkhof P, Kim SY, Zannad F. Safety and tolerability of the novel non-steroidal mineralocorticoid receptor antagonist BAY 94-8862 in patients with chronic heart failure and mild or moderate chronic kidney disease: a randomized, double-blind trial. Eur Heart J. 2013 Aug;34(31):2453-63. doi: 10.1093/eurheartj/eht187. Epub 2013 May 27. PMID: 23713082; PMCID: PMC3743070.
Pitt B, Filippatos G, Agarwal R, Anker SD, Bakris GL, Rossing P, Joseph A, Kolkhof P, Nowack C, Schloemer P, Ruilope LM; FIGARO-DKD Investigators. Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes. N Engl J Med. 2021 Dec 9;385(24):2252-2263. doi: 10.1056/NEJMoa2110956. Epub 2021 Aug 28. PMID: 34449181.
Filippatos G, Anker SD, Agarwal R, Ruilope LM, Rossing P, Bakris GL, Tasto C, Joseph A, Kolkhof P, Lage A, Pitt B; FIGARO-DKD Investigators. Finerenone Reduces Risk of Incident Heart Failure in Patients With Chronic Kidney Disease and Type 2 Diabetes: Analyses From the FIGARO-DKD Trial. Circulation. 2022 Feb 8;145(6):437-447. doi: 10.1161/CIRCULATIONAHA.121.057983. Epub 2021 Nov 13. PMID: 34775784; PMCID: PMC8812430.
Agarwal R, Pitt B, Palmer BF, Kovesdy CP, Burgess E, Filippatos G, Małyszko J, Ruilope LM, Rossignol P, Rossing P, Pecoits-Filho R, Anker SD, Joseph A, Lawatscheck R, Wilson D, Gebel M, Bakris GL. A comparative post hoc analysis of finerenone and spironolactone in resistant hypertension in moderate-to-advanced chronic kidney disease. Clin Kidney J. 2022 Oct 30;16(2):293-302. doi: 10.1093/ckj/sfac234. PMID: 36864892; PMCID: PMC9972517.
Wei H, Ren J, Li R, Qi X, Yang F, Li Q. Global, regional, and national burden of chronic kidney disease attributable to high fasting plasma glucose from 1990 to 2019: a systematic analysis from the global burden of disease study 2019. Front Endocrinol (Lausanne). 2024 Mar 27;15:1379634. doi: 10.3389/fendo.2024.1379634. PMID: 38601204; PMCID: PMC11004380.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024 Apr;105(4S):S117-S314. doi: 10.1016/j.kint.2023.10.018. PMID: 38490803.
Ikizler TA, Burrowes JD, Byham-Gray LD, Campbell KL, Carrero JJ, Chan W, Fouque D, Friedman AN, Ghaddar S, Goldstein-Fuchs DJ, Kaysen GA, Kopple JD, Teta D, Yee-Moon Wang A, Cuppari L. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. Am J Kidney Dis. 2020 Sep;76(3 Suppl 1):S1-S107. doi: 10.1053/j.ajkd.2020.05.006. Erratum in: Am J Kidney Dis. 2021 Feb;77(2):308. doi: 10.1053/j.ajkd.2020.11.004. PMID: 32829751.
Cosola C, Rocchetti MT, Sabatino A, Fiaccadori E, Di Iorio BR, Gesualdo L. Microbiota issue in CKD: how promising are gut-targeted approaches? J Nephrol. 2019 Feb;32(1):27-37. doi: 10.1007/s40620-018-0516-0. Epub 2018 Aug 1. PMID: 30069677.
Lew QJ, Jafar TH, Koh HW, Jin A, Chow KY, Yuan JM, Koh WP. Red Meat Intake and Risk of ESRD. J Am Soc Nephrol. 2017 Jan;28(1):304-312. doi: 10.1681/ASN.2016030248. Epub 2016 Jul 14. PMID: 27416946; PMCID: PMC5198288.
Khatri M, Moon YP, Scarmeas N, Gu Y, Gardener H, Cheung K, Wright CB, Sacco RL, Nickolas TL, Elkind MS. The association between a Mediterranean-style diet and kidney function in the Northern Manhattan Study cohort. Clin J Am Soc Nephrol. 2014 Nov 7;9(11):1868-75. doi: 10.2215/CJN.01080114. Epub 2014 Oct 30. PMID: 25359387; PMCID: PMC4220748.
Bellizzi V, Signoriello S, Minutolo R, Di Iorio B, Nazzaro P, Garofalo C, Calella P, Chiodini P, De Nicola L; ERIKA Study Group Investigators of the Italian Society of Nephrology-Conservative Therapy of CKD Work Group. No additional benefit of prescribing a very low-protein diet in patients with advanced chronic kidney disease under regular nephrology care: a pragmatic, randomized, controlled trial. Am J Clin Nutr. 2022 May 1;115(5):1404-1417. doi: 10.1093/ajcn/nqab417. PMID: 34967847.
Hahn D, Hodson EM, Fouque D. Low protein diets for non-diabetic adults with chronic kidney disease. Cochrane Database Syst Rev. 2020 Oct 29;10(10):CD001892. doi: 10.1002/14651858.CD001892.pub5. PMID: 33118160; PMCID: PMC8095031.
Villanego F, Naranjo J, Vigara LA, Cazorla JM, Montero ME, García T, Torrado J, Mazuecos A. Impact of physical exercise in patients with chronic kidney disease: Sistematic review and meta-analysis. Nefrologia (Engl Ed). 2020 May-Jun;40(3):237-252. English, Spanish. doi: 10.1016/j.nefro.2020.01.002. Epub 2020 Apr 15. PMID: 32305232.
Aydemir N, Pike MM, Alsouqi A, Headley SAE, Tuttle K, Evans EE, Milch CM, Moody KA, Germain M, Lipworth L, Himmelfarb J, Ikizler TA, Robinson-Cohen C. Effects of diet and exercise on adipocytokine levels in patients with moderate to severe chronic kidney disease. Nutr Metab Cardiovasc Dis. 2020 Jul 24;30(8):1375-1381. doi: 10.1016/j.numecd.2020.04.012. Epub 2020 Apr 21. PMID: 32571614; PMCID: PMC7659879.
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