Renal Disease and the Metabolic Syndrome

Paul Muntner, PhD, and Linda F. Fried, MD, MPH
(ASN Renal Week Clinical Nephrology Conference, November, 2007.)
Muntner: How is metabolic syndrome defined and how do definitions vary among various organizations? What is its prevalence? How do individual components of metabolic syndrome associated with progression of CKD? What are the treatment options?
Fried: What is the evidence that statins reduce cardiovascular disease endpoints in CKD? What did the 4D study show and how cane these negative results in stage 5D patients be explained? Is there an increased risk of stroke with statins in stage 5D patients? In other patients? What is the effect of statins on progression of CKD? What are the possible mechanisms? Which types of CKD patients might be expected to get the most benefit from statins? Is there an increased risk of tubular proteinuria? (more...)

key Try a new quiz by Linda McCann, RD, CSR, LD: QUIZ: Subjective Global Assessment. What does it include? What does it correlate with? How can we evaluate muscle tissue stores?
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key Try a new quiz by Judy Beto and our editor Sharon Stall: QUIZ: Management of the Patient with Hyperkalemia. Your dialysis patient has high predialysis serum K. What do you do? Dialyze? Stop eating? Lower dialysate K? Change meds? When and how should a dietitian intervene when evaluating CKD patients?
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key Try Sharon Stall's QUIZ: Body Composition Measures in the Dialysis Unit. Which methods of body composition should one use for routine assessment in the dialysis unit? What do the triceps skin fold and mid-arm circumference mean? How useful is the BMI?
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Updated: February 14, 2021 (Feb14)
Feb14 Semaglutide shown to effect substantial weight loss in obese persons.
Jul09 Predicing serum K from the EKG trace measured by an Apple watch.
Apr03 Rehydrating with soft drinks after exercise increases AKI injury markers
Nov17 Akkermansia gut bacteria and their role in insulin resistance and aging.
Jun12 Pharmacologic approach to weight loss that prevents food absorption.
Jun04 NKF 2018 Spring Clinical Meeting abstracts (.pdf)
Jan11 Lp(a) in the news in the New York Times
Jan09 Inhibitors of NMMT reduce obesity by increasing fat cell metabolism.
Apr18 High salt diet makes subjects drink less and eat more !?
Jul12 Dr. Fred Coe videos on urine calcium supersaturation in stone disease.
Jun30 FDA issues warning about Shiga-toxin producing E. Coli found in flour
May29 Three days of fasting every 10 days improve autoimmune diseases (in mice).
May29 Nicotinamide riboside protects mice from effects of diabetes.
May24 CRIC study shows a high urinary sodium excretion in CKD linked to higher CV risk.
Mar30 Oops! Vegetarian diet may have some drawbacks.
Industry Advances Emphasis
Metabolic Renal Syndrome (Beddhu) ASN Renal Week 2008
The Year in Nephrology: Hypertension and Metabolic Renal Syndrome (Griffin, Beddhu) ASN Renal Week 2008
Drug Prescription vs. Lifestyle Changes? (Dellsparger) ADC 2008
Prevention of Malnutrition (Lindholm) ADC 2008
How Culture Affects Food Choices and Dietary Adherence (Grant) ADC 2008
Nutritional Considerations for Home HD (Wiesen) ADC 2008
Nutritional Supplements and Active Vitamin D in CKD (Ho) ADC 2008
Herbal Pharmacology (McQueen) ADC 2008
Achieving Nutritional Targets (McCann) ADC 2008
Does Reverse Epidemiology Imply That Hyperlipidemia and Hypertension Should Not Be Treated? (Kalantar-Zadeh) ADC 2008
Obesity in the dialysis patient - good or bad? (Axelsson) RRI 2008
KEYNOTE ADDRESS:The metabolic syndrome and kidney disease (Ritz) RRI 2008
Non-osmotic sodium interaction with hypertension and tissue hydration (Titze) RRI 2008
How common is malnutrition in ESRD? An approach to diagnosis and management (Kuhlmann) RRI 2008
Antioxidant Mechanisms of Gamma- and Alpha-Tocopherols (Hensley) ASN Renal Week 2007
Obesity, Metabolic Syndrome and CKD (J. Kramer) ASN Renal Week 2007
History of the Practice of Nephrology (Himmelfarb) ASN Renal Week 2007
Metabolic Syndrome and CKD: Extent of the Problem and Correlations (Muntner) ASN Renal Week 2007
Keeping Our Eye on the Ball: Improving Outcomes through Practice Guidelines (S. Kliger) ASN Renal Week 2007
Stacking the Deck: An Examination of the Guideline Development Process Christopher R. Blagg Endowed Lectureship in Renal Disease and Public Policy (P. Kassirer) ASN Renal Week 2007
Reading Between the Guidelines (B. Van Wyck) ASN Renal Week 2007
Critical Review: Statins and CKD (F. Fried) ASN Renal Week 2007
Changing Practices with Nutritional Interventions (R. Sehgal) ASN Renal Week 2007
Antioxidant Mechanisms of Vitamin C (Frei) ASN Renal Week 2007
Renal Disease and the Metabolic Syndrome (Muntner, Fried) ASN Renal Week 2007
Understanding and Preventing Malnutrition in ESRD (Peter Stenvinkel, MD, PhD; Bengt Lindholm, MD, PhD; Jonas Axelsson, MD; Olof Heimbuerger, MD, PhD) ADC 2006 (audio only)
Sodium as a Uremic Toxin (Ritz) RRI 2006, Part 2 (handouts)
Uric acid as a Uremic Toxin (Ikizler, Nakagawa) RRI 2006, Part 2 (handouts)
Dry Weight Assessment and Rebound (Kuhlmann, Greenwood) RRI 2006, Part 3 (handouts)
Special Debate: Is Carnitine Valuable in Dialysis Patients? (Schreiber vs. Handelman) RRI 2006, Part 3 (handouts)
Diet and Optimal Health: A Progress Report (Willett) ASN Renal Week 2005 (audiofiles)
Obesity and the Kidney (Lord, Scherer, Fliser) ASN Renal Week 2005 (audiofiles)
Clinical Topics in Nutrition (Kopple, Kaysen, Coyne) ADC 2005 (audiofiles)
Inflammatory Load in Hemodialysis: What Havoc Does It Cause? (Lindholm, Kalantar-Zadeh, Fischer) ADC 2005 (audiofiles)
The Impact of Post-Dialysis Weight on Patient Outcomes in Hemodialysis (Charra) RRI 2005 (audiofiles)
Chronic Inflammation and Renal Disease: Practical Aspects Part Two of Two (Kaysen) ASN Board Review 2004
Chronic Inflammation and Renal Disease: Practical Aspects Part One of Two (Kaysen) ASN Board Review 2004
The Kidney in Pregnancy (August) ASN Board Review 2004
Nutrition across the continuu of care in kidney disease (Beto) US NKF Spring Clinical Meeting
The Malnutrition - Inflammation - Atherosclerosis or MIA syndrome (Stenvinkel) ASN 2002 Renal Week
Nutritional management of the critically ill patient (Ikizler) ASN 2002 Renal Week
Survival in Japanese vs. U.S. Asian hemodialysis patients: Questions relevant for U.S. nephrologists (Daugirdas) KDF 2002 State-of-the-Art

Hypertension, Salt and Bread (Akpolat et al) Am J Kidney Dis (Jun 2009)
Oral Phosphate Binders (Hutchison et al) Kidney Int May 2009
Bone, Fat, and Body Composition: Evolving Concepts in the Pathogenesis of Osteoporosis (Rosen and Klibanski) Am J Med (May 2009)
Visceral obesity: the link among inflammation, hypertension, and cardiovascular disease Hypertens (Apr 2009)
Influence of renal function and diet on acid-base status in chronic kidney disease patients J Ren Nutr (Mar 2009)
Alternative milk beverages J Ren Nutr (Mar 2009)
Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis Am J Med (Mar 2009)
AHA Scientific Statements: Implementing American Heart Association Pediatric and Adult Nutrition Guidelines Circulation (Mar 2009)
Effect of a very low-protein diet on outcomes: long-term follow-up of the Modification of Diet in Renal Disease (MDRD) Study Am J Kidney Dis (Feb 2009)
More is not always better: intensive glycemic control in type 2 diabetes Am J Kidney Dis (Jan 2009)
Clinical implications of disordered magnesium homeostasis in chronic renal failure and dialysis Semin Dial (Jan 2009)
Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: A consensus statement of the ADA and the Eur Assoc Study Diab Diabet Care (Jan 2009)
Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA Diabetes Trials: A position statement of the ADA, ACCF, and AHA. Diabet Care (Jan 2009)
American College of Endocrinology Pre-Diabetes Consensus Conference: Part Three Diabet Care (Dec 2008)
A vitamin D nutritional cornucopia: new insights concerning the serum 25-hydroxyvitamin D status of the US population Am J Clin Nutr (Dec 2008)
Salt, salt substitutes, and seasoning alternatives J Ren Nutr (Nov 2008)
Dietary protein requirements of younger and older adults Am J Clin Nutr (Nov 2008)
Adverse effects of gadolinium administration in hemodialysis patients: a role for chromium supplementation? Am J Kidney Dis (Nov 2008)
Fructose consumption and consequences for glycation, plasma triacylglycerol, and body weight: meta-analyses and meta-regression models of intervention studies Am J Clin Nutr (Nov 2008)
American College of Endocrinology pre-diabetes consensus conference: part one Diabet Care (Oct 2008)
Spurious Hyperphosphatemia in Patients on Hemodialysis With Catheters (Schiller et al) Am J Kidney Dis (Sep 2008)
Balkan Nephropathy: Evolution of Our Knowledge (Bamias and Boletis) Am J Kidney Dis (Sep 2008)
Translating the A1C assay into estimated average glucose values Diabet Care (Aug 2008)
Exercise and dialysis Hemodial Int (Jul 2008)
Dietary sodium and cardiovascular and renal disease risk factors: dark horse or phantom entry? (McCarron DA) NDT Jul 08
Population-based prevention of obesity: the need for comprehensive promotion of healthful eating, physical activity, and energy balance: A Scientific Statement From American Heart Association (Kumanyika SK et al) Circulation Jul 08
Exercise in Dialysis Patients: A Review (Johansen K) Hemodial Int - Jul - 08
Population-based prevention of obesity: the need for comprehensive promotion of healthful eating, physical activity, and energy balance: A Scientific Statement From American Heart Association Circulation (Jul 2008)
Debate: Weight loss and blood pressure control (Pro) vs. Dietary therapy for obesity: an emperor with no clothes (Con) Hypertens (Jun 2008)
Large artery stiffening with weight gain in humans: role of visceral fat accumulation Hypertens (Jun 2008)
Lipoprotein management in patients with cardiometabolic risk: Consensus statement from the American Diabetes Association and the American College of Cardiology Foundation Diabet Care (Apr 2008)
WNK kinases and renal sodium transport in health and disease: an integrated view Hypertens (Mar 2008)
Protein restriction and body composition in renal disease J Ren Nutr (Mar 2008)
A dietary alternative to phosphorus control J Ren Nutr (Mar 2008)
Changes in the potassium content of different potato varieties after cooking J Ren Nutr (Mar 2008)
Revisiting the dialysate sodium prescription as a tool for better blood pressure and interdialytic weight gain management in hemodialysis patients CJASN Mar 2008
Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study Brit Med J (Feb 2008)
Association between obesity and kidney disease: A systematic review and meta-analysis Kidney Int (Jan 2008)
Adiponectin, cardiovascular function, and hypertension Hypertens (Jan 2008)
Long term pharmacotherapy for obesity and overweight: updated meta-analysis (Rucker et al) Brit Med J (Dec 2007)
The pivotal role of sodium balance in control of blood pressure in dialysis patients (Tomson et al) Hemodial Int (Nov 2007)
Dietary antioxidants and primary prevention of age related macular degeneration: systematic review and meta-analysis (Chong et al) Brit Med J (Oct 2007)
Obesity paradox in patients with hypertension and coronary artery disease (Lavie et al) Am J Med (Oct 2007)
High salt intake: a cause of blood pressure-independent left ventricular hypertrophy? (Burnier et al) Nephrol Dial Transplat (Sep 2007)
Physical activity and public health in older adults Circulation (Aug 2007)
Expanding role for vitamin D in chronic kidney disease: importance of blood 25-OH-D levels and extra-renal 1alpha-hydroxylase in the classical and nonclassical actions of 1alpha,25-(OH)2-D3 (Jones) Semin Dial (Aug 2007)
Hidden Phosphorus: Where Do We Go From Here? (Murphy-Gutekunst L) J Ren Nutr (Jul 07)
Hidden phosphorus: where do we go from here? (Lisa Murphy- Gutekunst) J Ren Nutr (Jul 2007)
Impact of glucose levels on advanced glycation end products in hemodialysis (Godfrey) Hemodial Int (Jul 2007)
Hypomagnesemia in patients with type 2 diabetes (Pham et al) CJASN (03-2007)
Hypomagnesemia in patients with type 2 diabetes CJASN 03-07
Tube feeding in advanced dementia. The metabolic perspective. (Hoffer) Br Med J 12-06
Advanced glycation end products and nephrotoxicity of high-protein diets (Uribarri, Tuttle) CJASN 11-06
Protein Bars (Blasiola) J Ren Nutr 10-06
A History of Obesity, or How What Was Good Became Ugly and Then Bad (Eknoyan) Adv Chronic Kidney Dis 10-06
Review of dialysate calcium concentration in hemodialysis (Toussaint, Cooney, Kerr) Hemodial Int 10-06
Obesity: Growing Impact on CKD (McGill, Furth, Kaskel) Adv Chronic Kidney Dis 10-06
KDOQI Nutrition 2002
KDOQI Dyslipdemia 2004
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Salt, the Forgotten Killer

Sharon Stall, RD, MPH, CSR, has been a renal dietitian for 22 years. She is on the editorial board of the Journal of Renal Nutrition, edited the Gourmet Renal Cookbook published by Lenox Hill Hospital, and worked with research methods of body composition in dialysis patients.