The New Nordic Renal Diet Induces a Pronounced Reduction of Urine Acid Excretion and Uremic Toxins in Chronic Kidney Disease Patients (Stage 3 and 4) (bibtex)
by Nikita Misella Hansen, Peder Berg, Marianne Rix, Manan Pareek, Jens Leipziger, Anne-Lise Kamper, Arne Astrup, Mads Vaarby Sorensen and Louise Salomo
Abstract:
OBJECTIVE: Metabolic acidosis and the uremic toxins, indoxyl sulfate (IS) and p-cresyl sulfate (PCS), are associated with increased risks of kidney disease progression, muscle catabolism, cardiovascular disease, and mortality in patients with chronic kidney disease (CKD). The New Nordic Renal Diet (NNRD) is a plant-focused meal pattern, with reduced phosphorus and protein content compared to an average Danish diet. Due to a higher amount of plant-based products, we hypothesized that NNRD would reduce renal excretion of acids and uremic toxins. Thus, we evaluated the effects of NNRD on metabolic acidosis and uremic toxins in patients with moderate CKD, stages 3-4. DESIGN AND METHODS: This post hoc analysis is based on a randomized controlled crossover trial comparing 1 week of the NNRD to a control 1-week period of an average Danish diet, in patients with CKD stages 3 and 4. Urine pH and urine excretion of bicarbonate, ammonium, titratable acids, IS, and PCS alongside plasma total CO2 (tCO2) were measured at days 1, 4, and 7 in 18 patients. RESULTS: After 7 days on NNRD 24-hour urine net acid excretion was decreased by 80% (P \textless .001), 24-hour urine excretion of ammonium and bicarbonate decreased by 34% (P \textless .001), and increased by 678% (P \textless .001), respectively, compared with the control period. Plasma tCO2 was increased by 8% (P = .005). Moreover, 24-hour urine excretion of PCS and IS were reduced by 31% (P = .018) and 29% (P \textless .001), respectively. CONCLUSION: One week of NNRD in patients suffering from moderate CKD effectively improved metabolic acidosis with a marked reduction in urine net acid excretion that included a large increase in urine bicarbonate excretion. In addition, NNRD reduced urinary excretion of the uremic toxins PCS and IS. These results encourage further investigations of the long-term effects of NNRD on renal protection in patients with CKD.
Reference:
The New Nordic Renal Diet Induces a Pronounced Reduction of Urine Acid Excretion and Uremic Toxins in Chronic Kidney Disease Patients (Stage 3 and 4) (Nikita Misella Hansen, Peder Berg, Marianne Rix, Manan Pareek, Jens Leipziger, Anne-Lise Kamper, Arne Astrup, Mads Vaarby Sorensen and Louise Salomo), In Journal of Renal Nutrition: The Official Journal of the Council on Renal Nutrition of the National Kidney Foundation, volume 33, 2023.
Bibtex Entry:
@article{hansen_new_2023,
	abstract = {OBJECTIVE: Metabolic acidosis and the uremic toxins, indoxyl sulfate (IS) and p-cresyl sulfate (PCS), are associated with increased risks of kidney disease progression, muscle catabolism, cardiovascular disease, and mortality in patients with chronic kidney disease (CKD). The New Nordic Renal Diet (NNRD) is a plant-focused meal pattern, with reduced phosphorus and protein content compared to an average Danish diet. Due to a higher amount of plant-based products, we hypothesized that NNRD would reduce renal excretion of acids and uremic toxins. Thus, we evaluated the effects of NNRD on metabolic acidosis and uremic toxins in patients with moderate CKD, stages 3-4.
DESIGN AND METHODS: This post hoc analysis is based on a randomized controlled crossover trial comparing 1 week of the NNRD to a control 1-week period of an average Danish diet, in patients with CKD stages 3 and 4. Urine pH and urine excretion of bicarbonate, ammonium, titratable acids, IS, and PCS alongside plasma total CO2 (tCO2) were measured at days 1, 4, and 7 in 18 patients.
RESULTS: After 7 days on NNRD 24-hour urine net acid excretion was decreased by 80\% (P {\textless} .001), 24-hour urine excretion of ammonium and bicarbonate decreased by 34\% (P {\textless} .001), and increased by 678\% (P {\textless} .001), respectively, compared with the control period. Plasma tCO2 was increased by 8\% (P = .005). Moreover, 24-hour urine excretion of PCS and IS were reduced by 31\% (P = .018) and 29\% (P {\textless} .001), respectively.
CONCLUSION: One week of NNRD in patients suffering from moderate CKD effectively improved metabolic acidosis with a marked reduction in urine net acid excretion that included a large increase in urine bicarbonate excretion. In addition, NNRD reduced urinary excretion of the uremic toxins PCS and IS. These results encourage further investigations of the long-term effects of NNRD on renal protection in patients with CKD.},
	author = {Hansen, Nikita Misella and Berg, Peder and Rix, Marianne and Pareek, Manan and Leipziger, Jens and Kamper, Anne-Lise and Astrup, Arne and Vaarby Sorensen, Mads and Salomo, Louise},
	date-added = {2023-07-25 20:12:12 +0100},
	date-modified = {2023-07-25 20:13:21 +0100},
	doi = {10.1053/j.jrn.2022.09.010},
	issn = {1532-8503},
	journal = {Journal of Renal Nutrition: The Official Journal of the Council on Renal Nutrition of the National Kidney Foundation},
	keywords = {Metabolic Acidosis, Diet, Nordic Diet,},
	language = {eng},
	month = may,
	number = {3},
	pages = {412--419},
	pmid = {36195272},
	title = {The {New} {Nordic} {Renal} {Diet} {Induces} a {Pronounced} {Reduction} of {Urine} {Acid} {Excretion} and {Uremic} {Toxins} in {Chronic} {Kidney} {Disease} {Patients} ({Stage} 3 and 4)},
	volume = {33},
	year = {2023},
	bdsk-url-1 = {https://doi.org/10.1053/j.jrn.2022.09.010}}
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