Does Intragastric Balloon Treatment for Obesity in Chronic Kidney Disease Heighten Acute Kidney Injury Risk?

Background: The outcomes of intragastric balloon (IGB) placement to achieve weight loss in obese patients with chronic kidney disease (CKD) have not been reported to date. This study aimed to assess the safety and efficacy of the IGB as a weight-loss treatment among this patient population. Methods: A prospective, single-arm, ‘first in CKD' interventional study was conducted in patients with a body mass index >35 kg/m2 and CKD stages 3-4, referred for weight loss. After clinical assessment, the IGB was endoscopically inserted into the stomach and kept in place for 6 months. Complications, adverse events, acceptability, weight loss and metabolic responses were monitored over 6 months. Results: Eleven participants were recruited over 18 months. Two patients withdrew (1 prior to IGB insertion and 1 early removal after 3 days due to persistent vomiting) from the study; 9 patients completed the study. There were 5 episodes of acute kidney injury (AKI), occurring in 3 patients. After 6 months, the mean body mass decreased by 9.6% (SD ±6.8). Median waist circumference and total cholesterol decreased significantly (-7.7 cm; interquartile range (IQR) -15.3 to -3.9; and -0.2 mmol/l; IQR -0.6 to -0.05, respectively), with no changes in estimated glomerular filtration rate, blood pressure, triglycerides, adipokines, inflammation, or arterial stiffness measured by carotid-femoral pulse wave velocity. At IGB removal, there was 1 new case each of gastritis and esophagitis. Conclusions: Treatment with IGB has only moderate efficacy on weight loss; yet it results in a high rate of complications in obese patients with established CKD. The risk of AKI may be raised due to increased risk of dehydration secondary to gastrointestinal symptoms associated with IGB placement and reduced baseline kidney function

A new renal inpatient nutrition screening tool (Renal iNUT): a multicenter validation study.

BACKGROUND: Screening of patients with renal disease for malnutrition risk on hospital admission provides an opportunity to improve prognosis. This study aimed to assess the validity and reliability of the Renal iNUT, a novel renal-specific inpatient nutrition screening tool. METHODS: Adult inpatient admissions to three renal units were screened using the Renal Inpatient Nutrition Screening Tool (iNUT) and the generic Malnutrition Universal Screening Tool (MUST) and compared against nutritional status using Subjective Global Assessment (SGA) as the standard. Construct validity was assessed by Handgrip Strength (HGS), reliability by repeated iNUT administration and nurse opinion by questionnaire. RESULTS: Of 141 admissions, 45% were malnourished (SGA score B or C). Using iNUT, 49% patients had increased malnutrition risk (score ≥1), 35.5% requiring dietetic referral (score ≥2). MUST indicated 20% at increased malnutrition risk and dietetic referral in 7%. iNUT was more sensitive than MUST in identifying increased malnutrition risk (92.1% vs 44.4%) and dietetic referral (69.8% vs 15.9%). Specificity of iNUT for increased risk was 82.1% and 92.3% for dietetic referral. 47% patients had sarcopenic-range HGS, with significant difference between iNUT score ≥2 and 0 (p < 0.001). iNUT reliability assessed by kappa was 0.74 (95% CI, 0.58 to 0.9), indicating substantial agreement. Nurse evaluation (n = 71) was highly favorable. CONCLUSIONS: The Renal iNUT is a valid and reliable nutrition screening tool when used by nurses admitting patients to specialist renal wards. In comparison with MUST, use of iNUT is likely to improve the identification of malnourished patients for nutritional intervention and dietetic referral

Diet Quality, Self-Efficacy, and Health Literacy in Adults With Chronic Kidney Disease: A Cross-Sectional Study

Objective: Adherence to high-quality dietary patterns is associated with lower risk of disease progression and all-cause mortality in chronic kidney disease (CKD). Self-efficacy and health literacy are recognized as factors that may lead to better adherence to high-quality diets. However, these associations are not well studied in CKD. This study aims to explore the relationship between health literacy, self-efficacy, and diet quality in CKD. Methods: Participants with CKD stages 3a-5 recruited from 3 large tertiary hospitals were assessed using the Self-Efficacy for Managing Chronic Disease 6-item scale, the Health Literacy Questionnaire, and the Australian Eating Survey Food Frequency Questionnaire. Diet quality was measured using the Australian Recommended Food Score. Associations were examined using multivariable linear regression models, adjusted for sex and type 2 diabetes diagnosis. Results: Sixty participants were included in the analysis. Mean age of participants was 74.5 years and 58% were male. The mean Australian Recommended Food Score was poor (mean = 29.9 ± 9.1/73) and characterized by high intake of Processed foods and animal protein, and low intake of fruit and vegetables. Mean Self-Efficacy for Managing Chronic Disease 6-item scale was high (7.12 ± 2.07/10). Self-efficacy and health literacy domains 6 - Actively engage with healthcare providers and 7 - Navigating healthcare system independently predicted diet quality in the adjusted model for sex and type 2 diabetes. Conclusion: Adults with CKD report suboptimal diet quality. The results suggest that self-efficacy and aspects of health literacy should be considered when designing interventions aimed at improving diet quality in people with CKD.No Full Tex

Quality and Validity of Diet Quality Indices for Use in Australian Contexts: A Systematic Review

Diet quality indices (DQIs) are tools used to evaluate the overall diet quality against dietary guidelines or known healthy dietary patterns. This review aimed to evaluate DQIs and their validation processes to facilitate decision-making in the selection of appropriate DQIs for use in Australian contexts. A search of CINAHL, PubMed and Scopus electronic databases was conducted for studies published between January 2010 - May 2020, which validated a DQI, measuring >1 dimension of diet quality (adequacy, balance, moderation, variety) and was applicable to the Australian context. Data on constructs, scoring, weighting and validation methods (construct validity, criterion validity, reliability and reproducibility) were extracted and summarised. The quality of the validation process was evaluated using COSMIN Risk of Bias and Joanna Briggs Appraisal checklists. The review identified 27 indices measuring adherence to: national dietary guidelines (n=13), Mediterranean diet (n=8), and specific population recommendations and chronic disease risk (n=6). Extensiveness of the validation process varied widely across and within categories. Construct validity was the most strongly assessed measurement property, while evaluation of measurement error was frequently inadequate. DQIs should capture multiple dimensions of diet quality, possess a reliable scoring system, and demonstrate adequate evidence in their validation framework to support use in the intended context. Researchers need to understand the limitations of newly developed DQIs and interpret results in view of the validation evidence. Future research on DQIs is indicated to improve evaluation of measurement error, reproducibility and reliability.Full Tex

Obesity as a barrier to kidney transplantation: Time to eliminate the body weight bias?

There is clear evidence that survival rates following transplantation far exceed those for remaining on dialysis, regardless of body size measured by body mass index (BMI). Studies over the past 15 years also suggest little to no difference in long-term outcomes, including graft survival and mortality, irrespective of BMI, in contrast to earlier evidence. However, weight bias still exists, as access to kidney transplantation remains inequitable in centers using arbitrary BMI limits. Clinicians faced with the decision regarding listing based on body size are not helped by conflicting recommendations in national and international guidelines. Therefore, in clinical practice, obesity, and recommendations for weight loss, remain a controversial issue when assessing suitability for kidney transplantation. Obesity management interventions in end-stage kidney disease (ESKD), whether for weight loss for transplantation listing or for slowing kidney disease progression, are under-explored in trial settings. Bariatric surgery is the most successful treatment for obesity, but carries increased risk in the ESKD population, and the desired outcome of kidney transplant listing is not guaranteed. Centers that limit transplants to those meeting arbitrary levels of body mass, rather than adopting an individualized assessment approach, may be unfairly depriving many ESKD patients of the survival and quality of life benefits derived from kidney transplantation. However, robotic kidney transplantation surgery holds promise for reducing perioperative risks related to obesity, and may therefore represent an opportunity to remove listing criteria based on size