Should a low-protein diet and ketoanalogue supplementation be part of the management of advanced chronic kidney disease?

The vast majority of patients with advanced chronic kidney disease (CKD) who transition to end-stage kidney disease (ESKD) are treated with dialysis. Given that dialysis does not always have the intended effects of increasing longevity and/or improving health, particularly in those with high comorbidity burden and/or older age groups, there has been increasing emphasis on interventions that delay or avert the need for renal replacement therapy. Among the multi-disciplinary approaches used to reduce CKD progression, dietary interventions are a major cornerstone.

Effects of Vaccination on Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Nationwide Population-Based Cohort Study.

Background: Coronavirus 2019 (COVID-19) vaccination appears to have potential benefits for patients with chronic obstructive pulmonary disease (COPD). However, limited information is available on whether COVID-19 vaccination reduces acute exacerbation of COPD (AECOPD).

Methods: In the present study, 41,606 individuals with COPD were enrolled using the Korean National Health Insurance System-severe acute respiratory syndrome coronavirus 2 (NHIS SARS-CoV-2) database from 2020-2021.

Dialysis Transition Patterns of Chronic Kidney Disease Patients With and Without Heart Failure.

Objective: To compare dialysis transition patterns of chronic kidney disease (CKD) patients with heart failure (HF) and without HF, including inpatient "crash start" initiation of long-term ("maintenance") dialysis, early dialysis initiation as evaluated by estimated glomerular filtration rate (eGFR), and rate of central venous catheter (CVC) use for hemodialysis.

Methods: A cross-sectional study was performed within Kaiser Permanente Southern California of patients (age ≥18 years) with observed incidence of CKD who initiated maintenance dialysis between January 1, 2007, and December 31, 2018. Heart failure was further categorized into HF with preserved ejection fraction (>40%) or HF with reduced ejection fraction (≤40%).

Insights into high ammonia-resistant syntrophic microbiomes and metabolic pathways during continuous anaerobic digestion of cow manure.

Understanding microbial responses to ammonia is critical for defining thresholds and ensuring stable operation of anaerobic digestion (AD); however, an understanding of the microbiome's resistance mechanisms to high-total-ammonia-nitrogen (TAN) conditions remains limited. This study determined a TAN threshold of 7 g/L for continuous cow manure AD with increasing TAN levels. TAN was identified as the most critical factor influencing the AD performance, with CH production decreasing by > 50 % beyond this level.