Medical nutrition therapy using plant-focused low-protein meal plans for management of chronic kidney disease in diabetes.

Purpose Of Review: Nearly half of all Americans with chronic kidney disease (CKD) also have type-2-diabetes (T2D). Whereas traditional and emerging pharmacotherapies are increasingly frequently used for the management of CKD in diabetes (CKD/DM), the role of integrated or multimodal interventions including the potentially synergistic and additive effect of diet and lifestyle modifications in addition to pharmacotherapy has not been well examined, in sharp contrast to the well-known integrated approaches to heart disease.

Recent Findings: Low-carbohydrate low-fat diets are often recommended in T2D, whereas low-protein diets (LPD) are recommended by guidelines for nondiabetic CKD with increasing emphasis on plant-based protein sources.

Hemodialysis and estrogen levels in postmenopausal (HELP) patients: The multicenter HELP study.

Background: Low serum estrogen levels are associated with increased risk for hip fractures in healthy postmenopausal women. Although the rate of hip fractures is 4- to 24-fold greater in postmenopausal hemodialysis-dependent women (PHDW) compared with the general population, no published study has examined the prevalence of low serum estrogen levels or factors associated with low serum estrogen levels in this population.

Methods: We measured serum estrone (E1) and total estradiol (E2) levels in PHDW and investigated the independent association between serum estrogen levels and demographic and dialysis-related factors.

Permanent cessation of menses and postmenopausal hormone use in dialysis-dependent women: the HELP study.

Background: Earlier onset of menopause is associated with an increased risk for cardiovascular disease, especially among women with surgical menopause. Information on age at or reasons for the permanent cessation of menses among women with end-stage renal disease (ESRD) remains limited, although cardiovascular disease accounts for more than half of all cardiovascular deaths in this population.

Methods: We used data from the Hemodialysis and Estrogen Levels in Postmenopausal Patients Study to examine the reported age when menses permanently ceased, reasons for the permanent cessation of menses, and prevalence of surgical menopause.

High-normal blood pressure and microalbuminuria.

Background: High-normal blood pressure (BP) is associated with increased cardiovascular risk compared with optimal BP, but no study has specifically examined the association between high-normal BP and microalbuminuria, an established predictor of future cardiovascular events.

Methods: This was a cross-sectional study of normotensive (systolic BP [SBP] < 140 mm Hg, diastolic BP [DBP] < 90 mm Hg) individuals without diabetes with no hypertension history enrolled in the Third National Health and Nutrition Examination Survey. BP was categorized as high normal (SBP, 130 to 139 mm Hg or DBP, 85 to 89 mm Hg), normal (SBP, 120 to 129 mm Hg or DBP, 80 to 84 mm Hg), and optimal (SBP < 120 mm Hg and DBP < 80 mm Hg).

The association between gout and nephrolithiasis: the National Health and Nutrition Examination Survey III, 1988-1994.

Background: Gout, an inflammatory arthritis, reportedly afflicts more than 2 million men and women in the United States. Previous reports have suggested an association between gout and kidney stone disease; however, these studies did not adjust for such important potential confounders as obesity and the presence of hypertension. To our knowledge, no published study has examined the independent association between gout and kidney stone disease.