Nutrition-Based Management of Inflammaging in CKD and Renal Replacement Therapies

Abstract

Access to renal transplantation guarantees a substantial improvement in the clinical condition and quality of life (QoL) for end-stage renal disease (ESRD) patients. In recent years, a greater number of older patients starting renal replacement therapies (RRT) have shown the long-term impact of conservative therapies for advanced CKD and the consequences of the uremic milieu, with a frail clinical condition that impacts not only their survival but also limits their access to transplantation. This process, referred to as “inflammaging,” might be reversible with a tailored approach, such as RRT accompanied by specific nutritional support. In this review, we summarize the evidence demonstrating the presence of several proinflammatory substances in the Western diet (WD) and the positive effect of unprocessed food consumption and increased fruit and vegetable intake, suggesting a new approach to reduce inflammaging with the improvement of ESRD clinical status. We conclude that the Mediterranean diet (MD), because of its modulative effects on microbiota and its anti-inflammaging properties, may be a cornerstone in a more precise nutritional support for patients on the waiting list for kidney transplantation.

Evolving Concepts on Inflammatory Biomarkers and Malnutrition in Chronic Kidney Disease

“…Other components of chronic kidney disease-mineral and bone disorder, such as alkaline phosphatase, phosphate, and/or ionized calcium, have been associated with nutritional parameters. Similarly, omega-3 polyunsaturated fatty acids, known to have a strong anti-inflammatory effect, have lower levels in renal replacement therapy patients than in the general population [ 23 ].…”

Polyphenols and Novel Insights Into Post-kidney Transplant Complications and Cardiovascular Disease: A Narrative Review

“…To date, the MD is one of the most extensively studied dietary styles, and has demonstrated to reduce the risk of CVD, diabetes, and mortality in the general population ( 52 , 53 ). Mediterranean diet has also shown protection against lipid peroxidation and inflammation, and it is the most recommended diet for KTR ( 54 ). On the other hand, the western diet, well-recognized for its proinflammatory effects related to high sugar and saturated fat intake, reduced content in fiber, complex carbohydrates, micronutrients, and lack of bioactive molecules such as omega-3 polyunsaturated fatty acids and polyphenols ( 55 ), is recommended to be avoided in KTR.…”

“…Therefore, it may be considered as indirect evidence for beneficial effects of polyphenols in KTR. However, it must be considered that MD is rich in many other elements that also protect against CVD, for example fibers which are related to better glycemic control, and have intrinsic antioxidant and anti-inflammatory effect; omega 3 polyunsaturated fatty acid which is found in olive oil and fish; and micronutrients such as vitamin D, magnesium, and zinc, known for its protective effect against CVD and its anti-inflammatory properties ( 54 ). Although the protective effect of MD in KTR, cannot be attributed exclusively to polyphenols considering the existing evidence, it may hold a plea for future studies evaluating the contribution of dietary polyphenols to reduce the cardiovascular burden in KTR.…”

Interleukin-6 and Outcome of Chronic Hemodialysis Patients with SARS-CoV-2 Pneumonia

“…COVID-19 infection also had a triggering effect on the progression of chronic kidney disease to end-stage chronic renal failure with increased access to dialysis treatment [4]. Moreover, dialysis patients are commonly burdened by several comorbidities including cardiovascular disease, prothrombotic status, diabetes, malnutrition, vitamin D deficiency, advanced age, and immune dysfunction [5][6][7][8][9][10][11].…”