English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Background and Aims Controlled low-normal protein (LNP) diet in CKD patient is effective in controlling the progression of renal impairment. Oncological guidelines explain how a high protein level should be always required in patients (pts) affected by malignancies in order to compensate the cancer derived metabolism and avoid catabolism. But what about the onco-nephrological pts? Aim of our study is to investigate the metabolic impact of a low-normal protein diet in a consecutive cohort of 103 nephrological pts affected or not by urological non-metastatic malignancies. Method A consecutive cohort of 103 pts was enrolled in the Urological Department at San Raffaele Scientific Institute between 2018-2020. Inclusion criteria were: Age (&amp;gt;18 years old), eGFR (&amp;lt; 90 ml/min/1.73), Malnutritional Screening Tool (MTS&amp;lt;2), Urological Cancer aggressiveness (no metastatic process), Informed consent (signed). We divided the total cohort in 2 matched subgroups; case (CS: onco-nephrological pts with urological malignancies) and control (CT: nephrological pts) with a 2.1 ratio. Each patient underwent an initial nephrological and nutritional evaluation and was subsequently subjected to a conventional CKD LNP-diet (0,7-1 g/Kg/die: calories: 30-35 kcal per kg body weight/die) for a period of 6 months (+/- 2 moths). The diet was based on the estimated Glomerular Filtration Rate (CKD-EPI 2012 formula), comorbidities, nutritional status and hypermetabolic conditions. LNP-diets were integrated with aproteic food to maintain a relevant amount of high–biological value proteins, especially for oncological and advanced CKD pts. MTS, Body Mass Index (BMI), Phase Angle (PA), Fat Mass percentage (FM%), Fat-Free Mass Index (FFMI), body cell mass index (BCMI), extracellular:intracellular water ratio (ECW/ICW), waist circumference (WC), lab test exams and clinical variables were examined at baseline and after 6 months. Statistical analysis: Kruskal-Wallis rank sum test; Data analysis: R programming language and RStudio integrated development environment. Results Population divided as follows: average age: 69.8 (+/- 10.3); ♂ : ♀ ratio: 2.4; Hypertension: 57.28%; Diabetes: 19,41%; CKD classification: 3,88% stage 2, 87,37% above stage 3. At time zero no pts were underweight and 51 % were overweight or obese with difference condition of FM percentage (FM % average: 24.3 % ♀ and 18.1 % ♂for CS pts vs 31.6 % ♀ and 18.2 % ♂for CT pts). Only 2.1% of pts had a PA of less than 4°, considered a negative prognostic index (PA average: 5.6° for CS pts vs 5.5° for CT pts) and 6.3 % of pts had a value of cell mass less than 8 kg/m2 indicative of reduced lean mass (BCMI average: 10.4 kg / m2 for CS pts vs 11 kg / m2 for CT pts). An increase in ECW/ICW ratio greater than 1 was more present in CT pts in respect to CS pts (41.6 % vs 22.8 % and ECW/ICW average: 1.01 for CT pts vs 0.93 for CS pts) as well as WC measurement associated with increased cardiovascular risk (WC average: 87 cm ♀ and 99 cm ♂ for CS pts vs 97 cm ♀ and 104 cm ♂ for CT pts). After 6 months of diet, we observed a similar behavior between the CS and the CT cohorts in terms of renal metabolites and eGFR profile. In fact, the 65% of onco-nephrological and the 55% of nephrological pts displayed a significative decrease in urea plasmatic levels (- 27,76 mg/dl) and eGFR improvement (+ 6,27 ml/min/1,73). The nutritional status, as assessed by the MST, was preserved in both groups during the study. In addition, all pts had an improvement in BMI (CS: 2.8 kg/m2; CT :1.3 kg/m2) PA (CS: 2.8°; CT: 1.3°), BCMI (CS: 1.31 kg / m2; CT :0.38 kg / m2) and FFMI (CS; 0.1 ♀ and 0.1 ♂; CT; 2.9 ♀ and 1.1 ♂) and a decrease of WC (CS: - 1.3 cm; CT– 1,65), FM percentage (CS: 0 %; CT – 2.7) and ECW/ICW (CS: 0.02; CT 0.03). Conclusion Our study suggests that LNP high calorie diet ameliorates the nephrological scenarios, the metabolic complications, and the nutritional perspective in uro-oncological pts with stage 2-5 CKD. A larger prospective study to validate these results is on-going.

MO165CANCER, KIDNEY AND DIET: THE NUTRITIONAL MANAGEMENT IN ONCO-NEPHROLOGICAL PATIENTS. A SINGLE CENTER EXPERIENCE