AT PRESENT, almost one fourth of stage 5 CKD patients experience a life-threatening episode of hyperkalemia requiring emergency treatment, according to data cited in a recent article in Seminars in Dialysis (2007;20:431-439). The authors, Nirupama Putcha, MD, and Michael Allon, MD, note that although "many options have been proposed for the prevention of interdialytic hyperkalemia...prevention currently rests largely upon compliance with diet and a thoughtful use of medication regimens."

THE POSITIVE association between obesity and kidney disease (KD) is strongly supported by results of a recent meta-analysis by Wang et al (Kidney Int. 2008;73:19-33) that demonstrate a significantly increased risk for people with BMI greater than the normal range of 18.5-25 kg/m2. Along with CKD, the study also examined the occurrence of renal calculi and kidney cancer. According to the authors, 24.2% and 33.9% of KD cases among American men and women, respectively, could be prevented if overweight and obesity were eliminated.

RENAL HEALTH professionals recognize the detrimental effects of high sodium intake on BP control, congestive heart failure, and fluid balance in CKD patients.

The established practice for preventing urinary calculi is being challenged by results of a recent study (Whitson et al, Urology. 2007;70:634-637), which showed no correlation between urinary citrate levels and urinary pH.

WITH 45% of dialysis patients presenting as a result of diabetic kidney disease or with comorbidity of diabetes, studies are examining blood sugar control as a means to improving outcomes for this large segment of the dialysis population.

DESPITE regular dietary instruction, patients undergoing dialysis have a poor knowledge of dietary phosphorus compared with other nutrients important in CKD, according to researchers at the University of Wisconsin Medical School in Madison.

UNTIL RECENTLY, there was little interest in food oxalate values, as the dominant paradigm was that dietary oxalate contributed only 10% of daily oxalate excretion. This changed when Ross P. Holmes, PhD, of Wake Forest University School of Medicine in Winston-Salem, N.C., and his colleagues reported that 24% to 53% of urinary oxalate originated from dietary oxalate at typical intakes of 10-250 mg/day (Kidney Int. 2001;59:270-276).

CVD IS THE major cause of premature mortality in hemodialysis patients. There is some evidence to suggest that higher levels of n-3 fatty acid consumption than is typical in Western diets may reduce risk in the general population.

DIRECTLY DETERMINED glomerular filtration rate (GFR) is the gold standard for measuring renal function. Because its determination is relatively costly and complex, however, estimated GFR (eGFR) is used in clinical practice. Several formulas for calculating eGFR using serum creatinine (Cr) are currently in use, but disagreement persists over which is most appropriate for a given patient population.

HIGH-PROTEIN diets have been shown to accelerate renal deterioration in a number of studies of populations with even mildly reduced kidney function.