Editorial: Personalized Nutrition in Chronic Kidney Disease Provisionally Accepted

Lara Caldiroli^1* Alice Sabatino² Andreana De Mauri³

• ¹Department of Nephrology, Dialysis and Kidney Transplants, IRCCS Ca 'Granda Foundation Maggiore Policlinico Hospital, Italy
• ²Division of Renal Medicine, Baxter Novum. Department of Clinical Science, Intervention and Technology. Karolinska Institute, Stockholm, Sweden, Sweden
• ³Nephrology and Dialysis Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy, Italy

Many factors are involved in the deterioration of nutritional status in patients with CKD. These include unsupervised dietary changes which, combined with the loss of appetite often observed in this patient population, may lead to spontaneous reductions in energy and nutrient intake (11). In addition, negative energy and protein balance in patients with CKD/ESKD can be caused by the catabolic effects of kidney replacement therapy (KRT), metabolic and hormonal derangements, the presence of systemic inflammation and comorbidities, and reduced physical activity (11)(12).The clinical study by Xueting Tao et al. adds to the growing body of evidence supporting the efficacy of personalised nutrition therapy in ESKD patients on dialysis. This study analysed changes in residual renal function (RRF) and indicators of blood and kidney function in ESKD with personalised nutritional therapy. The results show that nutritional interventions for ESKD are effective in reducing the rate of decline in RRF and improving indicators of blood and kidney function in patients on dialysis. Their findings highlight the potential of nutritional interventions to preserve RRF and improve overall clinical outcomes in this population. Additionaly, a systematic review and meta-analysis by Song Ren and colleagues provides compelling evidence for the efficacy of oral nutritional supplements (ONS) in dialysis patients. By synthesising data from randomised controlled trials (RCTs), the study highlights the beneficial effects of ONS on key nutritional parameters, including body mass index (BMI), serum albumin levels, nitrogen balance and markers of systemic inflammation. These findings underscore the importance of including ONS as part of a comprehensive nutritional programme for dialysis patients, providing clinicians with a valuable tool to optimise patient care. However, as Andreja Ocepek's interventional study suggests, simply adding ONS to a regular diet may not be sufficient to address the multiple challenges of protein energy wasting in haemodialysis patients. The study highlights the need for comprehensive nutritional approaches tailored to individual patient needs, including personalised dietary counselling, close monitoring of nutritional parameters during dialysis treatment and psychological support.Changing the perspective prevention, some studies have shown that there is an association between dietinduced inflammation and the presence of common chronic diseases (10). However, there has been uncertainty about the influence of dietary inflammatory potential on the risk of chronic kidney disease (CKD) in middle-aged and older groups. On this regard, Meiqian Guo's looked at the relationship between the Dietary Inflammatory Index (DII) and CKD in people aged 40 years and older, showing a positive association between DII and CKD in this age group.Dietary patterns have been shown to be closely related to inflammation, which has been independently associated with cognitive impairment (CI) in patients undergoing haemodialysis (HD). However, the influence of inflammation-derived dietary patterns on CI in this population remains unclear. Yan Zhuang's investigation of the relationship between inflammation-derived dietary patterns and cognitive impairment in haemodialysis patients sheds light on the complex interplay between diet, inflammation, and cognitive health in this population. Dietary patterns that were associated with high CRP levels included high intake of rice, tea and coffee, alcohol and fruits, and low intake of dark vegetables and juice, and they contributed to an increased risk of CCI. The association between consumption of seafood, sweet drinks, and alcohol and CCI has not yet been established. However, they may be dietary factors that contribute to inflammation in patients undergoing HD.Another important challenge in the current nutritional management of patients with ESKD on haemodialysis is achieving a good dietary quality pattern (13). Fear of hyperkalemia often prevents clinicians from encouraging patients to eat fruits and vegetables, resulting in poor dietary fibre intake. A low dietary fibre intake seems to be associated with the development of low-grade systemic inflammation by promoting intestinal dysbiosis and should not be overlooked (14)(15). Xiao Bi's longitudinal observational study explores the complex relationship between gut microbiota dysbiosis and protein energy wasting (PEW) in haemodialysis patients. By examining changes in gut microbiota composition over time, the study identifies potential microbial markers associated with muscle mass loss and the occurrence of PEW. Such findings hold promise for the development of targeted interventions aimed at modulating the gut microbiota to reduce the risk of PEW in dialysis patients.Rounding off this special collection, Junlin Zhang describes the relationship between immune-nutrition indices and mortality outcomes in patients with CKD. The Mendelian randomisation study by Yu Yin et al. provides valuable insights into the causal relationships between serum metabolites and CKD incidence and progression. Chenming Li evaluates the role of specific amino acid metabolism in the development of diabetic kidney disease (DKD), providing new insights into the pathophysiological mechanisms underlying disease progression. Finally, Jianling Song investigates the association between coffee consumption and serum uric acid levels in a US population with CKD.Taken together, these studies underscore the multifaceted nature of nutritional care in CKD patients and highlight the importance of personalised interventions tailored to individual needs. We are confident that this reading will provide new information for clinicians and researchers in the field of nutrition and kidney disease.