Traditional dietary advice for people living with chronic kidney disease (CKD) focused predominantly on the quantity of energy and protein provided by the diet as well as restricting the consumption of single micronutrients. However, flaws in the assumptions that underlie this quantity-based approach have led to re-examination of medical nutrition therapy for kidney-related conditions, with a shift towards recommending more varied and liberalized plant-rich diets with a focus on dietary quality. Although clinical practice guidelines for patients with CKD have cautiously acknowledged this shift, less advice is available on how to translate new knowledge into practical and feasible recommendations that describe which foods patients should be advised to eat. In this Review, we provide a framework for the delivery of quality-oriented diet therapy for people with CKD based on the dietary principles of balance, variety and moderation. This approach also requires consideration of the manner in which foods are processed, prepared and integrated into the diet. Successful implementation requires a flexible, individualized approach that involves consideration of both CKD-specific and general dietary factors as well as potential barriers, challenges and behavioural determinants of the patient’s dietary choices and habits. Here, the authors discuss how to implement quality-focused dietary strategies for patients with chronic kidney disease. They discuss the principles of dietary balance, variety and moderation, food processing and cooking methods and approaches to enabling successful implementation of quality-focused dietary strategies.
The optimal intake of artificial nutrition in critically ill patients remains unclear. While calorie and protein intakes affect glomerular function in patients with chronic kidney disease, their relation to renal function at the acute phase of intensive care is insufficiently documented. We aimed to study associations of a low-calorie and low-protein diet with renal outcomes in critically ill patients. This post hoc analysis of the NUTRIREA-3 randomized-controlled trial included 3036 mechanically ventilated patients with shock. Calorie and protein intakes during the first 7 days were either low (6 kcal/kg and 0.2–0.4 g protein/kg/d) or standard (25 kcal/kg and 1.0–1.3 g protein/kg/d). The primary outcome was the incidence of acute kidney disease (AKD) during the ICU stay (up to ICU discharge or day 90 after inclusion, whichever occurred first). AKD during the ICU stay occurred in 669 (44.6
BACKGROUND:Data are needed on the effect of oxygen delivered through a high-flow nasal cannula, as compared with standard oxygen therapy, on intubation and mortality in patients with acute hypoxemic respiratory failure. METHODS:In this multicenter, open-label trial, we randomly assigned patients who had acute hypoxemic respiratory failure to receive high-flow-oxygen or standard-oxygen therapy. All the patients had a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of 200 or less, a respiratory rate of more than 25 breaths per minute, and pulmonary infiltrate on chest imaging. The primary outcome was death by day 28. RESULTS:A total of 1116 patients underwent randomization. Of these patients, 1110 (556 in the high-flow-oxygen group and 554 in the standard-oxygen group) were included in the analysis. Mortality at day 28 was 14.6% (in 81 of 556 patients) in the high-flow-oxygen group and 14.6% (in 81 of 554 patients) in the standard-oxygen group (difference, -0.05 percentage points; 95% confidence interval [CI], -4.21 to 4.10; P = 0.98). The incidence of intubation by day 28 was 42.4% (in 236 of 556 patients) in the high-flow-oxygen group and 48.4% (in 268 of 554 patients) in the standard-oxygen group (difference, -5.93 percentage points; 95% CI, -11.78 to -0.08). Serious adverse events (cardiac arrest or pneumothorax) occurred during spontaneous breathing in 13 patients (2.3%) in the high-flow-oxygen group and in 6 patients (1.1%) in the standard-oxygen group. CONCLUSIONS:Among patients with acute hypoxemic respiratory failure, the use of oxygen delivered through a high-flow nasal cannula did not significantly reduce mortality at day 28. (Funded by the French Ministry of Health and Fisher and Paykel Healthcare; SOHO ClinicalTrials.gov number, NCT04468126.).
ABSTRACT:Prognostic risk categorization aids treatment selection for patients with acute myeloid leukemia (AML). Although the European LeukemiaNet (ELN) classifications (2017 and 2022) for AML have been used to stratify outcomes for patients receiving intensive chemotherapy, their application to patients receiving less intensive therapy, such as azacitidine plus venetoclax, has been less satisfactory. In response, a 4-gene classifier that stratifies older patients with AML unfit for intensive chemotherapy into those with higher benefit (wild type), intermediate benefit (FLT3-internal tandem duplication [ITD] or NRAS/KRAS mutation), or lower benefit (TP53 mutation) after azacitidine plus venetoclax treatment was developed. We hypothesized that this 4-gene classifier may also have prognostic utility in patients receiving low-dose cytarabine (LDAC) plus venetoclax. Surprisingly, neither the ELN 2022 criteria nor the 4-gene azacitidine-venetoclax classifier model adequately stratified prognosis in a cohort of 139 patients receiving LDAC plus venetoclax. Patients with concurrent NPM1 and FLT3-ITD/RAS variants performed surprisingly well with LDAC plus venetoclax (complete remission [CR]/CR with incomplete blood count recovery [CRi] rate, 92%; median overall survival [OS], 29.67 months). Data-driven (sequential bootstrapping and tree-based) and empirical analyses identified complex karyotype and/or presence of TP53 mutation as prognostically relevant molecular/cytogenetic risk markers. Patients with complex karyotype and/or TP53 mutation displayed poor clinical outcomes (CR/CRi, 25%; median OS, 3.48 months). Notably, 74% of the study population lacked these poor prognostic markers and had a 67% CR/CRi rate with a median OS of 14.92 months. Overall, these data support the importance of molecular subclassification in defining treatment outcomes to venetoclax-based therapies. These trials were registered at www.clinicaltrials.gov as #NCT02287233 and #NCT03069352.
Introduction: Breaking is a high-risk discipline for the cervical spine, with movements such as the halo and headspin exposing dancers to significant stresses. Epidemiological studies highlight a high incidence of neck pain and injuries among breakers, while primary prevention remains limited due to a lack of data. Methods: This study aimed to evaluate preventive practices and propose an adapted prevention protocol based on existing rugby protocols. A questionnaire was remotely administered to French amateur and professional breakers, practicing movements with head support or not, and having experienced or not experienced neck pain or injuries. A total of 120 breakers responded to the questionnaire, and their data were analyzed across three axes: needs assessment, evaluation of interest in a prevention program, and identification of feasible exercises. Results: Among participants, 77.5% had previously experienced neck pain, and 51.7% had suffered cervical spine injuries. Specific neck warm-up was insufficient in most participants, and only 31.7% engaged in regular strengthening exercises of the neck. A strong interest in a prevention program was observed, and adapting rugby prevention exercises was deemed promising. Conclusion: Based on these results, a prevention protocol including specific warm-up and tailored muscle strengthening was proposed, with particular emphasis on head-supported isometric exercises. This protocol could serve as a basis for targeted prevention interventions aimed at reducing cervical injuries among breakers. Further studies are needed to evaluate the effectiveness of this prevention protocol.Level of Evidence: Level IV (Moderate).
