Tag Archives: kidney

Hydration strategy test for kidney stones is in water: Study

Posted on by
Reply

A large new clinical trial has taken a closer look at a long-standing piece of medical advice for kidney stone patients: drink more water. While the recommendation remains sound, the study suggests that actually sticking to it in real life is far harder than many assume.

Kidney stones are known for causing severe, often debilitating pain. In the United States, about one in 11 people will develop them at some point, and nearly half of those patients are likely to face a recurrence. Preventing that cycle has been a major focus for doctors, with high fluid intake widely seen as one of the most effective strategies.

To test how practical that advice is, researchers from the Urinary Stone Disease Research Network conducted what is now the largest behavioural study of its kind. The trial, coordinated by the Duke Clinical Research Institute and published in The Lancet on March 19, followed 1,658 adolescents and adults across six major U.S. medical centres over a two-year period.

Participants were split into two groups. One received standard care, while the other was enrolled in an intensive hydration programme designed to encourage higher fluid intake. This programme went beyond simple advice. It included smart water bottles that tracked how much participants drank, personalised daily hydration targets, reminder messages, financial incentives, and regular health coaching.

Each participant in the programme was given a tailored “fluid prescription,” calculated based on how much urine they typically produced and how much more fluid they would need to reach a target of at least 2.5 litres per day — a level believed to reduce the risk of stone formation.

The results showed that people in the programme did increase their fluid intake and produced more urine on average. However, the improvement was modest, and crucially, it did not translate into a significant reduction in the recurrence of symptomatic kidney stones across the group as a whole.

Researchers say this gap highlights a central challenge: adherence. Even with constant reminders, monitoring, and incentives, maintaining very high levels of daily fluid intake proved difficult.

Charles Scales, a senior author of the study and a professor at Duke University School of Medicine, noted that the findings underline how demanding such lifestyle changes can be. He pointed out that difficulty in maintaining these habits likely contributes to the high rate of recurrence seen in kidney stone patients.

Importantly, the study stands out for measuring actual stone recurrence rather than relying only on indirect markers such as fluid intake or urine output. Researchers used imaging and regular follow-ups to track whether new stones formed or existing ones grew, offering a more realistic picture of outcomes.

The findings are prompting experts to rethink a one-size-fits-all approach. Gregory Tasian, a co-senior author and paediatric urologist, said future strategies may need to be more personalised. Instead of asking every patient to meet the same hydration target, doctors may need to identify which patients benefit most from specific goals and why others struggle to maintain them.

The study also points to broader factors that may affect hydration habits — including work environments, daily routines, and individual health conditions — suggesting that behavioural solutions alone may not be enough.

Researchers are now calling for more tailored interventions, which could include customised hydration plans, better ways to address practical barriers to drinking more fluids, and even medical therapies aimed at preventing minerals from crystallising in urine.

For patients, the takeaway is clear but nuanced. Drinking more water still matters, but this study shows that turning that advice into a sustainable daily habit — and one that meaningfully reduces risk — is more complex than it appears.

As lead author Alana Desai put it, kidney stone disease is a chronic condition marked by sudden and often severe episodes that can disrupt everyday life. While many patients would welcome a simple solution, the path to prevention may require a more personalised and multifaceted approach.

Also Read:

Diets rich in these minerals may help prevent recurrent kidney stones

Kidney, Heart Transplants On Rise

 

Hidden acid imbalance in kidney disease raises red flags: Japan Study

Posted on by
Reply

A massive national survey in Japan has found a massive gap in the routine care of chronic kidney disease (CKD), and one of the major metabolic complications used to remain undiagnosed by lack of testing.

The researchers under the leadership of Mai Tanaka have conducted the study using the data of the Japan Chronic Kidney Disease Database Extension and analyzed the clinical records of over 21 university hospitals in the period between 2014 and 2021. It targeted individuals with moderate CKD (stages 3a to 4) that already have high susceptibility to disease progression and complications.

The results indicate a glaring omission: a simple and cheap test such as serum bicarbonate, which is used to diagnose metabolic acidosis, was ordered less than 10% per year. Consequently, the condition, which, as known, deteriorates kidney outcomes and general health, seems to be considerably under-measured in the everyday care.

Metabolic acidosis is a condition that develops when the body retains too much acid in it because of a deteriorated renal strength. It has also been associated with muscle atrophy, bone mineral loss, insulin resistance with accelerated kidney disease, and an increased risk of dying. The clinical practice is to intervene in cases where the bicarbonate of the body is lower than 22 mEq/L.

Nevertheless, the Japanese statistics indicate that the burden of the condition is being hidden by the low level of testing. Although the general prevalence seemed to be low in the general population of CKD, a more detailed look at patients that indeed underwent a test showed a significantly different pattern. Almost half of them fit the criteria of metabolic acidosis, and the rates were getting higher as the kidney function declined.

Follow up care was limited even among the patients who depicted definite biochemical signs of the condition. It was determined by the study that a gap between detection and clinical response was significant, with only 8.6% actually diagnosed and only 7.5% actually treated.

Metabolic Acidosis Undetected

The results are similar to those reported in North America where individual studies of the U.S. and Canadian cohorts have also indicated that metabolic acidosis is commonly undiagnosed in CKD patients. In such researches, less than every five patients was given sodium bicarbonate treatment in spite of the facts that acid retention was associated with persistent damage to the kidney by inflammation and fibrosis.

According to experts, the problem is not about access or price, since bicarbonate testing is readily available, but it is more about the failure to integrate it into a normal monitoring practice. Current guidelines, such as those of nephrology societies, suggest routine evaluation and correction of metabolic complications in CKD but this is not done so consistently.

The paper highlights a larger issue of concern of health systems where there has been a progressive growth in cases of CKD worldwide due to aging, increased incidences of diabetes and hypertension. Researchers indicate that regular bicarbonate testing may be an intervention that is scalable and practical as a part of the regular care panel.

Early identification of metabolic acidosis would enable clinicians to start treatment, either the use of alkali therapy or diet change at a time that might allow it to delay disease onset and minimize complications.

The authors have come to the conclusion that there is not as much a problem with the rarity of the condition but its invisibility in existing practice. In the absence of regular testing, there is a high-risk chance that a high and manageable element of kidney disease can be ignored, which has long-term patient consequences.

 

Also Read:

What are Zombie cells? Mayo Clinic researchers minimize cells in diabetic kidney disease

Polluted air may pose great threat to your kidneys, says study

 

Organ Donations After Cardiac Death Soar in US, Expand Transplant Lifeline 

Posted on by
Reply

One of the significant changes in the way people approach organ donation in the United States is the growing availability of transplantation organs, with almost half of all donors being patients whose heart has gone dead, according to latest studies.

According to the study by scientists at NYU Langone Health, it has been established that donation after circulatory death (DCD) has increased significantly in the last 25 years – marking an increase of 2 percent of all donors in 2000 to 49 percent in 2025. According to the findings published in Journal of the American Medicine, the development of medical technology is transforming transplant medicine.

The growth has been realized when demand is acute. According to the United Network for Organ Sharing, more than 100,000 individuals are already on transplant waiting lists in the U.S., and this fact requires finding new sources of viable organs.

Conventionally, organs donated have been infected out of patients who have been declared brain dead, those organs keep being oxygenated with the heart still beating. Conversely, DCD deals with patients who are not yet dead, but are on life support. In case life-sustaining treatment is withdrawn and the patient dies in a given period, then organs can be removed to be transplanted, though it must be otherwise previously agreed.

Drawbacks Overcome With Tech 

In past, organs transplanted by such sources were less viable because of a short period of lack of oxygen following the cessation of the heart. Nevertheless, these drawbacks have been overcome with the recent technology advances.

Improved organ preservation has been achieved using techniques like normothermic regional perfusion in which blood flow to organs is resumed following cardiac death and machine perfusion systems in which oxygenated fluids are delivered extravascularly. These inventions have made innovations through which the surgeons can safely utilize organs that were not considered to be perfect.

According to researchers, this has expanded the pool of donors. The researchers discovered that current DCD donors are older individuals with higher probabilities of underlying diseases like diabetes or hypertension as compared to previous generation, which is more inclusive in the selection of the donor.

Syed Ali Husain, the lead author, indicated that the increase in circulatory-death donations is already producing a tangible impact, and thousands of patients were already getting transplants who otherwise would not have been able to survive the wait.

Regional Disparity Persists

The national data on transplants also indicated that there were disparities in the connections of the regions. DCD donors contributed up to 73 per cent of all donations in certain regions of the country and only 11 per cent in other regions indicating a lack of balance in the practice.

The researchers working on the study underlined the importance of developing uniform national standards and ongoing involvement of the population to protect the ethics and preserve a trusting attitude towards the process of donating.

Researchers believe that more papers are required to understand long-term outcomes and enhance protocols as the DCD is becoming more popular. Further research will aim to enhance the process of donor identification and understand the performance of organs of donors who died of a circulatory death as opposed to the performance of organs of those who died of a traditional brain-death.

The results represent an important development in the field of transplant medicine – one that may aid in reducing the disparity between supply and demand of organs, and also pose new challenges to clinical practice, ethics and popular opinion.

Also Read:

New Chip Helps Diagnose Heart Attacks Based on Blood Test in Minutes

Heart attack prevention lags for people with stroke, peripheral artery disease: Study

What are Zombie cells? Mayo Clinic researchers minimize cells in diabetic kidney disease

Posted on by
Reply

The results of these researchers in Jacksonville, Fla., are that a drug-and-supplement combination therapy can be used to lessen the harmful effects of senescent cells, or, to be more exact, zombie cells, in diabetic kidney disease.

In an article published by the Lancet, the team has found that the combination of the cancer drug dasatanib and a naturally occurring substance quercetin reduced inflammation and enhanced protective factors in the kidney.

Diabetic kidney disease is the number one cause of renal failure and goes over 12 million individuals in the U.S. Whereas there is a partial cure in newer treatments to slow the loss of kidney function, it has no cure at all.

According to LaTonya Hickson, a nephrologist with Mayo Clinic in Florida and the main researcher of the study, the combination therapy, administered on a short term basis, decreased the amount of senescent cells within a preclinical diabetes kidney disease model and also led to the enhancement of kidney functioning. In order to prolong the health of the kidney, researchers have been keen on the solution to the existence of senescent cells, which do not get to pass through the natural process of death and instead hang around in tissues leading to aging and disease.

Therapy to Attack Senescent Cells

The therapeutic strategy is senolytics, natural and synthetic substances that in combination selectively attack senescent cells.

In a clinical trial that was previously carried out and was a pilot study, researchers at the Mayo Clinic led by Hickson discovered that dasatanib combination with quercetin diminished senescent cells of skin and fat tissues in diabetic kidney disease patients. The impact of the combination therapy on senescence and protective factors on the diabetic kidney, however, had not been described yet.

“The need to demonstrate that this single, momentary, treatment has an outcome on the kidneys was informed by the necessity to do so without the use of invasive procedures in the patients,” says Xiaohui Bian, a nephrologist who did the work as a post-doctoral fellow at Mayo Clinic and leads the study.

The group identified that the combination therapy enhanced kidney performance and protective mechanisms and minimized injury, senescent cells, and inflammation in a preclinical model of diabetic kidney disease. The combination therapy also lowered the number of senescent cells and the inflammatory response caused by them in cultured human kidney cells.

According to Hickson, the results indicate that this combination treatment has a potential to assist in reducing and stopping the damage of kidneys caused by diabetes. These two studies are now promising and indicate that larger scale research in patients with senolytics is warranted to enhance the health of the kidneys.

Diets rich in these minerals may help prevent recurrent kidney stones

Posted on by
Reply

Kidney stones can cause not only excruciating pain but also are associated with chronic kidney disease, osteoporosis and cardiovascular disease. If you’ve experienced a kidney stone once, you have a 30% chance of having another kidney stone within five years.

Changes in diet are often prescribed to prevent recurrent symptomatic kidney stones. However, little research is available regarding dietary changes for those who have one incident of kidney stone formation versus those who have recurrent incidents.

Mayo Clinic researchers designed a prospective study to investigate the impact of dietary changes. Their findings show that enriching diets with foods high in calcium and potassium may prevent recurrent symptomatic kidney stones.

Dietary factors were based on a questionnaire administered to 411 patients who had experienced first-time symptomatic kidney stones and a control group of 384 people — all of whom were seen at Mayo Clinic in Rochester and Mayo Clinic in Florida between 2009 and 2018. The findings, which were published in Mayo Clinic Proceedings, show that lower dietary calcium and potassium, as well as lower intake of fluids, caffeine and phytate, are associated with higher odds of experiencing a first-time symptomatic kidney stone.

Of the patients who had first-time stone formation, 73 experienced recurrent stones within a median of 4.1 years of follow-up. Further analysis found that lower levels of dietary calcium and potassium predicted recurrence.

“These dietary findings may have particular importance because recommendations for preventing kidney stones have been based primarily on dietary factors associated with first-time rather than recurrent stone formation,” says Andrew Rule, M.D., a Mayo Clinic nephrologist and senior author of the study. “Patients may not be likely to adjust their diet to prevent an incidence of kidney stones, but they are more likely to do so if it can help prevent recurrence.”

Fluid intake of less than 3,400 milliliters per day, or about nine 12-ounce glasses, is associated with first-time stone formation, along with caffeine intake and phytate, the study finds. Daily fluid intake includes intake from foods such as fruits and vegetables.

Low fluid and caffeine intake can result in low urine volume and increased urine concentration, contributing to stone formation. Phytate is an antioxidant compound found in whole grains, nuts and other foods that can lead to increased calcium absorption and urinary calcium excretion.

“Changing your diet to prevent kidney stones can be very difficult,” says Dr. Rule. “Thus, knowing the dietary factors that are most important for preventing kidney stone recurrence can help patients and providers know what to prioritize.”

Low dietary calcium and potassium was a more important predictor than fluid intake of recurrent kidney stone formation, says Api Chewcharat, M.D., the article’s first author and a postdoctoral research fellow at Mayo Clinic at the time of the study. “This is not to say high fluid intake is not important. We just did not find benefits of increasing fluid intake among those patients with a history of kidney stone formation.”

The study concludes that diets with daily intake of 1,200 milligrams of calcium may help prevent first-time and recurrent kidney stones. That daily intake is in line with the Department of Agriculture’s daily recommended nutrition.

While higher potassium intake also is recommended, the USDA does not make a recommendation for daily potassium intake. The study also doesn’t recommend an intake level.

Dr. Chewcharat says the takeaway is that patients should add more fruits and vegetables that are high in calcium and potassium to their diets. Fruits that are high in potassium include bananas, oranges, grapefruits, cantaloupes, honeydew melons and apricots. Vegetables include potatoes, mushrooms, peas, cucumbers and zucchini.

Polluted air may pose great threat to your kidneys, says study

Posted on by
Reply

There is good evidence that polluted air increases the risk of respiratory problems such as asthma — as well as organ inflammation, worsening of diabetes and other life-threatening conditions. But new research suggests air pollution can also fuel something else: chronic kidney disease, or CKD, which occurs when a person’s kidneys become damaged or cannot filter blood properly.

Recently published in PLOS ONE, a University of Michigan study highlights the lesser-known connection.

“Similar to smoking, air pollution contains harmful toxins that can directly affect the kidneys,” says Jennifer Bragg-Gresham, M.S., Ph.D., a Michigan Medicine epidemiologist and the study’s lead author.

“Kidneys have a large volume of blood flowing through them, and if anything harms the circulatory system, the kidneys will be the first to sense those effects.”

People with diabetes, obesity, high blood pressure or heart disease are at increased risk of developing CKD. Which is why high-risk patients who live in heavily populated or polluted areas should recognize the danger and take precautions, Bragg-Gresham says.

Why air pollution is dangerous?

Air pollution contains fine particulate matter, or PM2.5, which is a cocktail of microscopic particles.

Because these particles are virtually weightless, they can stay in the air longer, causing humans to unavoidably inhale them on a regular basis without knowing it. PM2.5 can lead to serious health effects when inhaled often.

By reviewing Medicare claims data and air-quality data from the Centers for Disease Control and Prevention, the study’s authors found a positive association between CKD rates and PM2.5 concentration.

Says study co-author Rajiv Saran, M.D., a Michigan Medicine nephrologist and director of the United States Renal Data System Coordinating Center at U-M: “If you look at areas that are heavily polluted versus areas that are less polluted, you will find more chronic kidney disease.”

According to figures cited in the new research, chronic kidney disease afflicts more than 27 million Americans. People with CKD have an eightfold increased risk of cardiovascular mortality.

Unfortunately, PM2.5 is almost impossible to avoid.

We encounter air pollution from many simple everyday activities, such as cooking and driving. Other contributors are smoking, burning wood, packaged spray products, household appliances and, perhaps the most obvious, industry and vehicle emissions.

Air pollution also contains heavy metals such as lead, mercury and cadmium — all of which are known to negatively affect the kidneys.

Problems and preventive measures

The U-M research examined several prior studies on the issue, including an effort conducted in select coal-mining areas of Appalachia that found a 19 percent higher risk of CKD among men and a 13 percent higher risk in women compared with those who lived in counties with no mining.

The good news: PM2.5 levels are much lower in the U.S. than in other industrialized countries such as China and India.

“What this means for the countries with higher PM2.5 is significantly higher odds of CKD,” says Bragg-Gresham, also an assistant research scientist at U-M. “Our research was only able to examine a small range of PM2.5 values present in America but was able to find a significant association.”

However, it’s still important to take precautions when exposed to air pollution, especially for people who have existing health conditions or who live in densely populated or polluted cities.

“In heavily polluted areas, consider wearing masks that cover your nose and mouth, limit hours outside and limit long hours commuting to work in high traffic as well,” Saran says, adding that the risk should be taken seriously.

“Many people don’t see the seriousness of air pollution because it isn’t something visible, but that doesn’t mean it’s any less important for your health.”