{"doi":"10.3389/fnut.2023.1088977","title":"Editorial: Nutrition and metabolism in kidney diseases","abstract":"The impairment of kidney function, which occurs in chronic kidney disease (CKD) and acute kidney injury (AKI), promotes specific alterations in nutrient metabolism (1) and induces a pro-inflammatory state (2). These alterations affect the nutritional status of the patients and increase morbidity and mortality risk. Among the many factors that are associated with poor outcomes in this population, protein-energy wasting, malnutrition, and sarcopenia play a significant role.Nutritional management in individuals with impaired kidney function varies depending on the disease severity, nutritional status, cause of disease, comorbidities, medications, and treatment methods. Therefore, understanding the available methods for assessing nutritional status, establishing dietary requirements, and strategies for preventing or treating potential nutritional derangements is essential for optimal care of patients with kidney diseases.In individuals with CKD, energy requirements have traditionally been considered to be higher based on early nitrogen balance studies. However, more recent studies have questioned these higher recommendations (3,4). Indirect calorimetry is the gold standard for measuring resting energy expenditure (REE); however, its availability in clinical settings is limited. Ramos-Acevedo et al., performed a study in individuals with CKD stages 3-5 without kidney replacement therapy, incorporating measures of nutritional status and other clinical variables. They found good concordance between their models and others validated in CKD. The authors concluded that clinicians should consider using formulas that include nutritional status and other variables, such as weight, fat-free mass, comorbidities, sex, and age.Similarly, Abi et al. utilised indirect calorimetry to measure REE in patients with stage 3-5 CKD and assess the relationship with the adipokines leptin, IL-6 and adiponectin in serum. In an initial analysis, the authors found that REE was positively correlated with leptin in males and females and negatively correlated with adiponectin in males only. However, when fat mass was accounted for using a multivariate linear regression model, the only significant relationship observed was between REE and leptin in males. This highlights the importance of considering the degree of adiposity when studying adipokines, as well as the possibility of a sex-specific relationship between adipokines and energy expenditure in CKD patients.Cardiovascular mortality is increased in populations with CKD, and there is considerable interest in how commonly assessed lipid risk factors can be utilised to understand and modulate cardiovascular risk (5). In a large retrospective study of Chinese peritoneal dialysis (PD) patients, Wu et al. observed that there was a U-shaped relationship between LDL cholesterol levels and cardiovascular mortality. When a subgroup analysis was performed, this U-shaped relationship only remained significant in those with serum albumin of less than 36 g/L, used as a biomarker of malnutrition. The authors concluded that nutritional status modifies the relationship between LDL cholesterol and cardiovascular mortality in PD.Lecamwasam et al. compared clinical and metabolomic data between patients with diabetes and early or late-stage CKD. In this study, the authors found no difference in LDL cholesterol between groups, although low-density lipoprotein triglyceride (LDL-TG) was increased in the late CKD group. The ratio between Apolipoprotein B1 and Apolipoprotein A1 (ApoB/ApoA1), a well established risk factor for cardiovascular disease ( 6), was increased in the late CKD group, driven by a reduction in ApoA1. These findings suggest that apolipoproteins may be useful for assessing cardiovascular risk in high risk populations such as CKD patients.Trimethylamine N-oxide (TMAO) is a uremic toxin which has been implicated in cardiovascular disease (7). Murray et al. fed pigs a highly heat-treated diet, high in resistant prot","journal":"Frontiers in Nutrition","year":2023,"id":398367,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9638,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1174606,"name":"Bárbara Perez Vogt","orcid":"0000-0002-2619-0354","position":1,"is_corresponding":false},{"id":275441,"name":"Annabel Biruete","orcid":"0000-0003-2549-0539","position":2,"is_corresponding":false},{"id":1174607,"name":"Thomas J. Wilkinson","orcid":"0000-0002-7855-7752","position":3,"is_corresponding":false},{"id":479657,"name":"Matthew Snelson","orcid":"0000-0003-4829-9550","position":4,"is_corresponding":false},{"id":1174605,"name":"Cassiana Regina de Góes","orcid":"0000-0003-1166-637X","position":0,"is_corresponding":true}],"reference_count":16,"raw_metadata":null,"created_at":"2026-07-19T01:19:47.744358Z","pmid":"36819692","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}