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Should We Let Dialysis Patients Eat Their Fruits and Veggies?

ABSTRACT:

SUBMITTER: Kovesdy CP

PROVIDER: S-EPMC8729484 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

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Should We Let Dialysis Patients Eat Their Fruits and Veggies?

Kovesdy Csaba P CP Kovesdy Csaba P CP

Clinical journal of the American Society of Nephrology : CJASN 20211201 12

PMID: 34853059

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Project description:Rationale: Epicardial adipose tissue (EAT) has been independently associated with non-calcified, high-risk coronary plaques in low-to intermediate risk subjects. Recently, a bidirectional communication was shown between EAT and diseased coronary arteries. In high-risk patients it is unknown whether quantitative measures of EAT can capture, and which molecular players are involved in this mutual interplay. Objective: In a high-risk population, we aimed to determine how the volume of EAT is linked to coronary artery disease (CAD) and to identify potential EAT-deregulated pathways in CAD patients specifically related to coronary artery calcification (CAC). Methods and Results: In a prospective cohort of 574 degenerative severe aortic stenosis patients referred to cardiac surgery, we quantified fat depots by computed tomography (CT) and performed a comparative quantitative proteomics of thoracic fat, including EAT, mediastinal (MAT) and subcutaneous (SAT) adipose tissues. We did not find an independent association of EAT volume with the severity, distribution and complexity of coronary stenosis in invasive coronary angiography. Although, EAT volume was correlated with high CAC, its cardiovascular risk factors-adjusted association was not significant. Taking as reference non-CAD matched-patients and compared to MAT and SAT, EAT proteomic signature of CAD was characterized by up-regulation of pro-calcifying annexins (Annexin A2, ANXA2), fatty acid binding transporters (FABP4) and inflammatory signaling proteins, and by down-regulation of fetuin-A and redox state regulatory enzymes. In EAT, ANXA2 regulation was positively correlated with CAC. EAT gene expression studies confirmed overexpression of ANXA2 and FABP4 in CAD, but no expression of FETUA was detected. Compared with non-CAD, fetuin-A circulating levels were higher in CAD, whereas no fetuin-A pericardial fluid differences were found. Conclusions: In this high-risk cohort, EAT presented an imbalance of pro-calcifying, pro-inflammatory and lipid transporters mediators. These local EAT-mediated regulatory mechanisms were not reflected by the CT volume of EAT alone.

Project description:Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are serious health concerns worldwide that require regular dialysis before a kidney transplant for a better quality of life. Due to aging and frailty, kidney dialysis patients are often limited in physical activity, which can lead to multiple health complications and sometimes result in patient death. Therefore, maintaining muscle health is crucial for kidney dialysis. We recently reported that personalized resistance-based exercise can improve frailty in kidney dialysis patients; however, the underlying molecular mechanisms by which resistance-based exercise improves muscle health are unknown. RNA-Seq analysis revealed that exercise promotes the expression of genes related to muscle stemness, regeneration, and differentiation. The IHC analysis revealed increased protein expression of stemness-associated proteins, including Lamin A/C, 5'-adenosine monophosphate-activated protein kinase (AMPK), paired box 7 (PAX7), vascular cell adhesion molecule 1 (VCAM-1), and Emerin. The IF analysis revealed increased protein expression of muscle differentiation markers, including myoblast determination protein 1 (MyoD), myosin heavy chain (MyoH), myogenin, desmin, dystrophin, and enolase 3. Furthermore, our study demonstrated that exercise upregulated proteins such as mitochondrial encoded cytochrome c oxidase III (MTCO3) and aconitase 2 (ACO2), which are involved in the oxidation of organic compounds and mitochondrial function in muscle. Moreover, we observed that exercise increased the protein expression of glucose transporter protein types 1 and 4 (GLUT1 and GLUT-4), glycogen synthase 1 and 2 (GYS1 and GYS2), and fatty acid binding protein 1 (FABP1), which participate in energy production through glucose uptake, glycogenesis, and fatty acid metabolism, respectively. These results suggest that personalized resistance-based muscle therapy in dialysis patients promotes the expression of genes and proteins associated with muscle stemness, regeneration, differentiation, and energy generation.

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Should We Let Dialysis Patients Eat Their Fruits and Veggies?

Publications

Should We Let Dialysis Patients Eat Their Fruits and Veggies?

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