I was fortunate enough to attend the National Kidney Foundation Spring Clinical Meeting in May this year in Long Beach California. It was a great conference. Thank you to the conference organizers and all the presenters.
My biggest take-aways are summarized by topic below.
Phosphorus
Phosphorus felt like the star of the conference! Learning about the new binder was interesting but also reviewing the state of the evidence for phosphorus lowering was super interesting.
- There is a new phosphorus lowering medication available in the USA called Tenapanor. This medication doesn’t work the same as traditional phosphorus binders, which binds phosphorus in the gut. Tenapanor reduces absorption of phosphorus at the intestine paracellular pathway.
- There is inadequate evidence that PO4 binders improve phosphorus levels in pre-dialysis CKD. Only observational studies suggest improved PO4 will improve outcomes for patients.
- Calcimetics (e.g. sensipar) can also improve phosphorus levels
- The HiLo trial, which was investigating ideal phosphorus targets in HD, was unfortunately stopped early due to low enrollment.
Weight Management
I attended two sessions on weight management, one on pharmacotherapy and nutrition, the other on bariatric surgery in the CKD population.
- Novel medications for weight loss are demonstrating an amazing ability to help people lose weight (in the case of Tirzaptide by as much as 24%!)
- There is no one documented diet or exercise plan that has been proven to effectively help people maintain weight loss over several years
- The concept that anyone can lose weight if they try hard enough is an assumption that hasn’t be supported by research
- Sleeve gastrectomy are the most common bariatric surgery in the USA and are less likely to result in malnutrition as they aren’t considered malabsorptive procedures. Daily supplementation of a number of micronutrients is recommended for life. I didn’t really get a great understanding of how to reconcile the micronutrient recommendations between these two populations – specifically for calcium and vitamin A.
Artificial Intelligence
- ChatGPT has been used to create menus and conduct nutrient analysis for patients living with CKD. It did really well at creating menus, less good at nutrient analysis. Next time a patient asks me for a meal plan, I am heading to ChatGPT to check it out!
Micronutrients:
- Renal vitamins are no longer recommended – there was a reference provided for this statement that I want to read more closely. I wasn’t sure if this was for the pre-dialysis population only or if it included those living on dialysis too. (Wang et al AJKD 2023; 83:3)
- In the USA, if a patient chooses to take supplements, encourage that they look for product that has been verified by a reputable third party.
- The herbal product with the most pronounced drug-herb interactions is St. Johns Wort.
Malnutrition
I was surprised that there wasn’t more discussion around how to prevent malnutrition/ideal protein intake to support nutritional status given the recent 2024 KDIGO guidelines disagreement with the 2020 KDOQI guidelines regarding ideal protein targets in CKD. That being said, there was one Malnutrition lecture. My biggest take away from this lecture was:
- As dietitians we need to be using metrics to measure the impacts of our nutritional assessments. These metrics can include the 7-point SGA, the Malnutrition-Inflammation Score (MIS) or Handgrip Strength measurements.
Potassium
I attended two lectures on potassium, one looking more closely at the link between potassium sources and fibre and the other looking at the management of potassium for cardio-renal outcomes.
- In line with my Hyperkalemia Assessment guideline, the first talk really hammered home the importance of considering all reasons for hyperkalemia
- The second presentation really reinforced the importance of staying on RAASi to improve outcomes for our patients, despite the increased hyperkalemia risk.
