In a comprehensive cross-sectional study examining 3,101 US counties, researchers identified significant geographic variations in how social and environmental determinants of health (SEDoH) influence cardio-kidney-metabolic (CKM) syndrome-related mortality. The study utilized geographically weighted models to analyze the impact of various SEDoH, finding that median household income, food insecurity, and high school completion rates were the most significantly associated factors with variations in mortality rates across different regions.

The findings highlight the complexity and the regional differences in the association between SEDoH and CKM-related mortality, suggesting that one-size-fits-all health policy solutions may not be effective. The detailed analysis reveals not only the disparities in mortality rates but also the differentials in the impact of factors like food insecurity, pollution levels, and educational attainment on health outcomes. These insights are crucial for policymakers and healthcare professionals aiming to develop targeted interventions that address the root causes of health disparities and enhance overall public health outcomes in diverse communities across the United States.

Reference: Vieira de Oliveira Salerno PR, Cotton A, Elgudin YE, et al. Social and Environmental Determinants of Health and Cardio-Kidney-Metabolic Syndrome–Related Mortality. JAMA Netw Open. 2024;7(9):e2435783. doi:10.1001/jamanetworkopen.2024.35783

This review, endorsed by the European Renal Osteodystrophy network, explores low bone turnover in chronic kidney disease (CKD), highlighting its inconsistent diagnostic criteria and association with conditions like adynamic bone disease (ABD). ABD, characterized by reduced bone turnover with normal mineralization, is increasingly recognized in hemodialysis patients. Factors such as impaired parathyroid hormone signaling, inflammation, malnutrition, diabetes, and suppressed WNT/β-catenin signaling contribute to low bone turnover, increasing risks for cardiovascular complications and fractures.

Antiresorptive agents like bisphosphonates and denosumab improve bone mineral density in CKD without significant cardiovascular risks but raise concerns about brittle bones, microfractures, and rebound bone loss, especially with denosumab. These risks highlight the need for individualized therapy and careful monitoring. Low bone turnover is not inherently harmful but depends on systemic factors driving its development. The review calls for tailored use of antiresorptive therapies and further studies to refine fracture prevention strategies in CKD.

Reference: Haarhaus M, Evenepoel P; European Renal Osteodystrophy (EUROD) workgroup; Chronic Kidney Disease Mineral and Bone Disorder (CKD-MBD) working group of the European Renal Association–European Dialysis and Transplant Association (ERA-EDTA). Differentiating the causes of adynamic bone in advanced chronic kidney disease informs osteoporosis treatment. Kidney Int. 2021;100(3):546-558. doi: 10.1016/j.kint.2021.04.043. 

Patients with chronic kidney disease (CKD) are at increased risk for hyperkalemia, a serious condition involving elevated plasma potassium levels. Low-potassium diets have been a key management strategy since the 1960s, as declining kidney function limits potassium excretion. Although compensatory mechanisms like colonic secretion help, many patients with CKD still experience postprandial hyperkalemia—potassium spikes after meals—due to impaired renal and cellular responses. Dietary adjustments, such as adding fiber and balancing meals, can help but do not fully address this challenge.

Potassium exchange resins, such as patiromer and sodium zirconium cyclosilicate, effectively manage chronic hyperkalemia by boosting fecal potassium excretion but show limited efficacy in preventing postprandial potassium spikes. Their mechanisms, which bypass kidney-like regulation, may not align with meal-related potassium absorption. While these medications are valuable for chronic management, they do not replace the need for dietary considerations or replicate healthy kidney function. Further research is needed to refine strategies for managing postprandial hyperkalemia in CKD.

Reference: St-Jules DE, Clegg DJ, Palmer BF, Carrero JJ. Can Novel Potassium Binders Liberate People with Chronic Kidney Disease from the Low-Potassium Diet? A Cautionary Tale. Clin J Am Soc Nephrol. 2022;17(3):467-472. doi: 10.2215/CJN.09660721.