Glucose anhydrous 20g / Sodium chloride 3.5g / Sodium citrate 2.9g oral powder sachets

Metabolic acidosis is a common complication of chronic kidney disease (CKD). The kidneys play a crucial role in acid-base balance, maintaining pH within the normal range (isohydria) by following mechanisms: bicarbonate reabsorption, ammogenesis, and titratable acidity. The anion gap describes the amount of unmeasured anions and is classically evaluated as the difference between the major cation (sodium) and the sum of the two major anions (chloride and bicarbonate). Metabolic acidosis can be divided into two types: normal anion gap metabolic acidosis and high anion gap metabolic acidosis. A high anion gap level is considered unfavorable in terms of prognosis as it is associated with increased mortality. Treatment of metabolic acidosis in patients with chronic kidney disease, despite available therapeutic options, is a challenge. Supplementation with bicarbonates does not improve prognosis on the one hand, and on the other hand, it may be harmful. The new KDIGO guidelines for 2024 have been significantly modified compared to 2012 after negative results of studies on bicarbonate supplementation. Bicarbonate supplementation is currently recommended only when levels are less than 18 mmol/L. This review provides an overview of the current knowledge on the pathophysiology, classification, and therapeutic options, including dietary recommendations and new pharmacology agents.

Abstract licence: CC BY

Sodium chloride (NaCl) is a commonly used additive in minimally processed fish-based products. The addition of NaCl to fish products and packaging in a modified atmosphere is usually efficient with regard to limiting the occurrence of the aquatic environmental pathogen Pseudomonas aeruginosa. Given the negative effects of excess NaCl in the diet, there is a growing demand to reduce NaCl in food products with safer substituents, but the knowledge of their impact on antibiotic resistant P. aeruginosa is limited. This study aimed to evaluate the physiological and transcriptome characteristics of P. aeruginosa NT06 isolated from fish and to determine the effect of selected concentrations of alternative NaCl compounds (KCl/NaL/NaC) on the P. aeruginosa NT06 virulence phenotype and genotype. In the study, among the isolated microorganisms, P. aeruginosa NT06 showed the highest antibiotic resistance (to ampicillin, ceftriaxone, nalidixic acid, and norfloxacin) and the ability to grow at 4 °C. The Comprehensive Antibiotic Resistance Database (CARD) and the Virulence Factor Database (VFDB) revealed the presence of 24 and 134 gene products assigned to AMR and VF in the P. aeruginosa NT06 transcriptome, respectively. KCl, KCl/NaL and KCl/NaL/NaC inhibited pyocyanin biosynthesis, elastase activity, and protease activity from 40 to 77%. The above virulence phenotypic observations were confirmed via RT–qPCR analyses, which showed that all tested AMR and VF genes were the most downregulated due to KCl/NaL/NaC treatment. In conclusion, this study provides insight into the potential AMR and VF among foodborne P. aeruginosa and the possible impairment of those features by KCl, NaL, and NaC, which exert synergistic effects and can be used in minimally processed fish-based products.

Abstract licence: CC BY 4.0

The tricarboxylic acid (TCA) cycle couples nutrient oxidation with the generation of reducing equivalents that power oxidative phosphorylation. Nevertheless, the requirement for components of the TCA cycle is context-specific, raising the question of which TCA cycle outputs support cell fitness. Here, we demonstrate that citrate clearance is an essential function of the TCA cycle. As citrate production increases, so do TCA cycle activity and dependence upon aconitase 2 (ACO2), the enzyme that initiates citrate catabolism in the TCA cycle. Disrupting citrate catabolism activates the integrated stress response and impairs cell fitness, and these effects are reversed by preventing citrate production or promoting mitochondrial citrate efflux. In vivo, ACO2 deficiency induces citrate accumulation and triggers tubular degeneration in the kidney, a tissue that physiologically takes up circulating citrate. Thus, intracellular citrate accumulation can be a metabolic liability, and citrate clearance is a major function of ACO2 in the TCA cycle.

Abstract licence: CC BY-NC-ND

BackgroundThis in-vitro and in-vivo study investigates the Gibbs-Donnan effect across the filter during continuous veno-venous hemofiltration (CVVH). In particular, we assessed its acid-base implications, applying the physical-chemical approach.MethodsA prospective, single-center study was conducted using the PrismaMax machine (Baxter). Two sets of in-vitro CVVH experiments (with and without albumin) were performed to quantify the Gibbs-Donnan effect. Electrolytes, glucose, and osmolarity changes were measured across the filter and in the ultrafiltrate. Strong ion difference and sieving coefficients of the main solutes were calculated. Similar measurements were performed in oligo-anuric critically ill patients undergoing CVVH.ResultsIn-vitro experiments without albumin showed a sieving coefficient of 1 for both positive and negative ions. On the contrary, when albumin was added, the sieving coefficient for sodium and chloride changed linearly with albumin concentration (r = -0.94, p ConclusionsThese in-vitro and in-vivo studies demonstrate that albumin linearly affects the sieving coefficient of ions, increasing the strong ion difference of plasma water during its passage through the filter and thus having a systemic alkalizing effect.

Abstract licence: CC BY

Carbohydrate supplementation optimises athletic performance, but the metabolic and performance impacts of commercial products/compositions are underexplored. We compared the efficacy of three commercial carbohydrate supplements: a glucose-fructose bar (GF-Bar), a glucose-fructose hydrogel (GF-Gel) and a maltodextrin-based gel (MD-Gel). Antegrade venous blood samples for glucose and insulin were measured alongside substrate utilisation in healthy Tier 2 athletes after ingesting 45 g of carbohydrates from the GF-Bar, GF-Gel and MD-Gel during a modified 1-h oral glucose tolerance test (OGTT). Additionally, the effect of supplementation on high-intensity interval exercise was evaluated during repeated maximal sprint performance. During the OGTT, the GF-Bar elicited greater total carbohydrate oxidation than MD-Gel (24.6 ± 7.4 g vs. 17.8 ± 8.6 g, P = 0.038) but not GF-Gel (20.1 ± 6.4 g, P > 0.05). Carbohydrate oxidation per minute varied over time (P -1) showing higher oxidation than GF-Gel (0.21 ± 0.05 g min-1) and MD-Gel (0.19 ± 0.06 g min-1). No differences were observed in glucose peak, time to peak glucose or insulin concentration (P > 0.05). Peak power (P = 0.011), mean power (P  0.05). Perceived exertion and gastrointestinal discomfort were similar between products (P > 0.05). Despite differences in carbohydrate oxidation during the OGTT, the GF-Bar, GF-Gel and MD-Gel displayed similar metabolic and sprint performance outcomes, suggesting that, within this study, carbohydrate formulation did not impact short-duration maximal exercise.

Abstract licence: CC BY