Karen Wiesen

FGF-23 and sFRP-4 in Chronic Kidney Disease and Post Renal Transplantation

Background: The phosphatonins fibroblast growth factor-23 (FGF-23) and FRP-4 are inhibitors of tubular phosphate reabsorption that may play a role in the hyperphosphatemia associated with chronic kidney disease (CKD) or in the hypophosphatemia associated with renal transplants. Methods: Plasma FGF-23, FRP-4, phosphorus and parathyroid hormone were measured in patients at all stages of CKD. Phosphate regulation of FGF-23 and secreted frizzled related protein-4 (sFRP-4) was examined in end-stage renal disease patients in the presence and absence of therapeutic phosphate binder usage. In renal transplant patients, plasma FGF-23, sFRP-4 and phosphorus concentrations were determined before and 4–5 days after transplantation. Results: Plasma FGF-23 correlated with creatinine clearance (r2 = –0.584, p < 0.0001) and plasma phosphorus (r2 = 0.347, p < 0.001) in CKD patients and with plasma phosphorus (r2 = 0.448, p < 0.001) in end-stage renal disease patients. Phosphate binder withdrawal increased FGF-23 levels. In kidney transplant patients, dramatic decreases in FGF-23 (–88.8 ± 5.4%) and phosphorus (–64 ± 10.2%) were observed by 4–5 days post-transplantation. In patients with post-transplant hypophosphatemia, FGF-23 levels correlated inversely with plasma phosphorus (r2 = 0.661, p < 0.05). sFRP-4 levels did not change with creatinine clearance or hyperphosphatemia in CKD or end-stage renal disease patients, and no relation was noted between post-transplant sFRP-4 levels and hypophosphatemia. Conclusions: In CKD, FGF-23 levels rose with decreasing creatinine clearance rates and increasing plasma phosphorus levels, and rapidly decreased post-transplantation suggesting FGF-23 is cleared by the kidney. Residual FGF-23 may contribute to the hypophosphatemia in post-transplant patients.

Academy of Nutrition and Dietetics and National Kidney Foundation: Revised 2014 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Nephrology Nutrition

Compelling evidence indicates that the incidence of chronic kidney disease (CKD) is increasing because of an aging population and a higher prevalence of cardiovascular disease, diabetes, and hypertension. Nutrition management of patients with CKD requires early disease recognition, appropriate interpretation of the markers and stages of CKD, and collaboration with other health care practitioners. Better management of CKD can slow its progression, prevent metabolic complications, and reduce cardiovascular related outcomes. Caring for patients with CKD necessitates specialized knowledge and skills to meet the challenges associated with this growing epidemic. The Academy of Nutrition and Dietetics Renal Dietitians Practice Group and the National Kidney Foundation Council on Renal Nutrition, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, have updated the 2009 Standards of Practice in Nutrition Care and Standards of Professional Performance as a tool for registered dietitian nutritionists working in nephrology nutrition to assess their current skill levels and to identify areas for additional professional development in this practice area. The Standards of Practice apply to the care of patients/clients with kidney disease. The Standards of Professional Performance consist of six domains of professionalism, including: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements that illustrate how nephrology nutrition principles can be applied to practice. The indicators describe three skill levels (ie, competent, proficient, and expert) for registered dietitian nutritionists working in nephrology nutrition.

American Dietetic Association and the National Kidney Foundation Standards of Practice and Standards of Professional Performance for Registered Dietitians (Generalist, Specialty, and Advanced) in Nephrology Care

The American Dietetic Association (ADA) Renal Dietitians Practice Group (RPG) and the National Kidney Foundation Council on Renal Nutrition (NKF CRN), under the guidance of the ADA Quality Management Committee and Scope of Dietetics Practice Framework Sub-Committee, have developed the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for Registered Dietitians (Generalist, Specialty, and Advanced) in Nephrology Care (Supplementary Figures 1, 2, and 3 are available only online at www.jrnjournal.org). The SOP and SOPP documents are based upon the 2008 Revised Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitians (RDs)(1), which are part of ADAs Scope of Dietetics Practice Framework(2). The 2008 Revised SOP in Nutrition Care and SOPP, along with the Code of Ethics(3), guide the practice and performance of RDs in all settings.

American Dietetic Association and the National Kidney Foundation Standards of Practice and Standards of Professional Performance for Registered Dietitians (generalist, specialty, and advanced) in nephrology care.

The Joint Standards Task Force of the American Dietetic Association Renal Dietitians Dietetic Practice Group and the National Kidney Foundation Council on Renal Nutrition: Deborah Brommage, MS, RD, CSR, CDN; Maria Karalis, MBA, RD, LDN; and Cathi Martin, RD, CSR, LDN: Co-chairs; Maureen McCarthy, MPH, RD, CSR, LD; Deborah Benner, MA, RD, CSR; Catherine M. Goeddeke-Merickel, MS, RD, LD; Karen Wiesen, MS, RD, LD; Laura Byham-Gray, PhD, RD; Jennie Lang House, RD, CSR, LD; Jessie Pavlinac, MS, RD, CSR, LD; Linda McCann, RD, CSR, LD

The Importance of Mentoring

interest in mentoring There is interest in mentoring, so it became quickly apparent that it was going to be a huge amount of work to match people into the right pairs. There was this amazing convergence between mentoring and young professionals who seek guidance/direction. I have experienced firsthand the issues identified with the frustration of young professionals can be resolved or minimized by leveraging mentoring both within their respective organization as well as through participation with professional societies. When I graduated college, one of the best insights my father ever provided me was to have a mentor throughout my professional development, but I did not take the time to appreciate his guidance. However, it did resonate with me and I have found myself remembering his advice often. graduating college

A Goal Fulfilled: Time to Pass the Gavel

For many years, I have had the opportunity to be involved with the National Kidney Foundation Council on Renal Nutrition (CRN) at the national level wearing many hats. I started as a Regional Representative in 1999 thinking that it would be the extent of my participation and little did I know where that would eventually lead. During the 10 years that I have been active at the national level, I have had the opportunity to meet many people and have made numerous friends. My own professional development has been enhanced by these friendships and with the experiences gained by working with the CRN. I wish to thank everyone for their ongoing professional support. My first message in the Journal of Renal Nutrition as CRNChair focused on the importance of mentoring, a topic I feel strongly about. For 20 years, I have been involved in educating dietetic interns in the area of renal nutrition. Professional growth is important for both the teacher and the student. To give back to your profession and to others who are up and coming in the field is a gift. You will growmore than you can realize and your profession will growwith you! Over the past 2 years, I have had the opportunity to meet many inspiring renal dietitians across the country who, despite having many demands on their time, are also involved in various forms of mentoring. I applaud these dietitians and encourage your continued