***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Low albumin level is a strong predictor of mortality and morbidity among hemodialysis patients , yet few interventions are available to improve albumin levels . Moreover , the relative importance of nutritional barriers versus inflammation in contributing to hypoalbuminemia is unclear . We sought to determine whether targeting specific nutritional barriers will improve albumin levels . METHODS We conducted a r and omized controlled trial involving 180 patients with baseline albumin levels less than 3.7 g/dL ( < 37 g/L ) at 44 long-term hemodialysis facilities . Study coordinators identified and intervened on specific barriers present among intervention patients , whereas control patients continued to receive the usual care . Barriers targeted included poor nutritional knowledge , poor appetite , help needed with shopping or cooking , low fluid intake , inadequate dialysis dose , depression , difficulty chewing , difficulty swallowing , gastrointestinal symptoms , and acidosis . RESULTS At baseline , intervention and control patients had similar albumin levels , dietary intakes , levels of inflammatory markers , and numbers of nutritional barriers . After 12 months , intervention patients had greater increases in albumin levels compared with control patients ( + 0.21 versus + 0.06 g/dL [ + 2.1 versus + 0.6 g/L ] ; P < 0.01 ) , as well as greater increases in energy intake ( + 4.1 versus -0.6 Kcal/d/kg ; P < 0.001 ) and protein intake ( + 0.13 versus -0.06 g/d/kg ; P < 0.001 ) . The intervention appeared most effective for barriers related to poor nutritional knowledge , help needed with shopping or cooking , and difficulty swallowing . About half the subjects had elevated levels of inflammatory markers , but there was no relationship between change in levels of albumin and inflammatory markers . CONCLUSION A nutrition intervention tailored to patient-specific barriers result ed in modest improvements in albumin levels regardless of levels of inflammatory markers OBJECTIVE This study addressed the long-term effect of various diets , particularly low-carbohydrate high-protein , on renal function on participants with or without type 2 diabetes . RESEARCH DESIGN AND METHODS In the 2-year Dietary Intervention R and omized Controlled Trial ( DIRECT ) , 318 participants ( age , 51 years ; 86 % men ; BMI , 31 kg/m2 ; mean estimated glomerular filtration rate [ eGFR ] , 70.5 mL/min/1.73 m2 ; mean urine microalbumin-to-creatinine ratio , 12:12 ) with serum creatinine < 176 μmol/L ( eGFR ≥30 mL/min/1.73 m2 ) were r and omized to low-fat , Mediterranean , or low-carbohydrate diets .  The 2-year compliance was 85 % , and the proportion of protein intake significantly increased to 22 % of energy only in the low-carbohydrate diet ( P < 0.05 vs. low-fat and Mediterranean ) . We examined changes in urinary microalbumin and eGFR , estimated by Modification of Diet in Renal Disease and Chronic Kidney Disease Epidemiology Collaboration formulas . RESULTS Significant ( P < 0.05 within groups ) improvements in eGFR were achieved in low-carbohydrate ( + 5.3 % [ 95 % CI 2.1–8.5 ] ) , Mediterranean ( + 5.2 % [ 3.0–7.4 ] ) , and low-fat diets ( + 4.0 % [ 0.9–7.1 ] ) with similar magnitude ( P > 0.05 ) across diet groups . The increased eGFR was at least as prominent in participants with ( + 6.7 % ) or without ( + 4.5 % ) type 2 diabetes or those with lower baseline renal function of eGFR < 60 mL/min/1.73 m2 ( + 7.1 % ) versus eGFR ≥60 mL/min/1.73 m2 ( + 3.7 % ) . In a multivariable model adjusted for age , sex , diet group , type 2 diabetes , use of ACE inhibitors , 2-year weight loss , and change in protein intake ( confounders and univariate predictors ) , only a decrease in fasting insulin ( β = −0.211 ; P = 0.004 ) and systolic blood pressure ( β = −0.25 ; P < 0.001 ) were independently associated with increased eGFR . The urine microalbumin-to-creatinine ratio improved similarly across the diets , particularly among participants with baseline sex-adjusted microalbuminuria , with a mean change of −24.8 ( P < 0.05 ) . CONCLUSIONS A low-carbohydrate diet is as safe as Mediterranean or low-fat diets in preserving/improving renal function among moderately obese participants with or without type 2 diabetes , with baseline serum creatinine < 176 μmol/L. Potential improvement is likely to be mediated by weight loss – induced improvements in insulin sensitivity and blood pressure Diabetic nephropathy has become the leading cause of uremia . Several lines of evidence suggest dietary factors other than protein intake have a substantial role in the progression of diabetic nephropathy to end-stage renal disease . The present investigation was initiated to evaluate whether a carbohydrate-restricted , low-iron-available , polyphenol-enriched ( CR-LIPE ) diet may delay and improve the outcome of diabetic nephropathy to a greater extent than st and ard protein restriction . To this aim , 191 diabetic patients , all with type 2 diabetes , were r and omized to either CR-LIPE or st and ard protein restriction and the following outcomes monitored : doubling of serum creatinine , cumulative incidence of end-stage renal disease , and all cause mortality . Over a mean follow-up interval of 3.9 + /- 1.8 years , serum creatinine concentration doubled in 19 patients on CR-LIPE ( 21 % ) and in 31 control subjects ( 39 % ) ( P < 0.01 ) . Renal replacement therapy or death occurred in 18 patients on CR-LIPE ( 20 % ) and in 31 control subjects ( 39 % ) ( P < 0.01 ) . These differences were independent from follow-up interval , sex , mean arterial blood pressure , HbA(1c ) , initial renal dysfunction , and angiotensin system inhibitor use . In conclusion , CR-LIPE was 40 - 50 % more effective than st and ard protein restriction in improving renal and overall survival rates Background Chronic kidney disease ( CKD ) is increasingly being recognized as an emerging public health problem in India . However , community based estimates of low glomerular filtration rate ( GFR ) and proteinuria are few . Validity of traditional serum creatinine based GFR estimating equations in South Asian subjects is also debatable . We intended to estimate and compare the prevalence of low GFR , proteinuria and associated risk factors in North India using Cockcroft-Gault ( CG ) and Modification of Diet In Renal Disease ( MDRD ) equation . Methods A community based , cross-sectional study involving multistage r and om cluster sampling was done in Delhi and its surrounding regions . Adults ≥ 20 years were surveyed .  CG and MDRD equations were used to estimate GFR ( eGFR ) . Low GFR was defined as eGFR < 60 ml/min/1.73 m2 . Proteinuria ( ≥ 1 + ) was assessed using visually read dipsticks . Odds ratios , crude and adjusted , were calculated to ascertain associations between renal impairment , proteinuria and risk factors . Results The study population had 3,155 males and 2,097 females . The mean age for low eGFR subjects was 54 years . The unst and ardized prevalence of low eGFR was 13.3 % by CG equation and 4.2 % by MDRD equation . The prevalence estimates of MDRD equation were lower across gender and age groups when compared with CG equation estimates . There was a strong correlation but poor agreement between GFR estimates of two equations . The survey population had a 2.25 % prevalence of proteinuria . In a multivariate logistic regression analysis ; age above 60 years , female gender , low educational status , increased waist circumference , hypertension and diabetes were associated with low eGFR . Similar factors were also associated with proteinuria . Only 3.3 % of subjects with renal impairment were aware of their disease . Conclusion The prevalence of low eGFR in North India is probably higher than previous estimates . There is a significant difference between GFR estimates derived from CG and MDRD equations . These equations may not be useful in epidemiological research . GFR estimating equations vali date d for South Asian population s are needed before reliable estimates of CKD prevalence can be obtained . Till then , primary prevention and management targeted at CKD risk factors must play a critical role in controlling rising CKD magnitude . Cost-benefit analysis of targeted screening programs is needed Background Weight gain and obesity are common after kidney transplantation , particularly during the first year . Obesity is a risk factor for the development of new-onset diabetes after transplantation , and is associated with reduced graft survival . There is a lack of evidence for effective interventions to prevent weight gain after kidney transplantation . Methods / Design The effect of INTEnsive Nutrition interventions on weight gain after kidney Transplantation ( INTENT ) trial is a single-blind ( outcomes assessor ) , r and omised controlled trial to assess the effect of intensive nutrition interventions , including exercise advice , on weight gain and metabolic parameters in the first year after transplantation . Participants will be r and omised during the first post-transplant month to either st and ard care  ( four visits with a renal dietitian over twelve months ) or intensive nutrition intervention  ( eight visits with a renal dietitian over the first six months , four visits over the second six months , and three visits over the first six months with an exercise physiologist ) . In the intensive intervention group , nutrition counselling will be provided using motivational interviewing techniques to encourage quality engagement . Collaborative goal setting will be used to develop personalised nutrition care plans . Individualised advice regarding physical activity will be provided by an exercise physiologist . The primary outcome of the study is weight at six months after transplant , adjusted for baseline ( one month post-transplant ) weight , obesity and gender . Secondary outcomes will include changes in weight and other anthropometric measures over 12 months , body composition ( in vivo neutron activation analysis , total body potassium , dual-energy X-ray absorptiometry , and bioelectrical impedance ) , biochemistry ( fasting glucose , lipids , haemoglobin A1c and insulin ) , dietary intake and nutritional status , quality of life , and physical function . Discussion There are currently few r and omised clinical trials of nutrition interventions after kidney transplantation . The INTENT trial will thus provide important data on the effect of intensive nutrition interventions on weight gain after transplant and the associated metabolic consequences . Additionally , by assessing changes in glucose metabolism , the study will also provide data on the feasibility of undertaking larger multi-centre trials of nutrition interventions to reduce the incidence or severity of diabetes after transplantation . Trial registration Australian New Zeal and Clinical Trials Registry Number : BACKGROUND AND AIMS The intake of antioxidant-rich foods may increase the blood levels of non enzymatic antioxidant capacity ( NEAC ) . NEAC takes into account all antioxidants from food and synergistic effects between them . We examined the effect of a 1-year intervention with Mediterranean diet on plasma NEAC and assessed whether it was related to baseline NEAC levels . METHODS AND RESULTS Five hundred sixty-four participants at high cardiovascular risk were r and omly selected from the PREDIMED ( Prevención con DIeta MEDiterránea ) Study , a large 3-arm r and omized clinical trial .  Blood NEAC levels were measured at baseline and after 1-year of dietary intervention with 1 ) a Mediterranean diet supplemented with virgin olive oil ( MED + VOO ) ; 2 ) a Mediterranean diet supplemented with nuts ( MED + nuts ) , or 3 ) a control low-fat diet .  Plasma NEAC was analyzed using FRAP ( ferric reducing antioxidant potential ) and TRAP ( total radical-trapping antioxidant parameter ) assays . Plasma FRAP levels increased after 1-year of intervention with MED + VOO [ 72.0 μmol/L ( 95 % CI , 34.2 - 109.9 ) ] and MED + nuts [ 48.9 μmol/L ( 24.3 - 73.5 ) ] , but not after the control low-fat diet [ 13.9 μmol/L ( -11.9 to 39.8 ) ] . Participants in the lowest quartile of plasma FRAP at baseline significantly increased their levels after any intervention , while those in the highest quartile decreased . Similar results occurred with TRAP levels . CONCLUSIONS This study shows that a 1-year of MED diet intervention increases plasma TAC level in subjects at high risk for cardiovascular disease . Moreover , the effectiveness of dietary supplementation with antioxidants may be related to baseline levels of plasma NEAC This study was conducted to determine whether a high-nitrogen , low-carbohydrate diet in the immediate post-operative 
    Output:
    
In very-low quality evidence , dietary interventions had uncertain effects on all-cause mortality or ESKD .
Dietary interventions have uncertain effects on mortality , cardiovascular events and ESKD among people with CKD as these outcomes were rarely measured or reported .
Dietary interventions may increase health-related quality of life , eGFR , and serum albumin , and lower blood pressure and serum cholesterol levels .