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Wang AYM, Elsurer Afsar R, Sussman-Dabach EJ, White JA, MacLaughlin H, Ikizler TA. Vitamin Supplement Use in Patients With CKD: Worth the Pill Burden? Am J Kidney Dis 2024; 83:370-385. [PMID: 37879527 DOI: 10.1053/j.ajkd.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 10/27/2023]
Abstract
All vitamins play essential roles in various aspects of body function and systems. Patients with chronic kidney disease (CKD), including those receiving dialysis, may be at increased risk of developing vitamin deficiencies due to anorexia, poor dietary intake, protein energy wasting, restricted diet, dialysis loss, or inadequate sun exposure for vitamin D. However, clinical manifestations of most vitamin deficiencies are usually subtle or undetected in this population. Testing for circulating levels is not undertaken for most vitamins except folate, B12, and 25-hydroxyvitamin D because assays may not be available or may be costly to perform and do not always correlate with body stores. The last systematic review through 2016 was performed for the Kidney Disease Outcome Quality Initiative (KDOQI) 2020 Nutrition Guideline update, so this article summarizes the more recent evidence. We review the use of vitamins supplementation in the CKD population. To date there have been no randomized trials to support the benefits of any vitamin supplementation for kidney, cardiovascular, or patient-centered outcomes. The decision to supplement water-soluble vitamins should be individualized, taking account the patient's dietary intake, nutritional status, risk of vitamins deficiency/insufficiency, CKD stage, comorbid status, and dialysis loss. Nutritional vitamin D deficiency should be corrected, but the supplementation dose and formulation need to be personalized, taking into consideration the degree of 25-hydroxyvitamin D deficiency, parathyroid hormone levels, CKD stage, and local formulation. Routine supplementation of vitamins A and E is not supported due to potential toxicity. Although more trial data are required to elucidate the roles of vitamin supplementation, all patients with CKD should undergo periodic assessment of dietary intake and aim to receive various vitamins through natural food sources and a healthy eating pattern that includes vitamin-dense foods.
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Affiliation(s)
- Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, People's Republic of China.
| | - Rengin Elsurer Afsar
- Department of Nephrology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey; Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Jennifer A White
- California State University at Northridge, Northridge, California
| | - Helen MacLaughlin
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - T Alp Ikizler
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt O'Brien Kidney Center, Nashville, Tennessee; Tennessee Valley Healthcare System, Nashville VA Medical Center, Nashville, Tennessee
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Oudman E, Wijnia JW, Severs D, Oey MJ, van Dam M, van Dorp M, Postma A. Wernicke's Encephalopathy in Acute and Chronic Kidney Disease: A Systematic Review. J Ren Nutr 2024; 34:105-114. [PMID: 37838073 DOI: 10.1053/j.jrn.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/02/2023] [Accepted: 10/08/2023] [Indexed: 10/16/2023] Open
Abstract
Thiamine (vitamin B1) deficiency is relatively common in patients with kidney disease. Wernicke's encephalopathy (WE) is caused by vitamin B1 deficiency. Our aim was to systematically review the signs and symptoms of WE in patients with kidney disease. We conducted a systematic literature review on WE in kidney disease and recorded clinical and radiographic characteristics, treatment and outcome. In total 323 manuscripts were reviewed, which yielded 46 cases diagnosed with acute and chronic kidney disease and WE published in 37 reports. Prodromal characteristics of WE were loss of appetite, vomiting, weight loss, abdominal pain, and diarrhea. Parenteral thiamine 500 mg 3 times per day often led to full recovery, while Korsakoff's syndrome was found in those receiving low doses. To prevent WE in kidney failure, we suggest administering high doses of parenteral thiamine in patients with kidney disease who present with severe malnutrition and (prodromal) signs of thiamine deficiency.
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Affiliation(s)
- Erik Oudman
- Experimental Psychology, Helmholtz Institute, Utrecht University, The Netherlands; Slingedael Center of Expertise for Korsakoff Syndrome, Lelie Care Group, Rotterdam, The Netherlands.
| | - Jan W Wijnia
- Experimental Psychology, Helmholtz Institute, Utrecht University, The Netherlands; Slingedael Center of Expertise for Korsakoff Syndrome, Lelie Care Group, Rotterdam, The Netherlands
| | - David Severs
- Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Misha J Oey
- Experimental Psychology, Helmholtz Institute, Utrecht University, The Netherlands; Slingedael Center of Expertise for Korsakoff Syndrome, Lelie Care Group, Rotterdam, The Netherlands
| | - Mirjam van Dam
- Experimental Psychology, Helmholtz Institute, Utrecht University, The Netherlands; Slingedael Center of Expertise for Korsakoff Syndrome, Lelie Care Group, Rotterdam, The Netherlands
| | - Maaike van Dorp
- Experimental Psychology, Helmholtz Institute, Utrecht University, The Netherlands; Slingedael Center of Expertise for Korsakoff Syndrome, Lelie Care Group, Rotterdam, The Netherlands
| | - Albert Postma
- Experimental Psychology, Helmholtz Institute, Utrecht University, The Netherlands; Slingedael Center of Expertise for Korsakoff Syndrome, Lelie Care Group, Rotterdam, The Netherlands
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Juszczak AB, Kupczak M, Konecki T. Does Vitamin Supplementation Play a Role in Chronic Kidney Disease? Nutrients 2023; 15:2847. [PMID: 37447174 PMCID: PMC10343669 DOI: 10.3390/nu15132847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
Although the role of vitamins in the human body is proven, guidelines for patients with chronic kidney disease (CKD) remain unclear. This narrative review summarizes the findings of 98 studies of CKD and the effects of vitamin D, B, C, A, E, and K supplementation on patients on dialysis for CKD, with the aim of summarizing the existing guidelines. The findings are promising, showing the potential effectiveness of vitamin supplementation with, for example, vitamins B, D, or C. However, recommendations are still ambiguous, especially in the case of vitamins A and K, due to the potential toxicity associated with higher doses for patients. Continued research is needed to rigorously evaluate the effectiveness and carefully consider the potential risks of some vitamin supplementation for patients with CKD.
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Uchida N, Ishida M, Yoshioka A, Takahashi T, Furuya D, Ebihara Y, Ito H, Yanagi A, Onishi H, Sato I. Investigation of Whole Blood Thiamine Concentration in Independently Ambulatory Residents of a Provincial Town in Japan: A Cross-Sectional Study. Cureus 2023; 15:e38800. [PMID: 37303326 PMCID: PMC10250136 DOI: 10.7759/cureus.38800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/13/2023] Open
Abstract
Background Thiamine deficiency (TD) is an important public health problem in nutrition, occurring in 2-6% of the population in Europe and the US, whereas thiamine levels are reported to be significantly reduced by 36.6-40% in some populations of East Asia. However, there is little information available at present, regarding factors such as age, despite the continued aging of society. Further, studies such as those mentioned above have not yet been undertaken in Japan, the country in which population aging is most advanced. Objective To investigate TD in the Japanese community-dwelling individuals who are independently ambulatory. Methods We undertook an examination of TD in blood samples obtained from 270 citizens in a provincial town, aged 25-97 years, who were able to walk to the venue and provide informed consent for inclusion in this research and of whom 8.9% had a history of cancer. We summarized the demographic characteristics of the subjects. The whole-blood thiamine concentrations were measured using the high-performance liquid chromatography method. A value of 21.3 ng/ml or less was taken as low and a borderline value was set as less than 28 ng/ml. Results The mean (±SD) whole blood thiamine concentration was 47.6 ± 8.7 ng/ml. No TD was observed to exist participating in this study, with no subjects even showing show borderline values. Further, there was no significant difference in thiamine level between those aged 65 or older and those aged less than 65. Conclusions No cases of TD were observed among the subjects in this study, nor was the concentration of thiamine found to be related to age. It is possible that the frequency of TD might be very low in citizens who have a certain level of activity. In the future, it is necessary to expand the prevalence of TD to a wider range of subjects.
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Affiliation(s)
- Nozomu Uchida
- Department of General Medicine, Ogano Town Central Hospital, Ogano, JPN
- Department of Psycho-oncology, Saitama Medical University International Medical Center, Hidaka, JPN
| | - Mayumi Ishida
- Department of Psycho-oncology, Saitama Medical University International Medical Center, Hidaka, JPN
| | - Akira Yoshioka
- Department of Clinical Oncology, Mitsubishi Kyoto Hospital, Kyoto, JPN
| | - Takao Takahashi
- Department of Supportive Medicine, Saitama Medical University International Medical Center, Hidaka, JPN
| | - Daisuke Furuya
- Department of General Medicine, Saitama Medical University International Medical Center, Hidaka, JPN
| | - Yasuhiro Ebihara
- Department of Laboratory Medicine, Saitama Medical University International Medical Center, Hidaka, JPN
| | - Hiroshi Ito
- Department of General Medicine, Ito Internal Medicine and Pediatric Clinic, Fukuoka, JPN
| | - Akiko Yanagi
- Department of Nursing, Maruyama Memorial General Hospital, Iwatsuki, JPN
| | - Hideki Onishi
- Department of Psycho-oncology, Saitama Medical University International Medical Center, Hidaka, JPN
| | - Izumi Sato
- Department of Clinical Epidemiology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, JPN
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Bicer I, Dizdar OS, Dondurmacı E, Ozcetin M, Yılmaz R, Gundogan K, Gunal AI. Furosemide-related thiamine deficiency in hospitalized hypervolemic patients with renal failure and heart failure. Nefrologia 2023; 43:111-119. [PMID: 36437201 DOI: 10.1016/j.nefroe.2022.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/25/2021] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND We aimed to describe the thiamine status in hospitalized hypervolemic heart failure (HF) and/or renal failure (RF) patients treated with furosemide and to investigate whether there was a difference in furosemide-related thiamine deficiency between patients with RF and HF. METHODS Patients who were diagnosed as hypervolemia and treated with intravenous furosemide (at least 40mg/day) were included in this prospective observational study. Whole blood thiamine concentrations were measured 3 times during hospital follow-up of patients. RESULTS We evaluated 61 hospitalized hypervolemic patients, of which 22 (36%) were men and 39 (64%) were women, with a mean age of 69.00±10.39 (45-90) years. The baseline and post-hospital admission days 2 and 4 mean thiamine levels were 51.71±20.66ng/ml, 47.64±15.43ng/ml and 43.78±16.20ng/ml, respectively. Thiamine levels of the hypervolemic patients decreased significantly during the hospital stay while furosemide treatment was continuing (p=0.029). There was a significant decrease in thiamine levels in patients who had HF (p=0.026) and also, thiamine was significantly lower in HF patients who had previously used oral furosemide before hospitalization. However, these findings were not present in patients with RF. CONCLUSIONS Thiamine substantially decreases in most hypervolemic patients receiving intravenous furosemide treatment during the hospital stay. Thiamine levels were significantly decreased with furosemide treatment in especially HF patients, but the decrease in thiamine levels did not detected at the same rate in RF patients. Diuretic-induced thiamine loss may be less likely in RF patients, probably due to a reduction in excretion.
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Affiliation(s)
- Irem Bicer
- Department of Internal Medicine, Kayseri City Training and Research Hospital, 38010 Kayseri, Turkey
| | - Oguzhan Sıtkı Dizdar
- Department of Internal Medicine and Clinical Nutrition, Kayseri City Training and Research Hospital, 38010 Kayseri, Turkey.
| | - Engin Dondurmacı
- Department of Cardiology, Kayseri City Training and Research Hospital, 38010 Kayseri, Turkey
| | - Merve Ozcetin
- Department of Internal Medicine, Kayseri City Training and Research Hospital, 38010 Kayseri, Turkey
| | - Rumeysa Yılmaz
- Department of Internal Medicine, Kayseri City Training and Research Hospital, 38010 Kayseri, Turkey
| | - Kursat Gundogan
- Division of Intensive Care and Clinical Nutrition Unit, Erciyes University Medicine School, 38039 Kayseri, Turkey
| | - Ali Ihsan Gunal
- Department of Internal Medicine Division of Nephrology, Kayseri City Training and Research Hospital, 38010 Kayseri, Turkey
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Nisar S, Tanvir M, Ganai MA, Kareem O, Muzaffer U, Wani IH. Clinical profile of subjects presenting as thiamine responsive upper GI upset: a pointer towards gastric beriberi. Nutrition 2022; 102:111730. [DOI: 10.1016/j.nut.2022.111730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
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Akkuzu E, Yavuz S, Ozcan S, Sincar S, Bayrakci B, Kendirli T, Pasaoglu H, Kalkan G. Prevalence and Time Course of Thiamine Deficiency in Critically Ill Children: A Multicenter, Prospective Cohort Study in Turkey. Pediatr Crit Care Med 2022; 23:399-404. [PMID: 35583619 DOI: 10.1097/pcc.0000000000002931] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the prevalence and time course of thiamine deficiency (TD) in PICU patients. DESIGN Multicenter, prospective, cohort study between May 2019 and November 2019. SETTING Three university-based tertiary care, mixed medical-surgical PICUs in Ankara, Turkey. PATIENTS PICU patients 1 month to 18 years old. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We studied 476 patients and grouped them by TD status on days 1 and 3 of the PICU admission. There might be a risk of unintended bias since we excluded 386 patients because of the absence of consent, inadequate blood samples, loss of identifier information, and recent vitamin supplementation. On day 1, TD was present in 53 of 476 patients (11.1%) and median (minimum-maximum) thiamine levels were 65.5 ng/mL (5-431 ng/mL). On day 3, TD was present in 27 of 199 patients (13.6%) with repeated measurement. The median (minimum-maximum) thiamine levels were 63 ng/mL (13-357 ng/mL). The time course of TD from day 1 to day 3 in these 199 patients was as follows. In 21 of 199 patients (10.6%) with TD on day 1, 11 of 21 (52%) continued to have TD on day 3 and the other 10 of 21 patients (48%) improved to no longer having TD. In 178 of 199 patients (89.4%) without TD on day 1, 16 of 178 (9%) went on to develop TD by day 3, and the other 162 of 178 (91%) continued to have normal thiamine status. CONCLUSIONS In the PICU population in three centers in Turkey, the prevalence of TD in the sample of patients was 11.1%. In those TD patients who had serial studies, we also identified that by day 3 some continued to be TD, and some patients improved to normal thiamine status. Of concern, however, is the population who develop TD over the course of PICU stay.
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Affiliation(s)
- Emine Akkuzu
- Department of Pediatrics, Division of Critical Care Medicine, Gazi University Hospital, Ankara, Turkey
| | - Sinan Yavuz
- Department of Pediatrics, Division of Critical Care Medicine, Life Support Center, Hacettepe University Hospital, Ankara, Turkey
| | - Serhan Ozcan
- Department of Pediatrics, Division of Critical Care Medicine, Ankara University Hospital, Ankara, Turkey
| | - Sahin Sincar
- Department of Pediatrics, Division of Critical Care Medicine, Gazi University Hospital, Ankara, Turkey
| | - Benan Bayrakci
- Department of Pediatrics, Division of Critical Care Medicine, Life Support Center, Hacettepe University Hospital, Ankara, Turkey
| | - Tanil Kendirli
- Department of Pediatrics, Division of Critical Care Medicine, Ankara University Hospital, Ankara, Turkey
| | - Hatice Pasaoglu
- Department of Biochemistry, Gazi University Hospital, Ankara, Turkey
| | - Gokhan Kalkan
- Department of Pediatrics, Division of Critical Care Medicine, Gazi University Hospital, Ankara, Turkey
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
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Bicer I, Dizdar OS, Dondurmacı E, Ozcetin M, Yılmaz R, Gundogan K, Gunal AI. Furosemide-related thiamine deficiency in hospitalized hypervolemic patients with renal failure and heart failure. Nefrologia 2021. [DOI: 10.1016/j.nefro.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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9
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Wang Y, Zheng Y, Chen P, Liang S, He P, Shao X, Cai G, Chen X. The weak correlation between serum vitamin levels and chronic kidney disease in hospitalized patients: a cross-sectional study. BMC Nephrol 2021; 22:292. [PMID: 34445968 PMCID: PMC8393712 DOI: 10.1186/s12882-021-02498-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 08/11/2021] [Indexed: 12/18/2022] Open
Abstract
Background Chronic kidney disease (CKD) has become a global public health problem. Accumulating evidence suggested that vitamins play important roles in the progression of CKD. Methods A cross-sectional study was conducted to investigate the vitamin status of patients with CKD at stage 1–5. The serum concentrations of 9 vitamins, vitamin A, B1, B2, B6, B9, B12, C, D, and E were measured by electroanalytical method with a Multi-Vitamin Analyzer. Pearson correlation and multiple linear regression between serum level of vitamins were analyzed. Results The median levels of vitamin A, B1, B2, B6, B9, B12, C and E were within the reference ranges or on the borderline. Vitamin D deficiency was found in all patients. Weak correlation was found between vitamin A or vitamin D and estimated glomerular filtration rate (eGFR). The Pearson correlation coefficient were − 0.21766 and 0.19752, respectively. Hypertension, diabetes mellitus, and atherosclerosis were the major comorbidities. Conclusions For the first time, the serum levels of 9 vitamins were measured simultaneously in patients with CKD at different stages. Vitamin D deficiency was found in all patients. Weak correlation between vitamin A or vitamin D and eGFR was found.
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Affiliation(s)
- Yong Wang
- Department of Nephrology, State Key Laboratory of Kidney Diseases, First Medical Center of Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, National Clinical Research Center for Kidney Diseases, Fuxing Road 28, 100853, Beijing, China
| | - Ying Zheng
- Department of Nephrology, State Key Laboratory of Kidney Diseases, First Medical Center of Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, National Clinical Research Center for Kidney Diseases, Fuxing Road 28, 100853, Beijing, China
| | - Pu Chen
- Department of Nephrology, State Key Laboratory of Kidney Diseases, First Medical Center of Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, National Clinical Research Center for Kidney Diseases, Fuxing Road 28, 100853, Beijing, China
| | - Shuang Liang
- Department of Nephrology, State Key Laboratory of Kidney Diseases, First Medical Center of Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, National Clinical Research Center for Kidney Diseases, Fuxing Road 28, 100853, Beijing, China
| | - Pengfei He
- Department of Nephrology, State Key Laboratory of Kidney Diseases, First Medical Center of Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, National Clinical Research Center for Kidney Diseases, Fuxing Road 28, 100853, Beijing, China
| | - Xiaolei Shao
- Department of Nephrology, State Key Laboratory of Kidney Diseases, First Medical Center of Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, National Clinical Research Center for Kidney Diseases, Fuxing Road 28, 100853, Beijing, China
| | - Guangyan Cai
- Department of Nephrology, State Key Laboratory of Kidney Diseases, First Medical Center of Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, National Clinical Research Center for Kidney Diseases, Fuxing Road 28, 100853, Beijing, China
| | - Xiangmei Chen
- Department of Nephrology, State Key Laboratory of Kidney Diseases, First Medical Center of Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, National Clinical Research Center for Kidney Diseases, Fuxing Road 28, 100853, Beijing, China.
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Hu X, Ouyang S, Xie Y, Gong Z, Du J. Characterizing the gut microbiota in patients with chronic kidney disease. Postgrad Med 2020; 132:495-505. [PMID: 32241215 DOI: 10.1080/00325481.2020.1744335] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: Emerging evidence suggests that gut microbiota dysbiosis plays a critical role in chronic kidney disease (CKD). However, the relationship between altered gut microbiome profiles and disease severity remains unclear. In this study, we sought to characterize the gut microbiota in CKD patients compared to healthy controls, and to explore potential relationships between gut microbiota composition and disease severity. Methods: Fecal samples were collected from 95 patients at different stages of CKD (non-dialysis patients from stage 1 to 5) and 20 healthy controls. Bacterial DNA was extracted for 16S ribosomal DNA sequencing targeting the V3-V4 region. The diversity and relative abundance of gut microbiota were analyzed as outcome indicators. Results: Differences were observed in the microbial composition and diversity of fecal samples from CKD patients and healthy controls. Specifically, disease severity was found to alter gut microbiota composition. Compared to that in healthy controls, CKD patients showed an increased abundance of Proteobacteria and decreased Synergistetes, most notably in disease stage 5. Lower levels of butyrate-producing bacteria and higher levels of potential pathogens were also detected in CKD patients. Further, Pyramidobacter and Prevotellaceae_UCG-001 were significantly decreased in the CKD1 group compared with healthy controls. Notably, nine microbial genera, including Escherichia-Shigella, Parabacteroides, Roseburia, rectale_group, Ruminococcaceae_NK4A214_group, Prevotellaceae_UCG.001, Hungatella, Intestinimonas, and Pyramidobacter, identified using a random forest model, distinguished between patients with CKD and healthy controls with high accuracy. Functional analysis also revealed that fatty acid and inositol phosphate metabolism were enriched in the CKD group, while aminoacyl-tRNA biosynthesis, oxidative phosphorylation, phenylalanine, tyrosine, and tryptophan biosynthesis, thiamine metabolism, pantothenate, and CoA biosynthesis, as well as valine, leucine, and isoleucine biosynthesis were enriched in healthy controls. Conclusion: Gut microbiota composition and function are associated with CKD severity. And, specific gut microbes are potentially helpful for CKD early diagnosis and prognosis monitoring.
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Affiliation(s)
- Xiaofang Hu
- Department of Pharmacy, Xiangya Hospital, Central South University , Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University , Changsha, Hunan, China.,The Hunan Institute of Pharmacy Practice and Clinical Research, Xiangya Hospital , Changsha, Hunan, China
| | - Shaxi Ouyang
- Department of Nephrology, Hunan Provincial People's Hospital, the First-affiliated Hospital of Hunan Normal University , Changsha, Hunan, China
| | - Yuhong Xie
- Department of Pharmacy, Xiangya Hospital, Central South University , Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University , Changsha, Hunan, China.,The Hunan Institute of Pharmacy Practice and Clinical Research, Xiangya Hospital , Changsha, Hunan, China
| | - Zhicheng Gong
- Department of Pharmacy, Xiangya Hospital, Central South University , Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University , Changsha, Hunan, China.,The Hunan Institute of Pharmacy Practice and Clinical Research, Xiangya Hospital , Changsha, Hunan, China
| | - Jie Du
- Department of Pharmacy, Xiangya Hospital, Central South University , Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University , Changsha, Hunan, China.,The Hunan Institute of Pharmacy Practice and Clinical Research, Xiangya Hospital , Changsha, Hunan, China
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Gwathmey KG, Grogan J. Nutritional neuropathies. Muscle Nerve 2019; 62:13-29. [PMID: 31837157 DOI: 10.1002/mus.26783] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 12/07/2019] [Accepted: 12/07/2019] [Indexed: 12/17/2022]
Abstract
Neuropathies associated with nutritional deficiencies are routinely encountered by the practicing neurologist. Although these neuropathies assume different patterns, most are length-dependent, sensory axonopathies. Cobalamin deficiency neuropathy is the exception, often presenting with a non-length-dependent sensory neuropathy. Patients with cobalamin and copper deficiency neuropathy characteristically have concomitant myelopathy, whereas vitamin E deficiency is uniquely associated with a spinocerebellar syndrome. In contrast to those nutrients for which deficiencies produce neuropathies, pyridoxine toxicity results in a non-length-dependent sensory neuronopathy. Deficiencies occur in the context of malnutrition, malabsorption, increased nutrient loss (such as with dialysis), autoimmune conditions such as pernicious anemia, and with certain drugs that inhibit nutrient absorption. When promptly identified, therapeutic nutrient supplementation may result in stabilization or improvement of these neuropathies.
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Affiliation(s)
| | - James Grogan
- University of Virginia, Charlottesville, Virginia
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