1
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Nakashima A, Yamamoto I, Kobayashi A, Kimura K, Yaginuma T, Nishio S, Kato K, Kawai R, Horino T, Ohkido I, Yokoo T. Active vitamin D analog and SARS-CoV-2 IgG after BNT162b2 vaccination in patients with hemodialysis. Ther Apher Dial 2024; 28:599-607. [PMID: 38504452 DOI: 10.1111/1744-9987.14121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/07/2024] [Accepted: 02/21/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Vaccination is the effective strategy for coronavirus disease 2019 (COVID-19). However, few studies have investigated the association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin (Ig)G and vitamin D. METHODS This study aimed to investigate the association between SARS-CoV-2 IgG and active vitamin D analogs in hemodialysis patients. Blood samples were collected four times: before vaccination and 30, 60, and 90 days after vaccination, BNT162b2 (Pfizer©). RESULTS A total of 418 patients were enrolled. The mean age was 71.1 ± 12 years. Almost two thirds of the patients were prescribed active vitamin D analogs. The distribution of SARS-CoV-2 IgG before vaccination was 235 (93-454) AU/mL. After multiple regression analyses, active vitamin D analog use was found to be associated with higher SARS-CoV-2 IgG levels from prevaccination to 90 days postvaccination. CONCLUSION This study demonstrated an association between higher SARS-CoV-2 IgG and active vitamin D analog use in hemodialysis patients. CLINICAL TRIAL REGISTRATION The study information was registered in the UMIN-CTR (UMIN 000046906).
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Affiliation(s)
- Akio Nakashima
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Izumi Yamamoto
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Arisa Kobayashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | | | | | | | - Kazuhiko Kato
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Rena Kawai
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Tetsuya Horino
- Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Tokyo, Japan
| | - Ichiro Ohkido
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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2
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Secondulfo C, Visco V, Virtuoso N, Fortunato M, Migliarino S, Rispoli A, La Mura L, Stellato A, Caliendo G, Settembre E, Galluccio F, Hamzeh S, Bilancio G. Vitamin D: A Bridge between Kidney and Heart. Life (Basel) 2024; 14:617. [PMID: 38792638 PMCID: PMC11123235 DOI: 10.3390/life14050617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/30/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
Chronic kidney disease (CKD) and cardiovascular disease (CVD) are highly prevalent conditions, each significantly contributing to the global burden of morbidity and mortality. CVD and CKD share a great number of common risk factors, such as hypertension, diabetes, obesity, and smoking, among others. Their relationship extends beyond these factors, encompassing intricate interplay between the two systems. Within this complex network of pathophysiological processes, vitamin D has emerged as a potential linchpin, exerting influence over diverse physiological pathways implicated in both CKD and CVD. In recent years, scientific exploration has unveiled a close connection between these two prevalent conditions and vitamin D, a crucial hormone traditionally recognized for its role in bone health. This article aims to provide an extensive review of vitamin D's multifaceted and expanding actions concerning its involvement in CKD and CVD.
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Affiliation(s)
- Carmine Secondulfo
- Department “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy
| | - Valeria Visco
- Department “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy
| | - Nicola Virtuoso
- Cardiology Unit, Salerno University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
| | - Martino Fortunato
- Cardiology Unit, Salerno University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
| | - Serena Migliarino
- Cardiology Unit, Salerno University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
| | - Antonella Rispoli
- Cardiology Unit, Salerno University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
| | - Lucia La Mura
- Centro Medico Ascione Srl, 80059 Torre del Greco, Italy
| | - Adolfo Stellato
- Department “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy
| | - Giuseppe Caliendo
- Department “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy
| | - Emanuela Settembre
- Department “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy
| | - Fabiana Galluccio
- Department of Medicine and Surgery, University of Naples “Federico II”, 80138 Napoli, Italy
| | - Sarah Hamzeh
- Department of Medicine and Surgery, University of Naples “Federico II”, 80138 Napoli, Italy
| | - Giancarlo Bilancio
- Department “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy
- Nephrology Unit, Salerno University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
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3
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Zhang YH, Xu X, Pi HC, Yang ZK, Johnson DW, Dong J. Oral vitamin D supplementation on the prevention of peritoneal dialysis-related peritonitis: A pilot randomised controlled trial. Perit Dial Int 2024; 44:27-36. [PMID: 37408329 DOI: 10.1177/08968608231182885] [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] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE Peritoneal dialysis (PD)-related peritonitis is independently associated with low serum 25-hydroxy vitamin D [25(OH)D] levels. Our objective is to examine the feasibility of conducting a large, randomised controlled trial to determine the effects of vitamin D supplementation on the risk of PD-related peritonitis. DESIGN Pilot, prospective, open-label randomised controlled trial. SETTING Peking University First Hospital, China. PARTICIPANTS Patients receiving PD who had recovered from a recent episode of peritonitis between 30 September 2017 and 28 May 2020. INTERVENTIONS Oral natural vitamin D supplementation (2000 IU per day) versus no vitamin D supplementation for 12 months. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were feasibility (recruitment success, retention, adherence, safety) and fidelity (change in serum 25(OH)D level during follow-up) for a large, randomised controlled trial in the future to determine the effects of vitamin D on PD-related peritonitis. Secondary outcomes were time to peritonitis occurrence and outcome of subsequent peritonitis. RESULTS Overall, 60 among 151 patients were recruited (recruitment rate was 39.7%, 95% CI 31.9-47.5%, recruitment rate among eligible patients was 61.9%, 95% CI 52.2-71.5%). Retention and adherence rates were 100.0% (95% CI 100.0-100.0%) and 81.5% (95% CI 66.8-96.1%), respectively. During follow-up, serum 25(OH)D levels increased in the vitamin D (VD) group (from 19.25 ± 10.11 nmol/L to 60.27 ± 23.29 nmol/L after 6 months, p < 0.001, n = 31), and remained higher (p < 0.001) than those in the control group (n = 29). No differences were observed between the two groups with respect to time to subsequent peritonitis (hazard ratio 0.85, 95% CI 0.33-2.17) or any of the peritonitis outcomes. Adverse events were uncommon. CONCLUSIONS A randomised controlled trial of the effect of vitamin D supplementation on peritonitis occurrence in patients receiving PD is feasible, safe and results in adequate serum 25(OH)D levels.
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Affiliation(s)
- Yu-Hui Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Xiao Xu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Hai-Chen Pi
- Department of Emergency Medicine, Peking University First Hospital, Beijing, China
| | - Zhi-Kai Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
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4
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Koppara NK, Medooru KK, Yadagiri LA, Vishnubotla SK, Rapur R, Bitla AR. A Study of Oxidative Stress, Inflammation, and Endothelial Dysfunction in Diabetic and Nondiabetic Chronic Kidney Disease Pre-Dialysis Patients. Indian J Nephrol 2023; 33:420-425. [PMID: 38174313 PMCID: PMC10752391 DOI: 10.4103/ijn.ijn_222_22] [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] [Received: 06/26/2022] [Revised: 10/13/2022] [Accepted: 11/29/2022] [Indexed: 01/05/2024] Open
Abstract
Background Oxidative stress, inflammation, and endothelial dysfunction represent a key triad for the development and progression of atherosclerosis. Due to chronic low-grade inflammation in chronic kidney disease (CKD), concentrations of various inflammatory, endothelial, and oxidative stress markers are elevated, increasing the risk of atherosclerosis. The present study was undertaken to compare oxidative stress, inflammation, and endothelial dysfunction in diabetic and nondiabetic CKD pre-dialysis patients. Materials and Methods This was an observational study on 120 CKD pre-dialysis patients: 60 with diabetes and 60 without diabetes. Markers of oxidative stress were measured in blood - malondialdehyde (MDA), ferric reducing ability of plasma (FRAP), paroxonase-1 (PON-1), ischemia-modified albumin (IMA); inflammation - interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP); and endothelial dysfunction - nitric oxide (NO), carotid wall intima-media thickness (CIMT). Comparisons between the two groups for continuous variables were made with the Student's unpaired t-test or Mann-Whitney test and for categorical values with χ2-test, as appropriate. Results MDA, IMA, IL-6, hsCRP, NO, and CIMT were significantly higher, while FRAP and PON-1 were significantly lower in the diabetic group when compared to nondiabetic group (P < 0.001). The number of atherosclerotic plaques was also significantly higher in the diabetic group compared to nondiabetic group. Conclusion Our study showed increased oxidative stress, inflammation, endothelial dysfunction, and atherosclerosis in diabetic CKD pre-dialysis patients when compared to nondiabetic CKD pre-dialysis patients and in late stages when compared to early stages of CKD in both groups, indicating increased cardiovascular risk in late stages and diabetic CKD pre-dialysis patients.
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Affiliation(s)
- Naveen Kumar Koppara
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Kusuma Kumari Medooru
- Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | | | - Siva Kumar Vishnubotla
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Ram Rapur
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Aparna R. Bitla
- Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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5
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Matias PJ, Laranjinha I, Ávila G, Azevedo A, Jorge C, Ferreira C, Aires I, Amaral T, Gil C, Ferreira A. Long-term cholecalciferol supplementation in hemodialysis patients: Effects on mineral metabolism, inflammation, and cardiac parameters. Semin Dial 2023; 36:29-36. [PMID: 35262225 DOI: 10.1111/sdi.13066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/13/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Low levels of 25-hydroxyvitamin D [25(OH)D] are frequent in chronic kidney disease and are associated with adverse outcomes. The aim of this 5-year prospective study was to evaluate the effects of cholecalciferol supplementation on mineral metabolism, inflammation and cardiac parameters in hemodialysis (HD) patients. METHODS The study included 97 patients. Cholecalciferol was given after HD according to 25(OH)D baseline levels measured twice (end of winter and of summer). The 25(OH)D levels, circulating bone metabolism, inflammation parameters, brain natriuretic peptide (BNP), pulse pressure (PP), and left ventricular mass index (LVMI) were evaluated before and after supplementation. RESULTS There was a significant increase in 25(OH)D levels after supplementation (p < 0.001); however, serum calcium (p = 0.02), phosphorus (p = 0.018), and iPTH (p = 0.03) were decreased. Magnesium levels increased during the study (p = 0.03). A reduction in the number of patients under active vitamin D (p < 0.001) and in the dose and number of patients treated with darbepoetin (p = 0.02) was observed. Serum albumin increased (p < 0.001), and C-reactive protein decreased (p = 0.01). BNP (p < 0.001), PP (p = 0.007), and LVMI (p = 0.02) were significantly reduced after supplementation. CONCLUSIONS Long-term cholecalciferol supplementation allowed correction of 25(OH)D deficiency, improved mineral metabolism with less use of active vitamin D, attenuated inflammation, reduced the dose of the erythropoiesis-stimulating agent, and improved cardiac dysfunction.
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Affiliation(s)
- Patrícia João Matias
- Dialysis Unit, Nephrocare Vila Franca de Xira, Vila Franca de Xira, Portugal.,Dialysis Unit, Dialverca, Forte da Casa, Portugal.,NIDAN, Lisbon, Portugal.,Faculdade de Ciências Médicas, NOVA Medical School, Lisboa, Portugal
| | - Ivo Laranjinha
- Dialysis Unit, Nephrocare Vila Franca de Xira, Vila Franca de Xira, Portugal.,Dialysis Unit, Dialverca, Forte da Casa, Portugal.,NIDAN, Lisbon, Portugal
| | - Gonçalo Ávila
- Dialysis Unit, Nephrocare Vila Franca de Xira, Vila Franca de Xira, Portugal.,Dialysis Unit, Dialverca, Forte da Casa, Portugal.,NIDAN, Lisbon, Portugal
| | - Ana Azevedo
- Dialysis Unit, Nephrocare Vila Franca de Xira, Vila Franca de Xira, Portugal.,Dialysis Unit, Dialverca, Forte da Casa, Portugal.,NIDAN, Lisbon, Portugal
| | - Cristina Jorge
- Dialysis Unit, Nephrocare Vila Franca de Xira, Vila Franca de Xira, Portugal.,Dialysis Unit, Dialverca, Forte da Casa, Portugal.,NIDAN, Lisbon, Portugal
| | - Carina Ferreira
- Dialysis Unit, Nephrocare Vila Franca de Xira, Vila Franca de Xira, Portugal.,Dialysis Unit, Dialverca, Forte da Casa, Portugal.,NIDAN, Lisbon, Portugal.,Faculdade de Ciências Médicas, NOVA Medical School, Lisboa, Portugal
| | - Inês Aires
- Dialysis Unit, Nephrocare Vila Franca de Xira, Vila Franca de Xira, Portugal.,Dialysis Unit, Dialverca, Forte da Casa, Portugal.,NIDAN, Lisbon, Portugal.,Faculdade de Ciências Médicas, NOVA Medical School, Lisboa, Portugal
| | - Tiago Amaral
- Dialysis Unit, Nephrocare Vila Franca de Xira, Vila Franca de Xira, Portugal.,Dialysis Unit, Dialverca, Forte da Casa, Portugal.,NIDAN, Lisbon, Portugal
| | - Célia Gil
- Dialysis Unit, Nephrocare Vila Franca de Xira, Vila Franca de Xira, Portugal.,Dialysis Unit, Dialverca, Forte da Casa, Portugal.,NIDAN, Lisbon, Portugal
| | - Aníbal Ferreira
- Dialysis Unit, Nephrocare Vila Franca de Xira, Vila Franca de Xira, Portugal.,Dialysis Unit, Dialverca, Forte da Casa, Portugal.,NIDAN, Lisbon, Portugal.,Faculdade de Ciências Médicas, NOVA Medical School, Lisboa, Portugal
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6
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Santos LMM, Figueiredo PHS, Silva ACR, Campos PC, Gonçalves GT, de Paula C Freitas J, da Silva Junior FA, Santos JM, Alves FL, Rodrigues VGB, Maciel EHB, Prates MCSM, Sañudo B, Taiar R, Bernardo-Filho M, Lima VP, Costa HS, Mendonça VA, Lacerda ACR. Determining factors of functioning in hemodialysis patients using the international classification of functioning, disability and health. BMC Nephrol 2022; 23:119. [PMID: 35331148 PMCID: PMC8944099 DOI: 10.1186/s12882-022-02719-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background Hemodialysis (HD) treatment affects functioning, physical activity level, clinical biomarkers, and body composition. However, the association between these variables with functioning, considering International Classification of Functioning, Disability and Health (ICF) domains remains unclear. Thus, the aim of this study was to investigate the possible association between physical activity, biomarkers, and body composition with functioning in HD patients in reference to the ICF. Methods Eighty HD patients performed different tests grouped according to ICF domain: Body structure and function – handgrip strength (HS), 5-repetition sit-to-stand test, and 60-s sit-to-stand test (5-STS, 60-STS, respectively); Activity – short physical performance battery (SPPB); and Participation – participation scale questionnaire. Physical activity [Human Activity Profile questionnaire (HAP)], body composition (Dual-energy X-ray absorptiometry), Parathormone (PTH), and alkaline phosphatase were analyzed as possible variables associated with ICF domains. Data analyses were performed using simple and multiple regression models adjusted for age, duration of HD, and diuresis volume. Results In the body structure and function domain, appendicular lean mass, PTH level, and age were associated with HS (R2 = 0.558); HAP and PTH were associated with 5-STS (R2 = 0.263); and HAP, PTH, duration of HD, and age were associated with 60-STS (R2 = 0.337). In the activity domain, HAP, PTH, alkaline phosphatase, duration of HD, age, and body fat were associated with SPPB (R2 = 0.689). Finally, only HAP was associated with the participation scale (R2 = 0.067). Conclusion Physical activity and PTH levels are determinant protagonists of functioning in all ICF domains in hemodialysis patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02719-5.
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Affiliation(s)
- Luciana M M Santos
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Laboratório de Fisiologia do Exercício - LAFIEX - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Pedro Henrique S Figueiredo
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Laboratório de Fisiologia do Exercício - LAFIEX - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Ana C R Silva
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Laboratório de Fisiologia do Exercício - LAFIEX - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Patrícia C Campos
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Laboratório de Fisiologia do Exercício - LAFIEX - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Gabriele T Gonçalves
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Laboratório de Fisiologia do Exercício - LAFIEX - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil
| | - Jaqueline de Paula C Freitas
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Laboratório de Inflamação e Metabolismo - LIM - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Fidelis Antônio da Silva Junior
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil
| | - Jousielle Márcia Santos
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Laboratório de Fisiologia do Exercício - LAFIEX - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil
| | - Frederico L Alves
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Faculdade de Medicina, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Unidade de Hemodiálise do Hospital Santa Casa de Caridade de Diamantina, Diamantina, Brazil
| | - Vanessa G B Rodrigues
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Faculdade de Medicina, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Unidade de Hemodiálise do Hospital Santa Casa de Caridade de Diamantina, Diamantina, Brazil
| | - Emílio Henrique B Maciel
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Faculdade de Medicina, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Unidade de Hemodiálise do Hospital Santa Casa de Caridade de Diamantina, Diamantina, Brazil
| | - Maria Cecília S M Prates
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Faculdade de Medicina, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Unidade de Hemodiálise do Hospital Santa Casa de Caridade de Diamantina, Diamantina, Brazil
| | - Borja Sañudo
- Department of Physical Education and Sports, Universidad de Sevilla, Seville, Spain
| | - Redha Taiar
- MATériaux et Ingénierie Mécanique (MATIM), Université de Reims Champagne-Ardenne, Reims, France
| | - Mario Bernardo-Filho
- Mechanical Vibration Laboratory and Integrative Practices (LAVIMPI), Biophysics and Biometrics Department, Institute of Biology Roberto Alcântara Gomes and Piquet Carneiro Polyclinic, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vanessa P Lima
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Laboratório de Fisiologia do Exercício - LAFIEX - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Henrique S Costa
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Laboratório de Inflamação e Metabolismo - LIM - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Vanessa A Mendonça
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Laboratório de Inflamação e Metabolismo - LIM - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Ana Cristina R Lacerda
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil. .,Laboratório de Fisiologia do Exercício - LAFIEX - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil. .,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil. .,Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
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Kojima S, Yamada S, Fujishima R, Koitabashi K, Shibagaki Y, Sakurada T. Evaluation of modifiable risk factors for peritoneal dialysis-related peritonitis: a single-center retrospective cohort study. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Peritoneal dialysis (PD)-related peritonitis risk factors can be categorized as modifiable and uncorrectable. We aimed to identify modifiable risk factors for PD-related peritonitis in our facility to prevent PD-related peritonitis and continue quality improvement.
Methods
This retrospective, observational study included 90 patients who started receiving PD after 2008 and who were continued for over 1 year. Twenty-three patients experienced 40 episodes of peritonitis. Several clinical factors identified at peritonitis onset among patients with a peritonitis history were compared with those identified 1 year after PD initiation among patients without a peritonitis history, and a multivariate analysis was performed. Several serum parameter levels were evaluated as time-average concentrations (TACs; from PD initiation to 1 month before peritonitis onset or to 1 year later). The clinical factors to be investigated were selected based on previous studies.
Results
There were no significant between-group differences in baseline characteristics regarding uncorrectable factors and TAC values for serum parameters. Use of exchange devices was significantly higher (95.7% vs 71.6%; p = 0.054) whereas administration of renin-angiotensin-aldosterone system (RAS) blockers, calcium channel blockers (CCBs), or oral vitamin D was significantly lower (35.0% vs 65.7%, p = 0.002; 55.0% vs 74.6%, p = 0.036; and 55.0% vs 74.6%, p = 0.036, respectively) in the patients with history of peritonitis, although we did not find a factor independently associated with peritonitis in multivariable logistic regression.
Conclusions
Although hypokalemia, hypoalbuminemia, and exchange device use which are considered as risk factors did not affect peritonitis, administration of RAS blockers, CCBs, and oral vitamin D is significantly larger in patients without peritonitis.
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8
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Low serum vitamin D concentration is correlated with anemia, microinflammation, and oxidative stress in patients with peritoneal dialysis. J Transl Med 2021; 19:411. [PMID: 34579742 PMCID: PMC8477502 DOI: 10.1186/s12967-021-03077-w] [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: 06/30/2021] [Accepted: 09/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is a form of dialysis to replace the function of kidney, that uses the peritoneum as a dialysis membrane to remove metabolites and water retained in the body. Vitamin D deficiency is prevalent in patients treated with PD. This research investigated the correlation between serum 25-hydroxyvitamin D [25(OH)D] concentration and anemia, microinflammation, and oxidative stress in PD patients. METHODS 62 PD patients and 56 healthy volunteers were recruited in this research. Serum concentrations of 25(OH)D and basic parameters of anemia were detected. The correlation between serum 25(OH)D concentration with anemia, oxidative stress, and microinflammatory state were analyzed. RESULTS In the PD group, the concentration of 25(OH)D was lower than the healthy control (HC) group (p < 0.001). Hemoglobin, red blood cell count (RBC), and total iron binding capacity (TIBC) in the PD group was significantly lower (all p < 0.001), while high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α) concentrations were significantly higher, than the HC group (all p < 0.001). In the PD group, malondialdehyde (MDA) concentration was higher than in the HC group (p < 0.001), while superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were lower (both p < 0.001). Serum 25(OH)D exhibited positive correlation with hemoglobin (r = 0.4509, p = 0.0002), RBC (r = 0.3712, p = 0.0030), TIBC (r = 0.4700, p = 0.0001), SOD (r = 0.4992, p < 0.0001) and GSH-Px (r = 0.4312, p = 0.0005), and negative correlation with hs-CRP (r = - 0.4040, p = 0.0011), TNF-α (r = - 0.4721, p = 0.0001), IL-6 (r = - 0.5378, p < 0.0001) and MDA (r = - 0.3056, p = 0.0157). CONCLUSION In conclusion, reduced serum 25(OH)D concentrations in PD patients contribute to anemia, oxidative stress and microinflammatory state.
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9
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Nata N, Siricheepchaiyan W, Supasyndh O, Satirapoj B. Efficacy of high versus conventional dose of ergocalciferol supplementation on serum 25-hydroxyvitamin D and interleukin-6 levels among hemodialysis patients with vitamin D deficiency: A multicenter, randomized, controlled study. Ther Apher Dial 2021; 26:378-386. [PMID: 34378863 DOI: 10.1111/1744-9987.13722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/27/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
Long-term dialysis involves a chronic inflammatory state and produces a high prevalence of vitamin D deficiency. A clinical trial was conducted in hemodialysis with serum 25-hydroxyvitamin D (25[OH]D) level <30 ng/ml. The conventional-group (N = 35) and the high-dose group (N = 35) were treated with ergocalciferol according to the K/DOQI guidelines and double dosage of ergocalciferol from the recommendation for 8 weeks, respectively. The main outcomes were measured by serum 25[OH]D and interleukin-6 (IL-6). At the end of 8 weeks, a statistically significant greater increase was observed of mean serum 25[OH]D levels and a decrease of mean parathyroid hormone levels in the high-dose group compared with the conventional-dose group. The high dose group had the higher achievement of vitamin D sufficiency than the conventional-dose group (97.4% vs. 76.4%, p = 0.012). No significant difference was found in mean changes of serum IL-6 level in both groups, except subgroup patients with vitamin D deficiency or serum 25[OH]D <20 ng/ml, high dose treatment suppressed serum IL-6 level (-2.67 pg/ml [IQR -6.56 to -0.17], p = 0.039). No differences were observed between the two groups in adverse events. Oral high-dose ergocalciferol supplementation has achieved higher vitamin D sufficiency than standard dose in end stage renal disease patients on dialysis.
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Affiliation(s)
- Naowanit Nata
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Wittaya Siricheepchaiyan
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Ouppatham Supasyndh
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Bancha Satirapoj
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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10
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Xi Y, Ma Y, Xie B, Di A, Xu S, Luo X, Wang C, Dai H, Yan G, Qi Z. Vitamin D3 combined with antibody agents suppresses alloreactive memory T-cell responses to induce heart allograft long-term survival. Transpl Immunol 2021; 66:101374. [PMID: 33592299 DOI: 10.1016/j.trim.2021.101374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The pre-stored memory T cells in organ transplant patient carry a high risk of allograft rejection. The current study aimed to determine whether the allogenic response of adoptively transferred memory T cells in mice was suppressed by vitamin D3 monotherapy alone or in combination with monoclonal antibody treatment. METHODS Prior to vascularized heterotopic heart transplantation, naïve C57BL/6 mice were primed with memory T cells. Recipient mice were administered vitamin D3 alone or in combination with monoclonal antibodies (anti-CD40L/ anti-LFA-1). Memory T cells and CD4+ forkhead box P3+ T cells in recipient spleens were measured using flow cytometry. Additionally, the expression of cytokines was measured by ELISA and quantitative PCR. Inflammatory factors in the grafts were identified by hematoxylin and eosin staining. RESULTS Vitamin D3 in conjunction with anti-CD40L/ anti-LFA-1 antibodies were administered according to the median survival time from 6.5 to 80 days. The results revealed that grafts were protected through the prevention of inflammatory cell infiltration. Combined treatment decreased the mRNA levels of IL-2, IFN-γ and IL-10 and increased the mRNA levels of IL-4, Foxp3 and TGF-β in the allograft. Rejection was suppressed by a reduction of CD4+CD44high CD62L+ and CD8+ CD44high CD62L+ memory T cells, the induction of regulatory T cells in the recipient spleen and a reduction of serum IL-2, IFN-γ and IL-10 levels. CONCLUSION Vitamin D3 efficiently protected allografts from memory T-cell allo-responses when combined with anti-CD40L/anti-LFA-1 antibodies therapy.
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Affiliation(s)
- Yanfeng Xi
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, School of Medicine, Xiamen University, Xiamen, Fujian, China; The tumor hospital of Chang Zhou, Chang Zhou, Jiangsu, China
| | - Yunhan Ma
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Baiyi Xie
- Department of Urology Surgery, Ruikang Hospital affiliated to Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Anjie Di
- Basic Medical Department of Medical College, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Shuangyue Xu
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Xuewei Luo
- Medicinal College, Guangxi University, Nanning, Guangxi, China
| | - Chenxi Wang
- Basic Medical Department of Medical College, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Helong Dai
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, Hunan, China; Clinical Immunology Center, Central South University, Changsha, Hunan 410000, China.
| | - Guoliang Yan
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, School of Medicine, Xiamen University, Xiamen, Fujian, China; Basic Medical Department of Medical College, School of Medicine, Xiamen University, Xiamen, Fujian, China.
| | - Zhongquan Qi
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, School of Medicine, Xiamen University, Xiamen, Fujian, China; Medicinal College, Guangxi University, Nanning, Guangxi, China.
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11
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Ting SW, Fan PC, Lin YS, Lin MS, Lee CC, Kuo G, Chang CH. Uremic pruritus and long-term morbidities in the dialysis population. PLoS One 2020; 15:e0241088. [PMID: 33104746 PMCID: PMC7588085 DOI: 10.1371/journal.pone.0241088] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022] Open
Abstract
Background Uremic pruritus (UP) is a multifactorial problem that contributes to low quality of life in dialysis patients. The long-term influences of UP on dialysis patients are still poorly understood. This study aims to elucidate the contribution of UP to long-term outcomes. Materials and method We used the Taiwan National Health Insurance Research Database to conduct this study. Patients on chronic dialysis were included and divided into UP and non-UP groups according to the long-term prescription of antihistamine in the absence of other indications. The outcomes include infection-related hospitalization, catheter-related infection, major adverse cardiac and cerebrovascular events (MACCE) and parathyroidectomy. Results After propensity score matching, 14,760 patients with UP and 29,520 patients without UP were eligible for analysis. After a mean follow-up of 5 years, we found that infection-related hospitalization, MACCE, catheter-related infection, heart failure and parathyroidectomy were all slightly higher in the UP than non-UP group (hazard ratio: 1.18 [1.16–1.21], 1.05 [1.01–1.09], 1.16 [1.12–1.21], 1.08 [1.01–1.16] and 1.10 [1.01–1.20], respectively). Subgroup analysis revealed that the increased risk of adverse events by UP was generally more apparent in younger patients and patients who underwent peritoneal dialysis. Conclusion UP may be significantly associated with an increased risk of long-term morbidities.
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Affiliation(s)
- Sze-Wen Ting
- Department of Dermatology, New Taipei City Tu-Cheng Municipal Hospital, New Taipei City (Built and Operated by Chang Gung Medical Foundation), Taoyuan, Taiwan
| | - Pei-Chun Fan
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Sheng Lin
- Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Puzi City, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ming-Shyan Lin
- Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Puzi City, Taiwan
| | - Cheng-Chia Lee
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - George Kuo
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Hsiang Chang
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
- * E-mail: ,
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12
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Yuan Q, Xie Y, Peng Z, Wang J, Zhou Q, Xiao X, Wang W, Huang L, Tang W, Li X, Zhang L, Wang F, Zhao MH, Tao L, He K, Wanggou S, Xu H. Urinary magnesium predicts risk of cardiovascular disease in Chronic Kidney Disease stage 1-4 patients. Clin Nutr 2020; 40:2394-2400. [PMID: 33160701 DOI: 10.1016/j.clnu.2020.10.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 12/23/2022]
Abstract
Observational studies on dietary or circulating magnesium and risk of cardiovascular disease (CVD) in Chronic Kidney Disease (CKD) stage 1-4 have reported no-to-modest inverse associations. 24 h Urinary magnesium concentration (24 h UMg), an indicator of intestinal magnesium absorption, may provide better insight into the connection of CKD progression. We examined 3179 participants aged 18-74 years with CKD stage 1-4 in the Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE) study, a prospective population-based cohort study. Data were analysed using Spearman rank-order correlation coefficients for all comparisons. We also performed a time-to-event analysis of the data using the Kaplan-Meier survival model, Cox proportional hazard model and competing risk Fine and Gray subdistribution hazard model. During a median follow-up of 4.19 years (interquartile range, 3.43-5.09 years), when modelling end-stage renal disease (ESRD), CVD and death, 24 h UMg was associated with risk of CVD (HR, 1.612 (95% CI, 1.056-2.460)), while no significant association with ESRD and death endpoints could be detected. 24 h UMg risk variants display a modest association with CVD in CKD stage 1-4 patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT03041987. Registered January 1, 2012. (retrospectively registered) (https://www.clinicaltrials.gov/ct2/show/NCT03041987?term=Chinese+Cohort+Study+of+Chronic+Kidney+Disease+%28C-STRIDE%29&rank=1).
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Affiliation(s)
- Qiongjing Yuan
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Yanyun Xie
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Zhangzhe Peng
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, China; Institute of Nephrology, Peking University, China; Key Laboratory of Renal Disease, Ministry of Health of China, China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, 100034, China
| | - Qiaoling Zhou
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Xiangcheng Xiao
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Wei Wang
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Ling Huang
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Wenbin Tang
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Xiaozhao Li
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, China; Institute of Nephrology, Peking University, China; Key Laboratory of Renal Disease, Ministry of Health of China, China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, 100034, China; Center for Data Science in Health and Medicine, Peking University, Beijing, China
| | - Fang Wang
- Renal Division, Department of Medicine, Peking University First Hospital, China; Institute of Nephrology, Peking University, China; Key Laboratory of Renal Disease, Ministry of Health of China, China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, 100034, China
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, China; Institute of Nephrology, Peking University, China; Key Laboratory of Renal Disease, Ministry of Health of China, China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, 100034, China; Peking-Tsinghua Center for Life Sciences, Beijing, China
| | - Lijian Tao
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Kevin He
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Siyi Wanggou
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Hui Xu
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China.
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13
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Olivier V, Dunyach-Remy C, Corbeau P, Cristol JP, Sutra T, Burtey S, Lavigne JP, Moranne O. Factors of microinflammation in non-diabetic chronic kidney disease: a pilot study. BMC Nephrol 2020; 21:141. [PMID: 32316931 PMCID: PMC7175551 DOI: 10.1186/s12882-020-01803-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/12/2020] [Indexed: 12/16/2022] Open
Abstract
Background The relationships between digestive bacterial translocation, uremic toxins, oxidative stress and microinflammation in a population of chronic kidney disease (CKD) patients without metabolic nor inflammatory disease are unknown. Methods Bacterial translocation, uremic toxins, oxidative stress, and inflammation were assessed by measuring plasma levels of 16S ribosomal DNA (16S rDNA), p-cresyl sulfate (PCS), indoxyl sulfate (IS), indole acetic acid (IAA), F2-isoprostanes, hsCRP and receptor I of TNFα (RITNFα) in patients without metabolic nor inflammatory disease. 44 patients with CKD from stage IIIB to V and 14 controls with normal kidney function were included from the nephrology outpatients. 11 patients under hemodialysis (HD) were also included. Correlations between each factor and microinflammation markers were studied. Results 16S rDNA levels were not increased in CKD patients compared to controls but were decreased in HD compared to non-HD stage V patients (4.7 (3.9–5.3) vs 8.6 (5.9–9.7) copies/μl, p = 0.002). IS, PCS and IAA levels increased in HD compared to controls (106.3 (73.3–130.4) vs 3.17 (2.4–5.1) μmol/l, p < 0.0001 for IS; 174.2 (125–227.5) vs 23.7 (13.9–52.6) μmol/l, p = 0.006 for PCS; and 3.7 (2.6–4.6) vs 1.3 (1.0–1.9) μmol/l, p = 0.0002 for IAA). Urea increased in non-HD stage V patients compared to controls (27.6 (22.7–30.9) vs 5.4 (4.8–6.4) mmol/l, p < 0.0001) and was similar in HD and in non-HD stage V (19.3 (14.0–24.0) vs 27.6 (22.7–30.9) mmol/l, p = 0.7). RITNFα levels increased in HD patients compared to controls (12.6 (9.6–13.3) vs 1.1 (1.0–1.4) ng/ml, p < 0.0001); hsCRP levels increased in non-HD stage V patients compared to controls (2.9 (1.4–8.5) vs 0.8 (0.5–1.7) mg/l, p = 0.01) and remained stable in HD patients (2.9 (1.4–8.5) vs 5.1 (0.9–11.5) mg/l, p = 1). F2-isoprostanes did not differ in CKD patients compared to controls. Among uremic toxins, IS and urea were correlated to RITNFα (r = 0.8, p < 0.0001 for both). PCS, IS and urea were higher in patients with hsCRP≧5 mg/l (p = 0.01, 0.04 and 0.001 respectively). 16S rDNA, F2-isoprostanes were not correlated to microinflammation markers in our study. Conclusions In CKD patients without any associated metabolic nor inflammatory disease, only PCS, IS, and urea were correlated with microinflammation. Bacterial translocation was decreased in patients under HD and was not correlated to microinflammation.
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Affiliation(s)
- Valerie Olivier
- Department of Nephrology - Dialysis - Apheresis, Caremeau Hospital, University Montpellier-Nîmes, CHU Nîmes, Nimes, France.
| | - Catherine Dunyach-Remy
- Department of Microbiology and Hospital Hygiene, U1047, INSERM, University of Montpellier, CHU Nîmes, Nîmes, France
| | - Pierre Corbeau
- UMR9002, Institute for Human Genetics, CNRS-University of Montpellier, Montpellier, France
| | - Jean-Paul Cristol
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France.,Department of Biochemistry and Hormonology, CHU Montpellier, Montpellier, France
| | - Thibault Sutra
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France.,Department of Biochemistry and Hormonology, CHU Montpellier, Montpellier, France
| | - Stephane Burtey
- C2VN, INSERM 1263, INRA 1260, Aix-Marseille University, Marseille, France
| | - Jean-Philippe Lavigne
- Department of Microbiology and Hospital Hygiene, U1047, INSERM, University of Montpellier, CHU Nîmes, Nîmes, France
| | - Olivier Moranne
- Department of Nephrology - Dialysis - Apheresis, Caremeau Hospital, University Montpellier-Nîmes, CHU Nîmes, Nimes, France.,EA2415, Laboratoire Epidémiologie, Santé Publique, Biostatistiques, University of Montpellier, Nîmes, France
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Boyer-Suavet S, Cremoni M, Dupeyrat T, Zorzi K, Brglez V, Benzaken S, Esnault V, Seitz-Polski B. Functional immune assay using interferon-gamma could predict infectious events in end-stage kidney disease. Clin Chim Acta 2020; 502:287-292. [DOI: 10.1016/j.cca.2019.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 12/19/2022]
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15
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Xie B, Ma Y, Xi Y, Di A, Chen X, Chen Y, Zhang L, Xu S, Wang C, Yan G, Qi Z. Combined treatment with vitamin D3 and antibody agents suppresses secondary heart transplant rejection in the early postoperative period. Transpl Immunol 2020; 59:101270. [PMID: 31953155 DOI: 10.1016/j.trim.2020.101270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Accelerated transplant rejection mediated by donor reactive memory T cells is another barrier to the induction of graft tolerance. The aim of this study was to investigate the immunosuppressing effects of vitamin D (1,25(OH)2D3), administered alone or in combination with a costimulatory blockade treatment, on rejection of secondary heart allografts in a mouse model. METHODS Circular full-thickness skin grafts from BALB/c mice were cut and grafted onto the lumbar regions of C57BL/6 mice as allo-primed recipients. Four weeks after skin grafting, the vascularized hearts from the BALB/c mice were transplanted heterotopically into the allo-primed recipients using a non-suture cuff technique. The recipients were then randomly divided into four groups and given either intraperitoneal injection of isotype, Ab, 1,25(OH)2D3, or a combination of Ab and 1,25(OH)2D3. Allograft incidence was determined by hematoxylin-eosin staining, and cytokine expression was assessed by the quantitative real-time polymerase chain reaction, enzyme-linked immunosorbent assays, and cytometric bead arrays. Spleen cells from the recipient were used to assess mixed lymphocyte reactions. Memory T cells and regulatory T cells (Tregs) in spleen cells were measured by flow cytometry. RESULTS The median allograft survival time was longer with the combined treatment with Ab and 1,25(OH)2D3 than with no treatment or with treatment with Ab or 1,25(OH)2D3 alone. The grafts were protected from infiltration by inflammatory cells and by inhibition of interleukin 2 and interferon gamma expression. Rejection was initially suppressed in the early postoperative period by a reduction in the number of memory T cells and induction of Foxp3+ Tregs, but this effect disappeared by day 15 after transplantation upon withdrawal of the treatment. CONCLUSION Vitamin D3 administered as an immunosuppressive agent, when combined with monoclonal antibody treatment, may protect heart grafts from memory T cell responses in a secondary heart transplant model.
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Affiliation(s)
- Baiyi Xie
- Organ Transplantation institute, School of Medicine, Xiamen University, Xiamen, Fujian, China; Fujian Key Laboratory of Organ and Tissue Regeneration, Xiamen, Fujian, China; School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yunhan Ma
- Organ Transplantation institute, School of Medicine, Xiamen University, Xiamen, Fujian, China; Fujian Key Laboratory of Organ and Tissue Regeneration, Xiamen, Fujian, China; School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yanfeng Xi
- Organ Transplantation institute, School of Medicine, Xiamen University, Xiamen, Fujian, China; Fujian Key Laboratory of Organ and Tissue Regeneration, Xiamen, Fujian, China; School of Medicine, Xiamen University, Xiamen, Fujian, China; The Tumor Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Anjie Di
- School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Xu Chen
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Yingyu Chen
- Organ Transplantation institute, School of Medicine, Xiamen University, Xiamen, Fujian, China; Fujian Key Laboratory of Organ and Tissue Regeneration, Xiamen, Fujian, China; School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Liyi Zhang
- Organ Transplantation institute, School of Medicine, Xiamen University, Xiamen, Fujian, China; Fujian Key Laboratory of Organ and Tissue Regeneration, Xiamen, Fujian, China; School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Shuangyue Xu
- Organ Transplantation institute, School of Medicine, Xiamen University, Xiamen, Fujian, China; Fujian Key Laboratory of Organ and Tissue Regeneration, Xiamen, Fujian, China; School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Chenxi Wang
- School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Guoliang Yan
- Organ Transplantation institute, School of Medicine, Xiamen University, Xiamen, Fujian, China; Fujian Key Laboratory of Organ and Tissue Regeneration, Xiamen, Fujian, China; School of Medicine, Xiamen University, Xiamen, Fujian, China.
| | - Zhongquan Qi
- Organ Transplantation institute, School of Medicine, Xiamen University, Xiamen, Fujian, China; Fujian Key Laboratory of Organ and Tissue Regeneration, Xiamen, Fujian, China; Medical College, Guangxi University, Nanning, Guangxi, China.
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Impaired production of immune mediators in dengue virus type 2-infected mononuclear cells of adults with end stage renal disease. Sci Rep 2019; 9:19783. [PMID: 31875015 PMCID: PMC6930266 DOI: 10.1038/s41598-019-56381-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 11/28/2019] [Indexed: 11/08/2022] Open
Abstract
Chronic kidney disease is an epidemiologically identified risk factor for development of severe dengue in dengue-affected patients. However, available data on the immune pathogenesis in end stage renal disease (ESRD) patients affected by dengue is insufficient. We performed an in vitro study to evaluate the sequential immunological reactions and viral load in dengue virus type 2-infected mononuclear cells of patients with ESRD (n = 34) and in healthy controls (n = 30). The concentrations of interleukins (IL)-1 receptor antagonist (Ra), IL-2, IL-6, IL-8, IL-10, IL-12p40, granulocyte-macrophage colony-stimulating factor (GM-CSF), monocyte chemotactic protein-1 (MCP-1), macrophage inflammatory protein-1b (MIP-1b), vascular endothelial growth factor (VEGF), tumor necrosis factor (TNF)-α and viral load cycle threshold (Ct) were measured in the dengue virus type 2-infected mononuclear cells at 6 h, 24 h, 48 h, and 72 h post-infection. We found in the ESRD group significantly higher GM-CSF and IL-2 levels at 6 h post-infection. However, IL-8, IL-10, IL-12p40, TNF-α, MCP-1, and MIP-1b levels were found significantly lower than in the control group. At 24 h, 48 h, and 72 h post-infection, significantly lower levels of IL-1Ra, IL-6, IL-8, IL-10, IL-12p40, TNF-α, MCP-1, and MIP-1b were detected in ESRD group. Concentration of VEGF at 24 h and 48 h, and of GM-CSF at 48 h and 72 h were also found to be lower in ESRD group than in control group. Compared with controls, the viral load Ct values were significantly lower in ESRD group at 6 h and 24 h post-infection No significant difference in viral load Ct values between two groups was found at 48 h and 72 h post-infection. Our study discloses that the expression of immune mediators of dengue-infected mononuclear cells is impaired in ESRD patients.
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Zhang YH, Xu X, Pi HC, Yang ZK, Johnson DW, Dong J. The effects of oral vitamin D supplementation on the prevention of peritoneal dialysis-related peritonitis: study protocol for a randomized controlled clinical trial. Trials 2019; 20:657. [PMID: 31779675 PMCID: PMC6883549 DOI: 10.1186/s13063-019-3784-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Vitamin D deficiency has been shown to be closely associated with peritoneal dialysis (PD)-related peritonitis. The aim of this study is to examine the feasibility of conducting a large, powered randomized controlled trial to determine the effects of vitamin D supplementation on the risk of PD-related peritonitis in patients who have already experienced an episode of peritonitis. METHODS This prospective, open-label randomized controlled pilot trial with blinded end-points aims to determine the feasibility of oral vitamin D supplementation and to explore its effects on the risk of subsequent PD-related peritonitis among PD patients who have recovered from a recent episode of peritonitis. Eligible patients will be randomized 1:1 to either oral vitamin D supplementation (2000 IU per day; intervention group) or no vitamin D supplementation (control group) in addition to usual care according to International Society for Peritoneal Dialysis guidelines. The sample size will be 30 patients for both groups. All participants will be followed for 12 months. The primary outcome is the assessment of feasibility (recruitment success, retention, adherence, safety) and fidelity (change in serum 25-hydroxyvitamin D level during follow-up) for a large, powered randomized controlled trial to determine the effects of vitamin D on the risk of PD-related peritonitis in the future. Secondary outcomes include time to peritonitis occurrence, recovery of peritonitis, peritonitis-related transition to hemodialysis, and peritonitis-related death (defined as death within 30 days of peritonitis onset). DISCUSSION This is the first randomized controlled trail investigating the effects of vitamin D supplementation on the risk of subsequent PD-related peritonitis among patients on PD. The findings for this pilot study will determine the feasibility of conducting a full-scale randomized controlled trail, which may provide a new strategy for preventing PD-related peritonitis among PD patients. TRIAL REGISTRATION Clinicaltrails.gov, NCT03264625. Registered on 29 August 2017.
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Affiliation(s)
- Yu-Hui Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Xiao Xu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Hai-Chen Pi
- Department of Emergency Medicine, Peking University First Hospital, Beijing, China
| | - Zhi-Kai Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
- Institute of Nephrology, Peking University, Beijing, China.
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Ministry of Health, Beijing, China.
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China.
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Toxines urémiques de moyen poids moléculaire : un véritable regain d’intérêt. Nephrol Ther 2019; 15:82-90. [DOI: 10.1016/j.nephro.2018.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/02/2018] [Indexed: 01/20/2023]
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Yoon UA, Kim YC, Lee H, Kwon S, An JN, Kim DK, Kim YS, Lim CS, Lee JP, Kim H. The impact of sunlight exposure on mortality of patients with end stage renal disease. Sci Rep 2019; 9:2230. [PMID: 30778098 PMCID: PMC6379426 DOI: 10.1038/s41598-019-38522-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 12/31/2018] [Indexed: 02/06/2023] Open
Abstract
Recent data suggest that reduced sunlight exposure is associated with increased mortality in the general population. To date, the association between sunlight exposure and mortality in dialysis patients has not been examined. Among 134,478 dialysis patients in the Korean end-stage renal disease (ESRD) cohort from 2001 to 2014, 31,291 patients were enrolled from seven metropolitan cities, and data were analyzed using bi-directional case-crossover design. We examined the association between short-term sunlight exposure and mortality in ESRD patients. We adjusted for temperature, humidity, and daily concentrations of nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), carbon monoxide (CO), and particle matter (PM10) as confounders. The characteristics of the study population included age (65.6 ± 12.26 (mean ± standard deviation [SD]) years), sex (male, 59.96%; female, 41.04%), comorbidity (diabetes, 53.58%; hypertension, 40.5%), and kidney dialysis type (hemodialysis, 73.02%; peritoneal dialysis, 26.98%). The mean ± SD follow-up time was 4.68 ± 4.37 years. The daily sunlight exposure was significantly decreased in the case group compared with the control group (P = 0.004). Sunlight exposure was associated with all-cause death overall (ORs [95% CI]: 0.99 [0.98-0.99], P = 0.042) in a fully adjusted model. Patients with diabetes (ORs [95% CI]: 0.98 [0.97-0.99], P = 0.016) or aged higher than 75 years (ORs [95% CI]; 0.97 [0.96-0.99], P = 0.020) had higher risks of mortality than patients without diabetes or aged below 75 years, respectively. These findings suggest that sunlight exposure is inversely correlated with all-cause mortality in dialysis patients.
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Affiliation(s)
- Una Amelia Yoon
- Department of Biostatistics and Epidemiology, School of Public Health, Seoul National University, Seoul, Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyewon Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea.,Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Soie Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung Nam An
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yon Su Kim
- Kidney Research Institute, Seoul National University Hospital, Seoul, Korea.,Department of Medical Science, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea. .,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Ho Kim
- Department of Biostatistics and Epidemiology, School of Public Health, Seoul National University, Seoul, Korea. .,Institute of Health and Environment, Seoul National University, Seoul, Korea.
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Deniz S, Aydemir Y, Şengül A, Emre JÇ, Tanrisev M, Özhan MH, Güney İ. Factors affecting TST level in patients undergoing dialysis: a multicenter study. Hemodial Int 2018; 23:81-87. [PMID: 30289192 DOI: 10.1111/hdi.12676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/30/2018] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The risk of TB is increased in patients with chronic kidney disease (CKD) when compared with individuals with normal renal function. We aimed to determine tuberculin skin test (TST) response and the factors which might affect the response in patients with CKD undergoing dialysis in this study. METHODS The purified protein derivative solution was administered to the patients and the diameter of induration was measured. Additionally, the age, gender and smoking status of the patients were interrogated. Comorbidities were recorded both by patients' self-reports and data from the hospital files. The number of Bacille Calmette-Guerin (BCG) scars was recorded by checking both shoulders. FINDINGS The study was conducted with a total of 371 patients (194 men and 177 women). The mean age was 60.09 ± 15.88, TST was 6.99 ± 6.9, duration of dialysis was 4.44 ± 4.5 (3.8-0.1,24). A total of 229 patients have comorbodities (61.7%, the most frequent was hypertension). Logistic regression model was performed. Gender, vitamin D treatment and high parathormone (PTH) levels remained in the final stage of the analysis and vitamin D intake and PTH levels were detected to be statistically significant (P = 0.002, 0.007, respectively). DISCUSSION This study is the first study which showed a correlation between TST negativity and increased PTH levels and receiving vitamin D treatment. Starting from this point, it was concluded that PTH may suppress the immune system and especially cellular immunity.
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Affiliation(s)
- Sami Deniz
- Clinic of Chest Diseases Dr. Suat Seren Chest Diseases and Thoracic Surgery Research and Education Hospital, İzmir, Turkey
| | - Yusuf Aydemir
- Chest Diseases Department, Sakarya University, Sakarya, Turkey
| | - Aysun Şengül
- Kocaeli Derince Research and Education Hospital, Derince, Kocaeli, Turkey
| | | | - Mehmet Tanrisev
- Department of Nephrology, Tepecik Research and Education Hospital, İzmir, Turkey
| | | | - İbrahim Güney
- Nephrology Department, Konya Research and Training Hospital, Konya, Turkey
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Jian-Pi-Yi-Shen Formula Regulates Inflammatory Cytokines Production in 5/6 Nephrectomized Rats via Suppression of NF-κB Activation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:7203547. [PMID: 30108662 PMCID: PMC6077543 DOI: 10.1155/2018/7203547] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/09/2018] [Indexed: 12/04/2022]
Abstract
Jian-Pi-Yi-Shen formula (JPYSF) is a Chinese herbal decoction used for treating chronic kidney disease (CKD) for over 20 years with good efficiency. However, the mechanism lacks solid evidence. In the present study, we tested the hypothesis that JPYSF may retard CKD progression via inhibition of inflammation in 5/6 nephrectomy (5/6 Nx) rat model. The 5/6 Nx rats were randomly divided into 2 groups: 5/6 Nx group and JPYSF group. Sham-operated rats served as control. JPYSF (2.06 g/kg/d) were administrated by gavage to 5/6 Nx rats daily for 6 weeks. Results showed that JPYSF treatment significantly improved kidney function and pathological injury in 5/6 Nx rats. Multiplex analysis of cytokines revealed that JPYSF reduced proinflammatory cytokines and increased anti-inflammatory cytokine production. Furthermore, JPYSF inhibited the activation of nuclear factor-kappa B (NF-κB) signaling pathway. In conclusion, our data demonstrated that JPYSF remarkably retards development and progression of CKD in a 5/6 Nx rat model, which may be associated with inhibition of inflammation via NF-κB signaling pathway.
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Ishigami J, Jaar BG, Rebholz CM, Grams ME, Michos ED, Wolf M, Kovesdy CP, Uchida S, Coresh J, Lutsey PL, Matsushita K. Biomarkers of Mineral and Bone Metabolism and 20-Year Risk of Hospitalization With Infection: The Atherosclerosis Risk in Communities Study. J Clin Endocrinol Metab 2017; 102:4648-4657. [PMID: 29029099 PMCID: PMC5718703 DOI: 10.1210/jc.2017-01868] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 09/22/2017] [Indexed: 12/11/2022]
Abstract
Context Mineral and bone disorders (MBDs) might be relevant in the etiology of infection. Objective To determine whether MBD biomarkers were associated with the incidence of hospitalization with infection. We also assessed the cross-sectional association between MBD biomarker levels and kidney function. Design, Setting, Participants Community-based cohort study of 11,218 participants with an estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73m2 in the Atherosclerosis Risk in Communities study. We assessed the cross-sectional associations of five MBD markers-fibroblast growth factor 23 (FGF23), 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH), calcium corrected for hypoalbuminemia, and phosphorus-with eGFR from 1990 to 1992 and their longitudinal associations with incident hospitalization with infection in 1990 to 2013. Main Outcome Incident hospitalization with infection. Results In age-, sex-, and race-adjusted models, lower eGFRs were significantly associated with greater levels of FGF23, PTH, and corrected calcium but not 25(OH)D or phosphorus. During follow-up, 5078 hospitalizations with infection occurred. In fully adjusted Cox models, with the second quartile as the reference, the hazard ratio (HR) was significantly greater in the highest quartile of FGF23 [HR, 1.12; 95% confidence interval (CI), 1.03 to 1.21], PTH (HR, 1.09; 95% CI, 1.01 to 1.18), and corrected calcium (HR, 1.11; 95% CI, 1.03 to 1.20), and lowest quartile for 25(OH)D (HR, 1.11; 95% CI, 1.03 to 1.21). The association with phosphorus was significant only when the outcome was restricted to primary diagnosis of infection. These findings were consistent across subgroups of age, sex, race, and eGFR (<60 vs ≥60 mL/min/1.73 m2). Conclusions MBD biomarkers were associated with eGFR and the subsequent risk of infection, supporting MBD involvement in the etiology of infection.
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Affiliation(s)
- Junichi Ishigami
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
| | - Bernard G. Jaar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205
| | - Casey M. Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
| | - Morgan E. Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205
| | - Erin D. Michos
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205
| | - Myles Wolf
- Division of Nephrology, Department of Medicine and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina 27710
| | - Csaba P. Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee 38163
| | - Shinichi Uchida
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
| | - Pamela L. Lutsey
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55454
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
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Messa P, Regalia A, Alfieri CM. Nutritional Vitamin D in Renal Transplant Patients: Speculations and Reality. Nutrients 2017; 9:nu9060550. [PMID: 28554998 PMCID: PMC5490529 DOI: 10.3390/nu9060550] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/15/2017] [Accepted: 05/22/2017] [Indexed: 12/14/2022] Open
Abstract
Reduced levels of nutritional vitamin D are commonly observed in most chronic kidney disease (CKD) patients and particularly in patients who have received a kidney transplant (KTx). In the complex clinical scenario characterizing the recipients of a renal graft, nutritional vitamin D deficiency has been put in relation not only to the changes of mineral and bone metabolism (MBM) after KTx, but also to most of the medical complications which burden KTx patients. In fact, referring to its alleged pleiotropic (non-MBM related) activities, vitamin D has been claimed to play some role in the occurrence of cardiovascular, metabolic, immunologic, neoplastic and infectious complications commonly observed in KTx recipients. Furthermore, low nutritional vitamin D levels have also been connected with graft dysfunction occurrence and progression. In this review, we will discuss the purported and the demonstrated effects of native vitamin D deficiency/insufficiency in most of the above mentioned fields, dealing separately with the MBM-related and the pleiotropic effects.
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Affiliation(s)
- Piergiorgio Messa
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20122, Italy.
- via Festa del Perdono, Università degli Studi di Milano, Milano 20122, Italy.
| | - Anna Regalia
- via Festa del Perdono, Università degli Studi di Milano, Milano 20122, Italy.
| | - Carlo Maria Alfieri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20122, Italy.
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Bi X, Tey SL, Leong C, Quek R, Henry CJ. Prevalence of Vitamin D Deficiency in Singapore: Its Implications to Cardiovascular Risk Factors. PLoS One 2016; 11:e0147616. [PMID: 26799569 PMCID: PMC4723156 DOI: 10.1371/journal.pone.0147616] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/06/2016] [Indexed: 02/06/2023] Open
Abstract
Objective Vitamin D deficiency is a global health challenge and has been linked to type 2 diabetes and other chronic diseases. However, the relationship between vitamin D status, body composition, and cardiovascular risks has not been well characterized in Asian populations. The objectives of this study were to examine the factors associated with the low vitamin D levels in a sunny tropical region and to assess the role of vitamin D status in cardiovascular risk factors. Design and Methods This was a cross-sectional study. One hundred and fourteen healthy participants (59 males and 55 females) residing in Singapore took part in this study. Plasma 25OH-D3 concentration was measured by using LC-MS/MS. Body fat (%) was measured by using three different techniques including bioelectrical impedance analysis (BIA), BOD POD, and dual-energy X-ray absorptiometry (DEXA). Basic anthropometric measurements, fasting blood glucose (FBG), fasting serum insulin (FSI), and lipid profiles were obtained using standard protocols. Results Approximately 42% of the participants were vitamin D deficient (< 20 ng/mL). Vitamin D status was inversely associated with body fat (%), homeostasis model assessment of insulin resistance (HOMA-IR), and total cholesterol/high density lipoprotein (TC/HDL) ratio, while positively associated with lean body mass (LBM) and hand grip strength (HGS). Conclusions The high prevalence of vitamin D deficiency in a sunny tropical region reinforces the need to recognize that sunlight alone is not the precursor for optimal vitamin D status. This raises the need to investigate public health measures that will encourage exposure to sunlight without overexposure that is harmful to skin. More importantly, vitamin D deficiency is associated with increased cardiovascular risks, i.e. HOMA-IR, TC/HDL, and LDL/HDL. Future studies should attempt to elucidate the potential mechanisms.
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Affiliation(s)
- Xinyan Bi
- Clinical Nutrition Research Centre, Centre for Translational Medicine, 14 Medical Drive #07–02, MD 6 Building, Singapore 117599, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Brenner Centre for Molecular Medicine, 30 Medical Drive, Singapore 117609, Singapore
| | - Siew Ling Tey
- Clinical Nutrition Research Centre, Centre for Translational Medicine, 14 Medical Drive #07–02, MD 6 Building, Singapore 117599, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Brenner Centre for Molecular Medicine, 30 Medical Drive, Singapore 117609, Singapore
| | - Claudia Leong
- Clinical Nutrition Research Centre, Centre for Translational Medicine, 14 Medical Drive #07–02, MD 6 Building, Singapore 117599, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Brenner Centre for Molecular Medicine, 30 Medical Drive, Singapore 117609, Singapore
| | - Rina Quek
- Clinical Nutrition Research Centre, Centre for Translational Medicine, 14 Medical Drive #07–02, MD 6 Building, Singapore 117599, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Brenner Centre for Molecular Medicine, 30 Medical Drive, Singapore 117609, Singapore
| | - Christiani Jeyakumar Henry
- Clinical Nutrition Research Centre, Centre for Translational Medicine, 14 Medical Drive #07–02, MD 6 Building, Singapore 117599, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Brenner Centre for Molecular Medicine, 30 Medical Drive, Singapore 117609, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore
- * E-mail:
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25
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Fibroblast growth factor-23, vitamin D and mineral metabolism in renal transplant recipients. INDIAN JOURNAL OF TRANSPLANTATION 2016. [DOI: 10.1016/j.ijt.2016.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Esteghamati A, Fotouhi A, Faghihi-Kashani S, Hafezi-Nejad N, Heidari B, Sheikhbahaei S, Zandieh A, Nakhjavani M. Non-linear contribution of serum vitamin D to symptomatic diabetic neuropathy: A case-control study. Diabetes Res Clin Pract 2016; 111:44-50. [PMID: 26548603 DOI: 10.1016/j.diabres.2015.10.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/23/2015] [Accepted: 10/12/2015] [Indexed: 12/12/2022]
Abstract
AIMS Vitamin D deficiency has recently been speculated to be associated with increased risk of diabetes neuropathy (DN). The aim of this study was to evaluate the odds of symptomatic DN across serum vitamin D levels. METHODS All patients with DM were assessed using diabetic neuropathy symptoms and diabetic neuropathy examination score. Overall, 150 cases with DN and 600 controls were included. Serum 25-hydroxyvitamin D (25-OH-D) was measured to determine vitamin D status. RESULTS A non-linear association between 25-OH-D and suffering from symptomatic DN was observed which was extracted after stratifying the ORs across different serum 25-OH-D levels. When compared to individuals with 25-OH-D of 30-40 ng/mL, patients with deficient (<20 ng/mL) vitamin D levels had higher odds of having symptomatic DN (OR: 2.04, 95%CI: 0.99-4.02, P=0.054). Participants with vitamin D values of greater than 40 ng/mL were also more likely to exhibit symptomatic DN (fully adjusted OR: 4.29, 95%CI: 1.59-11.55). CONCLUSIONS We hypothesize a non-linear contribution of serum vitamin D to symptomatic DN occurrence, which emphasizes that administration of vitamin D should be monitored and evaluated more carefully, especially in patients with diabetes.
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Affiliation(s)
- Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Sara Faghihi-Kashani
- Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Nima Hafezi-Nejad
- Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Behnam Heidari
- Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Sara Sheikhbahaei
- Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Ali Zandieh
- Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Jhorawat R, Jain S, Pal A, Nijhawan S, Beniwal P, Agarwal D, Malhotra V. Effect of vitamin D level on the immunogenicity to hepatitis B vaccination in dialysis patients. Indian J Gastroenterol 2016; 35:67-71. [PMID: 26876961 DOI: 10.1007/s12664-016-0621-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 01/19/2016] [Indexed: 02/04/2023]
Abstract
We undertook this study to assess the response of hepatitis B vaccination in dialysis patients and the effect of vitamin D level on the immunogenicity to hepatitis B vaccination. It was an observational study, which included 60 patients of end-stage renal disease on maintenance dialysis. Patients with anti-HBs antibody positive at baseline were excluded. All received intramuscular recombinant hepatitis B vaccination at 0, 1, 2, and 6 months 20 μg on each deltoid muscle bilateral. Anti-HBs antibody titers were measured at 4 and 7 months of vaccination and the titer ≥10 mIU/mL was considered as "positive". Vitamin D levels were measured at baseline before starting the vaccination. The mean vitamin D level was 15.0 ± 7.8 ng/mL. The vitamin D level <10 and <20 were 23.3% and 83.3%, respectively. The patients on hemodialysis had relatively higher vitamin D level than on peritoneal dialysis patients, i.e. 16.3 ± 8.5 and 11.5 ± 3.1 ng/mL, respectively (p = 0.03). Overall, 38 patients responded to the immunization (63.3%) and 11 patients were non-responders (36.7%) at 4 months. Difference of vitamin D level in responder (16.6 ± 9.1 ng/mL) and non-responder (12.4 ± 4.1 ng/mL) was not significant (p = 0.16). At 7 months (1 month after completion of vaccination) 61.9% were responders and 38.1% were non-responders. The vitamin D level in responders and non-responders were statistically not significant (p = 0.11). In responder, titer ≥100 mIU/mL was seen in 30% at 4 months and in 42.9% at 7 months (p = 0.05). In the good and weak responders at 7 months, vitamin D levels were 21.5 ± 10.8 and 10.1 ± 3.7 ng/mL, respectively (p = 0.37). The association of vitamin D level and anti-HBs antibody titer were not significant (r = 0.03 and 95% CI was -0.43 to 0.48, p = 0.89) in those who responded. Most patients on dialysis were vitamin D deficient. Vitamin D levels did not differ between responding and non-responding dialysis patients.
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Affiliation(s)
- Rajesh Jhorawat
- Department of Nephrology, Sawai Man Singh Medical College and Hospital, J L N Marg, Jaipur, 302 004, India.
| | - Shailendra Jain
- Department of Gastroenterology, Sawai Man Singh Medical College and Hospital, J L N Marg, Jaipur, 302 004, India
| | - Ajay Pal
- Department of Nephrology, Sawai Man Singh Medical College and Hospital, J L N Marg, Jaipur, 302 004, India
| | - Sandeep Nijhawan
- Department of Gastroenterology, Sawai Man Singh Medical College and Hospital, J L N Marg, Jaipur, 302 004, India
| | - Pankaj Beniwal
- Department of Nephrology, Sawai Man Singh Medical College and Hospital, J L N Marg, Jaipur, 302 004, India
| | - Dhananjai Agarwal
- Department of Nephrology, Sawai Man Singh Medical College and Hospital, J L N Marg, Jaipur, 302 004, India
| | - Vinay Malhotra
- Department of Nephrology, Sawai Man Singh Medical College and Hospital, J L N Marg, Jaipur, 302 004, India
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Liu WC, Zheng CM, Lu CL, Lin YF, Shyu JF, Wu CC, Lu KC. Vitamin D and immune function in chronic kidney disease. Clin Chim Acta 2015; 450:135-44. [PMID: 26291576 DOI: 10.1016/j.cca.2015.08.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/13/2015] [Accepted: 08/14/2015] [Indexed: 12/22/2022]
Abstract
The common causes of death in chronic kidney disease (CKD) patients are cardiovascular events and infectious disease. These patients are also predisposed to the development of vitamin D deficiency, which leads to an increased risk of immune dysfunction. Many extra-renal cells possess the capability to produce local active 1,25(OH)2D in an intracrine or paracrine fashion, even without kidney function. Vitamin D affects both the innate and adaptive immune systems. In innate immunity, vitamin D promotes production of cathelicidin and β-defensin 2 and enhances the capacity for autophagy via toll-like receptor activation as well as affects complement concentrations. In adaptive immunity, vitamin D suppresses the maturation of dendritic cells and weakens antigen presentation. Vitamin D also increases T helper (Th) 2 cytokine production and the efficiency of Treg lymphocytes but suppresses the secretion of Th1 and Th17 cytokines. In addition, vitamin D can decrease autoimmune disease activity. Vitamin D has been shown to play an important role in maintaining normal immune function and crosstalk between the innate and adaptive immune systems. Vitamin D deficiency may also contribute to deterioration of immune function and infectious disorders in CKD patients. However, it needs more evidence to support the requirements for vitamin D supplementation.
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Affiliation(s)
- Wen-Chih Liu
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, No.250, Wuxing Street, Taipei 110, Taiwan; Division of Nephrology, Department of Internal Medicine, Yonghe Cardinal Tien Hospital, No.80, Zhongxing St., Yonghe Dist., New Taipei City 234, Taiwan
| | - Cai-Mei Zheng
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, No.250, Wuxing Street, Taipei 110, Taiwan; Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, No.291, Zhongzheng Rd., Zhonghe Dist., New Taipei City 235, Taiwan
| | - Chien-Lin Lu
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, No.250, Wuxing Street, Taipei 110, Taiwan; Division of Nephrology, Department of Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, No.95, Wen Chang Road, Shih Lin Dist., Taipei 111, Taiwan
| | - Yuh-Feng Lin
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, No.250, Wuxing Street, Taipei 110, Taiwan; Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, No.291, Zhongzheng Rd., Zhonghe Dist., New Taipei City 235, Taiwan
| | - Jia-Fwu Shyu
- Department of Biology and Anatomy, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei 114, Taiwan
| | - Chia-Chao Wu
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Cheng-Kung Rd., Neihu Dist., Taipei 114, Taiwan.
| | - Kuo-Cheng Lu
- Department of Medicine, Cardinal Tien Hospital, School of Medicine, Fu Jen Catholic University, No.362, Chung-Cheng Rd, Hsin-Tien Dist., New Taipei City 231, Taiwan.
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Pi HC, Ren YP, Wang Q, Xu R, Dong J. Serum 25-Hydroxyvitamin D Level Could Predict the Risk for Peritoneal Dialysis-Associated Peritonitis. Perit Dial Int 2015. [PMID: 26224791 DOI: 10.3747/pdi.2014.00177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
UNLABELLED ♦ BACKGROUND As an immune system regulator, vitamin D is commonly deficient among patients on peritoneal dialysis (PD), which may contribute to their impaired immune function and increased risk for PD-related peritonitis. In this study, we aimed to investigate whether vitamin D deficiency could predict the risk of peritonitis in a prospective cohort of patients on PD. ♦ METHODS We collected 346 prevalent and incident PD patients from 2 hospitals. Baseline demographic data and clinical characteristics were recorded. Serum 25-hydroxyvitamin D (25[OH]D) was measured at baseline and prior to peritonitis. The mean doses of oral active vitamin D used during the study period were also recorded. The outcome was the occurrence of peritonitis. ♦ RESULTS The mean age of patients and duration of PD were 58.95 ± 13.67 years and 28.45 (15.04 - 53.37) months, respectively. Baseline 25(OH)D level was 16.15 (12.13 - 21.16) nmol/L, which was closely associated with diabetic status, longer PD duration, malnutrition, and inflammation. Baseline serum 25(OH)D predicted the occurrence of peritonitis independently of active vitamin D supplementation with a hazard ratio (HR) of 0.94 (95% confidence interval [CI] 0.90 - 0.98) after adjusting for recognized confounders (age, gender, dialysis duration, diabetes, albumin, residual renal function, and history of peritonitis). Compared to the low tertile, middle and high 25(OH)D level tertiles were associated with a decreased risk for peritonitis with HRs of 0.54 (95% CI 0.31 - 0.94) and 0.39 (95% CI 0.20 - 0.75), respectively. ♦ CONCLUSIONS Vitamin D deficiency evaluated by serum 25(OH)D rather than active vitamin D supplementation is closely associated with a higher risk of peritonitis.
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Affiliation(s)
- Hai-Chen Pi
- Renal Division, Department of Medicine, Institute of Nephrology, Peking University, Beijing, China
| | - Ye-Ping Ren
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Qin Wang
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Rong Xu
- Renal Division, Department of Medicine, Institute of Nephrology, Peking University, Beijing, China
| | - Jie Dong
- Renal Division, Department of Medicine, Institute of Nephrology, Peking University, Beijing, China
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31
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Lee YJ, Oh IH, Baek HJ, Lee CH, Lee SS. Effects of sun exposure and dietary vitamin D intake on serum 25-hydroxyvitamin D status in hemodialysis patients. Nutr Res Pract 2015; 9:158-64. [PMID: 25861422 PMCID: PMC4388947 DOI: 10.4162/nrp.2015.9.2.158] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 12/03/2014] [Accepted: 12/14/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND/OBJECTIVES Vitamin D deficiency is common in hemodialysis patients. The aim of this study was to identify whether or not sun exposure and dietary vitamin D intake have effects on serum 25-hydroxyvitamin D (25(OH)D) status in hemodialysis (HD) patients. The objective was to identify the main determinants of serum vitamin D status in the study subjects. SUBJECTS/METHODS A cross-sectional study of 47 HD patients (19 males and 28 females) was performed. We assessed serum 25(OH)D and 1,25(OH)2D levels between August and September 2012 and analyzed the prevalence of vitamin D deficiency in HD patients. To evaluate the determinants of serum 25(OH)D levels, we surveyed dietary vitamin D intake, degree of sun exposure, and outdoor activities. To compare biological variables, serum 25(OH)D was stratified as below 15 ng/ml or above 15 ng/ml. RESULTS Mean 25(OH)D and 1,25(OH)2D levels were 13.5 ± 5.8 ng/ml and 20.6 ± 11.8 pg/ml, respectively. The proportions of serum 25(OH)D deficiency (< 15 ng/ml), insufficiency (15-< 30 ng/ml), and sufficiency (≥ 30 ng/ml) in subjects were 72.4%, 23.4%, and 4.3%, respectively. Prevalence of vitamin D deficiency in female patients was 78.6%, whereas that in males was 63.2% (P = 0.046). Vitamin D intake and sun exposure time were not significantly different between the two stratified serum 25(OH)D levels. Dietary intake of vitamin D did not contribute to increased serum 25(OH)D levels in HD patients. The main effective factors affecting serum 25(OH)D status were found to be the sun exposure and active outdoor exercise. CONCLUSIONS Hypovitaminosis D is common in HD patients and is higher in females than in males. Sun exposure is the most important determinant of serum 25(OH)D status in HD patients.
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Affiliation(s)
- Yeon Joo Lee
- Department of Food and Nutrition, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul 133-791, Korea
| | - Il Hwan Oh
- Department of Nephrology, Hanyang University Seoul Hospital, Seoul 133-792, Korea
| | - Hee Jun Baek
- Department of Nutrition, Hanyang University Seoul Hospital, Seoul 133-792, Korea
| | - Chang Hwa Lee
- Department of Nephrology, Hanyang University Seoul Hospital, Seoul 133-792, Korea
| | - Sang Sun Lee
- Department of Food and Nutrition, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul 133-791, Korea
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Akchurin OM, Kaskel F. Update on inflammation in chronic kidney disease. Blood Purif 2015; 39:84-92. [PMID: 25662331 DOI: 10.1159/000368940] [Citation(s) in RCA: 377] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite recent advances in chronic kidney disease (CKD) and end-stage renal disease (ESRD) management, morbidity and mortality in this population remain exceptionally high. Persistent, low-grade inflammation has been recognized as an important component of CKD, playing a unique role in its pathophysiology and being accountable in part for cardiovascular and all-cause mortality, as well as contributing to the development of protein-energy wasting. SUMMARY The variety of factors contribute to chronic inflammatory status in CKD, including increased production and decreased clearance of pro-inflammatory cytokines, oxidative stress and acidosis, chronic and recurrent infections, including those related to dialysis access, altered metabolism of adipose tissue, and intestinal dysbiosis. Inflammation directly correlates with the glomerular filtration rate (GFR) in CKD and culminates in dialysis patients, where extracorporeal factors, such as impurities in dialysis water, microbiological quality of the dialysate, and bioincompatible factors in the dialysis circuit play an additional role. Genetic and epigenetic influences contributing to inflammatory activation in CKD are currently being intensively investigated. A number of interventions have been proposed to target inflammation in CKD, including lifestyle modifications, pharmacological agents, and optimization of dialysis. Importantly, some of these therapies have been recently tested in randomized controlled trials. KEY MESSAGES Chronic inflammation should be regarded as a common comorbid condition in CKD and especially in dialysis patients. A number of interventions have been proven to be safe and effective in well-designed clinical studies. This includes such inexpensive approaches as modification of physical activity and dietary supplementation. Further investigations are needed to evaluate the effects of these interventions on hard outcomes, as well as to better understand the role of inflammation in selected CKD populations (e.g., in children).
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Affiliation(s)
- Oleh M Akchurin
- Weill Cornell College of Medicine, Department of Pediatrics, New York, N.Y., USA
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Ferla S, Aboraia AS, Brancale A, Pepper CJ, Zhu J, Ochalek JT, DeLuca HF, Simons C. Small-Molecule Inhibitors of 25-Hydroxyvitamin D-24-Hydroxylase (CYP24A1): Synthesis and Biological Evaluation. J Med Chem 2014; 57:7702-15. [DOI: 10.1021/jm5009314] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Salvatore Ferla
- Medicinal
Chemistry, School of Pharmacy and Pharmaceutical Sciences, Cardiff University, King Edward VII Avenue, Cardiff CF10 3NB, U.K
| | - Ahmed S. Aboraia
- Medicinal
Chemistry, School of Pharmacy and Pharmaceutical Sciences, Cardiff University, King Edward VII Avenue, Cardiff CF10 3NB, U.K
| | - Andrea Brancale
- Medicinal
Chemistry, School of Pharmacy and Pharmaceutical Sciences, Cardiff University, King Edward VII Avenue, Cardiff CF10 3NB, U.K
| | - Christopher J. Pepper
- Department
of Haematology, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, U.K
| | - Jinge Zhu
- Department
of Biochemistry, University of Wisconsin—Madison, 433 Babcock Drive, Madison, Wisconsin 53706-1544, United States
| | - Justin T. Ochalek
- Department
of Biochemistry, University of Wisconsin—Madison, 433 Babcock Drive, Madison, Wisconsin 53706-1544, United States
| | - Hector F. DeLuca
- Department
of Biochemistry, University of Wisconsin—Madison, 433 Babcock Drive, Madison, Wisconsin 53706-1544, United States
| | - Claire Simons
- Medicinal
Chemistry, School of Pharmacy and Pharmaceutical Sciences, Cardiff University, King Edward VII Avenue, Cardiff CF10 3NB, U.K
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Jovanovich AJ, Ginde AA, Holmen J, Jablonski K, Allyn RL, Kendrick J, Chonchol M. Vitamin D level and risk of community-acquired pneumonia and sepsis. Nutrients 2014; 6:2196-205. [PMID: 24918697 PMCID: PMC4073143 DOI: 10.3390/nu6062196] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 05/14/2014] [Accepted: 05/23/2014] [Indexed: 01/14/2023] Open
Abstract
Previous research has reported reduced serum 25-hydroxyvitamin D (25(OH)D) levels is associated with acute infectious illness. The relationship between vitamin D status, measured prior to acute infectious illness, with risk of community-acquired pneumonia (CAP) and sepsis has not been examined. Community-living individuals hospitalized with CAP or sepsis were age-, sex-, race-, and season-matched with controls. ICD-9 codes identified CAP and sepsis; chest radiograph confirmed CAP. Serum 25(OH)D levels were measured up to 15 months prior to hospitalization. Regression models adjusted for diabetes, renal disease, and peripheral vascular disease evaluated the association of 25(OH)D levels with CAP or sepsis risk. A total of 132 CAP patients and controls were 60 ± 17 years, 71% female, and 86% Caucasian. The 25(OH)D levels <37 nmol/L (adjusted odds ratio (OR) 2.57, 95% CI 1.08-6.08) were strongly associated with increased odds of CAP hospitalization. A total of 422 sepsis patients and controls were 65 ± 14 years, 59% female, and 91% Caucasian. The 25(OH)D levels <37 nmol/L (adjusted OR 1.75, 95% CI 1.11-2.77) were associated with increased odds of sepsis hospitalization. Vitamin D status was inversely associated with risk of CAP and sepsis hospitalization in a community-living adult population. Further clinical trials are needed to evaluate whether vitamin D supplementation can reduce risk of infections, including CAP and sepsis.
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Affiliation(s)
- Anna J Jovanovich
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Denver, CO 80045 USA.
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado Denver, Denver, CO 80045 USA.
| | - John Holmen
- Intermountain Healthcare, Salt Lake City, UT 84157, USA.
| | - Kristen Jablonski
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Denver, CO 80045 USA.
| | | | - Jessica Kendrick
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Denver, CO 80045 USA.
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Denver, CO 80045 USA.
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Finamor DC, Sinigaglia-Coimbra R, Neves LCM, Gutierrez M, Silva JJ, Torres LD, Surano F, Neto DJ, Novo NF, Juliano Y, Lopes AC, Coimbra CG. A pilot study assessing the effect of prolonged administration of high daily doses of vitamin D on the clinical course of vitiligo and psoriasis. DERMATO-ENDOCRINOLOGY 2014; 5:222-34. [PMID: 24494059 PMCID: PMC3897595 DOI: 10.4161/derm.24808] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/10/2013] [Accepted: 04/25/2013] [Indexed: 12/14/2022]
Abstract
Autoimmunity has been associated with vitamin D deficiency and resistance, with gene polymorphisms related to vitamin D metabolism frequently described in affected patients. High doses of vitamin D3 may conceivably compensate for inherited resistance to its biological effects. This study aimed to assess the efficacy and safety of prolonged high-dose vitamin D3 treatment of patients with psoriasis and vitiligo. Nine patients with psoriasis and 16 patients with vitiligo received vitamin D3 35,000 IU once daily for six months in association with a low-calcium diet (avoiding dairy products and calcium-enriched foods like oat, rice or soya “milk”) and hydration (minimum 2.5 L daily). All psoriasis patients were scored according to “Psoriasis Area and Severity Index” (PASI) at baseline and after treatment. Evaluation of clinical response of vitiligo patients required a quartile grading scale. All patients presented low vitamin D status (serum 25(OH)D3 ≤ 30 ng/mL) at baseline. After treatment 25(OH)D3 levels significantly increased (from 14.9 ± 7.4 to 106.3 ± 31.9 ng/mL and from 18.4 ± 8.9 to 132.5 ± 37.0 ng/mL) and PTH levels significantly decreased (from 57.8 ± 16.7 to 28.9 ± 8.2 pg/mL and from 55.3 ± 25.0 to 25.4 ± 10.7 pg/mL) in patients with psoriasis and vitiligo respectively. PTH and 25(OH)D3 serum concentrations correlated inversely. The PASI score significantly improved in all nine patients with psoriasis. Fourteen of 16 patients with vitiligo had 25–75% repigmentation. Serum urea, creatinine and calcium (total and ionized) did not change and urinary calcium excretion increased within the normal range. High-dose vitamin D3 therapy may be effective and safe for vitiligo and psoriasis patients.
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Affiliation(s)
- Danilo C Finamor
- Laboratório de Fisiopatologia Clínica e Experimental; Universidade Federal de São Paulo; São Paulo, Brazil
| | - Rita Sinigaglia-Coimbra
- Laboratório de Fisiopatologia Clínica e Experimental; Universidade Federal de São Paulo; São Paulo, Brazil
| | - Luiz C M Neves
- Instituto de Ciências da Saúde; Universidade Paulista; São Paulo, Brazil
| | | | - Jeferson J Silva
- Laboratório de Fisiopatologia Clínica e Experimental; Universidade Federal de São Paulo; São Paulo, Brazil
| | - Lucas D Torres
- Laboratório de Fisiopatologia Clínica e Experimental; Universidade Federal de São Paulo; São Paulo, Brazil
| | - Fernanda Surano
- Laboratório de Fisiopatologia Clínica e Experimental; Universidade Federal de São Paulo; São Paulo, Brazil
| | | | - Neil F Novo
- Disciplina de Cirurgia Plástica; Universidade Federal de São Paulo; São Paulo, Brazil
| | - Yara Juliano
- Disciplina de Cirurgia Plástica; Universidade Federal de São Paulo; São Paulo, Brazil
| | - Antonio C Lopes
- Disciplina de Clínica Médica; Universidade Federal de São Paulo; São Paulo, Brazil
| | - Cicero Galli Coimbra
- Laboratório de Fisiopatologia Clínica e Experimental; Universidade Federal de São Paulo; São Paulo, Brazil
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Vitamin D and the Immune System from the Nephrologist's Viewpoint. ISRN ENDOCRINOLOGY 2014; 2014:105456. [PMID: 24587915 PMCID: PMC3920624 DOI: 10.1155/2014/105456] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 12/04/2013] [Indexed: 02/07/2023]
Abstract
Vitamin D and its analogues are widely used as treatments by clinical nephrologists, especially when treating chronic kidney disease (CKD) patients with secondary hyperparathyroidism. As CKD progresses, the ability to compensate for elevations in parathyroid hormone (PTH) and fibroblast growth factor-23 and for decreases in 1,25(OH)2D3 becomes inadequate, which results in hyperphosphatemia, abnormal bone disorders, and extra-skeletal calcification. In addition to its calciotropic effect on the regulation of calcium, phosphate, and parathyroid hormone, vitamin D has many other noncalciotropic effects, including controlling cell differentiation/proliferation and having immunomodulatory effects. There are several immune dysregulations that can be noted when renal function declines. Physicians need to know well both the classical and nonclassical functions of vitamin D. This review is an analysis from the nephrologist's viewpoint and focuses on the relationship between the vitamin D and the immune system, together with vitamin's clinical use to treat kidney diseases.
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Correlation of interleukin-17-producing effector memory T cells and CD4+CD25+Foxp3 regulatory T cells with the phosphate levels in chronic hemodialysis patients. ScientificWorldJournal 2014; 2014:593170. [PMID: 24558316 PMCID: PMC3914580 DOI: 10.1155/2014/593170] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 10/27/2013] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives. Hyperparathyroidism and hyperphosphatemia contribute to the inflammatory effects in chronic hemodialysis (HD) patients. Interleukin-17-producing CD4+ effector memory T (Th17) cells and CD4+CD25+Foxp3 regulatory T (Treg) cells both play critical roles in immune activation and inflammation. We investigated the relationship between the Treg and Th17 cells and the phosphate level in chronic HD patients. Methods. 105 patients aged ≥35 years on chronic HD over 3 months were enrolled. The peripheral blood mononuclear cells were collected, cultured, and stimulated by phytohemagglutinin-L, phorbol myristate acetate, and ionomycin at different time points for T cell differentiation. Results. The T cell differentiation was as follows: Th17 cells (mean ± standard deviation (SD): 25.61% ± 10.2%) and Treg cells (8.45% ± 4.3%). The Th17 cell differentiation was positively correlated with the phosphate and albumin levels and negatively correlated with age. The Treg cell differentiation was negatively correlated with albumin level and age. In the nondiabetes group (n = 53), the Th17 cell differentiation was predominantly correlated with the phosphate and iPTH (intact parathyroid hormone) levels as well as the dialysis vintage. Conclusion. Higher phosphate and iPTH levels and longer dialysis duration may increase Th17 cell differentiation, especially in the nondiabetic chronic HD patients.
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Serum 25-hydroxyvitamin D predicts the short-term outcomes of Chinese patients with acute ischaemic stroke. Clin Sci (Lond) 2014; 126:339-46. [PMID: 24020395 DOI: 10.1042/cs20130284] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Low vitamin D levels have been reported to contribute to the risk of cardiovascular events and mortality, especially stroke. In the present study we therefore evaluated the short-term prognostic value of serum 25(OH)D (25-hydroxyvitamin D) in Chinese patients with AIS (acute ischaemic stroke). From February 2010 to September 2012, consecutive stroke patients admitted to the emergency department at two hospitals in Beijing, China were identified. Clinical information was collected, and the serum concentration of 25(OH)D and NIHSS (National Institutes of Health Stroke Scale) were measured at the time of admission. Short-term functional outcome was measured using a modified Rankin Scale (mRS) at 90 days after admission. Multivariate analyses were performed using logistic regression models. During the inclusion period, 231 patients were diagnosed as having AIS, and 220 completed follow-up. The median serum 25(OH)D level was significantly lower in patients with AIS compared with normal controls [14.2 (10.2-18.9) ng/ml compared with 17.9 (12.5-22.9) ng/ml; P<0.001; values are medians (interquartile range)]. 25(OH)D was an independent prognostic marker of short-term functional outcome and death {0.79 (0.73-0.85) and 0.70 (0.50-0.98) respectively [values are odds rations (95% confidence intervals)]; P<0.01 for both, adjusted for NHISS, other predictors and vascular risk factors} in patients with AIS. In ROC (receiver operating characteristic) curve analysis, the prognostic accuracy of 25(OH)D was higher compared with all of the other serum predictors and was in the range of NIHSS score. In conclusion, these findings suggest that 25(OH)D is an independent prognostic marker for death and functional outcome within 90 days in Chinese patients with AIS even after adjusting for possible confounding factors.
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Foster TL, Ferrantelli E, van Wier-van der Schaaf T, Beelen RHJ. European Training and Research in Peritoneal Dialysis: scientific objectives, training, implementation and impact of the programme. J Ren Care 2013; 40:34-9. [PMID: 24325343 DOI: 10.1002/jorc.12041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) offers many advantages over hospital-based haemodialysis, including better quality of life. Despite this, there is a general under-utilisation of PD in Europe, which, to some extent, can be attributed to a lack of knowledge and education amongst renal clinicians and nurses. OBJECTIVES The specific aim of the European Training and Research in Peritoneal Dialysis (EuTRiPD) programme is to address this lack of knowledge, to develop a minimum of five biomarkers that allow the prediction of outcome in PD and three therapeutic treatments to improve outcome in PD. APPROACH EuTRiPD is a EU-wide consortium with clinical, academic and commercial partners set up to address this knowledge gap. By training through research and close collaboration between academic and commercial entities we hope to improve the outcome and uptake of PD. It is the goal of EuTRiPD to improve the currently hampered diagnostic therapeutic developments in renal replacement therapy (RRT) and structure existing high-quality PD-related research across Europe. CONCLUSION It is hoped that EuTRiPD can and will have a significant impact on socio-economic and scientific aspects of PD. It is the aim for EuTRiPD to boost the uptake of PD throughout Europe by making PD the obvious choice for patients.
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Affiliation(s)
- Tom L Foster
- Department of Molecular Cell Biology and Immunology, VU University Medical Center (VUMC), Amsterdam, The Netherlands
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Skov Dalgaard L, Fassel U, Østergaard LJ, Jespersen B, Schmeltz Søgaard O, Jensen-Fangel S. Risk of human papillomavirus-related cancers among kidney transplant recipients and patients receiving chronic dialysis--an observational cohort study. BMC Nephrol 2013; 14:137. [PMID: 23834996 PMCID: PMC3710213 DOI: 10.1186/1471-2369-14-137] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 07/01/2013] [Indexed: 12/16/2022] Open
Abstract
Background Individuals with end-stage renal disease (ESRD) have excess risk of various cancer types. However, the total burden of human papillomavirus-related cancers remains unknown. Methods We performed a nationwide observational cohort study during 1994–2010. For each person with ESRD, we sampled 19 population controls (without ESRD) matched on age, gender and municipality. Participants were followed until first diagnosis of human papillomavirus-related cancer, death, emigration, or 31 December 2010, whichever came first. Human papillomavirus-related cancers were extracted from Danish medical administrative databases. We considered cancers of the cervix, vulva, vagina, penis, anus, and subsets of head and neck cancers as human papillomavirus-related. We calculated incidence rates of human papillomavirus-related cancer and used Poisson regression to identify risk factors for human papillomavirus-related cancer. Results Among 12,293 persons with ESRD and 229,524 population controls we identified 62 and 798 human papillomavirus-related cancers, respectively. Incidence rates of human papillomavirus-related- cancer were 102 per 100,000 person-years (95% confidence interval [CI]; 79.5-131) among persons with ESRD and 40.8 per 100,000 person-years (95% CI; 38.1-43.7) among population controls. ESRD patients had 4.54 (95% CI, 2.48-8.31) fold increased risk of anal cancer and 5.81 fold (95% CI; 3.36-10.1) increased risk of vulvovaginal cancer. Adjusted for age, comorbidity, and sex, ESRD patients had 2.41 (95% CI; 1.83-3.16) fold increased risk of any human papillomavirus-related cancer compared with population controls. Compared with dialysis patients renal transplant recipients had an age-adjusted non-significant 1.53 (95% CI, 0.91-2.58) fold higher risk of human papillomavirus-related cancer. Conclusions Persons with ESRD have excess risk of potentially vaccine-preventable human papillomavirus-related cancers.
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Affiliation(s)
- Lars Skov Dalgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
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Effects of high-dose cholecalciferol on serum markers of inflammation and immunity in patients with early chronic kidney disease. Eur J Clin Nutr 2013; 67:264-9. [PMID: 23361158 DOI: 10.1038/ejcn.2012.217] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES Vitamin D has anti-inflammatory and immune-regulating properties. We aimed to determine if high-dose cholecalciferol supplementation for 1 year in subjects with early chronic kidney disease (CKD) improved circulating markers of inflammation and immunity. SUBJECTS/METHODS In this double-blind, randomized, placebo-controlled trial, 46 subjects with early CKD (stages 2 and 3) were supplemented with oral cholecalciferol (50 000 IU weekly for 12 weeks followed by 50 000 IU every other week for 40 weeks) or a matching placebo for 1 year. Serum tumor necrosis factor-α, interleukin-6, monocyte chemoattractant protein-1 (MCP-1), interferon gamma-induced protein-10 and neutrophil gelatinase-associated lipocalin were measured at baseline, 12 weeks and 1 year. Serum cathelicidin (LL-37) was measured at baseline and 12 weeks. An in vitro experiment was performed to investigate the effect of 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) treatment on MCP-1 secretion in THP-1 monocytes activated with lipopolysaccharide (LPS) and Pseudomonas aeruginosa. RESULTS By 12 weeks, serum MCP-1 decreased in the cholecalciferol group (66.2±2.5 to 60.8±2.6 pg/ml, group-by-time interaction P=0.02) but was not different from baseline at 1 year. Other markers of inflammation and immunity did not change. In vitro, LPS- and Pseudomonas-activated monocytes treated with 1,25(OH)2D3 had significantly less MCP-1 secretion compared with untreated cells. CONCLUSIONS High-dose cholecalciferol decreased serum MCP-1 concentrations by 12 weeks in patients with early CKD, although the decrease was not maintained for the remainder of the year. In vitro results confirm an MCP-1-lowering effect of vitamin D. Future studies should determine if vitamin D-mediated reductions in MCP-1 concentrations reflect improved clinical outcomes.
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Low 25-hydroxyvitamin D: a significant risk factor for acute kidney injury in critically ill patients. Crit Care Med 2013; 40:3314-5. [PMID: 23164775 DOI: 10.1097/ccm.0b013e3182632b2c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Role of vitamin D in insulin resistance. J Biomed Biotechnol 2012; 2012:634195. [PMID: 22988423 PMCID: PMC3440067 DOI: 10.1155/2012/634195] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 08/17/2012] [Accepted: 08/27/2012] [Indexed: 12/31/2022] Open
Abstract
Vitamin D is characterized as a regulator of homeostasis of bone and mineral metabolism, but it can also provide nonskeletal actions because vitamin D receptors have been found in various tissues including the brain, prostate, breast, colon, pancreas, and immune cells. Bone metabolism, modulation of the immune response, and regulation of cell proliferation and differentiation are all biological functions of vitamin D. Vitamin D may play an important role in modifying the risk of cardiometabolic outcomes, including diabetes mellitus (DM), hypertension, and cardiovascular disease. The incidence of type 2 DM is increasing worldwide and results from a lack of insulin or inadequate insulin secretion following increases in insulin resistance. Therefore, it has been proposed that vitamin D deficiency plays an important role in insulin resistance resulting in diabetes. The potential role of vitamin D deficiency in insulin resistance has been proposed to be associated with inherited gene polymorphisms including vitamin D-binding protein, vitamin D receptor, and vitamin D 1alpha-hydroxylase gene. Other roles have been proposed to involve immunoregulatory function by activating innate and adaptive immunity and cytokine release, activating inflammation by upregulation of nuclear factor κB and inducing tumor necrosis factor α, and other molecular actions to maintain glucose homeostasis and mediate insulin sensitivity by a low calcium status, obesity, or by elevating serum levels of parathyroid hormone. These effects of vitamin D deficiency, either acting in concert or alone, all serve to increase insulin resistance. Although there is evidence to support a relationship between vitamin D status and insulin resistance, the underlying mechanism requires further exploration. The purpose of this paper was to review the current information available concerning the role of vitamin D in insulin resistance.
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