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Mushtaq M, Usmani MR, Hameed N, Anwar A, Hashmi AA. Serum Vitamin B12 Deficiency in Chronic Hemodialysis Patients. Cureus 2024; 16:e58751. [PMID: 38779272 PMCID: PMC11110947 DOI: 10.7759/cureus.58751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Essential vitamins like folate and vitamin B12 are crucial for many physiological functions. Patients with renal failure undergoing regular hemodialysis in the general population may experience harmful effects from vitamin B12 deficits. Therefore, this study aimed to determine the frequency of vitamin B12 deficiency in hemodialysis patients and its association with other clinical parameters. Methods This cross-sectional study was conducted at the dialysis unit of Patel Hospital and Lifeline Hospital, Karachi, using a non-probability consecutive sampling technique after obtaining ethical approval from Lifeline Hospital (LLH/HR/02-22). The study duration was six months, from January 10, 2023, to July 22, 2023. A total of 135 adult renal failure patients with ages >18 and <70 years on maintenance hemodialysis for >1 year were included in the study. The chi-square test was used to determine the association between vitamin B12 deficiency and age and gender. A p-value of 0.05 was considered statistically significant. Results The study findings showed that out of 135 patients, 82 (60.7%) were males and 53 (39.3%) were females, with a mean age of 50.80 ± 10.03 years. The duration of hemodialysis was approximately 1-2 years in 98 (72.6%) patients, 2-3 years in 27 (20.0%) patients, and 3-4 years in only 9 (6.7%) patients. The mean serum vitamin B-12 levels were 411.61 ± 224.95 pg/ml, with 30 (22.2%) of the subjects being deficient. In terms of duration of hemodialysis, there was a significant association (p= 0.013). Between patients with normal 4 (4%) and deficient 5 (17%) vitamin B12 and 3-4 years of hemodialysis. Conclusion In this study, we found that a significant proportion of patients on chronic hemodialysis had vitamin B12 deficiency. Moreover, vitamin B12 deficiency was significantly associated with duration of hemodialysis. Therefore, we recommend periodic vitamin B12 testing in hemodialysis patients to avoid any associated complications.
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Affiliation(s)
- Mehdi Mushtaq
- Nephrology, Patel Hospital, Karachi, PAK
- Nephrology, Lifeline Hospital, Karachi, PAK
| | | | | | - Adnan Anwar
- Physiology, Hamdard College of Medicine & Dentistry, Karachi, PAK
- Internal Medicine, Essa General Hospital, Karachi, PAK
| | - Atif A Hashmi
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
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Sugai K, Hirano M, Oda A, Fujisawa M, Shono S, Ishioka K, Tamura T, Katsumata Y, Sano M, Kobayashi E, Hakamata Y. Establishment and application of a new 4/6 infarct nephrectomy rat model for moderate chronic kidney disease. Acta Cir Bras 2024; 39:e391324. [PMID: 38477787 DOI: 10.1590/acb391324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/15/2023] [Indexed: 03/14/2024] Open
Abstract
PURPOSE To develop a new 4/6 infarct nephrectomy (INx) model rat mimicking moderate chronic kidney disease (CKD) and to evaluate its application. METHODS We modified the conventional 5/6 INx rat model to create the 4/6 INx model by ligating the renal artery branch to induce infarction of one-third of the left kidney after right kidney removal and compared biochemically and histologically both models. To demonstrate the application of the 4/6 INx model, the effects of a supplementary compound containing calcium carbonate, chitosan, palm shell activated charcoal etc., that is effective for both CKD and its complications, were compared between both models. RESULTS Impairment of renal function in the 4/6 INx group was significantly more moderate than in the 5/6 INx group (P < 0.05). The 4/6 INx group showed less histological damage in kidney than in the 5/6 INx group. The supplementary compound did not improve CKD in the 5/6 INx group, but ameliorated elevation of blood urea nitrogen in the 4/6 INx group. CONCLUSIONS We developed the 4/6 INx model, which is more moderate than the conventional 5/6 INx model. This model could potentially demonstrate the effectiveness of drugs and supplements intended to prevent CKD and its progression.
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Affiliation(s)
- Kazuhisa Sugai
- Nippon Veterinary and Life Science University - School of Veterinary Nursing and Technology - Department of Basic Science - Tokyo, Japan
| | - Momoko Hirano
- Nippon Veterinary and Life Science University - School of Veterinary Nursing and Technology - Department of Basic Science - Tokyo, Japan
| | - Asahi Oda
- Nippon Veterinary and Life Science University - School of Veterinary Nursing and Technology - Department of Basic Science - Tokyo, Japan
| | - Masahiko Fujisawa
- Nippon Veterinary and Life Science University - School of Veterinary Nursing and Technology - Department of Basic Science - Tokyo, Japan
| | - Saori Shono
- Nippon Veterinary and Life Science University - School of Veterinary Nursing and Technology - Department of Applied Science - Tokyo, Japan
| | - Katsumi Ishioka
- Nippon Veterinary and Life Science University - School of Veterinary Nursing and Technology - Department of Veterinary Nursing - Tokyo, Japan
| | - Tomoyoshi Tamura
- Keio University - School of Medicine - Department of Emergency and Critical Care Medicine - Tokyo, Japan
| | - Yoshinori Katsumata
- Keio University - School of Medicine - Department of Cardiology - Tokyo, Japan
- Keio University - School of Medicine - Institute for Integrated Sports Medicine - Tokyo, Japan
| | - Motoaki Sano
- Keio University - School of Medicine - Department of Cardiology - Tokyo, Japan
| | - Eiji Kobayashi
- Nippon Veterinary and Life Science University - School of Veterinary Nursing and Technology - Department of Basic Science - Tokyo, Japan
- Keio University - School of Medicine - Department of Cardiology - Tokyo, Japan
- Jikei University - School of Medicine - Department of Kidney Regenerative Medicine - Tokyo, Japan
| | - Yoji Hakamata
- Nippon Veterinary and Life Science University - School of Veterinary Nursing and Technology - Department of Basic Science - Tokyo, Japan
- Nippon Veterinary and Life Science University - Research Center for Animal Life Science - Tokyo, Japan
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Wang AYM, Elsurer Afsar R, Sussman-Dabach EJ, White JA, MacLaughlin H, Ikizler TA. Vitamin Supplement Use in Patients With CKD: Worth the Pill Burden? Am J Kidney Dis 2024; 83:370-385. [PMID: 37879527 DOI: 10.1053/j.ajkd.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 10/27/2023]
Abstract
All vitamins play essential roles in various aspects of body function and systems. Patients with chronic kidney disease (CKD), including those receiving dialysis, may be at increased risk of developing vitamin deficiencies due to anorexia, poor dietary intake, protein energy wasting, restricted diet, dialysis loss, or inadequate sun exposure for vitamin D. However, clinical manifestations of most vitamin deficiencies are usually subtle or undetected in this population. Testing for circulating levels is not undertaken for most vitamins except folate, B12, and 25-hydroxyvitamin D because assays may not be available or may be costly to perform and do not always correlate with body stores. The last systematic review through 2016 was performed for the Kidney Disease Outcome Quality Initiative (KDOQI) 2020 Nutrition Guideline update, so this article summarizes the more recent evidence. We review the use of vitamins supplementation in the CKD population. To date there have been no randomized trials to support the benefits of any vitamin supplementation for kidney, cardiovascular, or patient-centered outcomes. The decision to supplement water-soluble vitamins should be individualized, taking account the patient's dietary intake, nutritional status, risk of vitamins deficiency/insufficiency, CKD stage, comorbid status, and dialysis loss. Nutritional vitamin D deficiency should be corrected, but the supplementation dose and formulation need to be personalized, taking into consideration the degree of 25-hydroxyvitamin D deficiency, parathyroid hormone levels, CKD stage, and local formulation. Routine supplementation of vitamins A and E is not supported due to potential toxicity. Although more trial data are required to elucidate the roles of vitamin supplementation, all patients with CKD should undergo periodic assessment of dietary intake and aim to receive various vitamins through natural food sources and a healthy eating pattern that includes vitamin-dense foods.
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Affiliation(s)
- Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, People's Republic of China.
| | - Rengin Elsurer Afsar
- Department of Nephrology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey; Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Jennifer A White
- California State University at Northridge, Northridge, California
| | - Helen MacLaughlin
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - T Alp Ikizler
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt O'Brien Kidney Center, Nashville, Tennessee; Tennessee Valley Healthcare System, Nashville VA Medical Center, Nashville, Tennessee
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Huo YM, Zhang SQ, Wu GP, Shan HB, Pan C. A robust method for simultaneous determination of eight B vitamins in human serum by liquid chromatography tandem mass spectrometry. J Sep Sci 2024; 47:e2300576. [PMID: 38117985 DOI: 10.1002/jssc.202300576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/22/2023]
Abstract
The level of vitamin B group in human serum is an important index of human health. Among B vitamins, cyanocobalamin in serum is unstable and its content is extremely low. Rapid and simultaneous detection of multiple B vitamins including cyanocobalamin is a challenge. Herein, we have developed a rapid and stable method that can realize the determination of thiamine, riboflavin, nicotinamide, pantothenic acid, pyridoxic acid, biotin, 5-methyltetrahydrofolate, and cyanocobalamin simultaneously in 6 min. The method was established based on protein precipitation with methanol and then chromatographic separation was achieved using Waters acquity ultra-high-performance liquid chromatography high strength silica T3 column, which was stable and sensitive especially for cyanocobalamin. Limit of quantification, precision, trueness, and matrix effect were validated according to the European Medicines Agency and United States Food and Drug guidelines and Clinical and Laboratory Standards Institute guidelines on bioanalytical method. The limit of quantification for thiamine, riboflavin, nicotinamide, pantothenic acid, pyridoxic acid, biotin, 5-methyltetrahydrofolate, and cyanocobalamin was 0.4, 0.4, 0.8, 2.0, 0.4, 0.1, 0.4, and 0.04 ng/mL separately, respectively. Intra- and interday precisions were 1.1%-12.4% and 2.0%-13.5%, respectively. The relative errors were between 0.3% and 13.3%, and the matrix effects were between 2.6% and 10.4%.
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Affiliation(s)
- Yu-Mei Huo
- Hangzhou Adicon Clinical Laboratories Co., Ltd, Hangzhou, P. R. China
| | - Shang-Qing Zhang
- Department of Chemistry, College of Sciences, Northeastern University, Shenyang, P. R. China
| | - Gao-Ping Wu
- Hangzhou Adicon Clinical Laboratories Co., Ltd, Hangzhou, P. R. China
| | - Hong-Bo Shan
- Hangzhou Adicon Clinical Laboratories Co., Ltd, Hangzhou, P. R. China
| | - Chao Pan
- Hangzhou Adicon Clinical Laboratories Co., Ltd, Hangzhou, P. R. China
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Wang Y, Gan LY, Yang B, Guan HJ, Zuo L. High-flux Hemodialysis Does Not Increase Vitamin B Loss Compared With Low-flux Hemodialysis. J Ren Nutr 2023; 33:676-681. [PMID: 37302722 DOI: 10.1053/j.jrn.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/25/2023] [Accepted: 06/04/2023] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVES A consistent effect of hemodialysis (HD) on vitamin B loss has not been fully demonstrated and the effect of high-flux hemodialysis (HFHD) is also inconclusive. The aim of this study was to identify the loss of vitamin B1, B3, B5, and B6 in a single HD session and to evaluate the effect of HFHD on vitamin B removal. METHODS Patients on maintenance HD were enrolled in this study. They were divided into low-flux hemodialysis (LFHD) group and HFHD group. Vitamin B1, B3, B5, and B6 (pyridoxal 5'-phosphate [PLP]) concentrations in blood pre- and post-HD sessions, as well as in the spent dialysate were measured. Loss of vitamin B was calculated and the difference in vitamin B loss between the 2 groups was compared. The association between HFHD and vitamin B loss was estimated using multivariable linear regression analysis. RESULTS Seventy-six patients were included, of whom 29 were on LFHD and 47 were on HFHD. The median reduction ratio of serum vitamins B1, B3, B5, and B6 after a single HD session was 38.1%, 24.9%, 48.4%, and 44.7%, respectively. The median concentration of vitamins B1, B3, B5, and B6 in the dialysate was 0.3 μg/L, 2.9 μg/mL, 2.0 μg/L, and 0.4 ng/mL. There was no difference in either the reduction ratio of vitamin B in blood, or the concentration in dialysate between LFHD and HFHD groups. After adjusting for covariates by multivariable regression, HFHD had no effect on vitamin B1, B3, B5, or B6 removal. CONCLUSIONS Vitamins B1, B3, B5, and B6 can be removed by HD and HFHD does not increase the loss.
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Affiliation(s)
- Yan Wang
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Liang-Ying Gan
- Department of Nephrology, Peking University People's Hospital, Beijing, China.
| | - Bing Yang
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Hong-Jie Guan
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
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Ghannoum M, Gosselin S, Hoffman RS, Lavergne V, Mégarbane B, Hassanian-Moghaddam H, Rif M, Kallab S, Bird S, Wood DM, Roberts DM, Anseeuw K, Berling I, Bouchard J, Bunchman TE, Calello DP, Chin PK, Doi K, Galvao T, Goldfarb DS, Hoegberg LCG, Kebede S, Kielstein JT, Lewington A, Li Y, Macedo EM, MacLaren R, Mowry JB, Nolin TD, Ostermann M, Peng A, Roy JP, Shepherd G, Vijayan A, Walsh SJ, Wong A, Yates C. Extracorporeal treatment for ethylene glycol poisoning: systematic review and recommendations from the EXTRIP workgroup. Crit Care 2023; 27:56. [PMID: 36765419 PMCID: PMC9921105 DOI: 10.1186/s13054-022-04227-2] [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: 08/11/2022] [Accepted: 10/18/2022] [Indexed: 02/12/2023] Open
Abstract
Ethylene glycol (EG) is metabolized into glycolate and oxalate and may cause metabolic acidemia, neurotoxicity, acute kidney injury (AKI), and death. Historically, treatment of EG toxicity included supportive care, correction of acid-base disturbances and antidotes (ethanol or fomepizole), and extracorporeal treatments (ECTRs), such as hemodialysis. With the wider availability of fomepizole, the indications for ECTRs in EG poisoning are debated. We conducted systematic reviews of the literature following published EXTRIP methods to determine the utility of ECTRs in the management of EG toxicity. The quality of the evidence and the strength of recommendations, either strong ("we recommend") or weak/conditional ("we suggest"), were graded according to the GRADE approach. A total of 226 articles met inclusion criteria. EG was assessed as dialyzable by intermittent hemodialysis (level of evidence = B) as was glycolate (Level of evidence = C). Clinical data were available for analysis on 446 patients, in whom overall mortality was 18.7%. In the subgroup of patients with a glycolate concentration ≤ 12 mmol/L (or anion gap ≤ 28 mmol/L), mortality was 3.6%; in this subgroup, outcomes in patients receiving ECTR were not better than in those who did not receive ECTR. The EXTRIP workgroup made the following recommendations for the use of ECTR in addition to supportive care over supportive care alone in the management of EG poisoning (very low quality of evidence for all recommendations): i) Suggest ECTR if fomepizole is used and EG concentration > 50 mmol/L OR osmol gap > 50; or ii) Recommend ECTR if ethanol is used and EG concentration > 50 mmol/L OR osmol gap > 50; or iii) Recommend ECTR if glycolate concentration is > 12 mmol/L or anion gap > 27 mmol/L; or iv) Suggest ECTR if glycolate concentration 8-12 mmol/L or anion gap 23-27 mmol/L; or v) Recommend ECTR if there are severe clinical features (coma, seizures, or AKI). In most settings, the workgroup recommends using intermittent hemodialysis over other ECTRs. If intermittent hemodialysis is not available, CKRT is recommended over other types of ECTR. Cessation of ECTR is recommended once the anion gap is < 18 mmol/L or suggested if EG concentration is < 4 mmol/L. The dosage of antidotes (fomepizole or ethanol) needs to be adjusted during ECTR.
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Affiliation(s)
- Marc Ghannoum
- grid.14848.310000 0001 2292 3357Research Center, CIUSSS du Nord-de-l’île-de-Montréal, University of Montreal, Montreal, QC Canada ,grid.137628.90000 0004 1936 8753Nephrology Division, NYU Langone Health, NYU Grossman School of Medicine, New York, NY USA ,grid.5477.10000000120346234Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sophie Gosselin
- grid.420748.d0000 0000 8994 4657Centre Intégré de Santé et de Services Sociaux (CISSS) de la Montérégie-Centre Emergency Department, Hôpital Charles-Lemoyne, Greenfield Park, QC Canada ,grid.86715.3d0000 0000 9064 6198Faculté de Médecine et Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada ,Centre Antipoison du Québec, Quebec, QC Canada
| | - Robert S. Hoffman
- grid.137628.90000 0004 1936 8753Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY USA
| | - Valery Lavergne
- grid.14848.310000 0001 2292 3357Research Center, CIUSSS du Nord-de-l’île-de-Montréal, University of Montreal, Montreal, QC Canada
| | - Bruno Mégarbane
- grid.411296.90000 0000 9725 279XDepartment of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris Cité University, Paris, France
| | - Hossein Hassanian-Moghaddam
- grid.411600.2Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,grid.411600.2Department of Clinical Toxicology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Siba Kallab
- grid.411323.60000 0001 2324 5973Department of Internal Medicine-Division of Nephrology, Lebanese American University - School of Medicine, Byblos, Lebanon
| | - Steven Bird
- Department of Emergency Medicine, U Mass Memorial Health, U Mass Chan Medical School, Worcester, MA USA
| | - David M. Wood
- grid.13097.3c0000 0001 2322 6764Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, and Clinical Toxicology, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Darren M. Roberts
- grid.430417.50000 0004 0640 6474New South Wales Poisons Information Centre, Sydney Children’s Hospitals Network, Westmead, NSW Australia ,grid.413249.90000 0004 0385 0051Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW Australia
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Water-Soluble Vitamins Status in Patients Undergoing Maintenance Hemodialysis. Nutrients 2023; 15:nu15020440. [PMID: 36678310 PMCID: PMC9862031 DOI: 10.3390/nu15020440] [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: 12/19/2022] [Revised: 01/08/2023] [Accepted: 01/12/2023] [Indexed: 01/17/2023] Open
Abstract
The concentration of water-soluble vitamins (except folic acid and vitamin B12) is not routinely measured, which may lead to undiagnosed deficiencies among hemodialysis (HD) patients. The aim of the study was to assess the blood concentration of water-soluble vitamins in HD patients in comparison with healthy subjects and to assess the impact of diabetes mellitus (DM) coexistence on the concentration of these vitamins. The two-center study included 142 HD patients and a control group of 31 healthy subjects. Vitamins concentration was determined using high-performance liquid chromatography (HPLC). Vitamin B1, B6, and B12 levels were significantly lower in the HD group than in the control group (p < 0.001). Vitamin B1 and B2 were negatively correlated with blood urea nitrogen (BUN) levels before HD (R = −0.39, R = −0.38; p < 0.05). Vitamin B3, B12, and C were positively correlated with the albumin concentration (R = 0.26, R = 0.27, R = 0.28; p < 0.05). Among diabetic patients, only the concentration of vitamin B1 was lower than among non-diabetic patients. The concentration of water-soluble vitamins may be related to the adequacy of dialysis, the time of laboratory determination since the last dialysis, diet, coexistence of other diseases, use of drugs, and dietary supplements in individual patients.
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Supplementation with Folic Acid and Cardiovascular Outcomes in End-Stage Kidney Disease: A Multi-Institution Cohort Study. Nutrients 2022; 14:nu14194162. [PMID: 36235814 PMCID: PMC9570520 DOI: 10.3390/nu14194162] [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: 09/21/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Folate is a water-soluble vitamin and is essential for maintaining cell functions. Dialysis removes folate, and folate deficiency is reported in patients with end-stage kidney disease (ESKD). However, there is no consensus as to the appropriate dosage of folate supplements and their advantages and disadvantages for patients with ESKD. METHODS This study was based on the electronic medical records of the Chang Gung Research Database (CGRD) of the Chang Gung Medical Foundation. We included patients who were diagnosed with ESKD, initiated hemodialysis, and were given folic acid supplements at any point from 1 January 2001 to 31 December 2019. The patients were divided into weekly and daily folic acid supplementation groups. We reduced the effects of confounding through the inverse probability of treatment weighting based on the propensity score. RESULTS We identified 2081 and 954 newly diagnosed patients with ESKD, who received daily and weekly folic acid supplements. The mean follow-up time was 5.8 years, and the event rates of arteriovenous access thrombosis were 17.0% and 23.6% in the daily and weekly folic acid supplementation groups (sub-distribution hazard ratio = 0.69, 95% confidence interval = 0.61 to 0.77), respectively. Neither group significantly differed in the occurrence of other clinical events, such as major cardiovascular cardiac events (e.g., myocardial infarction and ischemic stroke), all-cause mortality, cardiovascular death, infection death, malignancy, and adverse effects. CONCLUSION a daily 5 mg folic acid supplementation might result in a lower event rate of arteriovenous access thrombosis in patients with ESKD than weekly folic acid supplementation. Further prospective studies are warranted to explore the preventive effect of folate on thrombosis.
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Water-Soluble Vitamins and Trace Elements Losses during On-Line Hemodiafiltration. Nutrients 2022; 14:nu14173454. [PMID: 36079711 PMCID: PMC9458110 DOI: 10.3390/nu14173454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Maintenance hemodialysis induces water-soluble vitamins and trace elements losses, which is why recommendations regarding potential supplementation were provided, but mainly based on conventional hemodialysis. This study′s aim was to measure the water–soluble vitamins and trace element losses during one on-line post-dilution hemodiafiltration (HDF) session. Thirty-nine patients under maintenance HDF were enrolled. We used the Theraflux® sampler (Theradial Corp., Orvault, France) to analyze the full session dialysate mass transfer. Blood and dialysate samples were collected before and after one HDF session to measure B1, B2, B6, B9, B12, C vitamins, zinc, and selenium concentrations. Values significantly decreased for B1 (20.2%), B2 (13%), B6 (25.4%), B9 (32.6%), C (66.6%) and selenium (6.7%). No significant differences were found for vitamin B12 and zinc. The dialysate losses per session were 1.12 ± 0.88 mg for vitamin B1, 0.28 ± 0.30 mg for B2, 0.33 ± 0.09 mg for B6, 0.3 ± 0.18 mg for B9, 147.5 ± 145.50 mg for C and 25.75 ± 6.91 mg for zinc. Vitamin B12 and selenium were under detection values. In conclusion, during a standard 4hr-HDF session, we found important losses for vitamin B1, B6, B9, C and zinc, suggesting the need for regular monitoring of plasma levels and systematic supplementation of these compounds.
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Zhou JQ, Velimirovic M, Chang LL, Fenves AZ. Spontaneous haematomas and haematochezia due to vitamin C deficiency in a haemodialysis patient. BMJ Case Rep 2022; 15:e249711. [PMID: 35606035 PMCID: PMC9174824 DOI: 10.1136/bcr-2022-249711] [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] [Accepted: 05/15/2022] [Indexed: 11/04/2022] Open
Abstract
A man in his 50s with dialysis-dependent end-stage renal disease, several weeks history of progressive skin bruising and acute-onset gastrointestinal bleeding presented to the emergency department following a syncopal event during routine haemodialysis owing to profound hypotension. He was found to have a severe normocytic, normochromic anaemia requiring several blood transfusions. He followed a diet lacking fruits and vegetables and stopped taking renal multivitamins. All parameters of coagulation were unremarkable, but serum vitamin C level was undetectable, supporting a diagnosis of scurvy. Although typically associated with individuals who are at risk of malnourishment, such as those with alcohol use disorder, malabsorption, and those who experience homelessness, scurvy should be considered in patients receiving renal replacement therapy as vitamin C is removed during haemodialysis.
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Affiliation(s)
- James Q Zhou
- Harvard Medical School, Boston, Massachusetts, USA
- Hospital Medicine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marko Velimirovic
- Harvard Medical School, Boston, Massachusetts, USA
- Hospital Medicine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Leslie L Chang
- Harvard Medical School, Boston, Massachusetts, USA
- Hospital Medicine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew Z Fenves
- Harvard Medical School, Boston, Massachusetts, USA
- Clinician Educator, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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11
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The Impact of Chronic Kidney Disease on Nutritional Status and Its Possible Relation with Oral Diseases. Nutrients 2022; 14:nu14102002. [PMID: 35631140 PMCID: PMC9143067 DOI: 10.3390/nu14102002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/02/2022] [Accepted: 05/07/2022] [Indexed: 02/01/2023] Open
Abstract
Several studies have demonstrated a strong relation between periodontal diseases and chronic kidney disease (CKD). The main mechanisms at the base of this link are malnutrition, vitamin dysregulation, especially of B-group vitamins and of C and D vitamins, oxidative stress, metabolic acidosis and low-grade inflammation. In particular, in hemodialysis (HD) adult patients, an impairment of nutritional status has been observed, induced not only by the HD procedures themselves, but also due to numerous CKD-related comorbidities. The alteration of nutritional assessment induces systemic manifestations that have repercussions on oral health, like oral microbiota dysbiosis, slow healing of wounds related to hypovitaminosis C, and an alteration of the supporting bone structures of the oral cavity related to metabolic acidosis and vitamin D deficiency. Low-grade inflammation has been observed to characterize periodontal diseases locally and, in a systemic manner, CKD contributes to the amplification of the pathological process, bidirectionally. Therefore, CKD and oral disease patients should be managed by a multidisciplinary professional team that can evaluate the possible co-presence of these two pathological conditions, that negatively influence each other, and set up therapeutic strategies to treat them. Once these patients have been identified, they should be included in a follow-up program, characterized by periodic checks in order to manage these pathological conditions.
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Garavaglia ML, Giustarini D, Colombo G, Reggiani F, Finazzi S, Calatroni M, Landoni L, Portinaro NM, Milzani A, Badalamenti S, Rossi R, Dalle-Donne I. Blood Thiol Redox State in Chronic Kidney Disease. Int J Mol Sci 2022; 23:ijms23052853. [PMID: 35269995 PMCID: PMC8911004 DOI: 10.3390/ijms23052853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 02/05/2023] Open
Abstract
Thiols (sulfhydryl groups) are effective antioxidants that can preserve the correct structure of proteins, and can protect cells and tissues from damage induced by oxidative stress. Abnormal levels of thiols have been measured in the blood of patients with moderate-to-severe chronic kidney disease (CKD) compared to healthy subjects, as well as in end-stage renal disease (ESRD) patients on haemodialysis or peritoneal dialysis. The levels of protein thiols (a measure of the endogenous antioxidant capacity inversely related to protein oxidation) and S-thiolated proteins (mixed disulphides of protein thiols and low molecular mass thiols), and the protein thiolation index (the molar ratio of the S-thiolated proteins to free protein thiols in plasma) have been investigated in the plasma or red blood cells of CKD and ESRD patients as possible biomarkers of oxidative stress. This type of minimally invasive analysis provides valuable information on the redox status of the less-easily accessible tissues and organs, and of the whole organism. This review provides an overview of reversible modifications in protein thiols in the setting of CKD and renal replacement therapy. The evidence suggests that protein thiols, S-thiolated proteins, and the protein thiolation index are promising biomarkers of reversible oxidative stress that could be included in the routine monitoring of CKD and ESRD patients.
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Affiliation(s)
- Maria Lisa Garavaglia
- Department of Biosciences (Department of Excellence 2018–2022), Università degli Studi di Milano, Via Celoria 26, 20133 Milan, Italy; (M.L.G.); (G.C.); (L.L.); (A.M.)
| | - Daniela Giustarini
- Department of Biotechnology, Chemistry and Pharmacy (Department of Excellence 2018–2022), University of Siena, Via A. Moro 2, 53100 Siena, Italy;
| | - Graziano Colombo
- Department of Biosciences (Department of Excellence 2018–2022), Università degli Studi di Milano, Via Celoria 26, 20133 Milan, Italy; (M.L.G.); (G.C.); (L.L.); (A.M.)
| | - Francesco Reggiani
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy or (F.R.); (S.F.); or (M.C.); (S.B.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Silvia Finazzi
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy or (F.R.); (S.F.); or (M.C.); (S.B.)
| | - Marta Calatroni
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy or (F.R.); (S.F.); or (M.C.); (S.B.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Lucia Landoni
- Department of Biosciences (Department of Excellence 2018–2022), Università degli Studi di Milano, Via Celoria 26, 20133 Milan, Italy; (M.L.G.); (G.C.); (L.L.); (A.M.)
| | - Nicola Marcello Portinaro
- Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, 20133 Milan, Italy;
| | - Aldo Milzani
- Department of Biosciences (Department of Excellence 2018–2022), Università degli Studi di Milano, Via Celoria 26, 20133 Milan, Italy; (M.L.G.); (G.C.); (L.L.); (A.M.)
| | - Salvatore Badalamenti
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy or (F.R.); (S.F.); or (M.C.); (S.B.)
| | - Ranieri Rossi
- Department of Biotechnology, Chemistry and Pharmacy (Department of Excellence 2018–2022), University of Siena, Via A. Moro 2, 53100 Siena, Italy;
- Correspondence: (R.R.); (I.D.-D.)
| | - Isabella Dalle-Donne
- Department of Biosciences (Department of Excellence 2018–2022), Università degli Studi di Milano, Via Celoria 26, 20133 Milan, Italy; (M.L.G.); (G.C.); (L.L.); (A.M.)
- Correspondence: (R.R.); (I.D.-D.)
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The Grocery Store Dilemma. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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14
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WANG Q, LIU F, MENG J, MAO J, ZHANG L, WANG J. Oil chemical traits of kernels of different almond cultivars from China. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.27621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Qin WANG
- Xinjiang Academy of Forestry Sciences, China
| | - Fenglan LIU
- Xinjiang Academy of Forestry Sciences, China
| | | | - Jinmei MAO
- Xinjiang Academy of Forestry Sciences, China
| | - Liuping ZHANG
- Sinograin Zhenjiang Grains & Oils Quality Testing Center, China
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Reduced Plasma Ascorbate and Increased Proportion of Dehydroascorbic Acid Levels in Patients Undergoing Hemodialysis. Life (Basel) 2021; 11:life11101023. [PMID: 34685394 PMCID: PMC8538838 DOI: 10.3390/life11101023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 12/05/2022] Open
Abstract
Ascorbate functions as an electron donor and scavenges free radicals. Dehydroascorbic acid (DHA), the oxidized form of ascorbate, is generated as a result of these reactions. While low plasma ascorbate levels have been reported in hemodialysis patients worldwide, no studies have measured DHA because it is not generalized. In this study, we aimed to clarify whether plasma ascorbate levels are low in dialysis patients and whether plasma ascorbate levels fluctuate before and after dialysis. Moreover, we applied our previously established method to measure the plasma ascorbate and DHA levels in chronic kidney disease (CKD) stage G3–G5 non-hemodialysis-dependent patients, and pre- and post-dialysis plasma ascorbate and DHA levels in CKD stage G5D hemodialysis patients. The sample size was calculated using G-power software. The pre-dialysis plasma total ascorbate levels, including DHA, were significantly (56%) lower in hemodialysis patients than in non-hemodialysis-dependent CKD patients. After dialysis, there was a 40% reduction in the plasma total ascorbate levels. Hemodialysis increased the post-dialysis plasma proportions of DHA from 37% to 55%. The study results demonstrated lower plasma total ascorbate levels in hemodialysis patients compared with in non-hemodialysis-dependent CKD patients; these low levels in hemodialysis patients were further reduced by hemodialysis and increased DHA proportion.
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Nowicka M, Górska M, Nowicka Z, Edyko K, Goździk M, Kurnatowska I. Adherence to Pharmacotherapy and Lifestyle Recommendations Among Hemodialyzed Patients and Kidney Transplant Recipients. J Ren Nutr 2021; 31:503-511. [DOI: 10.1053/j.jrn.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 11/05/2020] [Accepted: 12/20/2020] [Indexed: 02/07/2023] Open
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Yan LJ, Zhang FR, Zeng YR, Zheng Y. Serum Folate and All-Cause Mortality is of Non-Linear Relationship Among Population with Chronic Kidney Disease: A Retrospective Cohort Study. Int J Gen Med 2021; 14:2695-2702. [PMID: 34188524 PMCID: PMC8233454 DOI: 10.2147/ijgm.s314904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023] Open
Abstract
AIM A transition toward high serum folate concentrations has been noticed following the mandatory folate fortification. To explore this further, we studied the relationship between folate and health outcomes in population with chronic kidney disease (CKD). METHODS We retrospectively explored the relationships between serum folate and risk of all-cause death in this population. We analyzed data of 2142 subjects with CKD who participated in the National Health and Nutrition Examination Survey (NHANES) 1999-2006. Vital status was followed through December 31, 2006. RESULTS Cox regression was used to estimate hazard ratios (HRs) of mortality for individuals with serum folate in rest quintiles compared with individuals with the fourth quintile. After an average follow-up of 57.4 months with 157 deaths recorded, a reversed J-shaped association was revealed after conducting multivariable adjustment. The mortality rate in population with lower and higher folate levels were 8.29% and 12.67%, respectively, and the corresponding adjusted HRs were 2.41 (95% confidence interval, CI=1.32-4.40) and 2.10 (1.20-3.70). Kaplan-Meier curve showed survival benefits for the fourth quintile of serum folate as compared to the first and fifth quintile. CONCLUSION Serum folate concentrations may influence all-cause mortality in a non-linear pattern in the CKD population. It is reasonable to recommend periodic surveillance in the CKD population to maintain the serum folate concentration in an appropriate level.
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Affiliation(s)
- Li-Jun Yan
- Department of Hemodialysis, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong Province, People’s Republic of China
| | - Fei-Ran Zhang
- Department of General Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong Province, People’s Republic of China
| | - Yu-Ran Zeng
- Department of Hemodialysis, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong Province, People’s Republic of China
| | - Yang Zheng
- Department of General Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong Province, People’s Republic of China
- Correspondence: Yang Zheng Department of General Surgery, The First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Jinping District, Shantou City, 515041, Guangdong Province, People’s Republic of ChinaTel +86-754-88905256Fax +86-754-88905320 Email
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Comparative Gut Microbiome Differences between Ferric Citrate and Calcium Carbonate Phosphate Binders in Patients with End-Stage Kidney Disease. Microorganisms 2020; 8:microorganisms8122040. [PMID: 33419265 PMCID: PMC7767080 DOI: 10.3390/microorganisms8122040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 01/07/2023] Open
Abstract
Gut dysbiosis in patients with chronic kidney disease (CKD) may induce chronic inflammation and increase morbidity. Phosphate-binding agents, generally used in patients with CKD, may potentially change the composition of the gut microbiota. This study aimed to compare the microbiota composition in hemodialysis patients treated with ferric citrate or calcium carbonate. The stool microbiota was investigated in hemodialysis patients treated with ferric citrate (n = 8) and calcium carbonate (n = 46) using 16S rRNA gene amplicon sequencing profiling using linear discriminant analysis of effect size. Further predictive functional profiling of microbial communities was obtained with Tax4Fun in R. Hemodialysis patients treated with calcium carbonate had a significantly reduced microbial species diversity (Shannon index and Simpson index) and an increased microbial alteration ratio compared with patients treated with ferric citrate. A distinct microbial community structure was found in patients treated with ferric citrate, with an increased abundance of the Bacteroidetes phylum and a decreased abundance of the phylum Firmicutes. Members of the order Lactobacillales were enriched in patients treated with calcium carbonate, whereas taxa of the genera Ruminococcaceae UCG-004, Flavonifractor, and Cronobacter were enriched in patients treated with ferric citrate phosphate binder. In conclusion, Ferric citrate therapy results in a more diverse microbiome community compared to calcium carbonate therapy in hemodialysis patients with phosphate binder treatment. The gut microbiome reflects the phosphate binder choice in hemodialysis patients, further affecting the physiological environment in the gastrointestinal tract.
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19
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Schwotzer N, Kanemitsu M, Kissling S, Darioli R, Benghezal M, Rezzi S, Burnier M, Pruijm M. Water-Soluble Vitamin Levels and Supplementation in Chronic Online Hemodiafiltration Patients. Kidney Int Rep 2020; 5:2160-2167. [PMID: 33305108 PMCID: PMC7710883 DOI: 10.1016/j.ekir.2020.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Supplementation of water-soluble vitamins is a common practice in hemodialysis patients, but dosages are largely based on conventional hemodialysis techniques. The aim of this study was to assess the status of water-soluble vitamins in patients on hemodiafiltration (HDF), and attempt to determine optimal dose of vitamin supplements. Methods This monocentric study included 40 patients on thrice-weekly chronic HDF. At baseline, all patients received 2 tablets of Dialvit containing B and C vitamins after each dialysis session. Predialysis samples of B and C vitamins were measured in both blood (n = 40) and a subgroup of dialysate (n = 6) samples. A second blood sample was obtained in 24 patients 3 months after dose adjustment of the vitamin supplement. Results At baseline, B-vitamin levels were high with, respectively, 0.4%, 10.0%, and 89.6% of patients in the low, normal, and high reference range. For vitamin C, most patients were in the normal range (5.0%, 82.5%, and 12.5% in low, normal, and high reference range). Three months after dose reduction, B vitamin levels decreased but stayed mostly at or above the normal range (1.4%, 25.7%, 72.9% in low, normal, and high reference range). Three patients (12.5%) developed vitamin C deficiency on low-dose substititon. Conclusion This study shows that the levels of most vitamins are above the normal range in patients on HDF receiving a classic dose of vitamin supplements, vitamin C excepted. Our study suggests that the classic dose of postdialysis vitamin B supplements may be reduced.
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Affiliation(s)
- Nora Schwotzer
- Service of Nephrology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Michiko Kanemitsu
- Service of Nephrology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sebastien Kissling
- Service of Nephrology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | | | - Serge Rezzi
- Swiss Vitamin Institute, Epalinges, Switzerland
| | - Michel Burnier
- Service of Nephrology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Menno Pruijm
- Service of Nephrology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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20
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Valeri A. Vitamin Supplementation in ESKD: Too Little or Too Much of a Good Thing? Kidney Int Rep 2020; 5:2125-2126. [PMID: 33306041 PMCID: PMC7710874 DOI: 10.1016/j.ekir.2020.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Anthony Valeri
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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21
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Duni A, Ikonomou M, Alekos J, Pappas C, Dounousi E. Wernicke encephalopathy: An unexpected cause of death in a peritoneal dialysis patient. Perit Dial Int 2020; 41:588-589. [PMID: 32990176 DOI: 10.1177/0896860820961294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Anila Duni
- Nephrology Department, 69157University Hospital of Ioannina, Greece
| | | | - John Alekos
- Nephrology Department, 69157University Hospital of Ioannina, Greece
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22
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Clinical risk assessment of biotin interference with a high-sensitivity cardiac troponin T assay. Clin Chem Lab Med 2020; 58:1931-1940. [DOI: 10.1515/cclm-2019-0962] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 07/20/2020] [Indexed: 12/12/2022]
Abstract
Abstract
Objectives
Biotin >20.0 ng/mL (81.8 nmol/L) can reduce Elecsys® Troponin T Gen 5 (TnT Gen 5; Roche Diagnostics) assay recovery, potentially leading to false-negative results in patients with suspected acute myocardial infarction (AMI). We aimed to determine the prevalence of elevated biotin and AMI misclassification risk from biotin interference with the TnT Gen 5 assay.
Methods
Biotin was measured using an Elecsys assay in two cohorts: (i) 797 0-h and 646 3-h samples from 850 US emergency department patients with suspected acute coronary syndrome (ACS); (ii) 2023 random samples from a US laboratory network, in which biotin distributions were extrapolated for higher values using pharmacokinetic modeling. Biotin >20.0 ng/mL (81.8 nmol/L) prevalence and biotin 99th percentile values were calculated. AMI misclassification risk due to biotin interference with the TnT Gen 5 assay was modeled using different assay cutoffs and test timepoints.
Results
ACS cohort: 1/797 (0.13%) 0-h and 1/646 (0.15%) 3-h samples had biotin >20.0 ng/mL (81.8 nmol/L); 99th percentile biotin was 2.62 ng/mL (10.7 nmol/L; 0-h) and 2.38 ng/mL (9.74 nmol/L; 3-h). Using conservative assumptions, the likelihood of false-negative AMI prediction due to biotin interference was 0.026% (0-h result; 19 ng/L TnT Gen 5 assay cutoff). US laboratory cohort: 15/2023 (0.74%) samples had biotin >20.0 ng/mL (81.8 nmol/L); 99th percentile biotin was 16.6 ng/mL (68.0 nmol/L). Misclassification risk due to biotin interference (19 ng/L TnT Gen 5 assay cutoff) was 0.025% (0-h), 0.0064% (1-h), 0.00048% (3-h), and <0.00001% (6-h).
Conclusions
Biotin interference has minimal impact on the TnT Gen 5 assay’s clinical utility, and the likelihood of false-negative AMI prediction is extremely low.
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Carrero JJ, González-Ortiz A, Avesani CM, Bakker SJL, Bellizzi V, Chauveau P, Clase CM, Cupisti A, Espinosa-Cuevas A, Molina P, Moreau K, Piccoli GB, Post A, Sezer S, Fouque D. Plant-based diets to manage the risks and complications of chronic kidney disease. Nat Rev Nephrol 2020; 16:525-542. [PMID: 32528189 DOI: 10.1038/s41581-020-0297-2] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2020] [Indexed: 02/07/2023]
Abstract
Traditional dietary recommendations for patients with chronic kidney disease (CKD) focus on the quantity of nutrients consumed. Without appropriate dietary counselling, these restrictions can result in a low intake of fruits and vegetables and a lack of diversity in the diet. Plant nutrients and plant-based diets could have beneficial effects in patients with CKD: increased fibre intake shifts the gut microbiota towards reduced production of uraemic toxins; plant fats, particularly olive oil, have anti-atherogenic effects; plant anions might mitigate metabolic acidosis and slow CKD progression; and as plant phosphorus has a lower bioavailability than animal phosphorus, plant-based diets might enable better control of hyperphosphataemia. Current evidence suggests that promoting the adoption of plant-based diets has few risks but potential benefits for the primary prevention of CKD, as well as for delaying progression in patients with CKD G3-5. These diets might also help to manage and prevent some of the symptoms and metabolic complications of CKD. We suggest that restriction of plant foods as a strategy to prevent hyperkalaemia or undernutrition should be individualized to avoid depriving patients with CKD of these potential beneficial effects of plant-based diets. However, research is needed to address knowledge gaps, particularly regarding the relevance and extent of diet-induced hyperkalaemia in patients undergoing dialysis.
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Affiliation(s)
- Juan J Carrero
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Ailema González-Ortiz
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador, Zubirán, Mexico
| | - Carla M Avesani
- Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Vincenzo Bellizzi
- Nephrology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Philippe Chauveau
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux et Aurad-Aquitaine, Bordeaux, France
| | - Catherine M Clase
- Departments of Medicine and Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Angeles Espinosa-Cuevas
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador, Zubirán, Mexico
| | - Pablo Molina
- Department of Nephrology, Hospital Universitari Dr Peset, Universitat de València, València, Spain
| | - Karine Moreau
- Renal transplant unit, Pellegrin Hospital, Bordeaux, France
| | - Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.,Nephrologie, Centre Hospitalier Le Mans, Le Mans, France
| | - Adrian Post
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Siren Sezer
- Department of Nephrology, Baskent University School of Medicine, Ankara, Turkey
| | - Denis Fouque
- Department of Nephrology, Université de Lyon, Carmen, Hospital Lyon-Sud, Lyon, France
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Raimann JG, Abbas SR, Liu L, Larive B, Beck G, Kotanko P, Levin NW, Handelman G. The effect of increased frequency of hemodialysis on vitamin C concentrations: an ancillary study of the randomized Frequent Hemodialysis Network (FHN) daily trial. BMC Nephrol 2019; 20:179. [PMID: 31101018 PMCID: PMC6525383 DOI: 10.1186/s12882-019-1311-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 03/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reports on vitamin C in HD patients have shown effects of vitamin C deficiency in association with scurvy symptoms. Dialyzability of water soluble vitamins is high, and substantial losses in those who are dialyzed more frequently were hypothesized. The randomized FHN Daily Trial compared the effects of in-center HD six versus three times per week. We studied baseline correlations between vitamin C and potentially associated parameters, and the effect of more frequent HD on circulating vitamin C concentrations. METHODS We studied vitamin C levels at baseline and months, 3, 5 and 11. Patients enrolled between 2007 and 2009 into the randomized FHN Daily trial in the East Coast consortium were approached for participation. Predialysis plasma samples were processed with metaphosphoric acid and frozen at - 70 °C for measurement with HPLC. Regression models between baseline log-transformed vitamin C and hemoglobin, CRP, eKt/V, ePCR and PTH, and a linear mixed-effects model to estimate the effect size of more frequent HD on plasma vitamin C, were constructed. RESULTS We studied 44 subjects enrolled in the FHN Daily trial (50 ± 12 years, 36% female, 29% Hispanics and 64% blacks, 60% anuric). Vitamin C correlated significantly with predialysis hemoglobin (r = 0.3; P = 0.03) and PTH (r = - 0.3, P = 0.04), respectively. Vitamin C did not significantly differ at baseline (6×/week, 25.8 ± 25.9 versus 3×/week, 32.6 ± 39.4 μmol/L) and no significant treatment effect on plasma vitamin C concentrations was found [- 26.2 (95%CI -57.5 to 5.1) μmol/L at Month 4 and - 2.5 (95%CI -15.6 to 10.6) μmol/L at Month 12. CONCLUSIONS Based on data from this large randomized-controlled trial no significant effect of the intervention on circulating plasma vitamin C concentrations was found, allaying the concerns that more frequent HD would affect the concentrations of water-soluble vitamins and adversely affect patient's well-being. Correlations between vitamin C and hemoglobin and PTH support the importance of vitamin C for normal bone and mineral metabolism, and anemia management.
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Affiliation(s)
- Jochen G Raimann
- Renal Research Institute, 315 East 62nd Street, 4th Floor, New York, NY, 10065, USA.
| | - Samer R Abbas
- Renal Research Institute, 315 East 62nd Street, 4th Floor, New York, NY, 10065, USA
| | - Li Liu
- Renal Research Institute, 315 East 62nd Street, 4th Floor, New York, NY, 10065, USA.,Renal Division, Peking University First Hospital, Beijing, People's Republic of China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing, China
| | | | - Gerald Beck
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Peter Kotanko
- Renal Research Institute, 315 East 62nd Street, 4th Floor, New York, NY, 10065, USA.,Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA
| | - Nathan W Levin
- Renal Research Institute, 315 East 62nd Street, 4th Floor, New York, NY, 10065, USA.,Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA
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Evliyaoglu O, van Helden J, Imöhl M, Weiskirchen R. Vitamin B1 interpretation: Erroneous higher levels in non-anemic populations. Nutrition 2019; 60:25-29. [DOI: 10.1016/j.nut.2018.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/14/2018] [Accepted: 09/03/2018] [Indexed: 02/06/2023]
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D'Costa MR, Winkler NS, Milliner DS, Norby SM, Hickson LJ, Lieske JC. Oxalosis Associated With High-Dose Vitamin C Ingestion in a Peritoneal Dialysis Patient. Am J Kidney Dis 2019; 74:417-420. [PMID: 30910370 DOI: 10.1053/j.ajkd.2019.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/18/2019] [Indexed: 01/15/2023]
Abstract
We report a case of systemic oxalosis involving the eyes and joints due to long-term use of high-dose vitamin C in a patient receiving maintenance peritoneal dialysis (PD). This 76-year-old woman with autosomal dominant polycystic kidney disease underwent living unrelated kidney transplantation 10 years earlier. The transplant failed 6 months before presentation, and she initiated hemodialysis therapy before transitioning to PD therapy 4 months later. During the month before presentation, the patient noted worsening arthralgias and decreased vision. Ophthalmologic examination revealed proliferative retinopathy and calcium oxalate crystals. Plasma oxalate level was markedly elevated at 187 (reference range, <1.7) μmol/L, and urine oxalate-creatinine ratio was high (0.18mg/mg). The patient reported taking up to 4g of vitamin C per day for several years. Workup for causes of primary and secondary hyperoxaluria was otherwise negative. Vitamin C use was discontinued, and the patient transitioned to daily hemodialysis for 2 weeks. Plasma oxalate level before the dialysis session decreased but remained higher (30-53μmol/L) than typical for dialysis patients. Upon discharge, the patient remained on thrice-weekly hemodialysis therapy with stabilized vision and improved joint symptoms. This case highlights the risk of high-dose vitamin C use in patients with advanced chronic kidney disease, especially when maintained on PD therapy.
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Affiliation(s)
| | | | - Dawn S Milliner
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; The Rare Kidney Stone Consortium, Mayo Clinic, Rochester, MN
| | - Suzanne M Norby
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; The Rare Kidney Stone Consortium, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
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Panchal S, Schneider C, Malhotra K. Scurvy in a hemodialysis patient. Rare or ignored? Hemodial Int 2018; 22:S83-S87. [PMID: 30411462 DOI: 10.1111/hdi.12705] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Chronic kidney disease and dialysis brings with it a plethora of complications, including malnutrition. Strict dietary restrictions in hemodialysis (HD) patients further complicate the picture as it increases the risk of deficiency of micronutrients, specifically water-soluble vitamins. Today, there is a lack of concrete guidelines concerning recommendations on vitamin supplementation in HD patients. This lack of data is partly due to our incomplete understanding of handling of vitamins in a uremic state. There is a dire need for more data on the impact of dialysis and uremic state on water-soluble vitamins to facilitate appropriate preventative supplementation. We present a case of scurvy in a HD patient that will contribute toward the understanding of vitamin status in HD. We hope it will aid in screening HD patients for vitamin C deficiency and individualizing supplementation of vitamin C.
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Affiliation(s)
- Sarju Panchal
- University of Missouri-School of Medicine, Class of 2019, One Hospital Drive, Columbia, Missouri 65212, USA
| | - Christine Schneider
- Division of Nephrology, Department of Medicine, University of Missouri, CE425, 1 Hospital Drive, Columbia, Missouri 65212, USA
| | - Kunal Malhotra
- Division of Nephrology, Department of Medicine, University of Missouri, CE425, 1 Hospital Drive, Columbia, Missouri 65212, USA
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Thiamine status in end-stage chronic kidney disease patients: a single-center study. Int Urol Nephrol 2018; 50:1913-1918. [DOI: 10.1007/s11255-018-1974-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/23/2018] [Indexed: 12/26/2022]
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Ravindran P, Wiltshire S, Das K, Wilson RB. Vitamin C deficiency in an Australian cohort of metropolitan surgical patients. Pathology 2018; 50:654-658. [PMID: 30177219 DOI: 10.1016/j.pathol.2018.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 06/30/2018] [Accepted: 07/03/2018] [Indexed: 11/18/2022]
Abstract
Vitamin C is an essential micronutrient in the human diet. While large population studies measuring vitamin C have been performed in other countries, there are few studies of deficiency in the Australian population. This study aimed to quantify vitamin C deficiency, identify scorbutic symptoms and examine dietary associations in a cohort of preoperative general surgical patients. Vitamin C levels were determined in a cohort of patients referred to a single surgeon between January 2011 and December 2013. Baseline data were collected along with data on fruit consumption, weekly citrus fruit intake and presence of scorbutic symptoms. A total of 309 patients were included in the study and 21.4% of our cohort showed a vitamin C level ≤11.4 μmol/L (deficient). Mean citrus fruit intake was significantly higher in the normal vitamin C groups (>28.4 μmol/L) and patients with vitamin C levels ≤28.4 were more likely to consume no fruit (p=0.0004) which was also significant on multivariate analysis. Neither age nor gender appeared predictive of suboptimal vitamin C levels. No symptoms were significantly related to vitamin C levels on multivariate analysis. Vitamin C deficiency was common in Australian adults attending a surgical practice within south western Sydney. Review of the Australian recommended daily allowance for vitamin C is suggested, not only in clinically well patients but particularly in ICU and hospital inpatients. Larger studies examining the prevalence and impact of vitamin C deficiency in the Australian population are required to further investigate these findings.
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Affiliation(s)
- Praveen Ravindran
- Department of Surgery, Liverpool Hospital, Sydney, NSW, Australia; Western Sydney University, Sydney, NSW, Australia; The MARCS Institute for Brain, Behaviour and Development, Sydney, NSW, Australia.
| | | | - Kamalakanta Das
- Department of Surgery, Liverpool Hospital, Sydney, NSW, Australia; Faculty of Medicine, Department of Surgery, University of New South Wales, Sydney, NSW, Australia
| | - Robert B Wilson
- Department of Surgery, Liverpool Hospital, Sydney, NSW, Australia; Faculty of Medicine, Department of Surgery, University of New South Wales, Sydney, NSW, Australia
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Soohoo M, Ahmadi SF, Qader H, Streja E, Obi Y, Moradi H, Rhee CM, Kim TH, Kovesdy CP, Kalantar-Zadeh K. Association of serum vitamin B12 and folate with mortality in incident hemodialysis patients. Nephrol Dial Transplant 2018; 32:1024-1032. [PMID: 27190367 DOI: 10.1093/ndt/gfw090] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 03/22/2016] [Indexed: 11/14/2022] Open
Abstract
Background Vitamin B12 (B12) and folate are essential vitamins that play important roles in physiological processes. In the general population, many studies have evaluated the association of these vitamins with clinical outcomes, yet this association in hemodialysis (HD) patients remains unclear. Methods We examined the association of serum folate and B12 with mortality in a 5-year cohort of 9517 (folate) and 12 968 (B12) HD patients using Cox models with hierarchical adjustment for sociodemographics, comorbidities, and laboratory variables associated with the malnutrition and inflammation complex syndrome. The associations of baseline B12 and folate (separately) with all-cause mortality were evaluated across five categories of B12 [<400 (reference), 400-<550, 550-<650, 650-<750 and ≥750 pg/mL] and folate [<6.2, 6.2-<8.4, 8.4-<11 (reference), 11-<14.3 and ≥14.3 ng/mL]. Results The study cohort with B12 measurements had a mean ± standard deviation age of 63 ± 15 years, among whom 43% were female, 33% were African-American, and 57% were diabetic. Higher B12 concentrations ≥550 pg/mL were associated with a higher risk of mortality after adjusting for sociodemographic and laboratory variables. However, only lower serum folate concentrations <6.2 ng/mL were associated with a higher risk of all-cause mortality when adjusted for sociodemographic variables [adjusted hazard ratio (95% confidence-interval): 1.18 (1.03-1.35)]. Conclusions Higher B12 concentrations are associated with higher all-cause mortality in HD patients independent of sociodemographics and laboratory variables, whereas lower folate concentrations were associated with higher all-cause mortality after accounting for sociodemographic variables. Further studies are warranted to determine the optimal B12 and folate level targets in this population.
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Affiliation(s)
- Melissa Soohoo
- Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Seyed-Foad Ahmadi
- Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Hemn Qader
- Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Elani Streja
- Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Yoshitsugu Obi
- Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Hamid Moradi
- Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Connie M Rhee
- Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Tae Hee Kim
- Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.,Department of Medicine, Inje University, Busan, South Korea
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis TN, USA, and Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
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Affiliation(s)
- Kamyar Kalantar-Zadeh
- From the Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, School of Medicine, Orange, the Long Beach Veterans Affairs Healthcare System, Long Beach, the Department of Epidemiology, University of California, Los Angeles (UCLA), and the Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance - all in California (K.K.-Z.); and the Department of Nephrology, Université Claude Bernard Lyon, Centre Hospitalier Lyon Sud, Cardiometabolism and Nutrition (CarMeN), Lyon, France (D.F.)
| | - Denis Fouque
- From the Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, School of Medicine, Orange, the Long Beach Veterans Affairs Healthcare System, Long Beach, the Department of Epidemiology, University of California, Los Angeles (UCLA), and the Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance - all in California (K.K.-Z.); and the Department of Nephrology, Université Claude Bernard Lyon, Centre Hospitalier Lyon Sud, Cardiometabolism and Nutrition (CarMeN), Lyon, France (D.F.)
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Jankowska M, Rudnicki-Velasquez P, Storoniak H, Rutkowski P, Rutkowski B, Krzymiński K, Dębska-Ślizień A. Thiamine Diphosphate Status and Dialysis-Related Losses in End-Stage Kidney Disease Patients Treated with Hemodialysis. Blood Purif 2017; 44:294-300. [DOI: 10.1159/000480651] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 08/22/2017] [Indexed: 11/19/2022]
Abstract
Aim: (1) To describe the whole blood content of thiamine diphosphate (TDP), a biologically active form of vitamin B1 in end-stage kidney disease patients treated with hemodialysis (HD); (2) to establish the impact of a single HD procedure on TDP blood concentrations; and (3) to describe potential explanatory variables influencing TDP dialysis related losses, including dialysis prescription, vitamin B1 dietary intake and supplementation. Methods: Single-center, cross-sectional study in 50 clinically stable maintenance HD patients. The assessment of whole blood TDP with the High Performance Liquid Chromatography method, before and after a single, middle-week dialysis session and analysis of clinical and laboratory parameters potentially influencing TDP status Results: We report a significant difference in TDP levels before and after HD sessions - 42.5 (95% CI 38.7-46.2) μg/L and 23.6 (95% CI 18.9-28.2) μg/L, respectively (p = 0.000). The magnitude of intradialytic TDP changes is highly variable among individuals and is negatively associated only with the body weight of the patients (p < 0.013). Vitamin B1 dietary intake and supplementation do not influence whole blood TDP and dialysis-related loss of TDP. Conclusions: TDP, a bioactive compound of vitamin B1, is substantially lost during the HD procedure, and the magnitude of its loss is associated with the patient's body weight but it is not influenced by vitamin B1 dietary intake and standard supplementation dose.
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Naturally Occurring Compounds: New Potential Weapons against Oxidative Stress in Chronic Kidney Disease. Int J Mol Sci 2017; 18:ijms18071481. [PMID: 28698529 PMCID: PMC5535971 DOI: 10.3390/ijms18071481] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 06/22/2017] [Accepted: 07/08/2017] [Indexed: 12/13/2022] Open
Abstract
Oxidative stress is a well-described imbalance between the production of reactive oxygen species (ROS) and the antioxidant defense system of cells and tissues. The overproduction of free radicals damages all components of the cell (proteins, lipids, nucleic acids) and modifies their physiological functions. As widely described, this condition is a biochemical hallmark of chronic kidney disease (CKD) and may dramatically influence the progression of renal impairment and the onset/development of major systemic comorbidities including cardiovascular diseases. This state is exacerbated by exposure of the body to uremic toxins and dialysis, a treatment that, although necessary to ensure patients' survival, exposes cells to non-physiological contact with extracorporeal circuits and membranes with consequent mitochondrial and anti-redox cellular system alterations. Therefore, it is undeniable that counteracting oxidative stress machinery is a major pharmacological target in medicine/nephrology. As a consequence, in recent years several new naturally occurring compounds, administered alone or integrated with classical therapies and an appropriate lifestyle, have been proposed as therapeutic tools for CKD patients. In this paper, we reviewed the recent literature regarding the "pioneering" in vivo testing of these agents and their inclusion in small clinical trials performed in patients affected by CKD.
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Jankowska M, Szupryczyńska N, Dębska-Ślizień A, Borek P, Kaczkan M, Rutkowski B, Małgorzewicz S. Dietary Intake of Vitamins in Different Options of Treatment in Chronic Kidney Disease: Is There a Deficiency? Transplant Proc 2017; 48:1427-30. [PMID: 27496421 DOI: 10.1016/j.transproceed.2015.11.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 11/06/2015] [Indexed: 10/21/2022]
Abstract
BACKGROUND The importance of diet in the management of kidney transplantation (KT), as well as other treatment options of chronic kidney disease (CKD), is generally acknowledged. However, data regarding vitamin intake are very limited. Vitamins are essential in maintaining good nutritional status and preventing many chronic complications. It is still not clear which treatment modality imposes the highest risk of dietary vitamin deficiency and whether successful KT reverses such a threat. METHODS We performed this observational study to assess dietary intake of vitamins in CKD patients: after successful KT, not yet dialyzed (ND), treated with hemodialysis (HD), and with peritoneal dialysis (PD). A total of 202 patients were recruited (45 KT, 50 ND, 45 HD, and 62 PD). Vitamin intakes were evaluated through the use of a 24-hour dietary recall and processed with the use of a computerized database. Each record was evaluated by a skilled dietitian. In general, vitamin intakes in all study groups were comparable, with KT and ND groups manifesting lower risk of deficiency than HD and PD groups. RESULTS The content of fat-soluble vitamins in diet was insufficient, with remarkably high prevalence of vitamin D deficiency. Mean intakes of water-soluble vitamins were close to recommended, with the exception of folic acid, which was profoundly deficient in all groups. CONCLUSIONS CKD patients are at risk of inadequate vitamin intake. Vitamin D and folic acid are universally deficient in diet. KT patients have the most satisfactory content of vitamins in their diet, whereas HD individuals are at highest risk of deficiency.
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Affiliation(s)
- M Jankowska
- Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Poland.
| | - N Szupryczyńska
- Department of Clinical Nutrition, Medical University of Gdańsk, Poland
| | - A Dębska-Ślizień
- Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Poland
| | - P Borek
- Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Poland
| | - M Kaczkan
- Department of Clinical Nutrition, Medical University of Gdańsk, Poland
| | - B Rutkowski
- Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Poland
| | - S Małgorzewicz
- Department of Clinical Nutrition, Medical University of Gdańsk, Poland
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Vitamins and Microelement Bioavailability in Different Stages of Chronic Kidney Disease. Nutrients 2017; 9:nu9030282. [PMID: 28294976 PMCID: PMC5372945 DOI: 10.3390/nu9030282] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/08/2017] [Accepted: 03/10/2017] [Indexed: 01/11/2023] Open
Abstract
Chronic kidney disease (CKD) predisposes one to either deficiency or toxic excess of different micronutrients. The knowledge on micronutrients—specifically water-soluble vitamins and trace elements—in CKD is very limited. Consequently, current guidelines and recommendations are mostly based on expert opinions or poor-quality evidence. Abnormalities of micronutrient resources in CKD develop for several reasons. Dietary restrictions and anorexia lead to an insufficient micronutrient intake, while diuretics use and renal replacement therapy lead to their excessive losses. Absorption is unpredictable, and metabolism impaired. Better understanding of the micronutrient needs of CKD patients could have an impact on many complications linked to vitamin and trace element disorders, including high mortality, increased risk of atherosclerosis, inflammation, oxidative stress, anemia, polyneuropathy, encephalopathy, weakness and fragility, muscle cramps, bone disease, depression, or insomnia. Here, we summarize the up-to-date knowledge on micronutrient resources in different stages of CKD, and share our experience with the assessment of micronutrient status.
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Jankowska M, Lichodziejewska-Niemierko M, Rutkowski B, Dębska-Ślizień A, Małgorzewicz S. Water soluble vitamins and peritoneal dialysis - State of the art. Clin Nutr 2016; 36:1483-1489. [PMID: 28089619 DOI: 10.1016/j.clnu.2016.12.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 12/20/2016] [Accepted: 12/22/2016] [Indexed: 01/19/2023]
Abstract
This review presents the results of a systematic literature search concerning water soluble vitamins and peritoneal dialysis modality. We provide an overview of the data available on vitamin requirements, dietary intake, dialysis related losses, metabolism and the benefits of supplementation. We also summarise the current recommendations concerning the supplementation of vitamins in peritoneal dialysis and discuss the safety of an administration of vitamins in pharmacological doses.
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Affiliation(s)
- Magdalena Jankowska
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland
| | | | - Bolesław Rutkowski
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland
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Cimbaljevic S, Suvakov S, Matic M, Pljesa-Ercegovac M, Pekmezovic T, Radic T, Coric V, Damjanovic T, Dimkovic N, Markovic R, Savic-Radojevic A, Simic T. Association of GSTO1 and GSTO2 Polymorphism with Risk of End-Stage Renal Disease Development and Patient Survival. J Med Biochem 2016; 35:302-311. [PMID: 28356881 PMCID: PMC5346808 DOI: 10.1515/jomb-2016-0009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/12/2016] [Indexed: 11/19/2022] Open
Abstract
Background Oxidative stress in patients with end-stage renal disease (ESRD) is associated with long-term cardiovascular complications. The cytosolic family of glutathione S-transferases (GSTs) is involved in the detoxication of various toxic compounds and antioxidant protection. GST omega class members, GSTO1 and GSTO2 possess, unlike other GSTs, dehydroascorbate reductase and deglutathionylation activities. The aim of this study was to clarify the role of genetic polymorphisms of GSTO1 (rs4925) and GSTO2 (rs156697) as risk determinants for ESRD development, as well as in the survival of these patients. Methods A total of 199 patients and 199 healthy subjects were included in the study and genotyped for both GSTO1 and GSTO2 polymorphism. Protein thiol and carbonyl groups as markers of protein oxidative damage were determined spectrophotometrically. Cox proportional hazard model and Kaplan-Meier analysis were performed to investigate the role of GSTO1 and GSTO2 genetic polymorphism on mortality of ESRD patients during the follow-up period (36 month). Results Individuals carrying the variant GSTO2 GG genotype were at 2.45-fold higher risk of ESRD development compared to the wild type GSTO2 AA genotype (OR=2.45; 95%CI=1.18–5.07; p=0.016). The results of GSTO1/GSTO2 haplotype analysis showed that the haplotype combination of GSTO1 (*A)/GSTO2 (*A) (GSTO1 variant/GSTO2 wild type allele) was protective for ESRD (OR=0.23 95%CI=0.12-0.44, p=0.001). Patients carrying at least one GSTO1 reference allele have shorter mean overall (Log rank=2.844, p =0.241) and cardiovascular survival probability (Log rank=4.211, p=0.122). Conclusions GSTO polymorphisms have been shown to act as significant markers in assessing the risk of ESRD development and patients’ survival.
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Affiliation(s)
| | - Sonja Suvakov
- Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Matic
- Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Pljesa-Ercegovac
- Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tanja Radic
- Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vesna Coric
- Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Damjanovic
- Clinical Department for Renal Diseases, Zvezdara University Medical Center, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nada Dimkovic
- Clinical Department for Renal Diseases, Zvezdara University Medical Center, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Rodoljub Markovic
- Department of Nephrology and Hemodialysis, University Teaching Hospital Zemun, Belgrade, Serbia
| | - Ana Savic-Radojevic
- Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Simic
- Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Oral vitamin C supplementation reduces erythropoietin requirement in hemodialysis patients with functional iron deficiency. Int Urol Nephrol 2016; 48:1519-24. [PMID: 27170339 DOI: 10.1007/s11255-016-1309-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Functional iron deficiency (FID) is a major cause of persistent anemia in dialysis patients and also contributes to a suboptimal response to erythropoietin (Epo) administration. Vitamin C acts as an enzyme cofactor and enhances mobilization of the ferrous form of iron to transferrin thus increasing its bioavailability. High-dose intravenous vitamin C has been shown to decrease the Epo requirement and improve hemoglobin levels in previous studies. This study assessed the effect of low-dose oral vitamin C on possible reduction in Epo dose requirements in stable hemodialysis patients with FID. METHODS This prospective study included 22 stable hemodialysis patients with FID defined as transferrin saturation (T sat) <30 % and ferritin levels of >100 mcg/L with Epo requirement of ≥4000 U/HD session. Patients received oral vitamin C 250 mg daily for 3 months. Hemoglobin, iron and T sat levels were recorded monthly. No one received iron supplementation during the study period. RESULTS There was a significant reduction in median Epo dose requirement in the 15 patients who completed the study, from 203.1 U/kg/week (95 % CI 188.4-270.6) to 172.8 U/kg/week (95 % CI 160.2-214.8), (P = 0.01). In the seven responders, there was 33 % reduction in Epo dose from their baseline. Despite adjustment of Epo dose, the mean hemoglobin level was significantly increased from 10.1 ± 0.6 to 10.7 ± 0.6 mg/dL (P = 0.03). No adverse effects of oral vitamin C were observed. CONCLUSION Daily low-dose oral vitamin C supplementation reduced Epo dose requirements in hemodialysis patients with FID. Limitations of this study include a small sample size and the lack of measurements of vitamin C and oxalate levels. Despite concerns regarding oral vitamin C absorption in dialysis patients, this study indicates vitamin C was well tolerated by all participants without reported adverse effect.
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Padayatty SJ, Levine M. Vitamin C: the known and the unknown and Goldilocks. Oral Dis 2016; 22:463-93. [PMID: 26808119 DOI: 10.1111/odi.12446] [Citation(s) in RCA: 378] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 01/08/2016] [Indexed: 12/11/2022]
Abstract
Vitamin C (Ascorbic Acid), the antiscorbutic vitamin, cannot be synthesized by humans and other primates, and has to be obtained from diet. Ascorbic acid is an electron donor and acts as a cofactor for fifteen mammalian enzymes. Two sodium-dependent transporters are specific for ascorbic acid, and its oxidation product dehydroascorbic acid is transported by glucose transporters. Ascorbic acid is differentially accumulated by most tissues and body fluids. Plasma and tissue vitamin C concentrations are dependent on amount consumed, bioavailability, renal excretion, and utilization. To be biologically meaningful or to be clinically relevant, in vitro and in vivo studies of vitamin C actions have to take into account physiologic concentrations of the vitamin. In this paper, we review vitamin C physiology; the many phenomena involving vitamin C where new knowledge has accrued or where understanding remains limited; raise questions about the vitamin that remain to be answered; and explore lines of investigations that are likely to be fruitful.
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Affiliation(s)
- S J Padayatty
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - M Levine
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Colombo G, Reggiani F, Podestà MA, Garavaglia ML, Portinaro NM, Milzani A, Badalamenti S, Dalle-Donne I. Plasma protein thiolation index (PTI) as a biomarker of thiol-specific oxidative stress in haemodialyzed patients. Free Radic Biol Med 2015; 89:443-51. [PMID: 26453922 DOI: 10.1016/j.freeradbiomed.2015.08.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/07/2015] [Accepted: 08/25/2015] [Indexed: 12/25/2022]
Abstract
The role of oxidative stress in patients with end stage renal disease (ESRD), which occurs at significantly higher levels than in the general population, is often underestimated in clinical practice. Emerging evidence highlights the strong correlation of oxidative stress with chronic inflammation and cardiovascular disease, which are highly prevalent in most patients on maintenance haemodialysis (HD) and are a major risk factor for mortality in this population. In this study, total plasma thiols and plasma S-thiolated proteins were measured in patients with ESRD, before and after a regular HD session, and compared to age-matched healthy subjects. We found a significant decrease in the level of total plasma thiols and, conversely, a significant increase in the level of S-thiolated proteins in these patients. In most patients, post-HD plasma level of total thiols did not differ from the one in healthy subjects, whereas plasma level of S-thiolated proteins was lower in HD patients than in age-matched healthy controls. This suggests that a single HD session restores plasma thiol redox status and re-establishes the antioxidant capacity of plasma thiols. Additionally, we determined protein thiolation index (PTI), i.e., the molar ratio between the sum of all low molecular mass thiols bound to S-thiolated plasma proteins and protein free cysteinyl residues. Patients with ESRD had a significantly higher PTI compared to age-matched healthy subjects and HD was associated with a decrease in PTI to normal, or lower than normal, levels. Although this study is limited in size, our results suggest that PTI is a useful indicator of thiol-specific oxidative stress in patients with ESRD on maintenance HD. This study also emphasizes that PTI determination is a cheap and simple tool suitable for large-scale clinical studies that could be used for routine screening of thiol-specific oxidative stress.
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Affiliation(s)
- Graziano Colombo
- Department of Biosciences, Università degli Studi di Milano, Milan, Italy
| | - Francesco Reggiani
- Humanitas Clinical and Research Center, Nephrology Unit, Rozzano, Milan, Italy
| | - Manuel A Podestà
- Humanitas Clinical and Research Center, Nephrology Unit, Rozzano, Milan, Italy
| | | | - Nicola M Portinaro
- Humanitas Clinical and Research Center, Clinica ortopedica e traumatologica, Rozzano, Milan, Italy
| | - Aldo Milzani
- Department of Biosciences, Università degli Studi di Milano, Milan, Italy
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Oh WC, Gardner DS, Devonald MAJ. Micronutrient and amino acid losses in acute renal replacement therapy. Curr Opin Clin Nutr Metab Care 2015; 18:593-8. [PMID: 26372512 DOI: 10.1097/mco.0000000000000220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW A wide range of renal replacement therapies is now available to support patients with acute kidney injury. These treatments utilize diffusion, convection or a combination of these mechanisms to remove metabolic waste products from the bloodstream. It is inevitable that physiologically important substances including micronutrients will also be removed. Here we review current knowledge of the extent of micronutrient loss, how it varies between treatment modalities and its clinical significance. RECENT FINDINGS Very few studies have specifically investigated micronutrient loss in renal replacement therapy for acute kidney injury. Recent data suggest that trace elements and amino acids are lost during intermittent dialysis, hybrid therapies such as sustained low-efficiency diafiltration and continuous therapies. Extent of micronutrient loss appears to vary with treatment type, with continuous convection-based treatments probably causing greatest losses. SUMMARY Patients with acute kidney injury are at high risk of disease-related malnutrition. The use of renal replacement therapy, although often essential for life support, results in loss of micronutrients into the filtrate or dialysate. Losses are probably greater with continuous convective treatments, but it is not yet known whether these losses are clinically significant or whether their replacement would improve patient outcomes.
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Affiliation(s)
- Weng C Oh
- aRenal and Transplant Unit, Nottingham University Hospitals NHS Trust bSchool of Medicine, University of Nottingham cSchool of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
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Tanaka H, Sirich TL, Plummer NS, Weaver DS, Meyer TW. An Enlarged Profile of Uremic Solutes. PLoS One 2015; 10:e0135657. [PMID: 26317986 PMCID: PMC4552739 DOI: 10.1371/journal.pone.0135657] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 07/23/2015] [Indexed: 01/01/2023] Open
Abstract
Better knowledge of the uremic solutes that accumulate when the kidneys fail could lead to improved renal replacement therapy. This study employed the largest widely available metabolomic platform to identify such solutes. Plasma and plasma ultrafiltrate from 6 maintenance hemodialysis (HD) patients and 6 normal controls were first compared using a platform combining gas and liquid chromatography with mass spectrometry. Further studies compared plasma from 6 HD patients who had undergone total colectomy and 9 with intact colons. We identified 120 solutes as uremic including 48 that had not been previously reported to accumulate in renal failure. Combination of the 48 newly identified solutes with those identified in previous reports yielded an extended list of more than 270 uremic solutes. Among the solutes identified as uremic in the current study, 9 were shown to be colon-derived, including 6 not previously identified as such. Literature search revealed that many uremic phenyl and indole solutes, including most of those shown to be colon-derived, come from plant foods. Some of these compounds can be absorbed directly from plant foods and others are produced by colon microbial metabolism of plant polyphenols that escape digestion in the small intestine. A limitation of the metabolomic method was that it underestimated the elevation in concentration of uremic solutes which were measured using more quantitative assays.
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Affiliation(s)
- Hisae Tanaka
- The Departments of Medicine, VA Palo Alto HCS and Stanford University, Palo Alto, CA, United States of America
| | - Tammy L. Sirich
- The Departments of Medicine, VA Palo Alto HCS and Stanford University, Palo Alto, CA, United States of America
| | - Natalie S. Plummer
- The Departments of Medicine, VA Palo Alto HCS and Stanford University, Palo Alto, CA, United States of America
| | - Daniel S. Weaver
- Bioinformatics Research Group, SRI International, Menlo Park, CA, United States of America
| | - Timothy W. Meyer
- The Departments of Medicine, VA Palo Alto HCS and Stanford University, Palo Alto, CA, United States of America
- * E-mail:
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Abstract
PURPOSE OF REVIEW Vitamin C is not only an essential nutrient involved in many anabolic pathways, but also an important player of the endogenous antioxidant defense. Low plasma levels are very common in critical care patients and may reflect severe deficiency states. RECENT FINDINGS Vitamin C scavenges reactive oxygen species such as superoxide and peroxynitrite in plasma and cells (preventing damage to proteins, lipids and DNA), prevents occludin dephosphorylation and loosening of the tight junctions. Ascorbate improves microcirculatory flow impairment by inhibiting tumor-necrosis-factor-induced intracellular adhesion molecule expression, which triggers leukocyte stickiness and slugging. Clinical trials in sepsis, trauma and major burns testing high-dose vitamin C show clinical benefit. Restoration of normal plasma levels in inflammatory patients requires the administration of 3 g/day for several days, which is 30 times the daily recommended dose. SUMMARY The recent research on the modulation of oxidative stress and endothelial protection offer interesting therapeutic perspectives, based on the biochemical evidence, with limited or even absent side-effects.
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Affiliation(s)
- Mette M Berger
- aAdult Intensive Care and Burns, University Hospital CHUV, Lausanne, Switzerland bDepartment of Intensive Care, VU University Medical Center, Amsterdam, the Netherlands
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