1
|
Berger MM, Broman M, Forni L, Ostermann M, De Waele E, Wischmeyer PE. Nutrients and micronutrients at risk during renal replacement therapy: a scoping review. Curr Opin Crit Care 2021; 27:367-377. [PMID: 34039873 PMCID: PMC8270509 DOI: 10.1097/mcc.0000000000000851] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW Malnutrition is frequent in patients with acute kidney injury. Nutrient clearance during renal replacement therapy (RRT) potentially contributes to this complication. Although losses of amino acid, trace elements and vitamins have been described, there is no clear guidance regarding the role of micronutrient supplementation. RECENT FINDINGS A scoping review was conducted with the aim to review the existing literature on micronutrients status during RRT: 35 publications including data on effluent losses and blood concentrations were considered relevant and analysed. For completeness, we also included data on amino acids. Among trace elements, negative balances have been shown for copper and selenium: low blood levels seem to indicate potential deficiency. Smaller size water soluble vitamins were found in the effluent, but not larger size liposoluble vitamins. Low blood values were frequently reported for thiamine, folate and vitamin C, as well as for carnitine. All amino acids were detectable in effluent fluid. Duration of RRT was associated with decreasing blood values. SUMMARY Losses of several micronutrients and amino acids associated with low blood levels represent a real risk of deficiency for vitamins B1 and C, copper and selenium: they should be monitored in prolonged RRT. Further Research is urgently required as the data are insufficient to generate strong conclusions and prescription recommendations for clinical practice.
Collapse
Affiliation(s)
- Mette M. Berger
- Lausanne University Hospital (CHUV) & University of Lausanne, Lausanne, Switzerland
| | - Marcus Broman
- Perioperative and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Lui Forni
- Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust, Department of Clinical & Experimental Medicine, School of Biosciences & Medicine, University of Surrey, Surrey
| | - Marlies Ostermann
- King's College London, Guy's & St Thomas’ Foundation Hospital, Department of Critical Care, London, UK
| | | | - Paul E. Wischmeyer
- Department of Anesthesiology and Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
2
|
Takahashi T, Beppu T, Hidaka Y, Hosoya T. Comparative study of a novel selective urate reabsorption inhibitor "dotinurad" among patient groups with different stages of renal dysfunction. Clin Exp Nephrol 2021; 25:1336-1345. [PMID: 34328574 PMCID: PMC8526486 DOI: 10.1007/s10157-021-02115-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/15/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Dotinurad is a selective urate reabsorption inhibitor (SURI), which selectively inhibits URAT1 to lower serum uric acid levels in patients with hyperuricemia. Herein, the effects of dotinurad were compared among patient groups with different stages of renal dysfunction. METHODS Patient data from four clinical trials were pooled and divided into four groups according to the stage of renal dysfunction to compare the effects of dotinurad at different stages. The grouping (stages G1-G3b) was based on the estimated glomerular filtration rate (eGFR) of the patients. In addition, patient data from a long-term study (34 or 58 weeks) were evaluated in the same manner. RESULTS In the pooled analysis, the percentage of patients achieving a serum uric acid level of ≤ 6.0 mg/dL was 64.7-100.0% at a dose of 2 or 4 mg. In the long-term analysis, the percentage of patients achieving a serum uric acid level of ≤ 6.0 mg/dL was 60.0-100.0% at a dose of 2 or 4 mg. Although the outcomes in stage G3b were worse due to higher baseline serum uric acid levels, satisfactory outcomes were observed in all stages. Even in stages G3a and G3b, when renal function declined, the eGFR remained constant throughout the dose period. CONCLUSION The efficacy of dotinurad was confirmed in hyperuricemic patients with normal renal function (stage G1) and mild to moderate renal dysfunction (stage G2-G3b). Dotinurad was found to be effective in the treatment of hyperuricemia in patients with mild to moderate renal dysfunction.
Collapse
Affiliation(s)
- Toshinari Takahashi
- Medical Affairs Department, Mochida Pharmaceutical Co., Ltd, 1-22 Yotsuya, Shinjuku City, Tokyo, 160-0004, Japan.
| | - Takanobu Beppu
- Medical Affairs Department, Fuji Yakuhin Co., Ltd, 9F Kanda Square Building, 2-2-1 Kandanishiki-cho, Chiyoda City, Tokyo, 101-8189, Japan
| | - Yuji Hidaka
- Akasaka Central Clinic, 3-21-16 Akasaka, Minato City, Tokyo, 107-0052, Japan
| | - Tatsuo Hosoya
- Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato City, Tokyo, 105-8461, Japan
| |
Collapse
|
3
|
Kumagai E, Hosohata K, Furumachi K, Takai S. Effectiveness of monitoring free carnitine levels for L-carnitine supplementation in hemodialysis patients to maintain carnitine sufficiency and nutritional factors. Ther Apher Dial 2021; 25:595-606. [PMID: 33470531 DOI: 10.1111/1744-9987.13621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/04/2021] [Accepted: 01/18/2021] [Indexed: 11/28/2022]
Abstract
We investigated the effectiveness of monitoring serum carnitine levels in hemodialysis patients receiving L-carnitine supplementation. One-hundred forty-five hemodialysis patients were divided into three groups. Group 1 consisted of patients (n = 30) who had been receiving supplementation before this study and then discontinued at the beginning. The remaining patients were divided into Group 2 (n = 13) and Group 3 (n = 102) based on their baseline free carnitine (FC) level, <20 or ≥ 20 μmol/L. Group 2 was started on supplementation, and Groups 1 and 3 were observed without any intervention for the first 6 months. FC was measured every 6 months in all three groups up to 18 months. All patients in whom FC was less than 20 μmol/L at 6 and 12 months were prescribed supplementation. After the first 6 months, the mean ± SD of FC changed from 262.5 ± 87.5 μmol/L at baseline to 70.8 ± 33.6 μmol/L (P < 0.001) in Group 1, from 17.4 ± 1.9 to 193.9 ± 43.3 μmol/L (P < 0.001) in Group 2, and from 49.2 ± 24.6 to 44.2 ± 19.8 μmol/L (P < 0.05) in Group 3. The acyl/free carnitine changed from 0.62 to 0.59 in Group 1 (P = 0.287), from 0.76 to 0.66 in Group 2 (P = 0.054) and from 0.57 to 0.60 in Group 3 (P < 0.05). Of the 145 patients, 126 continued follow-up for the full 18 months. FC remained in the normal range (36-74 μmol/L) within the 95% CI. FC was considered a strong predictor of carnitine deficiency after 6 months (AUC: 0.9146, cut-off value: 33.8 μmol/L). FC monitoring is essential for appropriate carnitine supplementation in hemodialysis patients.
Collapse
Affiliation(s)
- Etsuko Kumagai
- Kenwakai Hospital, Iida, Japan.,Department of Innovative Medicine, Osaka Medical College, Takatsuki, Japan
| | - Keiko Hosohata
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences, Takatsuki, Japan
| | | | - Shinji Takai
- Department of Innovative Medicine, Osaka Medical College, Takatsuki, Japan
| |
Collapse
|
4
|
Yano J, Kaida Y, Maeda T, Hashida R, Tonan T, Nagata S, Hazama T, Nakayama Y, Ito S, Kurokawa Y, Otome T, Shibata R, Tashiro K, Kakuma T, Matsuse H, Fukami K. l-carnitine supplementation vs cycle ergometer exercise for physical activity and muscle status in hemodialysis patients: A randomized clinical trial. Ther Apher Dial 2020; 25:304-313. [PMID: 32777142 PMCID: PMC8247310 DOI: 10.1111/1744-9987.13576] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 12/12/2022]
Abstract
Serum carnitine is decreased in hemodialysis patients, which induces muscle atrophy. Thus, we examined the different effects of l-carnitine and exercise on exercise activity and muscle status in hemodialysis patients. Twenty patients were divided into l-carnitine and cycle ergometer groups and were followed for 3 months. Muscle and fat mass, physical activities, and muscle status were evaluated by an impedance, physical function test, and magnetic resonance imaging, respectively. The l-carnitine significantly increased muscle mass (P = .023) and thigh circumference (P = .027), decreased fat mass (P = .007), and shortened chair stand-up time (P = .002) and 10-m walk test (P = .037). The fat fraction was improved by the l-carnitine (P = .047). Compared with the exercise group, l-carnitine improved the changes in 10-m walk test (P = .026), chair stand-up time (P = .014), and thigh circumference (P = .022). Baseline fibroblast growth factor-21 and myostatin levels predicted the l-carnitine-associated changes in exercise activities. l-carnitine, rather than exercise, improved physical activity and muscle status in hemodialysis patients.
Collapse
Affiliation(s)
- Junko Yano
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Yusuke Kaida
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Takashi Maeda
- Division of Rehabilitation, Kurume University Hospital, Kurume City, Fukuoka, Japan
| | - Ryuki Hashida
- Division of Rehabilitation, Kurume University Hospital, Kurume City, Fukuoka, Japan
| | - Tatsuyuki Tonan
- Department of Radiology, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Shuji Nagata
- Department of Radiology, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Takuma Hazama
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Yosuke Nakayama
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Sakuya Ito
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Yuka Kurokawa
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Takaomi Otome
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Ryo Shibata
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Kyoko Tashiro
- Research Institute of Medical Mass Spectrometry, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Tatsuyuki Kakuma
- Biostatistics Center, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Hiroo Matsuse
- Division of Rehabilitation, Kurume University Hospital, Kurume City, Fukuoka, Japan
| | - Kei Fukami
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| |
Collapse
|