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Bladbjerg EM, Levy-Schousboe K, Frimodt-Møller M, Kjærgaard KD, Strandhave C, Brasen CL, Frandsen NE, Hansen D, Marckmann P. No Detectable Coagulation Activation After Vitamin K (MK-7) Supplementation in Patients on Dialysis With Functional Vitamin K Deficiency: A One-Year Randomized, Placebo-Controlled Study. J Ren Nutr 2023:S1051-2276(23)00231-5. [PMID: 38128853 DOI: 10.1053/j.jrn.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 10/26/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Patients on dialysis treatment have poor functional vitamin K status, and this may increase the risk of vascular calcification. Vitamin K supplementation may therefore be relevant in patients on dialysis, but the procoagulant effects have not been studied. We evaluated effects of menaquinone-7 (MK-7) supplementation on biomarkers of coagulation in patients on dialysis. METHODS Double-blinded, placebo-controlled study in 123 patients on dialysis randomized to 52 weeks of vitamin K (MK-7, 360 μg/daily, n = 61) or placebo (n = 62). Measurements at baseline and after 52 weeks of intervention included thrombin generation (endogenous thrombin potential, peak thrombin concentration, time to peak, and lag time); clot activities of vitamin K-dependent coagulation factors (F) II, VII, IX, and X; prothrombin fragment 1 + 2 (F1+2); and proteins induced by vitamin K absence II (PIVKA-II). Between-group differences (vitamin K vs. placebo) at 52 weeks were determined with an analysis of covariance. Within-group changes in vitamin K and placebo groups were analyzed with a paired t-test. Vascular adverse events and serious adverse events were registered based on hospital records, laboratory data, and participant interviews and compared between groups using Fisher's exact test or Pearson's Chi-Squared test. RESULTS A between-group difference at 52 weeks was observed for PIVKA-II (P < .001). PIVKA-II decreased significantly from baseline to 52 weeks in the vitamin K group, but not in the placebo group. We observed no between-group differences or within-group changes for biomarkers of coagulation, except for FVII clot activity which was reduced in the placebo group (P = .04), and no between-group differences in adverse events and serious adverse events. CONCLUSION One year of vitamin K supplementation in patients on dialysis has no detectable effects on biomarkers of coagulation activation, clot activities of vitamin K-dependent coagulation factors, and vascular events or death, indicating no procoagulant effects of this treatment.
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Affiliation(s)
- Else-Marie Bladbjerg
- Department of Clinical Biochemistry, Unit for Thrombosis Research, Esbjerg Hospital, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark.
| | | | - Marie Frimodt-Møller
- Steno Diabetes Center, Copenhagen, Denmark; Department of Nephrology, Herlev University Hospital, Copenhagen, Denmark
| | - Krista D Kjærgaard
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Claus L Brasen
- Department of Biochemistry and Immunology, Lillebælt Hospital, University Hospital of Southern Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark
| | | | - Ditte Hansen
- Department of Nephrology, Herlev University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Marckmann
- Department of Medicine Sønderborg-Tønder, Hospital Sønderjylland, Sønderborg, Denmark
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Levy-Schousboe K, Marckmann P, Frimodt-Møller M, Peters CD, Kjærgaard KD, Jensen JD, Strandhave C, Sandstrøm H, Hitz MF, Langdahl B, Vestergaard P, Brasen CL, Schmedes A, Madsen JS, Jørgensen NR, Frøkjær JB, Frandsen NE, Petersen I, Hansen D. Vitamin K supplementation and bone mineral density in dialysis: results of the double-blind, randomized, placebo-controlled RenaKvit trial. Nephrol Dial Transplant 2023; 38:2131-2142. [PMID: 36460034 PMCID: PMC10539208 DOI: 10.1093/ndt/gfac315] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Vitamin K deficiency is highly prevalent in patients on dialysis and may contribute to their low bone mineral density (BMD) and increased risk of fracture. This study investigated the effect of menaquinone-7 (MK-7) supplementation on BMD in patients on chronic dialysis. METHODS In a multicentre, double-blind, placebo-controlled intervention trial, 123 patients on chronic dialysis were randomised to a daily oral supplement of either MK-7 360 µg or placebo for 2 years. BMD of the distal radius (1/3, mid, ultradistal and total), femoral neck, lumbar spine (L1-L4) and whole body was assessed by dual-energy X-ray absorptiometry. Serum levels of vitamin K1 and MK-7 and plasma levels of total osteocalcin, dephosphorylated-uncarboxylated matrix Gla protein and protein induced by vitamin K absence II were measured to assess vitamin K status. RESULTS After 2 years, an accelerated BMD loss of the 1/3 distal radius was found with MK-7 supplementation {mean difference of changes relative to placebo -0.023 g/cm2 [95% confidence interval (CI) -0.039 to -0.008]}, whereas the decrease in lumbar spine BMD seen in the placebo group was prevented [mean difference of changes between groups 0.050 g/cm2 (95% CI 0.015-0.085)]. No significant effects were observed at the remaining skeletal sites. Vitamin K status strongly improved in MK-7-supplemented participants. CONCLUSION Compared with placebo, an accelerated BMD loss of the 1/3 distal radius was found after 2 years of MK-7 supplementation, whereas a decline in lumbar spine BMD was prevented. As such, MK-7 supplementation might modify BMD site-specifically in patients on dialysis. In aggregate, our findings do not support MK-7 supplementation to preserve bone in patients on dialysis.
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Affiliation(s)
| | - Peter Marckmann
- Department of Medicine Sønderborg-Tønder, Hospital Sønderjylland, Sønderborg, Denmark
| | - Marie Frimodt-Møller
- Steno Diabetes Center, Copenhagen, Denmark
- Department of Nephrology, Herlev University Hospital, Copenhagen, Denmark
| | - Christian D Peters
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Krista D Kjærgaard
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jens D Jensen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Hanne Sandstrøm
- Department of Radiology, Zealand University Hospital, Roskilde, Denmark
| | - Mette F Hitz
- Department of Medicine, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bente Langdahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Peter Vestergaard
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Claus L Brasen
- Department of Biochemistry and Immunology, Lillebælt Hospital, University Hospital of Southern Denmark, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Anne Schmedes
- Department of Biochemistry and Immunology, Lillebælt Hospital, University Hospital of Southern Denmark, Denmark
| | - Jonna S Madsen
- Department of Biochemistry and Immunology, Lillebælt Hospital, University Hospital of Southern Denmark, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Niklas R Jørgensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Jens B Frøkjær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Niels E Frandsen
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Inge Petersen
- Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Ditte Hansen
- Department of Nephrology, Herlev University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Levy-Schousboe K, Frimodt-Møller M, Hansen D, Peters CD, Kjærgaard KD, Jensen JD, Strandhave C, Elming H, Larsen CT, Sandstrøm H, Brasen CL, Schmedes A, Madsen JS, Jørgensen NR, Frøkjær JB, Frandsen NE, Petersen I, Marckmann P. Vitamin K supplementation and arterial calcification in dialysis: results of the double-blind, randomized, placebo-controlled RenaKvit trial. Clin Kidney J 2021; 14:2114-2123. [PMID: 34476095 PMCID: PMC8406073 DOI: 10.1093/ckj/sfab017] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/05/2021] [Indexed: 01/05/2023] Open
Abstract
Background Arterial calcification is associated with cardiovascular mortality in dialysis patients. Active matrix Gla protein (MGP) is a vitamin K-dependent inhibitor of arterial calcification. Elevated plasma concentrations of inactive MGP, i.e. dephosphorylated-uncarboxylated MGP (dp-ucMGP), are prevalent in dialysis patients. MGP inactivity might contribute to arterial calcification. We investigated whether vitamin K supplementation had an effect on arterial calcification in chronic dialysis patients. Methods In a 2-year, double-blind, placebo-controlled intervention trial, 48 dialysis patients were randomized to vitamin K [menaquinone-7 (MK-7), 360 µg daily] or placebo. MK-7 in serum and dp-ucMGP in plasma were used to assess vitamin K status. Carotid-femoral pulse wave velocity (cfPWV) and scores of coronary arterial calcification (CAC) and abdominal aortic calcification (AAC) were used to assess arterial calcification. Results Thirty-seven participants completed Year 1, and 21 completed Year 2. At Year 2, serum MK-7 was 40-fold higher, and plasma dp-ucMGP 40% lower after vitamin K supplementation compared with placebo {mean dp-ucMGP difference: −1380 pmol/L [95% confidence interval (CI) −2029 to −730]}. There was no significant effect of vitamin K supplementation on cfPWV [mean difference at Year 2: 1.2 m/s (95% CI −0.1 to 2.4)]. CAC Agatston score increased significantly in vitamin K supplemented participants, but was not significantly different from placebo [mean difference at Year 2: 664 (95% CI −554 to 1881)]. AAC scores increased in both groups, significantly so within the placebo group at Year 1, but with no significant between-group differences. Conclusions Vitamin K supplementation improved vitamin K status, but did not hinder or modify the progression of arterial calcification in dialysis patients.
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Affiliation(s)
| | | | - Ditte Hansen
- Department of Nephrology, Herlev University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Jens Dam Jensen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Hanne Elming
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | | | - Hanne Sandstrøm
- Department of Radiology, Zealand University Hospital, Roskilde, Denmark
| | - Claus Lohman Brasen
- Department of Biochemistry and Immunology, Lillebælt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Anne Schmedes
- Department of Biochemistry and Immunology, Lillebælt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Jonna Skov Madsen
- Department of Biochemistry and Immunology, Lillebælt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Jens Brøndum Frøkjær
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Inge Petersen
- Department of Clinical Research, Odense University Open Patient data Explorative Network (OPEN), Odense, Denmark.,Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Peter Marckmann
- Department of Medicine, Sønderborg-Tønder, Hospital Sønderjylland, Sønderborg, Denmark
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Ewers B, Marott JL, Schnohr P, Nordestgaard BG, Marckmann P. Non-adherence to established dietary guidelines associated with increased mortality: the Copenhagen General Population Study. Eur J Prev Cardiol 2020; 28:1259-1268. [PMID: 32646303 DOI: 10.1177/2047487320937491] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 06/05/2020] [Indexed: 11/16/2022]
Abstract
AIMS The relevance of adherence to established dietary guidelines is repeatedly challenged. We hypothesised that non-adherence to established dietary guidelines is associated with an excess risk of cardiovascular, non-cardiovascular and all-cause mortality. METHODS We studied 100,191 white adult Danes aged 20-100 years recruited in 2003-2015 and followed up until December 2018. During follow-up equalling 865,600 person-years, 9273 individuals died. Participants' diets were assessed at baseline by a food frequency questionnaire focusing on key foods defining a healthy diet according to Danish dietary guidelines. Individuals were divided into five categories ranging from very high to very low adherence to dietary guidelines and studied with Cox and Fine-Gray regression models. At study inclusion, we collected demographic and lifestyle characteristics by questionnaire, made a physical examination and took a blood sample. RESULTS Cardiovascular, non-cardiovascular and all-cause mortality increased gradually with increasing non-adherence to dietary guidelines. Cardiovascular mortality was 30% higher (95% confidence interval 7-57%), non-cardiovascular mortality 54% higher (32-79%) and all-cause mortality 43% higher (29-59%) in individuals with very low adherence to dietary guidelines compared with those with very high adherence after adjustments for age, sex, education, income, smoking, leisure time physical activity and alcohol intake. Mortality risk estimates were similar in all strata of adjusted variables. CONCLUSION Non-adherence to Danish food-based dietary guidelines is associated with up to 43% increased all-cause mortality in a dose-response manner. The mortality excess was seen for both cardiovascular and non-cardiovascular causes. The public has good reasons to have confidence in and to adhere to established dietary guidelines.
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Affiliation(s)
| | - Jacob L Marott
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Denmark.,The Copenhagen General Population Study, Herlev and Gentofte Hospital, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Børge G Nordestgaard
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Denmark.,The Copenhagen General Population Study, Herlev and Gentofte Hospital, Denmark.,Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Peter Marckmann
- Department of Internal Medicine, Zealand University Hospital, Denmark
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Affiliation(s)
- Peter Marckmann
- Department of Internal Medicine, Section of Nephrology, Zealand University Hospital, Roskilde, Roskilde, Denmark
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6
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Carrero JJ, Thomas F, Nagy K, Arogundade F, Avesani CM, Chan M, Chmielewski M, Cordeiro AC, Espinosa-Cuevas A, Fiaccadori E, Guebre-Egziabher F, Hand RK, Hung AM, Ikizler TA, Johansson LR, Kalantar-Zadeh K, Karupaiah T, Lindholm B, Marckmann P, Mafra D, Parekh RS, Park J, Russo S, Saxena A, Sezer S, Teta D, Ter Wee PM, Verseput C, Wang AY, Xu H, Lu Y, Molnar MZ, Kovesdy CP. Global Prevalence of Protein-Energy Wasting in Kidney Disease: A Meta-analysis of Contemporary Observational Studies From the International Society of Renal Nutrition and Metabolism. J Ren Nutr 2018; 28:380-392. [DOI: 10.1053/j.jrn.2018.08.006] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 01/09/2023] Open
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7
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Lindeberg S, Berntorp E, Carlsson R, Eliasson M, Marckmann P. Haemostatic Variables in Pacific Islanders Apparently Free from Stroke and Ischaemic Heart Disease – The Kitava Study. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1655913] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryWe cross-sectionally measured plasminogen activator inhibitor-1 (PAI-1) activity, fibrinogen, factor VII (FVII:C) and VIII (FVIII:C) coagulant activity, and von Willebrand factor antigen (VWF:Ag) in 162 traditional horticulturalists older than 40 years from the tropical island of Kitava, Papua New Guinea, where the intake of western food is negligible and where stroke and ischaemic heart disease appear to be absent. Identical analyses were made in Swedish subjects of comparable ages.Kitavans had markedly lower PAI-1 activity, with 85% of males and 100% of females having PAI-1 activity ≤5 U/ml, as compared with 22 and 14% in Swedish males and females (p <0.0001). Surprisingly, Kitavans also had higher FVII:C, FVIII: C and VWF: Ag. Fibrinogen was 10% lower in Kitavan males while 25% higher in Kitavan females.The very low PAI-1 activity in Kitavans may explain some of their apparent freedom from cardiovascular disease and probably relates to their extreme leanness.
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Affiliation(s)
- Staffan Lindeberg
- The Department of Community Health Sciences, Lund University, Lund, Sweden
| | - Erik Berntorp
- The Department of Coagulation Disorders, Malmö University Hospital, Malmö, Sweden
| | - Roland Carlsson
- The Department of Medicine, Central Hospital, Karlstad, Sweden
| | - Mats Eliasson
- The Department of Medicine, Luleå Hospital and Umeå University, Sweden
| | - Peter Marckmann
- The Research Department of Human Nutrition, Royal veterinary and Agricultural University, Frederiksberg, Denmark
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Bladbjerg EM, Tholstrup T, Marckmann P, Sandström B, Jespersen J. Dietary Changes in Fasting Levels of Factor VII Coagulant Activity (FVII: C) Are Accompanied by Changes in Factor VII Protein and other Vitamin K-dependent Proteins. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1653757] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe mechanisms behind dietary effects on fasting coagulant activity of factor VII (FVII: C) are not clarified. In the present study of 15 young volunteers, two experimental diets differing in composition of saturated fatty acids (C18:0 [diet S] or C12:0 + C14:0 [diet ML]) were served for 3 weeks each. Fasting blood samples were collected before and after the dietary regimen and analysed for triglycerides, FVII:C, and protein concentrations of FVII, FII, FX, protein C, CRP, albumin, fibrinogen, and F1+2. FVII:C was significantly reduced on diet S compared with diet ML. This was accompanied by a decrease in FVII protein, F1+2 and the vitamin K-dependent proteins FII, FX, and protein C. In contrast, no changes were observed in triglycerides, FVII:C/FVII: Ag, albumin and CRP. Fibrinogen was increased on diet S compared with diet ML. Our findings suggest that the change in fasting FVII:C was part of a general change in concentrations of vitamin K-dependent proteins.
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Affiliation(s)
- E M Bladbjerg
- The Institute for Thrombosis Research, South Jutland University Centre, Esbjerg, and Department of Clinical Biochemistry, Ribe County Hospital in Esbjerg, Denmark
| | - T Tholstrup
- The Research Department of Human Nutrition, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark
| | - P Marckmann
- The Research Department of Human Nutrition, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark
| | - B Sandström
- The Research Department of Human Nutrition, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark
| | - J Jespersen
- The Institute for Thrombosis Research, South Jutland University Centre, Esbjerg, and Department of Clinical Biochemistry, Ribe County Hospital in Esbjerg, Denmark
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Abstract
SummaryPreliminary observations have suggested that non-fasting factor VII coagulant activity (FVII:C) may be related to the dietary fat content. To confirm this, we performed a randomised cross-over study. Seventeen young volunteers were served 2 controlled isoenergetic diets differing in fat content (20% or 50% of energy). The 2 diets were served on 2 consecutive days. Blood samples were collected at 8.00 h, 16.30 h and 19.30 h, and analysed for triglycerides, FVII coagulant activity using human (FVII:C) or bovine thromboplastin (FVII:Bt), and FVII amidolytic activity (FVIPAm). The ratio FVII:Bt/FVII:Am (a measure of FVII activation) increased from fasting levels on both diets, but most markedly on the high-fat diet. In contrast, FVII: Am (a measure of FVII protein) tended to decrease from fasting levels on both diets. FVII:C rose from fasting levels on the high-fat diet, but not on the low-fat diet. The findings suggest that high-fat diets increase non-fasting FVII:C, and consequently may be associated with increased risk of thrombosis.
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Affiliation(s)
- E M Bladbjerg
- The Section of Coagulation and Fibrinolysis, Department of Clinical Chemistry, Ribe County Hospital in Esbjerg, and Institute for Thrombosis Research, South Jutland University Centre, Esbjerg, Denmark
| | - P Marckmann
- The Research Department of Human Nutrition, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark
| | - B Sandström
- The Research Department of Human Nutrition, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark
| | - J Jespersen
- The Section of Coagulation and Fibrinolysis, Department of Clinical Chemistry, Ribe County Hospital in Esbjerg, and Institute for Thrombosis Research, South Jutland University Centre, Esbjerg, Denmark
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Beveridge LA, Khan F, Struthers AD, Armitage J, Barchetta I, Bressendorff I, Cavallo MG, Clarke R, Dalan R, Dreyer G, Gepner AD, Forouhi NG, Harris RA, Hitman GA, Larsen T, Khadgawat R, Marckmann P, Mose FH, Pilz S, Scholze A, Shargorodsky M, Sokol SI, Stricker H, Zoccali C, Witham MD. Effect of Vitamin D Supplementation on Markers of Vascular Function: A Systematic Review and Individual Participant Meta-Analysis. J Am Heart Assoc 2018; 7:JAHA.117.008273. [PMID: 29848497 PMCID: PMC6015391 DOI: 10.1161/jaha.117.008273] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Low 25‐hydroxyvitamin D levels are associated with an increased risk of cardiovascular events, but the effect of vitamin D supplementation on markers of vascular function associated with major adverse cardiovascular events is unclear. Methods and Results We conducted a systematic review and individual participant meta‐analysis to examine the effect of vitamin D supplementation on flow‐mediated dilatation of the brachial artery, pulse wave velocity, augmentation index, central blood pressure, microvascular function, and reactive hyperemia index. MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials, and http://www.ClinicalTrials.gov were searched until the end of 2016 without language restrictions. Placebo‐controlled randomized trials of at least 4 weeks duration were included. Individual participant data were sought from investigators on included trials. Trial‐level meta‐analysis was performed using random‐effects models; individual participant meta‐analyses used a 2‐stage analytic strategy, examining effects in prespecified subgroups. 31 trials (2751 participants) were included; 29 trials (2641 participants) contributed data to trial‐level meta‐analysis, and 24 trials (2051 participants) contributed to individual‐participant analyses. Vitamin D3 daily dose equivalents ranged from 900 to 5000 IU; duration was 4 weeks to 12 months. Trial‐level meta‐analysis showed no significant effect of supplementation on macrovascular measures (flow‐mediated dilatation, 0.37% [95% confidence interval, −0.23 to 0.97]; carotid‐femoral pulse wave velocity, 0.00 m/s [95% confidence interval, −0.36 to 0.37]); similar results were obtained from individual participant data. Microvascular function showed a modest improvement in trial‐level data only. No consistent benefit was observed in subgroup analyses or between different vitamin D analogues. Conclusions Vitamin D supplementation had no significant effect on most markers of vascular function in this analysis.
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Affiliation(s)
- Louise A Beveridge
- Department of Medicine for the Elderly, NHS Tayside, Dundee, United Kingdom
| | - Faisel Khan
- School of Medicine, University of Dundee, United Kingdom
| | | | - Jane Armitage
- Clinical Trial Service Unit and MRC Population Health Research Unit, University of Oxford, United Kingdom
| | - Ilaria Barchetta
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - Iain Bressendorff
- Department of Nephrology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | | | - Robert Clarke
- Clinical Trial Service Unit and MRC Population Health Research Unit, University of Oxford, United Kingdom
| | - Rinkoo Dalan
- Tan Tock Seng Hospital, Lee Kong Chian School of Medicine Nanyang Technological University, Singapore
| | - Gavin Dreyer
- Department of Nephrology, Barts Health NHS Trust, London, United Kingdom
| | - Adam D Gepner
- University of Wisconsin School of Medicine and Public Health and William S. Middleton Veterans Affairs Hospital, Madison, WI
| | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Ryan A Harris
- Department of Population Health Science, Georgia Prevention Institute Augusta University, Augusta, Georgia, USA
| | - Graham A Hitman
- Blizard Institute, Queen Mary University of London, United Kingdom
| | - Thomas Larsen
- University Clinic in Nephrology and Hypertension, Department of Medical Research, Regional Hospital West Jutland and Aarhus University, Aarhus, Denmark
| | - Rajesh Khadgawat
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Peter Marckmann
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Frank H Mose
- University Clinic in Nephrology and Hypertension, Department of Medical Research, Regional Hospital West Jutland and Aarhus University, Aarhus, Denmark
| | - Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Austria
| | - Alexandra Scholze
- Department of Nephrology, Odense University Hospital and Institute of Clinical Research University of Southern Denmark, Odense, Denmark
| | - Marina Shargorodsky
- Department of Endocrinology, Wolfson Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Seth I Sokol
- Division of Cardiology, Jacobi Medical Center, NY
| | - Hans Stricker
- Department of Angiology, Ospedale La Carita, Locarno, Switzerland
| | - Carmine Zoccali
- CNR-IFC Clinical Epidemiology and Pathphysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Miles D Witham
- School of Medicine, University of Dundee, United Kingdom
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Marckmann P, Koefoed M. SP676NEW AND SIMPLE METHOD FOR ASSESSMENT OF NUTRITIONAL STATUS. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peter Marckmann
- Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Mette Koefoed
- Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
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Levy-Schousboe K, Hansen D, Frimodt-Moeller M, Elming H, Toftager Larsen C, Marckmann P. SP536CORONARY ARTERIAL CALCIFICATION, ABDOMINAL AORTIC CALCIFICATION, AND PULSE WAVE VELOCITY IN DIALYSIS PATIENTS. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Ditte Hansen
- Dept. of Nephrology, Herlev Hospital, Herlev, Copenhagen, Denmark
| | - Marie Frimodt-Moeller
- Steno Diabetes Center Copenhagen, Steno Diabetes Center Copenhagen, Gentofte, Copenhagen, Denmark
| | - Hanne Elming
- Dept. of Cardiology, University Hospital of Zealand, Roskilde-Koege, Denmark
| | | | - Peter Marckmann
- Dept. of Medicine, University Hospital of Zealand, Roskilde, Denmark
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Hansen D, Marckmann P. Importance of Differentiation Between Phosphorous and Phosphate. J Ren Nutr 2017; 27:447. [DOI: 10.1053/j.jrn.2017.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 04/26/2017] [Indexed: 11/11/2022] Open
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Turner B, Mølgaard C, Marckmann P. Effect of dried garlic powder tablets on postprandial increase in pulse wave velocity after a fatty meal: preliminary observations. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/11026480510011343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Beate Turner
- Department of Human Nutrition and Centre for Advanced Food Studies, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark
| | - Christian Mølgaard
- Dansk Droge, Ishøj, Denmark Department of Internal Medicine, Roskilde Hospital, Roskilde, Denmark
| | - Peter Marckmann
- Department of Human Nutrition and Centre for Advanced Food Studies, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark
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Juliussen S, Hvidtfeldt D, Koefoed M, Kromann C, Andersen J, Marckmann P. MON-P105: The Effect of Protein-Energy Wasting and Obesity on Prognosis in Dialysis Patients - A Prospective Cohort Study With 9 to 12 Months Follow-Up Udarbejdetaf:. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30739-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Engberg H, Wehberg S, Bistrup C, Heaf J, Sørensen SS, Thiesson HC, Hansen JM, Svensson M, Green A, Marckmann P. Cancer risk and mortality after kidney transplantation: a population-based study on differences between Danish centres using standard immunosuppression with and without glucocorticoids. Nephrol Dial Transplant 2016; 31:2149-2156. [DOI: 10.1093/ndt/gfw304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/03/2016] [Indexed: 12/14/2022] Open
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Koefoed M, Kromann C, Juliussen S, Hvidtfeldt D, Andersen J, Marckmann P. MON-P106: Historical Study (1986-2014): Improvements In Nutritional Status Of Dialysis Patients. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30740-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Koefoed M, Kromann CB, Hvidtfeldt D, Juliussen SR, Andersen JR, Marckmann P. Historical Study (1986-2014): Improvements in Nutritional Status of Dialysis Patients. J Ren Nutr 2016; 26:320-4. [PMID: 27266624 DOI: 10.1053/j.jrn.2016.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/02/2016] [Accepted: 04/26/2016] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Malnutrition is common in dialysis patients and is associated with adverse clinical outcomes. Despite an increased focus on improved nutrition in dialysis patients, it is claimed that the prevalence of malnutrition in this group of patients has not changed during the last decades. Direct historical comparisons of the nutritional status of dialysis patients have never been published. To directly compare the nutritional status of past and current dialysis patients, we implemented the methodology of a study from 1986 on a population of dialysis patients in 2014. DESIGN Historical study comparing results of two cross-sectional studies performed in 1986 and 2014. SETTING We compared the nutritional status of hemodialysis (HD) and peritoneal dialysis (PD) patients attending the dialysis center at Roskilde Hospital, Denmark, in February to June 2014, with that of HD and PD patients treated at the dialysis center at Fredericia Hospital, Denmark, in April 1986. SUBJECTS Maintenance PD and HD patients (n = 64 in 2014 and n = 48 in 1986). METHODS We performed anthropometry (body weight, triceps skinfold, and midarm muscle circumferences [MAMCs]) and determined plasma transferrin. MAIN OUTCOME MEASURE Relative body weight, triceps skinfold, MAMC, body mass index, and prevalence of protein-caloric malnutrition as defined in the original study from 1986. RESULTS Average relative body weight, triceps skinfold, MAMC, and body mass index were significantly higher in 2014 compared with 1986. The prevalence of protein-caloric malnutrition was significantly lower in 2014 (18%) compared with 1986 (52%). CONCLUSIONS The nutritional status of maintenance dialysis patients has improved during the last 3 decades. The reason for this improvement could not be identified in the present study, but the most likely contributors are the higher prevalence of obesity in the general population, less predialytic malnutrition, and an improved focus on nutrition in maintenance dialysis patients.
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Affiliation(s)
- Mette Koefoed
- Department of Internal Medicine, Section of Nephrology, Holbæk Hospital, Denmark.
| | - Charles Boy Kromann
- Department of Internal Medicine, Section of Nephrology, Zealand University Hospital, Denmark
| | - Danni Hvidtfeldt
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | | | - Jens Rikardt Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Peter Marckmann
- Department of Internal Medicine, Section of Nephrology, Zealand University Hospital, Denmark
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Koefoed M, Kromann CB, Juliussen SR, Hvidtfeldt D, Ekelund B, Frandsen NE, Marckmann P. Nutritional Status of Maintenance Dialysis Patients: Low Lean Body Mass Index and Obesity Are Common, Protein-Energy Wasting Is Uncommon. PLoS One 2016; 11:e0150012. [PMID: 26919440 PMCID: PMC4771706 DOI: 10.1371/journal.pone.0150012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/08/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND AIMS Maintenance dialysis patients are at increased risk of abnormal nutritional status due to numerous causative factors, both nutritional and non-nutritional. The present study assessed the current prevalence of protein-energy wasting, low lean body mass index and obesity in maintenance dialysis patients, and compared different methods of nutritional assessment. METHODS In a cross-sectional study conducted in 2014 at Roskilde Hospital, Denmark, we performed anthropometry (body weight, skinfolds, mid-arm, waist, and hip circumferences), and determined plasma albumin and normalized protein catabolic rate in order to assess the prevalence of protein-energy wasting, low lean body mass index and obesity in these patients. RESULTS Seventy-nine eligible maintenance dialysis patients participated. The prevalence of protein-energy wasted patients was 4% (95% CI: 2-12) as assessed by the coexistence of low lean body mass index and low fat mass index. Low lean body mass index was seen in 32% (95% CI: 22-44). Obesity prevalence as assessed from fat mass index was 43% (95% CI: 32-55). Coexistence of low lean body mass index and obesity was seen in 10% (95% CI: 5-19). The prevalence of protein-energy wasting and obesity varied considerably, depending on nutritional assessment methodology. CONCLUSIONS Our data indicate that protein-energy wasting is uncommon, whereas low lean body mass index and obesity are frequent conditions among patients in maintenance dialysis. A focus on how to increase and preserve lean body mass in dialysis patients is suggested in the future. In order to clearly distinguish between shortage, sufficiency and abundance of protein and/or fat deposits in maintenance dialysis patients, we suggest the simple measurements of lean body mass index and fat mass index.
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Affiliation(s)
- Mette Koefoed
- Department of Internal Medicine, section of Nephrology, Holbæk Hospital, Health Sciences faculty, University of Copenhagen, Holbaek, Denmark
- * E-mail:
| | - Charles Boy Kromann
- Department of Dermatology, Roskilde Hospital, Health Sciences faculty, University of Copenhagen, Roskilde, Denmark
| | - Sophie Ryberg Juliussen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen N, Denmark
| | - Danni Hvidtfeldt
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen N, Denmark
| | - Bo Ekelund
- Department of Internal Medicine, section of Nephrology, Roskilde Hospital, Health Sciences faculty, University of Copenhagen, Roskilde, Denmark
| | - Niels Erik Frandsen
- Department of Internal Medicine, section of Nephrology, Roskilde Hospital, Health Sciences faculty, University of Copenhagen, Roskilde, Denmark
| | - Peter Marckmann
- Department of Internal Medicine, section of Nephrology, Roskilde Hospital, Health Sciences faculty, University of Copenhagen, Roskilde, Denmark
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Marckmann P. Misleading conclusions on health effects of cheese and meat-enriched diets in study sponsored by dairy industry. Am J Clin Nutr 2016; 103:291-2. [PMID: 26728695 DOI: 10.3945/ajcn.115.124503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Peter Marckmann
- From the Department of Internal Medicine, Roskilde Hospital, Roskilde, Denmark (e-mail: )
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Marckmann P, Osther P, Pedersen AN, Jespersen B. High-protein diets and renal health. J Ren Nutr 2014; 25:1-5. [PMID: 25091135 DOI: 10.1053/j.jrn.2014.06.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 05/21/2014] [Accepted: 06/06/2014] [Indexed: 12/16/2022] Open
Abstract
High-protein diets (i.e., protein content of more than 25% of energy or more than 2 g/kg body weight per day) based on meat and dairy products are repeatedly promoted for weight reduction and better health, but the evidence supporting these notions is quite dubious. As described in the present review, there is a reason to be concerned about adverse effects of such diets, including glomerular hyperfiltration, hypertensive effects of a concomitant increase in dietary sodium, and an increased risk of nephrolithiasis. These diet-induced physiological consequences might lead to an increase in the prevalence of chronic kidney disease in the general population without preexisting kidney disease. Accordingly, we find medical reasons to refrain from promoting high-protein diets, in particular those based on meat and dairy products, until clear-cut evidence for the safety and for the superiority of such diets on human health has been provided.
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Affiliation(s)
- Peter Marckmann
- Section of Nephrology, Department of Internal Medicine, Roskilde Hospital, Roskilde, Denmark.
| | - Palle Osther
- Department of Urology, Fredericia Hospital - a part of Hospital Littlebelt, University of Southern Denmark, Fredericia, Denmark
| | - Agnes N Pedersen
- Department of Nutrition, DTU Food, National Food Institute, Technical University of Denmark, Soeborg, Denmark
| | - Bente Jespersen
- Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark
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Borras M, Roig J, Betriu A, Vilar A, Hernandez M, Martin M, Fernandez ED, Dounousi E, Kiatou V, Papagianni A, Zikou X, Pappas K, Pappas E, Tatsioni A, Tsakiris D, Siamopoulos KC, Kim JK, Kim Y, Kim SG, Kim HJ, Ahn SY, Chin HJ, Oh KH, Ahn C, Chae DW, Yazici R, Altintepe L, Bakdik S, Guney I, Arslan S, Topal M, Karagoz A, Stefan G, Mircescu G, Capusa C, Stancu S, Petrescu L, Alecu S, Nedelcu D, Bennett AHL, Pham H, Garrity M, Magdeleyns E, Vermeer C, Zhang M, Ni Z, Zhu M, Yan J, Mou S, Wang Q, Qian J, Saade A, Karavetian M, ElZein H, de Vries N, de Haseth DE, Lay Penne E, van Dam B, Bax WA, Bots ML, Grooteman MPC, van den Dorpel RA, Blankenstijn PJ, Nube MJ, Wee PM, Park JH, Jo YI, Lee JH, Cianfrone P, Comi N, Lucisano G, Piraina V, Talarico R, Fuiano G, Toyonaga M, Fukami K, Yamagishi SI, Kaida Y, Nakayama Y, Ando R, Obara N, Ueda S, Okuda S, Granatova J, Havrda M, Hruskova Z, Tesar V, Viklicky O, Rysava R, Rychlik I, Kratka K, Honsova E, Vernerova Z, Maluskova J, Vranova J, Bolkova M, Borecka K, Benakova H, Zima T, Lu KC, Yang HY, Su SL, Cao YH, Lv LL, Liu BC, Zeng R, Gao XF, Deng YY, Boelaert J, t' Kindt R, Glorieux G, Schepers E, Jorge L, Neirynck N, Lynen F, Sandra P, Sandra K, Vanholder R, Yamamoto T, Nameta M, Yoshida Y, Uhlen M, Shi Y, Tang J, Zhang J, An Y, Liao Y, Li Y, Tao Y, Wang L, Koibuchi K, Tanaka K, Aoki T, Miyagi M, Sakai K, Aikawa A, Martins AR, Branco PQ, Serra FM, Matias PJ, Lucas CP, Adragao T, Duarte J, Oliveira MM, Saraiva AM, Barata JD, Masola V, Zaza G, Granata S, Proglio M, Pontrelli P, Abaterusso C, Schena F, Gesualdo L, Gambaro G, Lupo A, Pruijm M, Hofmann L, Stuber M, Zweiacker C, Piskunowicz M, Muller ME, Vogt B, Burnier M, Togashi N, Yamashita T, Mita T, Ohnuma Y, Hasegawa T, Endo T, Tsuchida A, Ando T, Yoshida H, Miura T, Bevins A, Assi L, Ritchie J, Jesky M, Stringer S, Kalra P, Hutchison C, Harding S, Cockwell P, Viccica G, Cupisti A, Chiavistelli S, Borsari S, Pardi E, Centoni R, Fumagalli G, Cetani F, Marcocci C, Scully P, O'Flaherty D, Sankaralingam A, Hampson G, Goldsmith DJ, Pallet N, Chauvet S, Beaune P, Nochy D, Thervet E, Karras A, Bertho G, Gallyamov MG, Saginova EA, Severova MM, Krasnova TN, Kopylova AA, Cho E, Jo SK, Kim MG, Cho WY, kim HK, Trivin C, Metzger M, Boffa JJ, Vrtovsnik F, Houiller P, Haymann JP, Flamant M, Stengel B, Thervet E, Roozbeh J, Yavari V, Pakfetrat M, Zolghadr AA, Kim CS, Kim MJ, Kang YU, Choi JS, Bae EH, Ma SK, Kim SW, Lemoine S, Guebre-Egziabher F, Dubourg L, Hadj-Aissa A, Blumberg S, Katzir Z, Biro A, Cernes R, Barnea Z, Vasquez D, Gordillo R, Aller C, Fernandez B, Jabary N, Perez V, Mendiluce A, Bustamante J, Coca A, Goek ON, Sekula P, Prehn C, Meisinger C, Gieger C, Suhre K, Adamski J, Kastenmuller G, Kottgen A, Kuzniewski M, Fedak D, Dumnicka P, Solnica B, Kusnierz-Cabala B, Kapusta M, Sulowicz W, Drozdz R, Zawada AM, Rogacev KS, Hummel B, Fliser D, Geisel J, Heine GH, Kretschmer A, Volsek M, Krahn T, Kolkhof P, Kribben A, Bruck H, Koh ES, Chung S, Yoon HE, Park CW, Chang YS, Shin SJ, Deagostini MC, Vigotti FN, Ferraresi M, Consiglio V, Scognamiglio S, Moro I, Clari R, Daidola G, Versino E, Piccoli GB, Mammadrahim Agayev M, Mehrali Mammadova I, Qarib Ismayilova S, Anguiano L, Riera M, Pascual J, Barrios C, Betriu A, Valdivielso JM, Fernandez E, Soler MJ, Tsarpali V, Liakopoulos V, Panagopoulou E, Kapoukranidou D, Spaia S, Kostopoulou M, Michalaki A, Nikitidou O, Dombros N, Zhu F, Abba S, Flores-Gama C, Williams C, Cartagena C, Carter M, Kotanko P, Levin NW, Kolesnyk M, Stepanova N, Driyanska V, Stashevska N, Kundin V, Shifris I, Dudar I, Zaporozhets O, Keda T, Ishchenko M, Khil M, Choe JY, Nam SA, Kim J, Cha JH, Gliga ML, Irimescu CG, Caldararu CD, Gliga MG, Toma LV, Gomotarceanu A, Park Y, Kim Y, Jeon J, Kwon SK, Kim SJ, Kim SM, Kim HY, Montero N, Soler MJ, Barrios C, Marquez E, Berrada A, Arias C, Prada JA, Orfila MA, Mojal S, Vilaplana C, Pascual J, Vigotti FN, Attini R, Parisi S, Fassio F, Deagostini MC, Ghiotto S, Ferraresi M, Clari R, Biolcati M, Todros T, Piccoli GB, Jin K, Vaziri ND, Tramonti G, Romiti N, Chieli E, Maksudova AN, Khusnutdinova LA, Tang J, Shi Y, Zhang J, Li Y, An Y, Tao Y, Wang L, Reque JE, Quiroga B, Lopez JM, Verdallez UG, Garcia de Vinuesa M, Goicoechea M, Nayara PG, Arroyo DR, Luno J, Tanaka H, Flores-Gama C, Abbas SR, Williams C, Cartagena C, Carter M, Thijssen S, Kotanko P, Levin NW, Zhu F, Berthoux FC, Azzouz L, Afiani A, Ziane A, Mariat C, Fournier H, Kusztal M, Dzierzek P, Witkowski G, Nurzynski M, Golebiowski T, Weyde W, Klinger M, Altiparmak MR, Seyahi N, Trabulus S, Bolayirli M, Andican ZG, Suleymanlar G, Serdengecti K, Niculae A, Checherita IA, Neagoe DN, Ciocalteu A, Seiler S, Rogacev KS, Pickering JW, Emrich I, Fliser D, Heine G, Bargnoux AS, Obiols J, Kuster N, Fessler P, Badiou S, Dupuy AM, Ribstein J, Cristol JP, Yanagisawa N, Ando M, Ajisawa A, Tsuchiya K, Nitta K, Bouquegneau A, Cavalier E, Krzesinski JM, Delanaye P, Tominaga N, Shibagaki Y, Kida K, Miyake F, Kimura K, Ayvazyan A, Rameev V, Kozlovskaya L, Simonyan A, Scholze A, Marckmann P, Tepel M, Rasmussen LM, Hara M, Ando M, Tsuchiya K, Nitta K, Kanai H, Harada K, Tamura Y, Kawai Y, Al-Jebouri MM, Madash SA, Leonidovna Berezinets O, Nicolaevich Rossolovskiy A. Lab methods / biomarkers. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Marckmann P. [Healthy and sustainable diet is the goal]. Ugeskr Laeger 2013; 175:1211. [PMID: 23833770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Marckmann P. [Reply: Diogenes study does not show weight loss]. Ugeskr Laeger 2013; 175:902. [PMID: 23734376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Marckmann P. [Nine reasons not to recommend protein rich diet]. Ugeskr Laeger 2013; 175:144. [PMID: 23451345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Scholze A, Bladbjerg EM, Sidelmann JJ, Diederichsen ACP, Mickley H, Nybo M, Argraves WS, Marckmann P, Rasmussen LM. Plasma concentrations of extracellular matrix protein fibulin-1 are related to cardiovascular risk markers in chronic kidney disease and diabetes. Cardiovasc Diabetol 2013; 12:6. [PMID: 23294625 PMCID: PMC3570481 DOI: 10.1186/1475-2840-12-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 01/03/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Fibulin-1 is one of a few extracellular matrix proteins present in blood in high concentrations. We aimed to define the relationship between plasma fibulin-1 levels and risk markers of cardiovascular disease. METHODS Plasma fibulin-1 was determined in subjects with chronic kidney disease (n = 32; median age 62.5, inter-quartile range 51 - 73 years) and 60 age-matched control subjects. Among kidney disease patients serological biomarkers related to cardiovascular disease (fibrinogen, interleukin 6, C-reactive protein) were measured. Arterial applanation tonometry was used to determine central hemodynamic and arterial stiffness indices. RESULTS We observed a positive correlation of fibulin-1 levels with age (r = 0.38; p = 0.033), glycated hemoglobin (r = 0.80; p = 0.003), creatinine (r = 0.35; p = 0.045), and fibrinogen (r = 0.39; p = 0.027). Glomerular filtration rate and fibulin-1 were inversely correlated (r = -0.57; p = 0.022). There was a positive correlation between fibulin-1 and central pulse pressure (r = 0.44; p = 0.011) and central augmentation pressure (r = 0.55; p = 0.001). In a multivariable regression model, diabetes, creatinine, fibrinogen and central augmentation pressure were independent predictors of plasma fibulin-1. CONCLUSION Increased plasma fibulin-1 levels were associated with diabetes and impaired kidney function. Furthermore, fibulin-1 levels were associated with hemodynamic cardiovascular risk markers. Fibulin-1 is a candidate in the pathogenesis of cardiovascular disease observed in chronic kidney disease and diabetes.
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Affiliation(s)
- Alexandra Scholze
- Clinical Research Unit, Department of Nephrology, Odense University Hospital, Odense, Denmark.
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Marckmann P, Agerskov H, Thineshkumar S, Bladbjerg EM, Sidelmann JJ, Jespersen J, Nybo M, Rasmussen LM, Hansen D, Scholze A. Randomized controlled trial of cholecalciferol supplementation in chronic kidney disease patients with hypovitaminosis D. Nephrol Dial Transplant 2012; 27:3523-31. [PMID: 22822092 DOI: 10.1093/ndt/gfs138] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hypovitaminosis D is common in chronic kidney disease (CKD). Effects of 25-hydroxyvitamin D replenishment in CKD are not well described. METHODS An 8-week randomized, placebo-controlled, double-blind parallel intervention study was conducted in haemodialysis (HD) and non-HD CKD patients. Treatment consisted of 40,000 IU of cholecalciferol orally per week. Plasma 25-hydroxyvitamin D (25-OHD), plasma 1,25-dihydroxyvitamin D (1,25-diOHD), plasma parathyroid hormone (PTH), serum phosphate, ionized serum calcium and serum fibroblast growth factor 23 (FGF-23) were analysed. We also investigated biomarkers related to cardiovascular disease (plasma D-dimer, plasma fibrinogen, plasma von Willebrand factor antigen and activity, plasma interleukin 6, plasma C-reactive protein, blood pressure, aortic augmentation index, aortic pulse wave velocity and 24-h urinary protein loss). Objective and subjective health variables were assessed (muscle function tests, visual analogue scores and Health Assessment Questionnaire). RESULTS Fifty-two CKD patients with 25-OHD <50 nmol/L at screening were included. Cholecalciferol supplementation led to a significant increase to a median of 155 nmol/L 25-OHD (interquartile range 137-173 nmol/L) in treated patients (n = 25, P < 0.001). In non-HD patients, we saw a significant increase in 1,25-diOHD (n = 13, P < 0.01) and a lowering of PTH (n = 13, P < 0.001). This was not observed in HD patients. Cholecalciferol supplementation caused a significant increase in serum calcium and FGF-23. CONCLUSIONS 25-OHD replenishment was effectively obtained with the employed cholecalciferol dosing. In non-HD patients, it had favourable effects on 1,25-diOHD and PTH. Vitamin D-supplemented patients must be monitored for hypercalcaemia. The present study could not identify significant pleiotropic effects of 25-OHD replenishment.
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Affiliation(s)
- Peter Marckmann
- Clinical Research Unit, Department of Nephrology, Odense University Hospital, Odense, Denmark.
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Sodemann U, Bistrup C, Marckmann P. Cancer rates after kidney transplantation. Dan Med Bull 2011; 58:A4342. [PMID: 22142571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Previous studies demonstrated a 3-5-fold increased cancer risk in kidney allograft recipients compared with the general population. Our aim was to estimate cancer frequencies among kidney allograft recipients who were transplanted in 1997-2000 and who were immunosuppressed according to a more modern steroid-free standard protocol based on basixilimab, ciclosporine and mycophenolate mofetil. MATERIAL AND METHODS This was a retrospective cohort study of patients receiving their first kidney allograft in 1997-2000 at Odense University Hospital, Denmark (n = 90). Histologically verified cancers were identified from a detailed search of the individual patient's medical records. RESULTS During an average follow-up time of 8.4 years, a total of 14 cancers were observed. The cancer incidence rate was 18.5 (95% confidence interval (CI): 11.0-31.3) per 1,000 years, and the cancer prevalence was 13.4% (95% CI: 5.6-21.2%) among survivors in 2007. The relative risk of prevalent cancer was 3.6 (95% CI: 2.0-6.5) compared with the general population. Patients with cancer had a poorer survival than patients without cancer. CONCLUSION The observed cancer incidence rate and prevalence were similar to figures derived from studies performed in the earlier eras of kidney transplantation. Reducing cancer rates after kidney transplantation remains an important challenge for nephrologists. FUNDING not relevant. TRIAL REGISTRATION not relevant.
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Affiliation(s)
- Ulrik Sodemann
- Department of Nephrology, Odense University Hospital, 5000 Odense C, Denmark.
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29
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Abstract
Vitamin D receptor agonists (VDRA) are currently recommended for the treatment of secondary hyperparathyroidism in stage 5 CKD. They are considered to be contraindicated in the presence of low or normal (for a dialysis patient) levels of PTH due to the risk of developing adynamic bone disease, with consequent vascular calcification. However, these recommendations are increasingly at odds with the epidemiological evidence, which consistently shows a large survival advantage for patients treated with low-dose VDRAs, regardless of plasma calcium, phosphate, or PTH. A large number of pleiotropic effects of vitamin D have been described, including inhibition of renin activity, anti-inflammation, and suppression of vascular calcification stimulators and stimulation of vascular calcification inhibitors present in the uremic milieu. Laboratory studies suggest that a normal cellular vitamin D level is necessary for normal cardiomyocyte and vascular smooth muscle function. While pharmacological doses of VDRA can be harmful, the present evidence suggests that the level of 1,25-dihydroxycholecalciferol should also be more physiological in stage 5 CKD, and that widespread use of low-dose VDRA would be beneficial. A randomized controlled trial to test this hypothesis is warranted.
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Affiliation(s)
- James Goya Heaf
- Department of Nephrology, University of Copenhagen Herlev Hospital, Herlev, Denmark.
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Iggman D, Gustafsson IB, Berglund L, Vessby B, Marckmann P, Risérus U. Replacing dairy fat with rapeseed oil causes rapid improvement of hyperlipidaemia: a randomized controlled study. J Intern Med 2011; 270:356-64. [PMID: 21466598 DOI: 10.1111/j.1365-2796.2011.02383.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rapeseed oil (RO), also known as canola oil, principally contains the unsaturated fatty acids 18:1n-9, 18:2n-6 and 18:3n-3 and may promote cardiometabolic health. OBJECTIVE To investigate the effects on lipoprotein profile, factors of coagulation and insulin sensitivity of replacing a diet rich in saturated fat from dairy foods (DF diet) with a diet including RO-based fat (RO diet). DESIGN During a 2×3-week randomized, controlled, cross-over trial, 20 free-living hyperlipidaemic subjects were provided with isocaloric test diets that differed in fat composition alone. Blood lipoprotein profile, coagulation and fibrinolytic factors and insulin sensitivity (euglycaemic clamp) were determined before and after the dietary intervention. RESULTS All subjects completed the study, and compliance was high according to changes in serum fatty acids. The RO diet, but not the DF diet, reduced the levels of serum cholesterol (-17%), triglycerides (-20%) and low-density lipoprotein cholesterol (-17%), cholesterol/high-density lipoprotein (HDL) cholesterol ratio (-21%), apolipoprotein (apo) B/apo A-I ratio (-4%) and factor VII coagulant activity (FVIIc) (-5%) from baseline. These changes were significantly different between the diets (P=0.05 to P<0.0001), except for FVIIc (P=0.1). The RO diet, but not the DF diet, modestly increased serum lipoprotein(a) (+6%) and tended to increase the glucose disappearance rate (K-value, +33%). HDL cholesterol, insulin sensitivity, fibrinogen and tissue plasminogen activator inhibitor-1 levels did not change from baseline or differ between the two diets. CONCLUSIONS In a diet moderately high in total fat, replacing dairy fat with RO causes a rapid and clinically relevant improvement in serum lipoprotein profile including lowering of triglycerides in hyperlipidaemic individuals.
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Affiliation(s)
- D Iggman
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
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31
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Abstract
Hypovitaminosis D is highly prevalent in adult kidney-transplanted patients. The knowledge of vitamin D status in kidney-transplanted children and adolescents is sparse. The present study investigated the vitamin D status of a cohort of kidney-transplanted children and adolescents, and the association between vitamin D status and plasma concentrations of PTH, ionized calcium, and phosphate. The study included 35 patients with a functioning graft. Their mean age was 12.0 yr, and the mean graft age was 2.8 yr. Forty percent of the patients were vitamin D insufficient (P-25-hydroxyvitamin D 40-75 nm), and 14% were deficient (P-25-hydroxyvitamin D < 40 nm). S-25-hydroxyvitamin D was inversely associated with PTH (p = 0.02) and positively associated with S-1,25-dihydroxyvitamin D (p = 0.02). There was no significant association between S-1,25-dihydroxyvitamin D and PTH. In conclusion, we found hypovitaminosis D in 54% of the study population despite the fact that samples were collected in spring and summer months. Hypovitaminosis D was associated with adverse effects on PTH and 1,25-dihydroxyvitamin D. Our data suggest that it is warranted to monitor vitamin D status of kidney-transplanted children and adolescents and indicate that correction of hypovitaminosis D might have favorable effects on calcium-phosphate metabolism.
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Sanyal S, Marckmann P, Scherer S, Abraham JL. Multiorgan gadolinium (Gd) deposition and fibrosis in a patient with nephrogenic systemic fibrosis--an autopsy-based review. Nephrol Dial Transplant 2011; 26:3616-26. [DOI: 10.1093/ndt/gfr085] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Khurram M, Skov L, Rossen K, Thomsen HS, Marckmann P. Nephrogenic systemic fibrosis: A serious iatrogenic disease of renal failure patients. ACTA ACUST UNITED AC 2009; 41:565-6. [DOI: 10.1080/00365590701701327] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Misbah Khurram
- Department of Nephrology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Lone Skov
- the Departments of Dermatology, Copenhagen University Hospital Gentofte, Gentofte, Denmark
| | - Kristian Rossen
- Pathology, Copenhagen University Hospital Gentofte, Gentofte, Denmark
| | - Henrik S. Thomsen
- Department of Diagnostic Radiology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Peter Marckmann
- Department of Nephrology, Copenhagen University Hospital Herlev, Herlev, Denmark
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35
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Ewers B, Riserus U, Marckmann P. Effects of unsaturated fat dietary supplements on blood lipids, and on markers of malnutrition and inflammation in hemodialysis patients. J Ren Nutr 2009; 19:401-11. [PMID: 19541503 DOI: 10.1053/j.jrn.2009.04.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2008] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE We examined the effects of commercially available unsaturated fat dietary supplements on blood lipids, and on markers of malnutrition and inflammation, in an adult population of hemodialysis (HD) patients. DESIGN This was a restricted, randomized (equal blocks), investigator-blinded 2x6 week crossover trial, without a washout interval. SETTING This study was conducted at the Department of Nephrology, Copenhagen University Hospital Herlev, Herlev, Denmark, in spring 2007. PATIENTS Participants included 40 (30 males and 10 females) stable, adult patients undergoing regular HD, with a mean age of 64.6 years and a mean body mass index of 23.3kg/m(2). INTERVENTION In addition to patients' habitual diets, oral unsaturated fat supplements (90mL of Calogen [SHS International, Ltd., Liverpool, UK] and 4 capsules of Pikasol [Dansk Droge, Ishoej, Denmark]) were given in one period, whereas no supplements were given in the other. Dietary supplements contributed 1.8 MJ (430kcal), 47g fat, 26.5g monounsaturated fatty acids, and 3g marine n-3 polyunsaturated fatty acids per day. Blood sampling and nutritional assessments were performed at baseline, after 6 weeks, and after 12 weeks. MAIN OUTCOME MEASURES Dietary intakes, blood lipids, dry body weight, serum albumin, and serum C-reactive protein comprised our main outcome measures. RESULTS According to a per-protocol analysis of 14 study completers, fat supplementation resulted in significantly increased total energy intake (+1.6 MJ/day, or 380kcal/day) and an increased dietary fat energy percentage (+9%). We observed no significant changes in blood lipids. Dry body weight (+0.49kg, P=.04) increased, and serum C-reactive protein concentration fell (-1.69mg/L, P=.01), with fat supplementation. Intention-to-treat analysis of 39 participants confirmed the absence of adverse blood-lipid changes. CONCLUSIONS Unsaturated fat supplementation increased total dietary energy intake to recommended levels, had no adverse impact on blood lipids, improved nutritional status as assessed according to dry body weight, and reduced systemic inflammation as assessed according to C-reactive protein serum concentrations. Adding unsaturated fat to the diet seems to be a safe and effective way to prevent and treat malnutrition in hemodialysis patients.
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Affiliation(s)
- Bettina Ewers
- Department of Internal Medicine, Copenhagen University Hospital, Frederiksberg, Denmark
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36
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Yderstraede KB, Clemmensen O, Nielsen AM, Marckmann P, Bygum A. [Calciphylaxis]. Ugeskr Laeger 2009; 171:1860-1864. [PMID: 19486617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Calciphylaxis is a serious condition including ischaemic, nodular necrosis of the subcutaneous tissue and occlusion of small and medium-sized arteries. The prevalence of calciphylaxis among patients on chronic haemodialysis constitutes 1-4 percent. The condition is associated with high mortality due to co-morbidity. Calciphylaxis seems to be preventable by optimized control of calcium-phosphorous metabolism in susceptible individuals. New and promising therapies are evolving. It is important to focus on this condition in order to provide the relevant therapy to the affected cases.
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Abstract
BACKGROUND Nephrogenic systemic fibrosis (NSF) is a serious disease that occurs in patients with severe renal disease and is believed to be caused by gadolinium-containing contrast agents. A detailed description of the late skin manifestations of NSF is important to help dermatologists and nephrologists recognize the disease. OBSERVATIONS We studied 17 patients with NSF late in the disease. All patients showed epidermal atrophy and hairlessness of the affected regions, primarily the lower legs. Affected areas were symmetrically distributed and hyperpigmented in most cases. Eleven patients showed confluent dermal plaques with thickening and hardening. In contrast, 3 patients presented with wrinkled, redundant skin as seen in cutis laxa. Patients with NSF had significantly poorer scores than control patients on the Daily Life Quality Index (mean [SD], 11. 4 [7.4] vs 1.5 [2. 3]; P < .001). CONCLUSIONS This descriptive case series of patients with NSF gives a detailed clinical picture of the skin manifestations late in the disease. It demonstrates that the clinical picture in the late stage has a varied presentation and that NSF has a significant effect on the quality of life.
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Affiliation(s)
- Nannie Bangsgaard
- Department of Dermatology, University Hospital of Copenhagen Gentofte, Niels Andersens Vej 65, DK-2900 Hellerup, Denmark.
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38
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Abstract
Gadolinium-based contrast agents were for many years considered safe, but this is no longer the case. The least stable agents may trigger the development of nephrogenic systemic fibrosis (NSF), a generalized fibrotic disorder, in renal failure patients. The use of gadodiamide and gadopentetate dimeglumine is now contraindicated in Europe and Japan in patients who have a glomerular filtration rate less than 30 mL/min/1.73 m(2), including those on dialysis. The fear of NSF, however, should not lead to an enhanced MR imaging examination being denied when there is a good clinical indication to give a gadolinium-based contrast agent.
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Affiliation(s)
- Henrik S Thomsen
- Department of Diagnostic Radiology, Copenhagen University Hospital Herlev, Herlev, Denmark.
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Frederiksen AM, Hansen JM, Ewers B, Gasbjerg A, Marckmann P. [Kidney function and immunosuppression of kidney-transplanted patients]. Ugeskr Laeger 2008; 170:1658-1662. [PMID: 18489879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION The number of kidney-transplanted patients is growing. This report describes the age, sex distribution, kidney function, graft age, and immunosuppressive drugs of kidney-transplanted patients followed at the outpatient clinic of the nephrology department at Copenhagen University Hospital, Herlev, Denmark. MATERIALS AND METHODS Cross-sectional study of all living kidney-transplanted patients with a functioning graft followed at Copenhagen University Hospital, Herlev (n=241). Data were extracted from patient records during November 2005-March 2006. RESULTS The sex distribution (131 males, 110 females) was equal. The average patient age was 52 years (SD 12), the average glomerular filtration rate 43 ml/min/1.73 m2 (range 6-114 ml/min/1.73 m2), and the average graft age was 8.3 years (range 0-28 years). Hyperparathyroidism was highly prevalent (64%). The majority of patients (74%) were treated with triple-drug immunosuppression, in most cases (46%) with the combination prednisolone-ciclosporine-azathioprine. During recent years, azathioprine has been increasingly replaced by mycophenolate mofetil. CONCLUSIONS The majority of kidney-transplanted patients with a functioning graft have sufficient kidney function to keep the patients free of uremic symptoms. Hyperparathyroidism is frequent. The immunosuppressive regimens used for kidney-transplanted patients are currently changing.
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40
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Marckmann P. An epidemic outbreak of nephrogenic systemic fibrosis in a Danish hospital. Eur J Radiol 2008; 66:187-90. [DOI: 10.1016/j.ejrad.2008.01.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Revised: 01/04/2008] [Accepted: 01/08/2008] [Indexed: 11/16/2022]
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41
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Ewers B, Gasbjerg A, Zerahn B, Marckmann P. Impact of Vitamin D Status and Obesity on C-Reactive Protein in Kidney-Transplant Patients. J Ren Nutr 2008; 18:294-300. [DOI: 10.1053/j.jrn.2007.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Indexed: 11/11/2022] Open
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Marckmann P, Nielsen AH, Sloth JJ. Possibly enhanced Gd excretion in dialysate, but no major clinical benefit of 3-5 months of treatment with sodium thiosulfate in late stages of nephrogenic systemic fibrosis. Nephrol Dial Transplant 2008; 23:3280-2. [PMID: 18436563 DOI: 10.1093/ndt/gfn217] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Gd-related nephrogenic systemic fibrosis was successfully treated with intravenous sodium thiosulfate according to a recent case report. METHODS Four haemodialysis patients with severe Gd-related nephrogenic systemic fibrosis were treated with intravenous sodium thiosulfate for 3-5 months. Symptoms and patients' experiences were investigated. The dialysate Gd content was monitored. RESULTS We observed no major clinical improvements in any patient. In one patient, we found slightly improved joint motion. Two patients had a subjective impression of slight improvements of joint motion and skin abnormalities. The dialysate Gd content was raised by the treatment, up to fivefold. CONCLUSIONS We could not confirm that sodium thiosulfate treatment results in marked and rapid improvement in late stages of Gd-related nephrogenic systemic fibrosis. However, dialysate contents of Gd seemed to increase. It is unknown whether increased Gd excretion will lead to long-term clinical improvements in late stages of nephrogenic systemic fibrosis.
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Affiliation(s)
- Peter Marckmann
- Department of nephrology, Copenhagen University Hospital Herlev, Herlev Ringvej 75, DK-2730 Herlev, Denmark.
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Abstract
Until recently it was believed that extracellular gadolinium-based contrast agents were safe for both the kidneys and all other organs within the dose range up to 0.3 mmol/kg body weight. However, in 2006, it was demonstrated that some gadolinium-based contrast agents may trig the development of nephrogenic systemic fibrosis, a generalized fibrotic disorder, in renal failure patients. As no prospective studies can be performed we must rely on retrospective data. From those data it is obvious that the prevalence of NSF is significantly higher after the unstable agent gadodiamide than after any other gadolinium-based agent (3-7% versus 0-1% per injection) in patients with reduced renal function. Prevalence after exposure to two gadodiamide injections is as high as 36% in patients with chronic kidney disease (CKD) stage 5. No report of NSF after the most stable agents has been reported in the peer-reviewed literature documenting that there is a difference between the various agents regarding triggering NSF.
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Affiliation(s)
- Henrik S Thomsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Herlev, Herlev Ringvej 75, DK-2730 Herlev, Denmark.
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Ewers B, Gasbjerg A, Moelgaard C, Frederiksen AM, Marckmann P. Vitamin D status in kidney transplant patients: need for intensified routine supplementation. Am J Clin Nutr 2008; 87:431-7. [PMID: 18258635 DOI: 10.1093/ajcn/87.2.431] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A high prevalence of vitamin D insufficiency has been found in the general population and in patients with chronic kidney disease. OBJECTIVE The aim was to examine vitamin D status and determinants and metabolic correlates of serum 25-hydroxyvitamin D in a population of adult Danish kidney transplant patients. DESIGN This was a cross-sectional study of 173 adult kidney transplant patients with a mean (+/-SD) age of 53.4 +/- 11.7 y and a median graft age of 7.4 y (interquartile range: 3.3-12.7 y). Serum concentrations of intact parathyroid hormone (S-PTH), 25-hydroxyvitamin D [S-25(OH)D], and 1,25-dihydroxyvitamin D [S-1,25(OH)(2)D] were measured. Dietary and supplementary intake of vitamin D, avoidance of solar ultraviolet B exposure, and selected lifestyle factors were assessed in a subgroup (n = 97). RESULTS Fifty-one percent of the patients had vitamin D insufficiency [S-25(OH)D 40-75 nmol/L], and an additional 29% had moderate-to-severe vitamin D deficiency [S-25(OH)D < or = 39 nmol/L]. In multiple regression analysis, sun avoidance (negative association) and vitamin D supplementation (positive association) were independent determinants of S-25(OH)D concentrations. Low S-25(OH)D concentrations were associated with 1) increased S-PTH concentrations (P = 0.0002), independently of S-1,25(OH)(2)D concentrations, and 2) decreased S-1,25(OH)(2)D concentrations (P = 0.002), independently of graft function. CONCLUSIONS Hypovitaminosis D is common among Danish kidney transplant patients and is associated with reduced concentrations of S-1,25(OH)(2)D and increased S-PTH concentrations. Sun avoidance and vitamin D supplementation are important determinants of vitamin D status. The observed hypovitaminosis D might be corrected by intensified routine vitamin D supplementation as opposed to the current supplementation practice.
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Affiliation(s)
- Bettina Ewers
- Department of Nephrology, Copenhagen University Hospital Herlev, Herlev, Denmark
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Abraham JL, Thakral C, Skov L, Rossen K, Marckmann P. Dermal inorganic gadolinium concentrations: evidence for in vivo transmetallation and long-term persistence in nephrogenic systemic fibrosis. Br J Dermatol 2007; 158:273-80. [PMID: 18067485 DOI: 10.1111/j.1365-2133.2007.08335.x] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gadolinium (Gd)-based magnetic resonance contrast agents (GBMCA), including gadodiamide, have been identified as the probable causative agents of the serious disease, nephrogenic systemic fibrosis (NSF). OBJECTIVES To investigate retained Gd-containing deposits in skin biopsies from patients with NSF and to determine their relative concentrations over time from administration of GBMCA. METHODS An investigator-blinded retrospective study, analysing 43 skin biopsies from 20 patients with gadodiamide-related NSF and one NSF-negative gadodiamide-exposed dialysis patient, ranging from 16 days to 1991 days after Gd contrast dose. Utilizing automated quantitative scanning electron microscopy/energy-dispersive X-ray spectroscopy we determined the concentration of Gd and associated elements present as insoluble deposits in situ in the tissues. RESULTS We detected Gd in skin lesions of all 20 patients with NSF, whereas Gd was undetectable in the NSF-negative patient. Gd concentration increased over time in 60% of patients with multiple sequential biopsies (n=10), decreasing only when the initial sampling time was >23 months after first gadodiamide dose. All Gd-containing deposits contained phosphorus, calcium and sodium. The ratio of Gd to calcium in tissue deposits correlated positively with the gadodiamide dose and with serum ionized calcium at the time of Gd exposure. CONCLUSIONS These findings demonstrate the in vivo release (through transmetallation) of the toxic free Gd3+ from gadodiamide, and its retention in apatite-like deposits. We suggest that Gd may be mobilized over time from bone stores, explaining variably delayed onset of NSF and increasing skin concentration over time in patients with NSF.
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Affiliation(s)
- J L Abraham
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
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Thomsen HS, Marckmann P. CMR 2007: 9.01: Twenty-five Danish single center cases of NSF. Contrast Media Mol Imaging 2007. [DOI: 10.1002/cmmi.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Until recently it was believed that extracellular gadolinium based contrast agents were safe for both the kidneys and all other organs within the dose range up to 0.3 mmol/kg body weight. However, in 2006, it was demonstrated that some gadolinium based contrast agents may trigger the development of nephrogenic systemic fibrosis, a generalised fibrotic disorder, in renal failure patients. Accordingly, the use of gadodiamide and gadopentate dimeglumine for renal failure patients was banned in Europe in spring 2007. The same two compounds should only be used cautiously in patients with moderate renal dysfunction. The current paper reviews the situation (July 2007) regarding gadolinium based contrast agent and the severe delayed reaction to some of these agents. The fear of nephrogenic systemic fibrosis should not lead to a denial of a well indicated enhanced magnetic resonance imaging examination.
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Affiliation(s)
- Henrik S Thomsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Herlev, Denmark.
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Thomsen HS, Marckmann P, Logager VB. Enhanced computed tomography or magnetic resonance imaging: a choice between contrast medium-induced nephropathy and nephrogenic systemic fibrosis? Acta Radiol 2007; 48:593-6. [PMID: 17611863 DOI: 10.1080/02841850701370717] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
BACKGROUND Nephrogenic systemic fibrosis may be caused by gadolinium (Gd)-containing magnetic resonance imaging contrast agents. Most reported cases were associated with one particular agent, gadodiamide. Yet, unidentified cofactors might explain why only a minority of renal failure patients exposed to gadodiamide develop nephrogenic systemic fibrosis. METHODS We conducted a case-control study of 19 histologically verified cases and 19 sex- and age-matched controls. All subjects had chronic renal failure when exposed to gadodiamide. Clinical, biochemical and pharmacological data were retrieved from medical records. RESULTS Cases had been exposed to a mean gadodiamide dose of 0.29 mmol/kg (range 0.18-0.50) shortly before first signs of nephrogenic systemic fibrosis. Controls had been exposed to 0.28 mmol/kg (0.13-0.49). Cumulative gadodiamide exposure while in chronic kidney disease stage 5 was significantly higher among cases compared with controls (0.41 vs 0.31 mmol/kg, P = 0.05) and among severe cases (n = 9) compared with non-severe cases (0.49 vs 0.33 mmol/kg, P = 0.02). Severe cases developed primarily among patients in regular haemodialysis therapy at exposure. Cases had higher serum concentrations of ionized calcium and phosphate than controls and tended to receive higher doses of epoietin-beta than controls at time of exposure. Severe cases were treated with higher doses of epoietin-beta than non-severe cases at exposure (10.8 vs 4.4 10(3) IU/week, P = 0.02). CONCLUSIONS Increasing cumulative gadodiamide exposure, high-dose epoietin-beta treatment, and higher serum concentrations of ionized calcium and phosphate increase the risk of gadodiamide-related nephrogenic systemic fibrosis in renal failure patients. Severe cases seem to develop primarily among patients in regular haemodialysis therapy at exposure.
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Affiliation(s)
- Peter Marckmann
- Department of Nephrology, Herlev Hospital, DK-2730 Herlev, Denmark.
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Nielsen NS, Pedersen A, Sandström B, Marckmann P, Høy CE. Different effects of diets rich in olive oil, rapeseed oil and sunflower-seed oil on postprandial lipid and lipoprotein concentrations and on lipoprotein oxidation susceptibility. Br J Nutr 2007. [DOI: 10.1079/bjn2002567] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Elevated concentrations of fasting and non-fasting triacylglycerol-rich lipoproteins (TRL) as well as oxidative changes of lipoproteins may increase the risk of ischaemic heart disease. To compare the effects of different diets rich in unsaturated fatty acids on the concentrations andin vitrooxidation of fasting and postprandial lipoproteins eighteen males consumed diets enriched with rapeseed oil (RO), olive oil (OO), or sunflower-seed oil (SO) in randomised order for periods of 3 weeks followed by a RO test meal. In the postprandial state the concentrations of cholesterol and triacylglycerol (TAG) in TRL were higher after consumption of OO compared with RO and SO (P<0·04), possibly related to differences in the fasting state. The propagation rates for VLDL and LDL oxidation were higher in the postprandial compared with the fasting state irrespective of diet. In the fasting state, the propagation rates were highest after SO (P<0·001), and in the postprandial state, SO gave rise to a shorter VLDL lag time (P=0·03) and a higher propagation rate than OO consumption (P=0·04). Overall, the SO diet resulted in a higher postprandial propagation rate of LDL (P<0·001) compared with RO and OO, while there was no effect of diet on LDL oxidation lag time. Our results suggest that RO and SO diets lower the postprandial cholesterol and TAG concentrations compared with OO, while RO and OO diets result in similar and lowerin vitrosusceptibility to oxidation of lipoproteins than SO.
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