0
selected
-
1.
Effect of kidney donation on bone mineral metabolism.
Hiemstra, TF, Smith, JC, Lim, K, Xu, D, Kulkarni, S, Bradley, JA, Paapstel, K, Schoenmakers, I, Bradley, JR, Tomlinson, L, et al
PloS one. 2020;(7):e0235082
Abstract
Kidney donation results in reductions in kidney function and lasting perturbations in phosphate homeostasis, which may lead to adverse cardiovascular sequelae. However, the acute effects of kidney donation on bone mineral parameters including regulators of calcium and phosphate metabolism are unknown. We conducted a prospective observational controlled study to determine the acute effects of kidney donation on mineral metabolism and skeletal health. Biochemical endpoints were determined before and after donation on days 1, 2 and 3, 6 weeks and 12 months in donors and at baseline, 6 weeks and 12 months in controls. Baseline characteristic of donors (n = 34) and controls (n = 34) were similar: age (53±10 vs 50±14 years, p = 0.33), BMI (26.3±2.89 vs 25.9±3.65, p = 0.59), systolic BP (128±13 vs 130±6 mmHg, p = 0.59), diastolic BP (80±9 vs 81±9 mmHg, p = 0.68) and baseline GFR (84.4±20.2 vs 83.6±25.2 ml/min/1.73m2, p = 0.89). eGFR reduced from 84.4±20.2 to 52.3±17.5 ml/min/1.73m2 (p<0.001) by day 1 with incomplete recovery by 12 months (67.7±22.6; p = 0.002). Phosphate increased by day 1 (1.1(0.9-1.2) to 1.3(1.1-1.4) mmol/L, p <0.001) but declined to 0.8(0.8-1.0) mmol/L (p<0.001) before normalizing by 6 weeks. Calcium declined on day 1 (p = 0.003) but recovered at 6 weeks or 12 months. PTH and FGF-23 remained unchanged, but α-Klotho reduced by day 1 (p = 0.001) and remained low at 6 weeks (p = 0.02) and 1 year (p = 0.04). In this study, we conclude that kidney donation results in acute disturbances in mineral metabolism characterised by a reduced phosphate and circulating α-Klotho concentration without acute changes in the phosphaturic hormones FGF23 and PTH.
-
2.
[Effect of a four-week vitamin and mineral supplementation on the nutritional status and urinary excretion of arsenic in adolescents].
Monroy Torres, R, Espinosa Pérez, A, Ramírez Gómez, X, Carrizales Yáñez, L, Linares Segovia, B, Mejía Saavedra, J
Nutricion hospitalaria. 2018;(4):894-902
Abstract
INTRODUCTION adequate nutrition in adolescence is important for growth and development. There are environmental factors that cannot be avoided, such as exposure to heavy metals through natural sources such as water. Arsenic is a metalloid that can cause damage to health (alterations in nutritional status, diabetes, cancer) and it has been found in concentrations higher than those allowed in drinking water. OBJECTIVE to measure the effect of vitamin and mineral supplementation on the nutritional status and urinary excretion of arsenic in adolescents exposed to this metal through drinking water. MATERIAL AND METHODS an observational, follow-up study of a cohort was conducted to assess the efficacy of vitamin and mineral supplementation on supplementation in 45 adolescents exposed to arsenic in drinking water, who were given a daily multivitamin supplement for four weeks. Weekly nutritional status and arsenic levels in urine and drinking water were evaluated. RESULTS the basal nutritional intake was low for proteins, fiber, folic acid, vitamin B2, B6, B12, E, C, selenium and iron, increasing their consumption through the supplement during the intervention and with an increase of approximately 1 g/dl of hemoglobin in all participants. At the end of the intervention, there was an increase in fat-free mass and a decrease in the percentage of body fat. In relation to the urinary excretion of arsenic, the biggest elimination of this metalloid was observed from the first week of intervention (35.91 μg/g Cr [IC 95% = 23.2-74.8 μg/g Cr]), which was statistically significant compared to basal levels of urinary arsenic (43.2 μg/g Cr [IC 95% = 30.8-117.6 μg/g Cr]) (p < 0.05), with an average water consumption with As of 96.2 ± 7.5 μg/l. CONCLUSION four weeks of supplementation with vitamins and minerals in the adolescent population studied improved nutritional status and increased metalloid excretion significantly in the first and second week after intervention.
-
3.
Treatment of Vitamin and Mineral Deficiencies After Biliopancreatic Diversion With or Without Duodenal Switch: a Major Challenge.
Homan, J, Schijns, W, Aarts, EO, Janssen, IMC, Berends, FJ, de Boer, H
Obesity surgery. 2018;(1):234-241
Abstract
BACKGROUND Vitamin and mineral deficiencies are a major concern after biliopancreatic diversion (BPD) and BPD with duodenal switch (BPD/DS). Evidence-based guidelines how to prevent or how to treat deficiencies in these patients are currently lacking. The aim of the current study is to give an overview of postsurgical deficiencies and how to prevent and treat these deficiencies. METHODS Retrospective evaluation of a 1-year structured monitoring and treatment schedule for various deficiencies in 34 patients after BPD or BPD/DS. RESULTS Patients were introduced into the program 12-90 months after surgery. Vitamin B1, B6, B9, and B12 deficiencies could be prevented by mean daily doses of 2.75 mg, 980 μg, 600 μg, and 350 μg, respectively. However, many patients continued to develop deficiencies of vitamin A, D, iron, calcium, and zinc despite major dose adjustments. Current observations suggest that at least total daily doses of 200 mg Fe in premenopausal women and 100 mg in men, 100 mg of Zinc, 3000 mg of calcium, and weekly doses of at least 50,000 IU solubilized vitamin A and vitamin D are needed to prevent the occurrence of major deficiencies. CONCLUSION Exceptionally high supplementation doses are needed to prevent and treat vitamin and mineral deficiencies in patients after BPD or BPD/DS. Further refinement and simplification of treatment schedules is needed. Focus on improvement of compliance to treatment is recommended.
-
4.
COSMOS Project: Hemodialysis scenario in Europe.
Cannata-Andía, JB, Fernández Martín, JL
Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia. 2016;(4):381-8
-
5.
Refining the definition of clinically important mineral and bone disorder in hemodialysis patients.
Danese, MD, Halperin, M, Lowe, KA, Bradbury, BD, Do, TP, Block, GA
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2015;(8):1336-44
-
-
Free full text
-
Abstract
BACKGROUND It is important to identify an easily defined subset of patients at increased risk of adverse clinical outcomes associated with mineral and bone disorder (MBD) biomarkers (parathyroid hormone, calcium and phosphate). METHODS Observational cohort study of 26 221 prevalent hemodialysis patients in Davita clinics as of 31 August 2005 and followed up until 31 December 2006 (16 months). Predictors were 12 possible definitions of 'clinically important' MBD based on all 3 biomarkers, and 18 alternative definitions based on only 1 or 2 biomarkers. Events were death alone and a composite of cardiovascular hospitalization or death. Excess events were calculated based on a multivariate Cox model using 5224 patients in target for all MBD biomarkers and applied to 20 997 patients out of target for at least one biomarker. Excess events attributable to MBD were estimated by subtracting the multivariate model-derived predicted number from the actual number. Outcomes were the proportion of excess events attributable to MBD captured by each definition (threshold ≥70%) and the reduction in the population size considered to have clinically important MBD (threshold ≥30%). The excess fraction was excess events divided by actual events. RESULTS Patients with more biochemical markers out of target tended to be younger, black and have longer times since starting dialysis. The excess fraction associated with MBD ranged from ∼10 to 26% depending on the clinical endpoint and definition. The only definition to meet the thresholds required at least two of the three MBD biomarkers to be out of target (high or low). It captured 82% of excess composite endpoints and 74% of excess deaths and reduced the at-risk population by 46%. CONCLUSIONS Patients with at least two of three MBD biomarkers out of target represent a subgroup of patients at elevated risk of adverse clinical events.
-
6.
Variations in oral vitamin and mineral supplementation following bariatric gastric bypass surgery: a national survey.
Dunstan, MJ, Molena, EJ, Ratnasingham, K, Kamocka, A, Smith, NC, Humadi, S, Irukulla, S
Obesity surgery. 2015;(4):648-55
Abstract
BACKGROUND Bariatric surgery (including gastric bypass) is associated with long-term deficiencies in vitamins and minerals, which may have deleterious effects on physiology. The American Association of Clinical Endocrinologists' (AACE) guidelines regarding post-operative vitamin supplementation have recently been endorsed by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Supplements have cost implications. Non-branded multivitamins may have similar compositions to branded multivitamins, but at a lower cost. This study assesses multivitamin supplementation following bariatric gastric bypass in England against AACE guidelines. It also examines the composition and cost of branded and non-branded multivitamins. METHODS Micronutrient amounts in common multivitamin preparations were obtained from product literature. Costs were collected from a standard retailer. To determine vitamin prescribing patterns, the 37 NHS hospitals performing bariatric gastric bypasses in England were contacted. Practice was assessed against AACE guidelines. RESULTS All non-branded multivitamins met AACE guidelines for composition. Most had similar compositions to branded multivitamins, and all were cheaper. There was no standard practice regarding post-operative supplementation among the 35 responding hospitals. Only 7/35 (20%) hospitals followed the guidance for two-tablet doses of multivitamins. Immediately post-operatively, 25/35 (71%) hospitals administered calcium carbonate and vitamin D (none recommended calcium citrate, as recommended by AACE to improve absorption), and only 9/35 (26%) hospitals recommended iron to all patients. CONCLUSION Most non-branded multivitamins are lower cost alternatives to branded multivitamins, with similar compositions. The AACE recommendation for two-tablet doses of multivitamins is not being met by most English centres. Calcium and iron supplementation is also inadequate.