Pre-Transplant Hyperparathyroidism and Graft or Patient Outcomes After Kidney Transplantation.

The impact of pre-transplant parathyroid hormone (PTH) levels on early or long-term kidney function after kidney transplantation is subject of debate. We assessed whether severe hyperparathyroidism is associated with delayed graft function (DGF), death-censored graft failure (DCGF), or all-cause mortality. In this single-center cohort study, we studied the relationship between PTH and other parameters related to bone and mineral metabolism, including serum alkaline phosphatase (ALP) at time of transplantation with the subsequent risk of DGF, DCGF and all-cause mortality using multivariable logistic and Cox regression analyses. In 1,576 kidney transplant recipients (51.6 ± 14.0 years, 57.3% male), severe hyperparathyroidism characterized by pre-transplant PTH ≥771 pg/mL (>9 times the upper limit) was present in 121 patients. During 5.2 [0.2-30.0] years follow-up, 278 (15.7%) patients developed DGF, 150 (9.9%) DCGF and 432 (28.6%) died. A higher pre-transplant PTH was not associated with DGF (HR 1.06 [0.90-1.25]), DCGF (HR 0.98 [0.87-1.13]), or all-cause mortality (HR 1.02 [0.93-1.11]). Results were consistent in sensitivity analyses. The same applied to other parameters related to bone and mineral metabolism, including ALP. Severe pre-transplant hyperparathyroidism was not associated with an increased risk of DGF, DCGF or all-cause mortality, not supporting the need of correction before kidney transplantation to improve graft or patient survival.

Dietary pattern analysis among stone formers: resemblance to a DASH-style diet / Análise do padrão alimentar de pacientes litiásicos: similaridades com o padrão de dieta DASH

Abstract Recent epidemiological studies have shown that dietary patterns may have a more persistent impact on the risk of stone formation than single nutrients of the diet. Dietary Approaches to Stop Hypertension (DASH), a low-sodium and fruits/vegetables-rich diet, has been associated with a lower risk of nephrolithiasis, due to altered urinary biochemistry. This observational study aimed to investigate whether the dietary pattern of stone formers (SF) resembled a DASH-diet and its influence on urinary lithogenic parameters. Anthropometric data, fasting serum sample, 24-h urine samples, and a 3-day food intake record under an unrestricted diet were obtained from 222 SF and compared with 136 non-SF subjects (controls). The DASH-diet food portions were determined from the food records whereas intakes of sodium chloride (NaCl) and protein (protein equivalent of nitrogen appearance, PNA) were estimated from 24-hr urinary sodium and urea. A dietary profile close to a DASH-diet was not observed in any of the groups. NaCl intake and PNA were significantly higher in SF versus non-SF (12.0 ± 5.2 v.s. 10.1 ± 3.4 g/day, p = 0.01 and 1.8 ± 0.1 v.s. 1.4 ± 0.1 g/kg/day, p = 0.03). SF exhibited a positive correlation of NaCl intake and PNA with urinary calcium, oxalate and uric acid, and of PNA with urinary sodium. SF consumed more vegetables and legumes, but less fruits and low-fat dairy items than non-SF. The present series presented a dietary profile characterized by low calcium and high salt and protein contents, not reflecting an ideal DASH-style diet pattern.

Resumo Estudos epidemiológicos recentes mostraram que os padrões alimentares podem ter um impacto mais persistente sobre o risco de formação de cálculos do que apenas os nutrientes da dieta. A dieta DASH (Dietary Approaches to Stop Hypertension), uma dieta pobre em sódio e rica em frutas/vegetais, tem sido associada a um menor risco de nefrolitíase, devido às alterações metabólicas urinárias. Este estudo observacional teve como objetivo investigar se o padrão alimentar de pacientes litiásicos (Lit) se assemelhava a uma dieta estilo DASH e sua influência nos parâmetros litogênicos urinários. Dados antropométricos, amostra de soro em jejum, amostras de urina de 24 horas e um registro de ingestão alimentar de 3 dias sob dieta irrestrita foram obtidos de 222 Lit e comparados com 136 indivíduos não-Lit (controles). As porções de alimentos do padrão de dieta DASH foram determinadas a partir dos registros alimentares, enquanto a ingestão de cloreto de sódio (NaCl) e proteína (Equivalente Protéico do Aparecimento de Nitrogênio Urinário, PNA) foram estimadas a partir da uréia e sódio urinários de 24 horas. Um perfil alimentar próximo a uma dieta estilo DASH não foi observado em nenhum dos grupos. A ingestão de NaCl e PNA foram significativamente maiores nos Lit versus não-Lit (12,0 ± 5,2 v.s. 10,1 ± 3,4 g/dia, p = 0,01 e 1,8 ± 0,1 v.s. 1,4 ± 0,1 g/kg/dia, p = 0,03). Os Lit exibiram uma correlação positiva entre a ingestão de NaCl e PNA com cálcio, oxalato e ácido urinários, e de PNA com sódio urinário. Os Lit consumiram mais vegetais e leguminosas, mas menos frutas e lácteos com teor reduzido de gordura do que os não-Lit. A presente série apresentou um padrão alimentar caracterizado por reduzido consumo de cálcio e elevado em sal e proteínas, não refletindo um padrão ideal de dieta DASH.