Vitamin D and Its Metabolites Status before and during Chemotherapy in Caucasian Breast Cancer Patients.

BACKGROUND: The predictive role of vitamin D (VD) in breast cancer (BC) patients' survival is still being investigated. This paper aims to evaluate the changes in VD metabolites during chemotherapy (CTH) and the predictive role of VD status in Caucasian BC patients treated with CTH. METHODS: Vitamin D and its metabolites were assessed with reference LC-MS/MS methodology in 98 consecutive BC patients starting CHT, after 3 and 6 months, and compared to the control group. RESULTS: The frequency of VD deficiency in BC patients was greater than in the control group (56.1% vs. 37.2%). After 6 months of CTH, the number of VD-deficient BC patients slightly increased to 60%. The concentrations of VD active forms [25(OH)D2, 25(OH)D3], and catabolites [24,25(OH)2D3 and 3-epi-25(OH)D3] decreased after 3 and 6 months of CTH compared to the baseline values. Strong positive correlations between concentrations of 3-epi-25(OH)D3 and 25(OH)D in both groups were found. Similar correlations were also observed between 24,25(OH)2D3 and 25(OH)D levels. Kaplan-Meier survival analysis showed significantly longer survival in BC patients without deficiency (>20 ng/mL) at baseline (HR = 2.44 (95% CI 1.07-5.59), p = 0.026). CONCLUSIONS: (1) Our data provide further evidence that BC patients before CTH are more VD-deficient than the general population and this deficiency increases further during CTH treatment, as observed using the reference LC-MS methodology. (2) Presented results show that VD catabolism is not affected in BC patients. (3) The poorer survival in VD-deficient BP patients supports the importance of VD supplementation in BC patients with 25(OH)D levels below 20 ng/mL.

The Impact of Iodine Concentration Disorders on Health and Cancer.

Iodine deficiency is an ongoing problem. The implementation of salt iodization has significantly reduced the effects of iodine deficiency worldwide in recent years, and the remaining iodine deficiency is mild to moderate. Iodine is an essential substrate for the synthesis of thyroid hormones in the thyroid gland. It can also act as an antioxidant, as well as an anti-proliferative and pro-apoptotic factor. Pregnant women, breastfeeding women, and children are particularly affected by iodine deficiency. It leads to thyroid diseases and metabolic and developmental disorders, as well as cancer. However, an excessive iodine intake may, similarly to iodine deficiency, lead to the development of goiter, and toxic amounts of iodine can lead to thyroiditis, hyperthyroidism, and hypothyroidism, and even to the development of papillary thyroid cancer. Correcting iodine deficiency potentially reduces the chance of developing malignancies. Additional research is needed to better understand both the effect of iodine on carcinogenesis and the clinical outcome of iodine deficiency compensation on cancer patients' prognosis. The upcoming public health challenge appears to be reducing salt consumption, which could result in a lower iodine intake. Thus, an iodine enrichment vehicle other than salt could be considered if salt iodine levels are not increased to compensate, and urine iodine levels should be monitored more frequently.

Factors affecting vitamin D status in outpatients with abdominal aortic aneurysm and peripheral artery disease- a single centre study.

BACKGROUND AND AIMS: Vitamin D (VD) deficiency is considered an important risk factor for the development of atherosclerosis and aortic aneurysms. The deficiency is claimed to enhance degeneration and remodeling of collagen and elastin fibers in the artery wall, leading to its weakening and progressive dilatation. This study aimed to assess vitamin D status, in outpatients with abdominal aneurysms (AAA) and peripheral artery disease (PAD) not treated with VD, and factors affecting serum 25-OH-D levels. METHODS AND RESULTS: This cross-sectional study involved 59 outpatients with AAA and 150 with PAD. AAA was defined as local dilation of the aorta diameter >30 mm in imaging. None of the patients was prescribed VD containing medicines. Serum 25-OH, iPTH, phosphorus and calcium levels were assessed in all study participants. VD status was categorized according to commonly used cut-offs for serum 25-OH-D (<20 ng/mL - deficiency, <30 ng/mL -insufficiency). Serum 25-OH-D levels were similar in patient with AAA and PAD [1-3Q: 26.2 (18.8-37.6) vs 21.8 (15.9-31.4) ng/mL; p = 0.30], with deficiency noted in 25.4% with AAA and 41.8% with PAD (p < 0.05). Multiple regression analysis revealed that VD deficiency was explained by past stroke episodes [OR = 2.80 (95%CI: 1.22-6.41)]. Secondary hyperparathyroidism was diagnosed in 1.7% of patients with AAA and 1.9% with PAD. CONCLUSIONS: The frequency of VD deficiency in outpatient with AAA is not greater than in those with PAD. Past stroke episode is associated with an increased occurrence of VD deficiency in both outpatients with AAA and PAD other than sun exposure and diet.

Prevalence of hypokalemia in older persons: results from the PolSenior national survey.

PURPOSE: Hypokalemia is one of the most common electrolyte disturbances in clinical practice. There are only a few epidemiological studies analyzing the occurrence of hypokalemia in older persons. The aim of the study was to determine the prevalence of hypokalemia in the Polish older population. METHODS: Serum potassium concentration was estimated in 4654 participants (2270 females and 2384 males, mean age 76.5 [11.0] years), who participated in the PolSenior study. Hypokalemia was defined as serum potassium concentration below 3.5 mmol/L. Hypokalemia was found in 39 participants (0.84%) and was significantly more frequent among females (28 females = 1.23% and 11 males = 0.46%; p = 0.003). The prevalence of hypokalemia was not related to age. Among 3303 participants suffering from arterial hypertension, 1093 were treated with potassium-losing diuretics. RESULTS: Hypokalemia was significantly more frequent among hypertensive than normotensive older participants (1.06 vs. 0.30% respectively; p = 0.007) and among hypertensive participants treated with potassium losing diuretics than ones untreated with these drugs (1.96 vs. 0.46% respectively; p < 0.001). In hypertensive participants, the prevalence of hypokalemia did not depend significantly on oral supplementation of potassium (1.92 and 0.98% respectively, NS). None of 81 participants using laxative agents presented hypokalemia. CONCLUSIONS: This study demonstrates that: older age seems not to appear to be a significant risk factor of hypokalemia. Hypokalemia is more often found in the older hypertensive patients treated with potassium losing diuretics, and prevention of diuretic-induced hypokalemia with oral supplementation of potassium seems to be insufficient.

Severity of Vitamin D Deficiency Predicts Mortality in Ischemic Stroke Patients.

BACKGROUND: Vitamin D (VD) deficiency is considered an independent risk factor for death due to cardiovascular events including ischemic stroke (IS). We assessed the hypothesis that decreased levels of 25-hydroxyvitamin D (25-OH-D) are associated with increased risk of mortality in patients with IS. METHODS: Serum 25-OH-D, intact parathyroid hormone (iPTH), and intact fibroblast growth factor 23 (iFGF23) levels were assessed in serum of 240 consecutive patients admitted within the 24 hours after the onset of IS. Mortality data was obtained from the local registry office. RESULTS: Only three subjects (1.3%) had an optimal 25-OH-D level (30-80 ng/mL), 25 (10.4%) had a mildly reduced (insufficient) level, 61 (25.4%) had moderate deficiency, and 151 (62.9%) had a severe VD deficiency. 20% subjects had secondary hyperparathyroidism. The serum 25-OH-D level was significantly lower than that in 480 matched subjects (9.9 ± 7.1 vs. 21.0 ± 8.7 ng/mL). Of all the patients, 79 (32.9%) died during follow-up observation (44.9 months). The mortality rates (per year) were 4.81 and 1.89 in a group with and without severe VD deficiency, respectively (incidence rate ratio: 2.52; 95% CI: 1.44-4.68). There was no effect of secondary hyperparathyroidism and iFGF23 levels on mortality rates. Age, 25 - OH - D < 10 ng/mL, and functional status (modified Rankin scale) were significant factors increasing the risk of death in multivariable Cox proportional hazard regression test. CONCLUSIONS: Severe VD deficiency is an emerging, strong negative predictor for survival after IS, independent of age and functional status. VD supplementation in IS survivals may be considered due to high prevalence of its deficiency. However, it is uncertain whether it will improve their survival.

Relationship between plasma levels of sclerostin, calcium-phosphate disturbances, established markers of bone turnover, and inflammation in haemodialysis patients.

PURPOSE: Data concerning the relation between increased levels of circulating sclerostin (a physiological inhibitor of bone formation) and bone turnover in patients with chronic renal failure (CRF) are limited. Therefore, the aim of this study was to evaluate associations between plasma sclerostin levels and calcium-phosphate disturbances, markers of bone turnover as well as inflammation in haemodialysis (HD) patients. METHODS: In plasma samples obtained in 150 stable HD patients (92 men) aged 40-70 years, levels of sclerostin, fibroblast growth factor (cFGF23), osteocalcin, the N-terminal propeptide of type I procollagen, C-terminal telopeptide of the alpha chain of type I collagen (ß-CTx), and inflammatory markers (IL-6 and TNF-α) in addition to routine parameters (calcium, phosphorus, parathyroid hormone-iPTH, 25-OH-D, alkaline phosphatase) were measured. RESULTS: Plasma sclerostin concentrations were significantly higher in HD men than women (2.61 vs. 1.88 ng/mL, p < 0.01). Patients with sclerostin levels above median were characterized by lower iPTH and IL-6, but higher cFGF23 and TNF-α (significantly only in men) concentrations. Plasma sclerostin concentration positively correlated with serum 25-OH-D (τ = 0.204), phosphorus (τ = 0.1482), and TNF-α (τ = 0.183) and inversely with iPTH (τ = - 0.255), alkaline phosphatase (τ = - 0.203), IL-6 (τ =- 0.201), and ß-CTx (τ = - 0.099) levels. In multivariate regression analysis, variability of sclerostin levels was explained by sex and 25-OH-D and phosphorus levels. CONCLUSIONS: Increased circulating sclerostin levels seem to reflect slower bone turnover in HD patients. Low levels of sclerostin are associated with vitamin D deficiency and good phosphates alignment.

Utilization of medical rehabilitation services among older Poles: results of the PolSenior study.

BACKGROUND: Rehabilitation tailored to older adults' needs might improve their functional performance and quality of life, as well as increase social participation. The aim of the study was to evaluate the use of medical rehabilitation services among older Poles in relation to socio-economic and health-related determinants. MATERIALS AND METHODS: Data regarding medical rehabilitation were obtained from the nationwide, multidisciplinary PolSenior project (2007-2012) conducted on representative sample of 4813 respondents (48.3% women) aged 65+ years. Socio-economic status, physical functioning, falls, chronic pain, and formal disability occurrence, as well as self-rated health were accounted for. RESULTS: One in six respondents (18.9% women vs. 15.8% men, p < 0.005) underwent medical rehabilitation during 12 months prior to the survey. Respondents mostly received electrotherapy or light radiation therapy (61.3%). Multivariate logistic regression analysis revealed that women aged 80+ years and men aged 90+ years had a significantly lower chance of using rehabilitation services compared to the youngest study participants (65-69 y.o.). City dwellers used rehabilitation services nearly twice as frequently as rural dwellers. Respondents with university education level were most likely to take part in these services. Dependence in IADL decreased participation in medical rehabilitation, while formal disability and chronic pain promoted utilization of rehabilitation services. CONCLUSIONS: Younger age, city dwelling, higher education, functional independence, formal disability certificate, and chronic pain increased participation in medical rehabilitation. Such results of the study should be considered in planning actions towards reducing health inequalities at the national level and promoting health and well-being among older adults.

Prevalence and factors promoting the occurrence of vitamin D deficiency in the elderly.

Vitamin D deficiency affects a large part of the population of elderly people, especially women, who live in moderate climate countries due to a reduced amount of vitamin D in the diet (small sea fish consumption) and reduced content of 7-dehydrocholesterol, which causes decreased skin synthesis. The lowest seasonal concentration of 25(OH)D3 is usually observed during winter and spring. Sun exposure influences 25(OH)D3 concentration more strongly in men than in women. Sociodemographic factors that increase the risk of vitamin D deficiency in the elderly include poor environmental conditions, low economic status, lower educational level, drug exposure (smoking), reduced physical activity, overall poor health and obesity, which causes reduced skin exposure to sunlight. The use of medications or supplements that contain vitamin D and staying in a nursing home that employ such supplementation are factors that prevent deficiency. Significant prevalence of diseases of the gastrointestinal tract may contribute to cholecalciferol and ergocalciferol malabsorption or impair their liver transformation. In addition, the high incidence of chronic kidney disease in old age reduces processing hydroxylation of vitamin D and the formation of active metabolites. Vitamin D deficiency can not only cause bone mineralization disorders, but also increase incidence of cardiovascular diseases, cancers, type 2 diabetes and depression. The aim of this study was to summarize current knowledge about the risk factors of vitamin D deficiency development in the elderly population.

Efficacy and safety of vitamin D supplementation in patients with chronic lymphocytic leukemia.

BACKGROUND: Vitamin D (VD) deficiency in chronic lymphocytic leukemia (CLL) is associated with inferior prognosis, shorter time to treatment and worse overall survival. VD deficiency is the first potentially modifiable prognostic factor in CLL. Currently, however, there is a lack of studies concerning VD supplementation in CLL patients. AIM: To evaluate the efficacy and safety of VD supplementation in patients with CLL. METHODS: A 6-month interventional study was conducted in CLL patients with lower serum 25-OH-D3 concentrations (< 30 ng/ml) than currently recommended. Patients with VD insufficiency (20-30 ng/ml) received 2000 IU of cholecalciferol/day, patients with moderate deficiency (10-19.9 ng/ml) received 4000 IU/day, and patients with severe VD deficiency (<10 ng/ml) received 6000 IU/day. RESULTS: In the analyzed group of 13 CLL subjects, only 1 patient had a VD level within the optimal range (30-80 ng/ml), 7 had an insufficient concentration, 4 had moderate deficiency, and 1 had severe deficiency. Secondary hyperparathyroidism was diagnosed in 4 subjects. Cholecalciferol supplementation (mean dose of 3384 ± 1211 IU) was followed by a significant increase in 25-OH-D3 concentration (from 17.3 ± 5.8 to 41.4 ± 17.5 ng/ml; p<0.05) and decrease in PTH (p<0.05). Five patients did not achieve the recommended 25-OH-D3 concentration. Calcium level remained unchanged and no patients developed hypercalcemia. CONCLUSIONS: VD replenishment is safe and can be effectively achieved by means of the employed cholecalciferol dosage in the majority of patients. However, some subjects may require higher doses to obtain the optimal level and immune function.

C-C motif ligand 11 reduction in CLL patients serum after vitamin D supplementation.

BACKGROUND: Vitamin D (VD) deficiency results in a worse prognosis in patients with chronic lymphocytic leukemia (CLL) and may affect the production of cytokines. Nonetheless, there is the lack of studies dealing with VD supplementation and its impact on chemokines in CLL patients. AIM: The primary endpoint of our interventional study was to evaluate the effect of cholecalciferol supplementation on serum chemokines levels in CLL patients. MATERIALS AND METHODS: Eighteen subjects with CLL were enrolled for the study. Six-month-long cholecalciferol supplementation was performed in CLL patients with serum 25-OH-D3 levels below 30 ng/ml. Cytokines levels were assessed at the beginning of the study and after 6 months. Baseline measurements of cytokines were compared to those in apparently healthy controls. RESULTS: Increased levels of CCL2, CCL3, CCL4, CXCL8, CXCL10, TNFα, bFGF, G-CSF, and VEGF were found in CLL patients in comparison with the healthy controls. In the course of the VD supplementation a decrease in serum levels of chemokines CCL11, CCL3, and cytokine PDGF-BB was observed. The decrease of CCL11 was found in CLL patients on VD supplementation solely, whereas the decrease of CCL3 and PDGF-BB was observed in CLL subjects on both chemotherapy and VD supplementation. CONCLUSION: The VD supplementation may exert beneficial effect on chemokines levels in CLL patients with VD deficiency.

Patients' satisfaction with therapy methods of advanced chronic venous disease.

BACKGROUND: To assess patients' satisfaction from the therapy of advanced chronic venous disorders (CVD) in everyday clinical practice in Poland, and to compare the efficacy of various venoactive drugs (VADs) in venous ulcers healing process. METHODS: Seven hundred and eighty unselected adult patients with active (N.=441) or healed (N.=339) venous ulcers participated in the non-interventional observational 6-week study. RESULTS: Compression therapy and VADs were utilized by 81.5% and 89.2% of patients respectively: 31.2% of all patients underwent surgical procedures for vein incompetence, 61.3% were satisfied with surgical methods, 43% with compression therapy, and 32.6% with VADs ­ with highest rate of satisfied patients in the group taking Ruscus aculeatus and HMC and ascorbic acid (51.4%). Of 377 patients with active venous ulcers smaller than 200 cm2, adherent to VADs, 18.0% have been cured, and 66.6% have improved during 6-week period of observation. Multiple logistic regression analysis revealed that the compression therapy (OR=2.74), the size of ulcer ≤10 cm2 (OR=2.70) were increasing the change of ulcer healing. No VADs was better than another in the healing process. CONCLUSION: 1) Compression therapy and VADs are highly utilized by patients with advanced CVD. 2) Patients are more satisfied with surgical than conservative treatment of advanced CVD. 3) More than half of the patients with the advanced stage CVD taking Ruscus aculeatus and HMC and ascorbic acid is satisfied with the obtained improvement. 4) Ruscus aculeatus and HMC and ascorbic acid is similarly effective as other frequently used VADs in venous ulcer healing. 5) Ruscus aculeatus and HMC and ascorbic acid exerting effects on veins, capillaries and lymphatic vessels may explain the positive results observed in this study.

[Vitamin D deficiency among women diagnosed with breast cancer and unclear benefits of vitamin supplementation]. / Niedobory witaminy D u kobiet z rakiem piersi i niepewne korzysci z jej suplementacji.

Breast cancer is the most common cancer in the world and also in Poland. Morbidity for breast cancer is increasing, but mortality rate is still on the same level. In Poland morbidity has increased almost two times during the last 30 years. Vitamin D deficiency in the general population is a common phenomenon, especially among obese and elder. It increases the risk of development and worsens the prognosis in breast cancer. In recent years, the role of vitamin D and its nuclear receptor (VDR) in cancer epidemiology, and its impact on the regulation of immune processes have raised interest. VDR acts as ligand-activated transcription factor. Recent studies suggest a role of vitamin D in the regulation of energy pathways in tumor cells. Another observation on vitamin D is its inhibitory effect on inflammation and regulation of glucose metabolism in neoplastic cell. This article explores the available literature on the effect of vitamin D supplementation in women with breast cancer, describes the potential regulatory vitamin D depend mechanisms occurring in the breast cancer. Due to the limited data on the efficacy and safety, the optimal dose of vitamin D in supplementation of patients with cancer breast has not been determined.

Ramipril/amlodipine single pill - effectiveness, tolerance and patient satisfaction with antihypertensive therapy in relation to nutritional status.

BACKGROUND: Overweight and obesity decrease the effectiveness of antihypertensive therapy despite the more frequent use of polytherapy. One method for improving therapy effectiveness is by decreasing non-compliance with the use of fixed-dose combinations (FDC). The aim of this study was to assess the effectiveness, tolerance, and satisfaction with ramipril/amlodipine FDC antihypertensive therapy in relation to nutritional status. METHODS: The survey enrolled 24,240 hypertensive patients recently switched to ramipril/amlodipine FDC (EGIRAMLON) at the same doses as previously prescribed separate pills. RESULTS: The effectiveness of antihypertensive therapy increased during follow-up from 32.9% to 76.5%. Overweight and obesity were associated with the increased risk of not attaining the recommended BP values [adjusted for age OR=0.74 (95% CI 0.67-0.83) and 0.70 (0.61-0.81) for overweight; 0.54 (0.47-0.60) and 0.49 (0.42-0.57) for obese, at the first and the second examination, respectively]. "Very good" or "good" the FDP tolerance was reported by 98.8%, 97.6% and 96.4%, respectively. Adverse events (AE) were reported in 0.35% of patients regardless of nutritional status. High levels of satisfaction with the FDC were reported by 57.0% of patients with normal weight, 54.5% of overweight, and 50.6% with obesity. Effectiveness and convenience were the most important for patients. CONCLUSIONS: The effectiveness of therapy with ramipril/amlodipine FDC in the study population was high, but slightly lower in overweigh and obese. This FDC was well tolerated and a significant number of patients satisfied with the therapy regardless of nutritional status. Although the perceived tolerance and satisfaction with treatment were lower in obese and overweight than in normal weight patients; the incidence of AE and perceived benefit from the use of a single-pill, compared to multiple tablets, were comparable irrespective of nutritional status.

Fibroblast growth factor 23 (FGF23) and early chronic kidney disease in the elderly.

BACKGROUND: Better biomarkers of CKD reflecting responses to decreased glomerular filtration rate (GFR) are needed. We determined the value of estimated GFR (eGFR) as a threshold for the increase of plasma cFGF23 (C-terminal) and intact fibroblast growth factor-23 (iFGF23) (intact) concentrations in the course of chronic kidney disease (CKD) and compared this eGFR value with values related to increased serum intact parathyroid hormone (iPTH) or phosphorus concentrations in an elderly population. METHODS: We measured plasma iFGF23, cFGF23, serum phosphorus, calcium, albumin, creatinine, urea, cystatin C, iPTH and vitamin 25-OH-D3 in 3780 population-based study participants aged ≥ 65 years. RESULTS: Serum phosphorus concentrations hardly increased until mean eGFR reached 47.3 ± 4.7 mL/min/1.73 m(2) but then increased exponentially. Similarly, both iPTH and iFGF23 increased slightly in early CKD but then increased exponentially when eGFR reached 55.0 ± 4.2 mL/min/1.73 m(2) for iPTH and 51.6 ± 5.7 mL/min/1.73 m(2) for iFGF23. The departure point for exponential increases in cFGF23 preceded those for iPTH and iFGF23 and occurred at a mean eGFR of 57.7 ± 7.8 mL/min/1.73 m(2). The prevalence of increased iFGF23 occurred at a remarkably higher eGFR value than that of cFGF23 across the CKD stages. CONCLUSIONS: The increase in cFGF23 preceded both the increase in iPTH and iFGF23 as eGFR declined. Increased plasma iFGF23 level did not precede the rise in serum iPTH concentrations and did not occur before stage-3 CKD in elderly persons. However, cFGF23 was not an early marker of CKD in the elderly subjects.

Functional characterization of calcium-sensing receptor codon 227 mutations presenting as either familial (benign) hypocalciuric hypercalcemia or neonatal hyperparathyroidism.

Familial benign hypocalciuric hypercalcemia (FBHH), in which calcium homeostasis is disordered, can be distinguished from mild primary hyperparathyroidism by the finding of a heterozygous loss-of-function mutation in the calcium-sensing receptor (CaSR). Here, we report a Polish kindred with FBHH, the proband of which had undergone an unsuccessful parathyroidectomy. Direct sequence analysis of exon 4 of her CASR gene identified a heterozygous R227Q mutation in the extracellular domain of the receptor. This mutation segregated with other affected family members. A de novo heterozygous R227L mutation had previously been identified in a case of neonatal hyperparathyroidism. We performed a functional analysis by transiently transfecting wild-type and mutant (R227Q, R227L) CaSRs in human embryonic kidney (HEK293) cells. Both mutant receptors were expressed at a similar level to that of the wild-type, demonstrated a 160-kDa molecular species consistent with having undergone full maturation, and were visualized on the cell surface. Although both mutants were impaired in their MAPK responses to increasing extracellular calcium concentrations relative to wild type, this was more marked for R227L (EC(50) = 9.7 mM) than R227Q (EC(50) = 7.9 mM) relative to wild type (EC(50) = 3.7 mM). When cotransfected with wild-type CaSR to mimic the heterozygous state, the curves for both R227Q and R227L were right shifted intermediate to the curves for wild type and the respective mutant. This differential responsiveness may account, in part, for the markedly different clinical presentation of the R227Q mutation, classic FBHH, vs. the neonatal hyperparathyroidism of the R227L mutation.

[Hypercalciuria with severe hypocalcaemia in association with distal renal tubular acidosis--case report and differential diagnostics]. / Hiperkalcjuria z ciezka hipokalcemia w przebiegu kwasicy cewkowej dystalnej--opis przypadku i diagnostyka róznicowa.

Neither severe distal renal tubular acidosis nor hypercalciuria have been recognized to cause severe hypocalcaemia. We describe a 53 years old woman with distal renal tubular acidosis and hypercalciuria who demonstrated severe hypocalcemia, normalized after calcium and vitamin D supplementation and treatment with thiazide.

[Prevalence of anemia, calcium-phosphorus abnormalities and metabolic acidosis in different stages of chronic renal failure]. / Stopien niewydolnosci nerek a czestosc wystepowania niedokrwistosci, zaburzen gospodarki wapniowo-fosforanowej oraz kwasicy metabolicznej.

BACKGROUND: Chronic kidney disease (CKD) is associated with the reduction of haemoglobin concentration and a variety of biochemical abnormalities including changes in serum concentration of sodium, potassium, calcium, phosphate, bicarbonate, and hydrogen ions. However, data concerning epidemiology of these abnormalities are rare and incomplete, especially among subjects with mild to moderate CKD. PATIENTS AND METHODS: Patients with a serum creatinine concentration > 110 micromol/l hospitalized in the Department of Nephrology, Endocrinology and Metabolic Diseases Medical University of Silesia from 1998 to 2002 were analyzed. Patients with acute renal failure or chronic renal failure treated with renal replacement therapy were excluded from this study. A total of 653 patients (262F and 391M) were divided into 9 subgroups differing from each other by progressive decline of glomerular filtration rate (GFR). RESULTS: A statistically significant decrease in haemoglobin concentration and increase in the prevalence of anaemia were found in patients with GFR < 50 ml/min. In a large number of patients with a GFR < 80 but > 50 ml/min, Hb concentration <11 g/dl was observed. Mean MCV, MCH and serum iron concentration were similar in all studied subgroups. A progressive increase in serum phosphorus concentration and decrease of calcaemia was found in patients with GFR < 30 ml/min. The elevated Ca x P product (> 4.44 mmol2/12) was noticed almost exclusively in patients with GFR< 30 ml/min. A decompensated metabolic acidosis was observed in 29.8% of patients with GFR <30 ml/min. CONCLUSIONS: Anaemia is an early symptom of chronic kidney disease preceding disturbances of calcium, phosphate and hydrogen ions metabolism. These abnormalities seem to be of therapeutic relevance.

Influence of sevelamer hydrochloride on serum concentration of whole (1-84) and N-terminally truncated (7-84) parathyroid hormone fragments in hemodialysis uremic patients.

Phosphate retention stimulates parathyroid hormone (PTH) secretion in uremic patients. Sevelamer hydrochloride is an aluminium- and calcium-free phosphate binder used in the treatment of secondary hyperparathyroidism in uremic patients. The influence of the phosphate lowering effect on serum levels of whole PTH-1-84 and N-terminally truncated PTH-7-84 has not been studied. Seventeen hemodialysis (HD) patients (nine male, eight female) with chronic renal failure and serum phosphorus concentrations, despite calcium carbonate treatment, >2.0 mmol/L were enrolled in this study. Patients did not receive aluminium containing binders. Blood samples for serum concentration assessments of calcium, phosphorus, PTH-1-84 and N-terminally truncated PTH-7-84, carboxyterminal cross-linked collagen fragments (Ctx), total (AP) and bone specific alkaline phosphatase activity (BAP) were drawn twice: before and after 5-week sevelamer administration (in addition to calcium carbonate). Sevelamer treatment was followed by a significant reduction in serum phosphorus level (from 2.46 +/- 0.09 to 2.07 +/- 0.10 mmol/L; p=0.009), PTH-1-84 level (from 396 +/- 75 to 298 +/- 64 pg/mL; p=0.03) and PTH-1-84/PTH-7-84 ratio (from 1.78 +/- 0.18 to 1.55 +/- 0.19; p=0.01), while serum PTH-7-84 levels declined only slightly (from 220 +/- 35 to 183 +/- 25 pg/mL; p=0.11). Serum calcium, Ctx concentrations, AP and BAP activity did not change markedly. There was a significant positive correlation between changes of phosphorus and PTH-1-84 (tau=0.48; p=0.007) or PTH-7-84 concentration (tau=0.43; p=0.02). A 5-week sevelamer treatment suppressed both PTH-1-84 (change statistically significant) and PTH-7-84 (change statistically non-significant) serum concentration in HD uremic patients seemingly related to changes in phosphatemia.