How Is Body Composition and Nutrition Status Associated with Erythropoietin Response in Hemodialyzed Patients? A Single-Center Prospective Cohort Study.

Background: Anemia is the most common finding in patients with end-stage kidney disease undergoing renal replacement therapy. A certain percentage of patients does not respond adequately to erythropoietin (EPO) treatment, not being able to reach desirable hemoglobin levels even when treated with large-dose EPO and intravenous/oral iron. In our study, we wanted to further investigate how nutritional status is associated with erythropoietin responsiveness. To quantify EPO response, we used the Erythropoietin Resistance Index (ERI), which is defined as the weekly weight-adjusted dose of EPO divided by the hemoglobin level. Patients and methods: Seventy-eight patients undergoing hemodialysis were included. All of them were measured by a SECA mBCA body composition analyzer and evaluated by Kalantar-Zadeh's MIS score. Routine biochemical tests were also taken into account. The Shapiro-Wilk test was used to study the distributions of quantitative variables, which were significantly different from normal (p < 0.05). We used nonparametric Mann-Whitney U-test to compare groups. Correlations were studied by means of Spearman's rank correlation coefficient. Bonferroni correction for multiple testing was performed. To find independent determinants of ERI, we additionally performed multivariate analysis using the General Linear Model (GLM). Results: In terms of body composition, factors that are associated with high ERI are low BMI, low fat mass, low visceral fat volume, high total body water percentage, low phase angle and low fat-free mass. In addition to body composition parameters, total MIS score and IL-6 serum levels correlated positively with ERI value. IL-6 was an independent determinant of ERI value, based on multivariate analysis. After correction for multiple analysis, BMI and eGFR both remained significant factors associated with EPO response. Conclusions: It seems crucial to prevent inflammatory malnutrition as a part of a holistic approach to anemia treatment in dialysis patients.

Effect of Diet and Supplementation on Serum Vitamin C Concentration and Antioxidant Activity in Dialysis Patients.

Loss of vitamin C, especially in conjunction with an inadequate supply, can lead to decreased plasma concentrations of vitamin C. This in turn can lead to overt or subclinical deficiency. The present study aimed to evaluate the effects of diet and supplementation on vitamin C concentrations and serum antioxidant activity (FRAP) in hemodialysis (HD) patients. Sixty-eight HD patients participated in the study. In all of them, the diet was initially determined, and they were divided into five groups according to the diet and supplementation used. Group 1 received an unchanged diet, considered by them to be optimal; in group 2, the standard diet used in HD patients was introduced; in group 3, a standard diet enriched with natural antioxidants was employed; in group 4, a standard diet as in group 2 was used, but enriched with supplements (vitamin C, vitamin E, Se, and Zn). In contrast, group 5 consisted of HD patients with coexisting diabetes. Vitamin C serum levels were determined by high-performance liquid chromatography HPLC and antioxidant activity by The Ferric Reducing Ability of Plasma FRAP. The study shows that a well-chosen diet can slow the build-up of malnutrition and increase antioxidant activity as measured by the FRAP method in the blood of hemodialysis patients. Vitamin C supplementation can improve antioxidant status in hemodialysis patients. * The results presented in this paper complement our study, which assessed the effect of diet on the activity of erythrocyte antioxidant enzymes: Catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px), but also on the concentrations of non-enzymatic antioxidants (tocopherols, carotenoids, and vitamin C) in hemodialysis patients. In the study, plasma malondialdehyde (MDA) concentrations were assessed as an indicator of oxidative damage.

[Cancer or vitamin B12 deficiency? Difficult differential diagnosis in elderly]. / Nowotwór czy niedobór witaminy B12? Trudna diagnostyka róznicowa u osób starszych.

Vitamin B12 deficiency anaemia in adults is usually caused by Addison- Biermer's disease. The presence of antibodies against gastric parietal cells and intrinsic factor (IF) in blood is typical for the disease. The gastrointestinal malabsorption or a diet poor in vitamin B12 are rarer causes. The disease manifests in hematological, neurological, psychiatric disorders and trophic changes of the tongue and oral mucosa, which leads to weight loss. A CASE REPORT: The authors describe a case of a 70-year-old woman with severe vitamin B12 deficiency based on chronic inflammatory lesions of the gastric mucosa caused by Helicobacter pylori infection. The patient had haematological (pancytopenia), neurological (problems with memory, concentration, numbness of the limbs, gait instability) and gastrological disorders (loss of appetite, weight loss). The laboratory and imaging diagnostics were performed. The neoplasmatic background was abandoned and pure vitamin B12 deficiency was diagnosed. All symptoms resolved completely after the supplementation and eradication of Helicobacter pylori. CONCLUSIONS: The article demonstrates the problem of many severe, non- specific complications of vitamin B12 deficiency which requires extensive diagnostics and treatment. The similarity of symptoms may suggest a malignant disease especially in elderly patients.

Lack of association of C599T polymorphism in the glutathione peroxidase (GPX1) gene with delayed graft function, acute kidney graft rejection and chronic allograft nephropathy.

BACKGROUND: The glutathione peroxidase/glutathione system is a major defense in oxidative stress. Glutathione peroxidase (GPx) is a selenium-containing antioxidant enzyme that effectively reduces hydrogen peroxide and lipid peroxides to water and lipid alcohols, respectively, and in turn oxidizes glutathione to glutathione disulfide. Previous studies have shown that the activity of glutathione peroxidase is genetically determined and is associated with polymorphisms in GPX1 gene. The aim of the present study was to examine the association between the C599T polymorphism in the glutathione peroxidase (GPX1) gene and delayed graft function of kidney allografts, acute rejection and chronic allograft nephropathy. MATERIAL/METHODS: One hundred eighty-seven recipients of first cadaveric renal transplants from the Department of Nephrology, Transplantology and Internal Medicine of Pomeranian Medical University were included in this retrospective study. Genotyping of C599T polymorphism in the GPX1 gene was performed using PCR-RFLP method. RESULTS: There were no significant associations between this polymorphism and delayed graft function, acute rejection and chronic allograft nephropathy. CONCLUSIONS: The present results suggest that GPX1 C599T polymorphism has no influence on the graft function in the first phase after transplantation, as well as on the acute kidney graft rejection and chronic allograft nephropathy.

[Oxidative stress and trace elements affect the activity of sodium transporting systems in a cellular membrane of a erythrocyte]. / Stres oksydacyjny i pierwiastki sladowe wplywaja na aktywnosc systemów transportujacych sód w blonie komórkowej erytrocytu.

We examined the activity of sodium transporting systems (STS) in a cellular membrane of erythrocytes in a group of 21 patients under chronic hemodialysis treatment with the dialyzing fluid containing glucose HD-g(+), and 22 patients dialysed with the fluid not containing glucose HD-g(-), 21 patients with chronic kidney failure already not treated with dialysis and 21 control group. We examined the concentration of antioxidative system cofactors, such as zinc, copper and selenium in erythrocytes and plasma. The marker of oxidative stress in erythrocytes and plasma was the concentration of TBARS. Among all STS we examined the activity of Na(+)/K(+) ATP-ase, Na(+)/K(+)/Cl(-); co-transport, Na(+)/Li(+) exchanger, Na(+), K(+)-outflow. Copper zinc and selenium as cofactors of antioxidative enzymes may reflect the antioxidative processes inside the organism undergoing the influence of free radicals.

Influence of glucose in the dialysate on the activity of erythrocyte-glutathione-peroxidase and blood selenium concentration in hemodialyzed patients.

BACKGROUND: The aim of the study was to show the influence of glucose in the dialysate on the intensity of oxidative stress, activity of glutathione peroxidase (GSHPx) and concentration of selenium in patients undergoing regular hemodialysis. METHODS: The study was comprised of 85 patients hemodialyzed with dialysate containing glucose [HD-g(+)] or not containing glucose [HD-g(-)], patients with chronic renal failure on conservative treatment and control group. The concentrations of the products of reaction with thiobarbituric acid (TBARS), concentration of selenium in erythrocytes and plasma, concentration of copper in erythrocytes and the activity of GSHPx were determined. RESULTS: GSHPx had significantly higher activity in HD-g(-) group before HD than in control group. In HD-g(+) group before hemodialysis, the activity of GSHPx was significantly lower than in the control group. After HD, the activity showed a statistically significant increase. In both hemodialyzed groups, selenium concentration before hemodialysis both in plasma and erythrocytes was significantly lower, compared to control group. In the group of patients with CRF on conservative treatment, selenium concentration in RBC was significantly higher, compared to concentrations obtained in other groups except for control group. The increase of copper concentration in erythrocytes was accompanied by the increase of oxidative stress and increase of TBARS concentration. The opposite relationship was observed for selenium-its concentration was inversely correlated to copper concentration. CONCLUSIONS: In both groups of hemodialyzed patients, hemodialysis caused the increase of GSHPx in erythrocyte activity and increase of plasma and erythrocyte selenium concentration.

Copper modifies the activity of sodium-transporting systems in erythrocyte membrane in patients with essential hypertension.

The aim of the study was to verify the hypothesis if copper could influence the activity of sodium-transporting systems in erythrocyte membrane that could be related to essential hypertension. The examined group of patients consisted of 15 men with hypertension. The control group was 11 healthy male volunteers. The Na+/H+ exchanger (NHE) activity in erythrocytes was determined according to Orlov et al. The activity of transporting systems (ATP-Na+/K+; co-Na+/K+/Cl-; ex-Na+/Li+; free Na+ and K+ outflow [Na+, K+-outflow]) was determined according to Garay's method. The concentration of copper in plasma was assessed using atomic absorption spectrometry. The activity of ATP-Na+/K+ (micromol/L red blood cells [RBCs]/h) in hypertensive patients was 2231.5 +/- 657.6 vs 1750.5 +/- 291 in the control (p < 0.05), the activity of co-Na+/K+/Cl- (micromol/L RBCs/h) in hypertensives was 171.3 +/- 77.9 vs 150.7 +/- 53.9 in the control (NS). Na+-outflow (micromol/L RBCs/h) in hypertensives was 118.3 +/- 51.6 vs 113.3 +/- 24.4 in the control (NS). The K+-outflow (micromol/L RBCs/h) in hypertensives was 1361.7 +/- 545.4 vs 1035.6 +/- 188.3 in the control (NS). The activity of ex-Na+/Li+ (micromol/L RBCs/h) in hypertensive patients was 266.1 +/- 76.1 vs 204.1 +/- 71.6 in the control (p < 0.05). NHE activity (mmol/L RBCs/h) in hypertensives was 9.7 +/- 2.96 vs 7.7 +/- 1.33 in the control (p < 0.05). In hypertensive patients, negative correlation was found between the activity of Na+/K+/Cl- co-transport and plasma copper concentration (Rs = -0.579, p < 0.05) and between the activity of ex-Na+/Li+ and plasma copper concentration (Rs = -0.508, p < 0.05). Plasma copper concentration significantly influences the activity of sodium transporting systems in erythrocyte membrane. Copper supplementation could be expected to provide therapeutic benefits for hypertensive patients.

Do trace elements modify the activity of erythrocyte sodium-proton exchanger in hemodialyzed patients?

The kinetics (Vmax and Km) of the erythrocyte Na+-H+ exchanger was studied in a group of 21 patients undergoing regular hemodialysis (HD) and in 21 control subjects. The activity of antioxidative enzymes--superoxide dismutase and glutathione peroxidase--as well as the concentrations of their cofactors--zinc, copper, and selenium--in plasma and in erythrocytes were determined. The thiobarbituric acid-reactive substances (TBARS) concentration served as an indicator of oxidative stress intensity in plasma and erythrocytes. It was found that in the control group the concentration of copper in erythrocytes was positively correlated with Km and Vmax. When the concentration of copper increased, the shape of the kinetic curve changed from sigmoidal to hyperbolic. In the control group, the concentration of zinc in erythrocytes also correlated with Km. However, the results obtained for the group of hemodialyzed patients were the opposite: when the erythrocyte concentration of copper increased, a Km decline was observed and the shape of the curve changed from hyperbolic to sigmoidal. In the group of hemodialyzed patients, we also found a positive correlation between Km and the concentration of selenium in erythrocytes, and a negative correlation between Km and erythrocyte TBARS.

Dietary trans fatty acids and composition of human atheromatous plaques.

Dietary fatty acids are incorporated into atheromatous plaques mainly in the form of cholesterol esters. Physicochemical properties of the plaque (e. g. mechanical strength) depend on its fatty acid composition. Trans isomers of unsaturated fatty acids (TFA) are known to reduce the availability of fatty acid precursors for the synthesis of anticoagulant PG(1) and PG(3) prostaglandins. The present study was undertaken to determine the content of trans isomers in atheromatous plaques and to search for correlations between trans isomers in the plaque and adipose tissue. Atheromatous plaques were obtained from 31 patients who underwent surgery due to atherosclerotic stenosis of the abdominal aorta, iliac or femoral arteries. Fatty acids were extracted and separated as methyl esters using gas chromatography (GC) with an internal standard. Correlations were searched for with statistical methods, taking the level of significance as p < 0.05. We found spatial and positional isomers of sixteen- and eighteen-carbon fatty acids in plaques and adipose tissue, with elaidic acid (C18:1 trans-9) being the most abundant. Every plaque and adipose tissue sample contained linolelaidic acid (C18:2 trans-9 trans-12) which is derived exclusively from linoleic acid, as well as conjugated dienes of linoleic acid (CLA) produced during oxidative processes. The presence of trans isomers of fatty acids in the atheromatous plaque seems to be of relevance to plaque formation. Of much concern is the detection of elaidic and linolelaidic acids which adversely affect the physiologically important metabolism of eicosanoids. The TFA pool in adipose tissue has little effect on the amount of these acids in the atheromatous plaque. Apparently, the presence of TFA in atheromatous plaques is the result of processes taking place during plaque formation and maturation.