Phase angle and donor type are determinants of coronary artery calcification in stable kidney transplant recipients at twelve months after transplantation.

BACKGROUND AND AIM: Coronary artery calcification (CAC) partially explains the excess cardiovascular morbidity and mortality after kidney transplantation. This study aimed to investigate determinants of CAC in stable kidney transplant recipients at 12 months post-transplantation. METHODS AND RESULTS: CAC-score was quantified by the Agatston method using non-contrast enhanced computed tomography, and age- and sex-standardized CAC-percentiles were calculated. Univariable and multivariable multinomial logistic regression was performed to study potential determinants of CAC. The independent determinants were included in multivariable multinomial logistic regression adjusting for potential confounders. 203 KTRs (age 54.0 ± 14.7 years, 61.1% male) were included. Participants were categorized into four groups according to CAC percentiles (p = 0 [CAC-score = 0], n = 68; p ≥ 1%-p ≤ 50% [CAC score = 29.0 (4.0-166.0)], n = 31; p > 50 ≤ 75% [CAC score = 101.0 (23.8-348.3)], n = 26; and p>75% [CAC score = 581.0 (148.0-1652)], n = 83). Upon multivariable multinomial logistic regression, patients with a narrower phase angle and patients who had received a graft from a deceased donor had a higher risk of being in the >75th CAC-percentile. CONCLUSIONS: This study identifies not only metabolic and transplant-related factors, but also phase angle, a composite marker of cell integrity, as an independent determinant of CAC at 12 months after kidney transplantation. This study offers new perspectives for future research into the value of bioelectrical impedance analysis in relation to vascular calcification in kidney transplant recipients.

Interplay between gut microbiota, bone health and vascular calcification in chronic kidney disease.

Deregulations in gut microbiota may play a role in vascular and bone disease in chronic kidney disease (CKD). As glomerular filtration rate declines, the colon becomes more important as a site of excretion of urea and uric acid, and an increased bacterial proteolytic fermentation alters the gut microbial balance. A diet with limited amounts of fibre, as well as certain medications (eg phosphate binders, iron supplementation, antibiotics) further contribute to changes in gut microbiota composition among CKD patients. At the same time, both vascular calcification and bone disease are common in patients with advanced kidney disease. This narrative review describes emerging evidence on gut dysbiosis, vascular calcification, bone demineralization and their interrelationship termed the 'gut-bone-vascular axis' in progressive CKD. The role of diet, gut microbial metabolites (ie indoxyl sulphate, p-cresyl sulphate, trimethylamine N-oxide (TMAO) and short-chain fatty acids (SCFA)), vitamin K deficiency, inflammatory cytokines and their impact on both bone health and vascular calcification are discussed. This framework may open up novel preventive and therapeutic approaches targeting the microbiome in an attempt to improve cardiovascular and bone health in CKD.

Dietary Recommendations for Bariatric Patients to Prevent Kidney Stone Formation.

Bariatric surgery (BS) is one of the most common and efficient surgical procedures for sustained weight loss but is associated with long-term complications such as nutritional deficiencies, biliary lithiasis, disturbances in bone and mineral metabolism and an increased risk of nephrolithiasis, attributed to urinary metabolic changes resultant from low urinary volume, hypocitraturia and hyperoxaluria. The underlying mechanisms responsible for hyperoxaluria, the most common among all metabolic disturbances, may comprise increased intestinal oxalate absorption consequent to decreased calcium intake or increased dietary oxalate, changes in the gut microbiota, fat malabsorption and altered intestinal oxalate transport. In the current review, the authors present a mechanistic overview of changes found after BS and propose dietary recommendations to prevent the risk of urinary stone formation, focusing on the role of dietary oxalate, calcium, citrate, potassium, protein, fat, sodium, probiotics, vitamins D, C, B6 and the consumption of fluids.

Relação da introdução precoce do leite de vaca com o desenvolvimento da obesidade em lactentes / Relationship of early feeding with cow milk with the development of obesity in infancy

Introdução: A alimentação até dois anos repercute ao longo da vida. A OMS enfatiza o aleitamento materno exclusivo (AME) até os seis meses, estendendo-se até dois anos aliado à alimentação complementar. A duração do AME no Brasil é muito baixa (1,8 mês). A oferta precoce de leite de vaca (LV), com baixa densidade e biodisponibilidade de micronutrientes, vem aumentando e favorecendo o desenvolvimento da obesidade. O fato do LV conter altas concentrações de proteínas pode sobrecarregar os rins imaturos dos lactentes e afetar a adiposidade. Objetivos: Associar o consumo precoce de LV com o desenvolvimento da obesidade em lactentes. Metodologia: Revisão bibliográfica referente ao tema proposto, utilizando-se as bases Bireme, SciELO e Pubmed. Desenvolvimento: O LV possui alta concentração proteica que pode causar elevação dos níveis circulantes de IgF-1, aumentando a resistência à insulina e promovendo a lipogênese. O leite materno (LM) possui hormônios (leptina e adiponectina) que agem no hipotálamo e controlam o centro da saciedade, regulando o balanço energético do lactente e reduzindo a ingestão de alimentos. O LV não possibilita esse mecanismo, acarretando aumento do consumo alimentar e predispondo à obesidade. Outra hipótese para o aumento de peso é a adição de carboidratos simples, feita muitas vezes de maneira inadequada e em quantidades significativas, elevando a oferta calórica e contribuindo para maior ganho de peso. Conclusão: O uso do LV como forma de alimentação nos dois primeiros anos está associado ao ganho excessivo de peso, atribuído à composição inadequada e à maneira inapropriada de administração do leite...