Vitamin B12 status in kidney transplant recipients: association with dietary intake, body adiposity and immunosuppression (original) (raw)
Related papers
The American journal of clinical nutrition, 2017
Background: Previous studies have reported low circulating concentrations of pyridoxal-5-phospate (PLP) in renal transplant recipients (RTRs). It is unknown whether this is because of low intake or altered handling, and it is also unknown whether variation in circulating concentrations of PLP influences long-term outcome.Objective: We compared vitamin B-6 intake and circulating PLP concentrations of RTRs with those of healthy controls and investigated long-term clinical implications of vitamin B-6 deficiency in stable outpatient RTRs.Design: In a longitudinal cohort of 687 stable RTRs (57% male; mean ± SD age: 53 ± 13 y) with a median (IQR) follow-up of 5.3 y (4.8-6.1 y) and 357 healthy controls (47% male; age 54 ± 11 y), baseline vitamin B-6 was measured as plasma PLP by high-performance liquid chromatography (HPLC). Vitamin B-6 deficiency was defined as PLP <20 nmol/L, and insufficiency as PLP 20-30 nmol/L. Dietary intake was assessed by validated food-frequency questionnaires....
BMJ Open, 2020
ObjectivesWe examine the association between vitamin B12 level and risk for acute kidney injury (AKI) in patients undergoing living donor liver transplantation (LDLT).DesignRetrospective observational cohort study.SettingUniversity hospital, from January 2009 to December 2018.ParticipantsA total of 591 patients who underwent elective LDLT were analysed in this study. Those with a preoperative history of kidney dysfunction, vitamin B12 supplementation due to alcoholism, low vitamin B12 (<200 pg/mL) or missing laboratory data were excluded.Primary and secondary outcome measuresThe population was classified into AKI and non-AKI groups according to Kidney Disease Improving Global Outcomes (KDIGO) criteria, and associations between perioperative factors and AKI were analysed. After 1:1 propensity score (PS) matching, the association between high vitamin B12 (>900 pg/mL) and postoperative AKI was evaluated.ResultsPreoperative vitamin B12 was higher in the AKI group. Potentially sign...
Potential Contributors To The Decreased Vitamin B6 Levels After Transplantation
2014
Vitamin B6 deficiency as measured by plasma concentrations of pyridoxal 5` phosphate (P5P), the active form of vitamin B6, has been reported in several organ transplant recipients. The highest incidence of vitamin B6 deficiency has been observed in small bowel transplant recipients. The current study evaluated the potential mechanisms (increased degradation of P5P due to higher levels of alkaline phosphatases; or decreased formation of P5P due to decreased expression and activity of pyridoxal kinase) that may contribute to such observations. Higher plasma concentrations of alkaline phosphatases, decreased plasma albumin concentrations and higher amount of excretion of 4-pyridoxic acid in the urine of small bowel transplant patients supported the role of increased degradation of P5P. Of the various medications used by transplant patients that were tested using computation approach, pantoprazole, trimethoprim, acyclovir, valganciclovir and mycophenolic acid appeared to be most likely to inhibit pyridoxal kinase. Tacrolimus, the primary immunosuppressive drug used in most transplant recipients had limited impact on pyridoxal kinase expression and activity. A pro-inflammatory cytokine, TNFα, decreased the expression and activity of pyridoxal kinase in primary cultures of human hepatocytes. The higher plasma concentrations of TNF-α observed in small bowel transplant patients is consistent with a decreased activity of pyridoxal kinase in the liver of these patients, and supported decreased formation of P5P also as a contributor to the observed vitamin B6 deficiency. Additional studies in an animal model where an organ that was not directly involved in the absorption, formation or degradation of vitamin B6 (a composite allograft tissue iv transplantation), showed a significant reduction in the expression of pyridoxal kinase in the liver. This suggested that the process of organ transplantation (immune activation and inflammation) itself led to vitamin B6 deficiency. Our studies indicate that vitamin B6 deficiency is expected in all transplant recipients; however, the magnitude of deficiency is likely to be affected by the immunogenicity of the transplanted organ and the immune status of the patient. Given the potential effect of vitamin B6 deficiency (neurotoxicity), and the low cost of vitamin B6, it is prudent to consider supplementation of all transplant patients with vitamin B6. v TABLE OF CONTENTS LIST OF TABLES .
Vitamins Status Following Solid Organ Transplantation
Journal of Molecular Biomarkers & Diagnosis, 2015
Solid organ transplantation is a popular solution for many end stage organ failures. The functional evaluation of these transplanted organs is multi-factorial and involves many aspects involving organ function, overall patient wellbeing and quality of life. Literature reports on vitamin status following transplantation had been collected together in this review article. This review summarizes the current status of research in this area with focus on reported deficiencies in vitamins following solid organ transplantation. The deficiencies in either fat-soluble vitamins like vitamin D, vitamin A and vitamin K as well as water soluble vitamins like vitamin B6, vitamin B12 and thiamine have been summarized. The reported deficiencies are noteworthy and necessitate a critical evaluation and interventions in many transplantation programs
Endocrine, 2015
Vitamin D deficiency is common among kidney transplant (KT) recipients because of reduced sunlight exposure, low intake of vitamin D, the immunosuppressive drug regimen administered, and steroid therapy. Glucocorticoids regulate expression of genes coding for enzymes that catabolize vitamin D, further reducing its level in serum. Although vitamin D primarily regulates calcium homeostasis, vitamin D deficiency is associated with the risk of several diseases, such as diabetes mellitus and tuberculosis. Aim of this review is to highlight endocrine and metabolic alterations due to the vitamin D deficiency by evaluating the mechanisms involved in the development of KT-related disease (cardiovascular, bone mineral density, and new-onset diabetes after transplantation). Next, we review evidence to support a link between low vitamin D status and KT-related diseases. Finally, we briefly highlight strategies for restoring vitamin D status in KT patients.
Nutritional status of renal transplant patients
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2002
To assess the effect of renal transplantation on the nutritional status of patients. Prospective descriptive study. Renal Transplant Clinic at Tygerberg Hospital, Western Cape. Fifty-eight renal transplant patients from Tygerberg Hospital were enrolled in the study. The sample was divided into two groups of 29 patients each: group 1, less than 28 months post-transplant; and group 2, more than 28 months post-transplant. Nutritional status assessment comprised biochemical evaluation, a dietary history, anthropometric measurements and a clinical examination. Serum vitamin B6 levels were below normal in 56% of patients from group 1 and 59% from group 2. Vitamin B6 intake, however, was insufficient in only 14% of patients from group 1 and 10% from group 2. Serum vitamin C levels were below normal in 7% of patients from group 1 and 24% from group 2, while vitamin C intake was insufficient in 21% and 14% of patients from groups 1 and 2 respectively. Serum magnesium levels were below normal...
The American Journal of Cardiology, 2002
Atherothrombotic complications are frequently seen in patients undergoing heart transplantation. These patients have high plasma total homocysteine concentrations associated with lower folate and vitamin B 6 levels. The relation between these metabolic abnormalities and the development of vascular complications, however, remains unclear. Fasting plasma total homocysteine, folate, vitamin B 12 , vitamin B 6 , and creatinine were measured in 160 cardiac transplant recipients who were followed for a mean duration of 28 ؎ 9 months after blood draw (mean 59 ؎ 28 months after transplant). Cardiovascular events and causes of mortality were determined and Cox proportional-hazards regression analysis was used to identify the independent predictors for cardiovascular events and mortality. Twenty-five patients developed cardiovascular events and 17 died (11 cardiovascular deaths). Mean ؎ SD total homocysteine value was 18.4 ؎ 8.5 (range 4.3 to 63.5 mol/L). Hyperhomocysteinemia (>15 mol/L) was seen in 99 patients (62%). Levels were no different in patients with or without cardiovascular complications/death (16.8 ؎ 6.2 vs 18.9 ؎ 9 mol/L, p ؍ 0.4). However, vitamin B 6 deficiency was seen in 21% of recipients with and in 9% without cardiovascular complications/death (p ؍ 0.05). The relative risk for cardiovascular events, including cardiovascular death, increased 2.7 times (confidence interval 1.2 to 5.9) for B 6 levels <20 nmol/L compared with those with normal B 6 levels (p ؍ 0.02). Thus, hyperhomocysteinemia is common in transplant recipients but may have no causal role in the atherothrombotic vascular complications of transplantation. Deficiency of vitamin B 6 , however, may predict adverse outcomes, suggesting a possible role for supplementation with this vitamin. ᮊ2002 by Excerpta Medica, Inc.
Lipids in Health and Disease, 2011
Background: The kidneys are essential for the metabolism of vitamin A (retinol) and its transport proteins retinolbinding protein 4 (RBP4) and transthyretin. Little is known about changes in serum concentration after living donor kidney transplantation (LDKT) as a consequence of unilateral nephrectomy; although an association of these parameters with the risk of cardiovascular diseases and insulin resistance has been suggested. Therefore we analyzed the concentration of retinol, RBP4, apoRBP4 and transthyretin in serum of 20 living-kidney donors and respective recipients at baseline as well as 6 weeks and 6 months after LDKT. Results: As a consequence of LDKT, the kidney function of recipients was improved while the kidney function of donors was moderately reduced within 6 weeks after LDKT. With regard to vitamin A metabolism, the recipients revealed higher levels of retinol, RBP4, transthyretin and apoRBP4 before LDKT in comparison to donors. After LDKT, the levels of all four parameters decreased in serum of the recipients, while retinol, RBP4 as well as apoRBP4 serum levels of donors increased and remained increased during the follow-up period of 6 months. Conclusion: LDKT is generally regarded as beneficial for allograft recipients and not particularly detrimental for the donors. However, it could be demonstrated in this study that a moderate reduction of kidney function by unilateral nephrectomy, resulted in an imbalance of components of vitamin A metabolism with a significant increase of retinol and RBP4 and apoRBP4 concentration in serum of donors.
A Study of Vitamin B12 Levels In Chronic Kidney Disease Patients In Tertiary Care Hospital
IOSR Journals , 2019
INTRODUCTION Chronic kidney disease is a growing health burden in the world, with an estimate of nearly 20 million affected.CKD is defined as either sustained reduction in kidney function with a glomerular filtration rate is less than 60ml/min/1.73 mt2 or evidence of kidney damage . Lack of erythropoietin ,iron , deficiency anemia and shortened red cell lifespan are the major factor contributing to anemia in CRF.Another possibility is nutritional deficiency,vegetarian diet or deranged metabolism of vitamins in uremic patients OBJECTIVE : To Define prevalence of Vitamin B12 deficiency in Chronic Kidney Disease (CKD) patients MATERIALS AND METHOD It is a hospital based cross sectional study conducted in Osmania General Hospital in January 2019. Study included 60 patients suffering from CKD disease who were taking treatment in hemodialysis nephrology unit. After taking informed consent, patients underwent history recording, clinical examination.Laboratory investigations included urine examination, blood sugar profile ,renal function test and Serum vitaminB12. The individual venous blood,3ml sample taken in red vacutainer and Analysed on ADVIA CENTAUR XPT siemens immunoassay analyzer for vit B12 levels by CMIA method . RESULT AND DISCUSSION: Out of total 60 subjects, 42 were males and 18 were females with a mean age of 48.32 +/- 5.63 years. Vitamin B12 deficiency was observed in significant cases,p value<0.005. This deficiency is caused by inadequate nutrition and loss through the haemodialysis procedure.Another possibility is deranged metabolism of vitamins in uremic patients. Similarly mean duration of CKD was also significantly associated with presence of Vitamin B12 deficiency. CONCLUSION: Present study showed high prevalence of Vitamin B12 deficiency in CKD patients. Most of the patients had associated neurological, hematological and gastro-intestinal symptoms .Hence all the treating nephrologists should anticipate the deficiency of Vitamin B12 in CKD patients.
Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2013
To investigate correlation of vitamin B12 with obesity insulin resistance, metabolic syndrome. The cross-sectional and primary care-based study was carried out. Anthropometric, blood pressure measurements and bioelectric impedance analysis (BIA) were recorded. Vitamin B12, folic acid, hemogram, insulin, ferritin, iron, total iron binding capacity and other biochemical tests were assayed. The subjects were grouped as obesity, overweight, control, metabolic syndrome (MetS) and insulin resistance (IR). Correlation of vitamin B12 with body mass index (BMI), IR, age, and BIA was evaluated. The study enrolled 976 patients (obesity: 414, overweight: 212, and control: 351). The mean age in groups of obesity, overweight and control were 35.9 ± 8.7, 28.9 ± 6.3 and 33.1 ± 8.7, respectively (p = 0.142). Vitamin B12 level was significantly lower in patients with obesity and overweight than healthy individuals (178.9 ± 25.2; 219.8 ± 78.5, and 328.5 ± 120.5, p less than 0.001, respectively). Vitam...