Predictive role of vitamin B12 in acute kidney injury in living donor liver transplantation: a propensity score matching analysis (original) (raw)
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British Journal of Nutrition
The aim of the present study was to evaluate the prevalence of vitamin B12 (B12) deficiency in kidney transplant recipients (KTR), and its possible association with B12 dietary intake, body adiposity, and immunosuppressive drugs. In this cross-sectional study were included 225 KTR, aged 47.50±12.11years, and 125 (56%) were men. Serum levels of B12 were determined by chemiluminescent microparticle intrinsic factor assay and the cut-off of 200 pg/mL was used to stratify KTR into B12 sufficient or B12 deficient group. B12 dietary intake was evaluated by three 24h dietary recalls and was considered adequate when ≥ 2.4 mcg/day. Body adiposity was estimated after taking anthropometric measures and using dual energy x-ray absorptiometry (DXA) method. B12 deficiency was seen in 14% of the individuals. B12 deficient group, compared to the B12 sufficient group, exhibited lower intake of B12 [2.42(1.41-3.23) vs. 3.16(1.94-4.55) mcg/day, p=0.04] and higher values of waist circumference [96.0(88...
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....
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.
Liver Transplantation, 2013
Deficiencies in vitamins A, D, and E have been linked to night blindness, bone health, and post-liver transplant reperfusion injury. The aim of this study was to determine the prevalence and predictive factors of fat-soluble vitamin deficiencies in liver transplant candidates. We reviewed the medical records of liver transplant candidates at our center from January 2008 to September 2011. The etiology of cirrhosis, Model for End-Stage Liver Disease score, Child-Pugh class, body mass index (BMI), and vitamin A, vitamin E, and vitamin 25-OH-D levels were recorded. Patients were excluded for incomplete laboratory data, short gut syndrome, celiac disease, pancreatic insufficiency, or prior liver transplantation. Sixty-three patients were included. The most common etiologies of liver disease were alcohol (n 5 23), hepatitis C virus (n 5 19), and nonalcoholic steatohepatitis (n 5 5). Vitamin A and D deficiencies were noted in 69.8% and 81.0%, respectively. Only 3.2% of the patients were vitamin E-deficient. There were no documented cases of night blindness. Twenty-five of the 55 patients with bone density measurements had osteopenia, and 10 had osteoporosis. Four patients had vertebral fractures. There was 1 case of posttransplant reperfusion injury in a patient with vitamin E deficiency. In a multivariate analysis, there were no statistically significant predictors for vitamin D deficiency. The Child-Pugh class [odds ratio (OR) 5 6.84, 95% confidence interval (CI) 5 1.52-30.86, P 5 0.01], elevated total bilirubin level (OR 5 44.23, 95% CI 5 5.02-389.41, P < 0.001), and elevated BMI (OR 5 1.17, 95% CI 5 1.00-1.36, P 5 0.045) were found to be predictors of vitamin A deficiency. In conclusion, the majority of liver disease patients evaluated for liver transplantation at our center had vitamin A and D deficiencies. The presence or absence of cholestatic liver disease did not predict deficiencies, whereas Child-Pugh class, bilirubin level, and elevated BMI predicted vitamin A deficiency. Liver Transpl 000:000-000, 2013. V C 2013 AASLD.
Increased Vitamin B12 levels are associated with mortality in critically ill medical patients
Clinical Nutrition, 2012
Background & aims: We describe an observational study in critically ill medical patients showing the association between serum Vitamin B12 levels measured on or near admission and the outcome in these patients. Methods: We used the database of patients admitted to the Medical Intensive Care Unit (MICU) at the Hadassah-Hebrew University Medical Center in Jerusalem, Israel, to analyze associations between patient demographics, background, diagnoses and serum Vitamin B12 levels with hospital and 90 day outcomes. Results: Higher mean Vitamin B12 levels were found in patients who did not survive their hospital stay (1719 pg/ml vs 1003 pg/ml, p < 0.01). Those who had died by 90 days after admission to the MICU also had higher Vitamin B12 levels than survivors (1593 pg/ml vs 990 pg/ml). Regression analysis showed that elevated Vitamin B12 levels were associated with increased 90 day mortality, even after controlling for other variables. Survival analysis also showed an increased mortality rate in patients with Vitamin B12 levels over 900 pg/ml (p < 0.0002). Conclusions: Our data show that high serum Vitamin B12 levels are associated with increased mortality in critically ill medical patients. We suggest that Vitamin B12 levels should be included in the work-up of all medical intensive care patients, particularly those with a chronic health history and increased severity of illness.
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.
Vitamin K Status and Mortality After Kidney Transplantation: A Cohort Study
American journal of kidney diseases : the official journal of the National Kidney Foundation, 2014
Vitamin K modulates calcification by activating calcification inhibitors such as matrix Gla protein (MGP). In kidney transplant recipients, vitamin K insufficiency is common, but implications for long-term outcomes are unclear. Single-center observational study with a longitudinal design. 518 stable kidney transplant recipients; 56% men; mean age, 51±12 (SD) years; and a median of 6 (IQR, 3-12) years after kidney transplantation. Plasma desphosphorylated-uncarboxylated MGP (dp-ucMGP) levels, reflecting vitamin K status. All-cause mortality and transplant failure. At inclusion, median dp-ucMGP level was 1,038 (IQR, 733-1,536) pmol/L, with 473 (91%) patients having vitamin K insufficiency (defined as dp-ucMGP>500pmol/L). During a median follow-up of 9.8 (IQR, 8.5-10.2) years, 152 (29%) patients died and 54 (10%) developed transplant failure. Patients in the highest quartile of dp-ucMGP were at considerably higher mortality risk compared with patients in the lowest quartile (HR, 3.1...
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