Hyperparathyroidism and parathyroidectomy in patients on renal replacement therapy

Background. Secondary hyperparathyroidism (sHPT) is characterized by over function of the parathyroid glands and disturbances in mineral metabolism as a result of renal failure. It is common among patients with end-stage renal disease (ESRD) and it often persists after successful renal transplantation. sHPT is associated with osteoporosis and cardiovascular morbidity and mortality. There are two main ways to treat this condition, either by medical therapy or surgical removal of the parathyroid glands, parathyroidectomy (PTX). Another complication in patients with ESRD is New-Onset Diabetes After Transplantation (NODAT). Immunosuppressive medications and personal risk factors for diabetes mellitus have been associated with the condition. We aimed to study the effect of PTX on the risk of death, cardio-/cerebrovascular events (CVE), and hip fractures. We also studied the incidence of NODAT at our department and whether there is an association between NODAT and sHPT.Methods. A nested index-referent study was performed within the Swedish Renal Registry (SRR). Patients on maintenance dialysis or with renal transplant at the time of PTX were included. The PTX patients were randomly matched for age, sex and underlying renal disease with up to five referent patients who had not undergone PTX. To calculate survival time and hazard ratios (HR), indexes and referents were assigned the calendar date (d) of the PTX of the index patient. The risk of death, CVE, and fractures after PTX were calculated using crude and adjusted Cox proportional hazards regressions. Data were extracted from patient charts to calculate the incidence of NODAT, and logistic regressions were performed to analyze potential risk factors for NODAT including sHPT.Results. There were 20 056 patients in the SRR between 1991 and 2009. Of these, 579 (423 on dialysis and 156 with a renal transplant at d) incident patients with PTX were matched with 1234/736 non-PTX patients. The adjusted relative risk of death was a HR of 0.80 [95% confidence interval (CI) 0.65–0.99] for dialysis patients who had undergone PTX compared with matched patients who had not. Corresponding result for the patients with a renal allograft at d was a HR of 1.10 (95% CI 0.71–1.70). The results for CVE:s were a HR of 1.24 (95% CI 1.03–1.49) for dialysis patients with PTX compared to non-PTX dialysis patients and a HR of 0.53 (95% CI 0.34–0.84) for transplanted patients. The HR for hip fractures in PTX patients was 0.40 (95% CI 0.18–0.88) compared to non-PTX patients. We found a first-year post-transplant incidence of NODAT of 15%, and an odds ratio (OR) of 4.25 (95% CI 1.13-15.92) for the association between PTH levels above twice the normal range and NODAT.Conclusions. PTX was associated with improved survival in patients on maintenance dialysis. However, there was no survival advantage after PTX in patients with a functioning renal allograft. PTX was associated with a higher risk of CVE after PTX for patients on maintenance dialysis. This was in contrast to some previous studies. However, the risk was lower for patients with a functioning renal allograft at the time of PTX. Parathyroidectomy was associated with a reduced risk of hip fractures in women with sHPT. The first-year cumulative incidence of NODAT was 15% at our department between the years 2000 and 2011. We showed an association between elevated levels of PTH and NODAT in transplanted patient

Hyperparathyroidism and new onset diabetes after renal transplantation.

Secondary hyperparathyroidism persists after renal transplantation in a substantial number of patients. Primary hyperparathyroidism and secondary hyperparathyroidism are both associated with abnormalities in glucose metabolism, such as insufficient insulin release and glucose intolerance. The association of hyperparathyroidism and diabetes after renal transplantation has, as far as we know, not been studied. Our aim was to investigate whether hyperparathyroidism is associated with new-onset diabetes mellitus after transplantation (NODAT) during the first year posttransplantation

From sewage sludge ash to a recycled feed phosphate-digestibility of precipitated calcium phosphate in broiler chickens and growing pigs

Today, EU is largely (-92%) dependent on the import of phosphates as most mines are located outside Europe. Because of the limited availability, phosphorus (P) is included on the list of Critical Raw Materials. Precipitated calcium phosphate (PCP) recovered from sewage sludge ash is a novel and sus-tainable option to replace mined P as raw material in feed phosphates, e.g. monocalcium phosphate (MCP) or dicalcium phosphate, but the digestibility has not yet been tested in vivo. The aim was therefore to determine PCP and MCP apparent ileal digestibility (AID) of P in broiler chickens and apparent (ATTD) and true (TTTD) total tract digestibility of P in growing pigs. A chicken study comprised 240 Ross 308 chickens that were housed in groups of eight from day 21 to day 28. Five diets were used, a basal diet and two test diets, which contributed either 0.075% (low) or 0.150% (high) additional P for each of the test sources (MCP and PCP). The basal and test diets were composed to achieve increasing levels of P and AID was calculated with regression analysis. In the pig study, eight individually housed pigs were used in a change-over study with two experimental periods. The pigs were fed a basal P-free diet in a preperiod to be able to estimate endogenous P losses and then two different diets in two periods using a change-over design, where MCP and PCP were the only P source, providing in total 0.33 (basal diet), 4.42 (MCP) and 3.53 (PCP) g kg-1P, respectively. The AID of P in PCP and MCP for chickens was 58.4 and 75.1% (P = 0.166). The ATTD and TTTD of P in PCP for pigs were 58.4 and 67.2%, respectively, which was lower (P < 0.001) than the corresponding values for MCP (82.1 and 89.1%), respectively. The digestibility of calcium (Ca) did not differ in the chicken diets with high inclusion levels of PCP and MCP (54.7 and 55.3%, respectively, P = 0.535), but was lower for PCP than MCP in the pig study (57.8 and 70.8% respectively, P = 0.001). In conclusion, the digestibility of P in PCP for chickens did not differ from conventional MCP, whereas for pigs, it was lower, but could be a viable alternative to other common sources of P.(c) 2023 The Authors. Published by Elsevier B.V. on behalf of The Animal Consortium. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

The QCD transition temperature: results with physical masses in the continuum limit II.

We extend our previous study [Phys. Lett. B643 (2006) 46] of the cross-over temperatures (T_c) of QCD. We improve our zero temperature analysis by using physical quark masses and finer lattices. In addition to the kaon decay constant used for scale setting we determine four quantities (masses of the \Omega baryon, K^*(892) and \phi(1020) mesons and the pion decay constant) which are found to agree with experiment. This implies that --independently of which of these quantities is used to set the overall scale-- the same results are obtained within a few percent. At finite temperature we use finer lattices down to a <= 0.1 fm (N_t=12 and N_t=16 at one point). Our new results confirm completely our previous findings. We compare the results with those of the 'hotQCD' collaboration.Comment: 19 pages, 8 figures, 3 table

A variant in the transcription factor 7-like 2 (TCF7L2) gene is associated with an increased risk of gestational diabetes mellitus.

Aims/hypothesis Genetic and epidemiological studies suggest an association between gestational diabetes mellitus and type 2 diabetes. Both are polygenic multifactorial disorders characterised by beta cell dysfunction and insulin resistance. Our aim was to investigate whether common genetic variants that have previously been associated with type 2 diabetes or related phenotypes would also confer risk for gestational diabetes mellitus. Materials and methods In 1,881 unrelated pregnant Scandinavian women (649 women with gestational diabetes mellitus, 1,232 non-diabetic control subjects) we genotyped the transcription factor 7-like 2 (TCF7L2 rs7903146), adiponectin (ADIPOQ +276G>T), peroxisome-proliferator activated receptor, gamma 2 (PPARG Pro12Ala), PPARGcoactivator, 1 alpha (PPARGC1A Gly482Ser), forkhead box C2 (FOXC2 −512C>T) and β3-adrenergic receptor (ADRB3 Trp64Arg) polymorphisms using TaqMan allelic discrimination assay or RFLP. Results The CC, CT and TT genotype frequencies of the TCF7L2 rs7903146 variant differed significantly between women with gestational diabetes mellitus and control women (46.3, 43.6 and 10.1% vs 58.5, 35.3 and 6.2%, p=3.7×10−6, corrected p value [Pc] for multiple testing Pc=2.2×10−5). The T-allele was associated with an increased risk of gestational diabetes mellitus (odds ratio 1.49 [95% CI 1.28–1.75], p=4.9×10−7 [Pc=2.8×10−6]). Compared with wild-type CC-genotype carriers, heterozygous (CT-genotype) and homozygous (TT-genotype) carriers had a 1.6-fold (95% CI 1.26–1.93, p=3.7×10−5 [Pc=0.0002]) and a 2.1-fold (95% CI 1.41–2.99, p=0.0001 [Pc=0.0008]) increased risk of gestational diabetes mellitus, respectively. The other polymorphisms studied were not significantly associated with gestational diabetes mellitus (ADIPOQ +276G>T: 1.17 [1.01–1.36], p=0.039 [Pc=0.23]; PPARG Pro12Ala: 1.06 [0.87–1.29], p=0.53; PPARGC1A Gly482Ser: 0.96 [0.83–1.10], p=0.54; FOXC2 −512C>T: 1.01 [0.87–1.16], p=0.94; and ADRB3 Trp64Arg: 1.22 [0.95–1.56], p=0.12). Conclusions/interpretation The TCF7L2 rs7903146 variant is associated with an increased risk of gestational diabetes mellitus in Scandinavian women

Fewer hospitalizations and prolonged technique survival with home hemodialysis : a matched cohort study from the Swedish Renal Registry

Background: Patients on home hemodialysis (HHD) exhibit superior survival compared with patients on institutional hemodialysis (IHD) and peritoneal dialysis (PD). There is a sparsity of reports comparing morbidity between HHD and IHD or PD and none in a European population. The aim of this study is to compare morbidity between modalities in a Swedish population. Methods: The Swedish Renal Registry was used to retrieve patients starting on HHD, IHD or PD. Patients were matched according to sex, age, comorbidity and start date. The Swedish Inpatient Registry was used to determine comorbidity before starting renal replacement therapy (RRT) and hospital admissions during RRT. Dialysis technique survival was compared between HHD and PD. Results: RRT was initiated with HHD for 152 patients; these were matched with 608 patients with IHD and 456 with PD. Patients with HHD had significantly lower annual admission rate and number of days in hospital. (median 1.7 admissions; 12 days) compared with IHD (2.2; 14) and PD (2.8; 20). The annual admission rate was significantly lower for patients with HHD compared with IHD for cardiovascular diagnoses and compared with PD for infectious disease diagnoses. Dialysis technique survival was significantly longer with HHD compared with PD. Conclusions: Patients choosing HHD as initial RRT spend less time in hospital compared with patients on IHD and PD and they were more likely than PD patients, to remain on their initial modality. These advantages, in combination with better survival and higher likelihood of renal transplantation, are important incentives for promoting the use of HHD.Funding Agencies|Skane Regional Council; Southern Health Care Region; Paul Frankenius Foundation; Swedish Society of Nephrology</p