Trace elements in hemodialysis patients: a systematic review and meta-analysis

<p>Abstract</p> <p>Background</p> <p>Hemodialysis patients are at risk for deficiency of essential trace elements and excess of toxic trace elements, both of which can affect health. We conducted a systematic review to summarize existing literature on trace element status in hemodialysis patients.</p> <p>Methods</p> <p>All studies which reported relevant data for chronic hemodialysis patients and a healthy control population were eligible, regardless of language or publication status. We included studies which measured at least one of the following elements in whole blood, serum, or plasma: antimony, arsenic, boron, cadmium, chromium, cobalt, copper, fluorine, iodine, lead, manganese, mercury, molybdenum, nickel, selenium, tellurium, thallium, vanadium, and zinc. We calculated differences between hemodialysis patients and controls using the differences in mean trace element level, divided by the pooled standard deviation.</p> <p>Results</p> <p>We identified 128 eligible studies. Available data suggested that levels of cadmium, chromium, copper, lead, and vanadium were higher and that levels of selenium, zinc and manganese were lower in hemodialysis patients, compared with controls. Pooled standard mean differences exceeded 0.8 standard deviation units (a large difference) higher than controls for cadmium, chromium, vanadium, and lower than controls for selenium, zinc, and manganese. No studies reported data on antimony, iodine, tellurium, and thallium concentrations.</p> <p>Conclusion</p> <p>Average blood levels of biologically important trace elements were substantially different in hemodialysis patients, compared with healthy controls. Since both deficiency and excess of trace elements are potentially harmful yet amenable to therapy, the hypothesis that trace element status influences the risk of adverse clinical outcomes is worthy of investigation.</p

Bowel preparation: Comparing metabolic and electrolyte changes when using sodium phosphate/polyethylene glycol

AbstractBackgroundMany patients with various types of colonic pathology undergo invasive procedures that require mechanical bowel preparation. The most commonly used medications for bowel preparation include phosphate-containing drugs which are low cost and enable this procedure to be performed in an outpatient setting, as opposed to other medications, such as polyethylene glycol. Recent studies have suggested that freely using phosphate-containing drugs might lead to renal function impairment in a small group of patients. Despite this, many surgeons still use these drugs to prepare their patients. We conducted a comparative study to check the side effects of phosphate-containing drugs compared to polyethylene glycol when used for bowel cleansing.MethodsWe conducted a double blind prospective randomized study that included 40 patients undergoing surgery for colonic pathology, all of whom underwent bowel cleansing (20 with sodium phosphate and 20 with polyethylene glycol). During the perioperative course, electrolyte parameters were collected from serum and urine and compared between the two groups of patients.ResultsChanges in electrolyte and metabolic parameters were shown in both groups, but more prominently in patients prepared with sodium phosphate. In addition, early signs of renal function impairment appeared in this group. The differences in metabolic and electrolyte changes between the two groups were statistically significant.ConclusionsOn the basis of this study, we propose that the wide use of phosphate-containing drugs for colonic preparation might be dangerous for the specific group of patients that is prone to develop renal failure or electrolyte abnormalities

LONGITUDINAL CHANGES IN PHASE ANGLE REFLECT CHANGES IN SERUM IL-6 LEVELS IN MAINTENANCE HEMODIALYSIS PATIENTS

We hypothesized that longitudinal changes in phase angle (PA) may have independent associations with changes in inflammatory parameters over time and consequently with long-term survival in maintenance hemodialysis (MHD) patients.Dietary energy and protein intake, biochemical markers of nutrition, body composition (anthropometry and bioimpedance analysis) and IL-6 as inflammatory marker, were measured at baseline and at 6, 12, 18 and 24 months following enrollment, in 101 prevalent hemodialysis patients (37% women) with a mean age of 64.6±11.5 years. Observation of this cohort was continued over 3 additional years.Longitudinally, 1O increase in PA over time, controlling for demographic and clinical parameters, was associated with a delay in longitudinal elevation of IL-6 (linear estimate: -2.11 (95% CI: -3.47; -0.75) pg/ml/mo; p=0.002 for PA X Time interaction). A decrease or increase in PA over time was associated with inverse linear changes in IL-6 levels (adjusted r=-0.305, p=0.005) and correspondingly with higher or lower death risk. For each 1O increase in PA, the crude and adjusted mortality hazard ratios using Cox models with effect of time varying risk were 0.62 (95% CI: 0.54; 0.71) and 0.61 (95% CI: 0.53; 0.71), respectively.In conclusion, longitudinal changes in PA appeared to be reliable in detecting changes in nutritional and inflammatory parameters over time - combination that may contribute to understanding of its prognostic bearing

High Insulin Requirements and Poor Metabolic Control do not Modify the Expression, Regulation and PKC Mediated Activation of the p21ras Pathway in PBMC from Type II Diabetic Patients

Aims To asses whether clinically severe insulin resistance and poor metabolic control in patients with type II diabetes are associated with aberrant expression or function of the p21ras pathway. Methods We examined the expression and function of the p21ras pathway in resting and activated PBMC from 10 insulin treated patients with type II diabetes characterized by high insulin requirements and poor metabolic control (IR group) and 10 age and sex matched well controlled patients treated by diet alone or oral hypoglycemic medications (WC group). Results Levels of p21ras and its regulatory elements: p21rasGAP and hSOS1, were comparable in the two groups. The induced activities of p21ras and its associated down-stream regulatory enzyme MAP-kinase following TPA stimulation were also comparable in the IR and WC patients. Conclusions Taken together, these data indicate that clinically significant severe insulin resistance does not modify the expression, regulation and activation of p21ras pathway in PBMC of patients with type II diabetes