Tryptophan Intake and Tryptophan Losses in Hemodialysis Patients: A Balance Study

Tryptophan depletion is common in hemodialysis patients. The cause of this depletion remains largely unknown, but reduced nutritional tryptophan intake, losses during dialysis or an increased catabolism due to an inflammatory state are likely contributors. Currently, little is known about tryptophan homeostasis in hemodialysis patients. We assessed dietary tryptophan intake, measured plasma tryptophan during dialysis, and measured the combined urinary and dialysate excretion of tryptophan in 40 hemodialysis patients (66 ± 15 years and 68% male). Patients had low tryptophan concentrations (27 ± 9 µmol/L) before dialysis. Mean dietary tryptophan intake was 4454 ± 1149 µmol/24 h. Mean urinary tryptophan excretion was 15.0 ± 12.3 μmol/24 h, dialysate excretion was 209 ± 67 μmol/24 h and combined excretion was 219 ± 66 µmol/24 h, indicating only 5% of dietary tryptophan intake was excreted. No associations were found between plasma tryptophan concentration and tryptophan intake, plasma kynurenine/tryptophan ratio or inflammatory markers. During dialysis, mean plasma tryptophan concentration increased 16% to 31 ± 8 µmol/L. Intradialytic increase in plasma tryptophan was associated with a lower risk of mortality, independent of age, sex and dialysis vintage (HR: 0.87 [0.76–0.99]; P = 0.04). Tryptophan intake was well above the dietary recommendations and, although tryptophan was removed during dialysis, mean plasma tryptophan increased during dialysis. The cause of this phenomenon is unknown, but it appears to be protective.

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Racial and Sex Disparities in Trauma Outcomes Based on Geographical Region

The American Surgeon ◽

10.1177/0003134820960063 ◽

2020 ◽

pp. 000313482096006

Author(s):

William Q. Duong ◽

Areg Grigorian ◽

Cyrus Farzaneh ◽

Jeffry Nahmias ◽

Theresa Chin ◽

...

Keyword(s):

United States ◽

The United States ◽

Trauma Patients ◽

Improvement Program ◽

Trauma Outcomes ◽

Risk Of Death ◽

Hospital Access ◽

Risk Of Mortality ◽

Sex Disparities ◽

Male Patients

Objectives Disparities in outcomes among trauma patients have been shown to be associated with race and sex. The purpose of this study was to analyze racial and sex mortality disparities in different regions of the United States, hypothesizing that the risk of mortality among black and Asian trauma patients, compared to white trauma patients, will be similar within all regions in the United States. Methods The Trauma Quality Improvement Program (2010-2016) was queried for adult trauma patients, separating by U.S. Census regions. Multivariable logistic regression analyses were performed for each region, controlling for known predictors of morbidity and mortality in trauma. Results Most trauma patients were treated in the South (n = 522 388, 40.7%). After risk adjustment, black trauma patients had a higher associated risk of death in all regions, except the Northeast, compared to white trauma patients. The highest associated risk of death for blacks (vs. whites) was in the Midwest (odds ratio [OR] 1.30, P < .001). Asian trauma patients only had a higher associated risk of death in the West (OR 1.39, P < .001). Male trauma patients, compared to women, had an increased associated risk of mortality in all four regions. Discussion This study found major differences in outcomes among different races within different regions of the United States. There was also both an increased rate and associated risk of mortality for male patients in all regions. Future prospective studies are needed to identify what regional differences in trauma systems including population density, transport times, hospital access, and other trauma resources explain these findings.

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Hyperkalemia excursions and risk of mortality and hospitalizations in hemodialysis patients: results from DOPPS-Italy

Journal of Nephrology ◽

10.1007/s40620-021-01209-5 ◽

2022 ◽

Author(s):

Pietro Manuel Ferraro ◽

Davide Bolignano ◽

Filippo Aucella ◽

Giuliano Brunori ◽

Loreto Gesualdo ◽

...

Keyword(s):

Hemodialysis Patients ◽

Risk Of Mortality

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Effects of a novel method of acute tryptophan depletion on plasma tryptophan and cognitive performance in healthy volunteers

Psychopharmacology ◽

10.1007/s00213-004-2141-y ◽

2004 ◽

Vol 178 (1) ◽

pp. 92-99 ◽

Cited By ~ 49

Author(s):

E. A. T. Evers ◽

D. E. Tillie ◽

F. M. van der Veen ◽

C. K. Lieben ◽

J. Jolles ◽

...

Keyword(s):

Healthy Volunteers ◽

Cognitive Performance ◽

Acute Tryptophan Depletion ◽

Tryptophan Depletion ◽

Plasma Tryptophan ◽

Novel Method

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Role of Roxadustat in Improving Erythropoiesis-Stimulating Agent (ESA)-Resistant Anemia in Patients on Maintenance Hemodialysis

Blood ◽

10.1182/blood-2020-141759 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 47-47

Author(s):

Satoshi Funakoshi

Keyword(s):

Iron Metabolism ◽

Conflicts Of Interest ◽

Hypoxia Inducible Factor ◽

Transferrin Saturation ◽

Hemodialysis Patients ◽

Maintenance Hemodialysis ◽

Reactive Protein ◽

Study Results ◽

Dialysis Vintage ◽

Patients With Diabetes

Background: Roxadustat, an oral hypoxia-inducible factor (HIF) prolyl hydroxylase inhibitor, is shown to stimulate erythropoiesis thus improving iron metabolism. Again, while hyperglycemic states are known to be associated with a decreased tissue hypoxia response, to date, roxadustat has not been revaluated for its role in improving anemia in patients with or without diabetes in clinical settings. Methods: A total of 64 hemodialysis patients being treated with epoetin α (9000 units weekly) participated in the study after giving informed consent. They were switched from intravenous epoetin α to oral roxadustat (100 mg 3 times weekly) therapy and were assessed 8 weeks later for improvements in anemia, as well as for changes in parameters for iron metabolism and C-reactive protein (CRP). Results: The study included 39 patients without diabetes (mean age, 71.1 ± 12.1 years; mean dialysis vintage, 7.5 ± 7.4 years; mean GA, 16.2 ± 2.9%) and 27 patients with diabetes (mean age, 70.3 ± 10.3 years; mean dialysis vintage, 5.9 ± 5.5 years; mean GA, 24.9 ± 5.5%). As shown in Table, after 8 weeks the Hb concentration was significantly increased from 10.3 ± 0.8 g/dL at baseline to 10.7 ± 1.3 g/dL in patients without diabetes (P = 0.03) but was not increased in patients with diabetes (from 10.4 ± 0.6 at baseline to 10.5 ± 1.1 g/dL). Again, the serum iron, ferritin concentrations and the transferrin saturation ratio were decreased, irrespective of whether or not they had diabetes, with no change shown in serum CRP level. Conclusion: Switching hemodialysis patients with ESA-resistant anemia from ESA to roxadustat led to improvements in anemia only in those without diabetes, while study results suggested the involvement of mechanisms, other than impaired iron utilization or inflammation, in the impairment of hematopoiesis in those with diabetes. Table Disclosures No relevant conflicts of interest to declare.

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The Effect of Dhamma Practice on Depression Outcomes in Hemodialysis Patients

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.01.11083 ◽

2021 ◽

Vol 104 (1) ◽

pp. 44-51

Keyword(s):

Quality Of Life ◽

Blood Pressure ◽

Statistical Significance ◽

Bodily Pain ◽

Laboratory Data ◽

Hemodialysis Patients ◽

Study Results ◽

Dialysis Vintage ◽

Severity Of Depression

Background: Depression impairs the quality of life (QOL), increases risk of hospitalization and death in hemodialysis patients. Antidepressant medications can lead to more severe side effects. Dhamma practice by Chanting and Anapanasati meditation may relieve depressive symptoms in hemodialysis patients. Objective: To evaluate the effect of Dhamma practice on depression outcome and QOL in hemodialysis patients. Materials and Methods: The authors conducted a quasi-experimental research, a time series design. Patients who were hemodialyzed three times a week at Bhumirajanagarindra Kidney Institute Hospital were enrolled. Participants were trained to practice the Chanting with Anapanasati meditation for 35 minutes every hemodialysis session for six months. Comparison of depression scores, severity of depression, QOL, vital signs, laboratory data, and biomarkers (F2-isoprostanes) was made between the beginning and the end of the study. Results: Forty patients were eligible for participation in the present study. The average age was 63.7±13.1 years. Median dialysis vintage was 29.5 months. After Dhamma practice for six months, diastolic blood pressure was decreased significantly (p=0.015). Median depression score decreased from 9.5 to 4 (p<0.001). The proportion of depressive patients were decreased from 17.5% to 2.5%. The severity of depression trended to decrease, but without statistical significance. F2-isoprostanes was decreased significantly (p<0.001). Both physical aspects (role physical, bodily pain, and physical component scale) and mental aspects (vitality, role emotional, mental health, and mental component scale) of QOL were significantly improved. Conclusion: Dhamma practice by Chanting and Anapanassati meditation significantly decreased blood pressure, and depression, and improved QOL both physically and mentally, in hemodialysis patients. Keywords: Depression, Quality of life, Hemodialysis, Meditation, Buddhist chanting, Dhamma.

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P1491INTRADIALYTIC HYPOTENSION AND PROGOSIS IN HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1491 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Yuto Takenaka ◽

Satoru Kishi ◽

Kyosuke Nishio ◽

Kazunobu Masaki ◽

Toyohiro Hashiba ◽

...

Keyword(s):

Univariate Analysis ◽

Mortality Rates ◽

Hemodialysis Patients ◽

Hemoglobin Level ◽

Intradialytic Hypotension ◽

Prognostic Impact ◽

Dialysis Vintage ◽

All Cause Mortality ◽

Group A ◽

Group B

Abstract Background and Aims The aim of this study was to investigate the prognostic impact of intradialytic hypotension (IDH). Method This study comprised 237 hemodialysis patients (158 males, 64±13 years old, dialysis vintage:110±88 months) in a community-based dialysis center. IDH was recorded in 12 consecutive hemodialysis sessions from February to April in 2014. The patients were divided into 2 groups: Group A, patients with IDH, and Group B, those without IDH, and all-cause mortality rates for 4 years were examined. IDH was defined as a rapid symptomatic fall of systolic blood pressure by at least 30 mmHg or that required medical intervention. Logistic regression was used to investigate the association between IDH and mortality. Results IDH was observed in 123 patients (52 %). The frequency of IDH was 3.8±3.1 times during 12 hemodialysis sessions in Group A. Mortality rates from all causes of death were significantly higher in Group A than in Group B (40 % and 17 % at 4 years, respectively, p < 0.05). Univariate analysis showed that IDH, age, female, dry weight, ultrafiltration rate (UFR), serum albumin level, and serum hemoglobin level were significantly associated with all-cause mortality. In multivariate analysis, IDH, age, UFR, and serum hemoglobin level were independent risk factors for all-cause mortality (Table). Conclusion In our population, IDH was associated with a poor prognosis at 4 years.

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Revised Reference Values for the Intake of Sodium and Chloride

Annals of Nutrition and Metabolism ◽

10.1159/000484355 ◽

2017 ◽

Vol 72 (1) ◽

pp. 12-17 ◽

Cited By ~ 9

Author(s):

Daniela Strohm ◽

Angela Bechthold ◽

Sabine Ellinger ◽

Eva Leschik-Bonnet ◽

Peter Stehle ◽

...

Keyword(s):

Breast Milk ◽

Reference Values ◽

Salt Intake ◽

Sodium Intake ◽

Chloride Salt ◽

Dietary Recommendations ◽

Balance Study ◽

Lactating Women ◽

Adverse Health Effects ◽

Sodium Loss

Background: In January 2017, the nutrition societies of Germany, Austria and Switzerland revised the reference values for sodium and chloride intake. Methods: For adults, the estimated value for sodium intake was derived on the basis of a balance study. The estimated values for children and adolescents were extrapolated from this estimated value considering differences in body mass. For infants aged 0 to under 4 months, an estimated value was set based on the sodium intake via breast milk. From this value the estimated value for infants aged 4 to under 12 months was also derived by extrapolation. The estimated value for lactating women takes into account the fact that the sodium loss via breast milk is compensated through homoeostatic mechanisms. Except for infants, the reference values for chloride intake were derived based on the estimated values for sodium intake. Results: For adults, pregnant and lactating women, the estimated values for sodium and chloride intake are set at 1,500 and 2,300 mg/day. Discussion and Conclusion: Reference values for sodium and chloride can be derived in terms of estimated values. Considering dietary recommendations for sodium and chloride, it must be taken into account that high intake of sodium chloride (salt) is associated with adverse health effects, for example, hypertension and cardiovascular diseases. Therefore, it is necessary to lower salt intake in the general population.

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Self-Care Behavior Profiles With Arteriovenous Fistula in Hemodialysis Patients

Clinical Nursing Research ◽

10.1177/1054773818787110 ◽

2018 ◽

Vol 29 (6) ◽

pp. 363-367 ◽

Cited By ~ 2

Author(s):

Clemente Neves Sousa ◽

Patrícia Marujo ◽

Paulo Teles ◽

Marta Nunes Lira ◽

Vanessa Filipa Ferreira Dias ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Self Care ◽

Dialysis Unit ◽

Dialysis Vintage ◽

Gender Education ◽

Male Patients ◽

Stage Renal Disease ◽

End Stage ◽

Behavior Profiles ◽

Care Behavior

Patients with end-stage renal disease should be educated and trained to take care of their own arteriovenous fistula (AVF) with the purpose of developing self-care behaviors concerning vascular access. This was a prospective and observational study. We designed this research to identify clinically meaningful self-care behavior profiles in hemodialysis (HD) patients, and it was carried out in a private dialysis unit in the Lisbon region, Portugal, involving 101 patients. The proportion of male patients was 66.3%, the mean age was 60.9 years, and the frequency of self-care behaviors was 71%. Cluster analysis based on the subscale scores grouped patients in two clusters named “moderate self-care” and “high self-care.” Those profiles exhibit significant differences concerning gender, education, employment, dialysis vintage, AVF duration, and information on care with the AVF. Identification of self-care-behavior profiles in HD patients with AVF enables one to adjust education programs to the patients’ characteristics.

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Associations of Calcium from Food Sources versus Phosphate Binders with Serum Calcium and FGF23 in Hemodialysis Patients

Journal of Clinical Medicine ◽

10.3390/jcm8101680 ◽

2019 ◽

Vol 8 (10) ◽

pp. 1680 ◽

Cited By ~ 1

Author(s):

Sara Mahdavi ◽

Antonio Bellasi ◽

Karan Nagra ◽

Luke Johnston ◽

Paul Tam ◽

...

Keyword(s):

Serum Calcium ◽

Statistical Significance ◽

Dietary Calcium ◽

Hemodialysis Patients ◽

Food Sources ◽

Phosphate Binders ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Dialysis Vintage ◽

25 Oh Vitamin D

Background: Dysregulated serum calcium and FGF23 are associated with increased mortality and morbidity rates in patients receiving hemodialysis. Preliminary data suggest serum calcium regulates FGF23 secretion independently of serum phosphate, parathyroid hormone, and 25-OH vitamin D. It is unclear to what extent dietary and prescription sources of calcium influence calcium and FGF23 levels, and whether they confound this relationship. In this cross-sectional analysis of a multi-ethnic cohort of prevalent hemodialysis patients, association of dietary calcium and prescribed calcium were examined against serum calcium and FGF23. Bi- and multivariable linear regression was used for all analyses. Results: 81 patients (mean age 58 years, dialysis vintage 2 years, 51 men) participated. Dietary calcium was inversely associated with FGF23 (p = 0.04) however association of FGF23 with prescribed calcium did not reach statistical significance (0.08). In multivariable models, dietary calcium and prescribed calcium were associated in opposing directions with serum calcium (prescribed calcium; ß-coefficient = −0.35, p = 0.005 versus dietary calcium; ß-coefficient = 0.35, p = 0.03). FGF23 was independently associated with serum calcium (p = 0.007). Conclusions: We found differing, sometimes opposing, associations between serum calcium and FGF23 levels when considering prescribed versus dietary sources of calcium. Serum calcium and FGF23 were strongly correlated regardless of possible confounders examined in this hemodialysis cohort. Dietary calcium was associated with higher serum calcium and lower FGF23 concentrations, while prescribed calcium was only inversely associated with serum calcium. Further studies are required to confirm these associations and determine causality.

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