Chronic increase of bone turnover markers after biliopancreatic diversion is related to secondary hyperparathyroidism and weight loss. Relation with bone mineral density.

BACKGROUND: Biliopancreatic diversion (BPD) is the most effective bariatric procedure. Around 70% of these patients have secondary hyperparathyroidism (SH) in the long term as a consequence of calcium and vitamin D malabsorption. This work was aimed to study the influence of SH on bone turnover and its relationship with bone mineral density (BMD). METHODS: Bone turnover markers were determined in 63 BPD patients and 34 morbidly obese controls. In the BPD group, we also studied the influence of age, loss of weight, common channel length, PTH, vitamin D, and serum calcium on bone turnover as well as its relation with BMD. RESULTS: BPD patients showed significantly higher PTH, osteocalcin, and beta-CTx levels than controls. In the multivariate regression analysis, only PTH (beta=0.42; P=0.0002), menopausal status (beta=0.31; P=0.007) and the percentage of lost BMI (beta=-0.24; P=0.03) significantly predicted the osteocalcin level (R2=0.33; F=9.56; P<0.0001). Similarly, only PTH (beta=0.39; P=0.0005), menopausal status (beta=0.37; P=0.001) and the percentage of lost BMI (beta=-0.23; P=0.04) significantly predicted the beta-CTx level (R2=0.33; F=9.82; P<0.0001). Osteocalcin and beta-CTx levels correlated negatively with BMD at lumbar spine (r=-0.38, P=0.002 and r=-0.30, P=0.02, respectively). CONCLUSIONS: Chronic SH and the loss of weight determine a high rate of bone turnover that is associated with decreasing BMD in BPD patients.

Very early serum creatinine as a surrogate marker for graft survival beyond 10 years.

BACKGROUND: Available studies of early serum creatinine (SCr) as a surrogate marker for long-term graft loss are multicenter, registry-based or limited to 5- to 7-year survival. METHODS: This was a single-center observational retrospective study. SCr during the first year post-kidney transplant as an independent variable in determining long-term (>10-year) graft survival in 754 first cadaver kidney transplants was assessed with univariate and multivariate models. RESULTS: Kaplan-Meier survival estimates showed that recipient female sex, a transplant procedure performed after 1997, donor age under 55 years, immunosuppression including tacrolimus and/or mycophenolate mofetil and absence of acute rejection, were significantly related to better long-term graft survival. SCr at 1, 3, 6 and 12 months stratified into 2 mg/dL groups was also strongly related to long-term graft survival. Multivariate Cox models showed that increased SCr at any point during the first year had a higher relative risk for ultimate graft loss. CONCLUSIONS: Early graft function is strongly correlated with long-term graft survival (>or=10 years). Mild differences in SCr (1.5 vs. 1.6-2 mg/dL) are associated with highly significant impact on long-term survival, longer than previously described. However, the "hard" predictive value of SCr as an isolated tool is not strong enough. Other early surrogate end points for graft loss are needed.

Vitamin D deficiency is associated with the metabolic syndrome in morbid obesity.

BACKGROUND & AIMS: Vitamin D deficiency has been recently associated with the metabolic syndrome. However, it is not known whether this possible association of vitamin D deficiency with the metabolic syndrome is still present at very high degrees of obesity, as in morbidly obese patients. METHODS: Transversal, observational study that included 73 consecutive morbidly obese patients (body mass index 40 kg/m(2)). In every patient, anthropometric variables were recorded, fasting blood was assayed for 25-hydroxyvitamin D concentrations, lipid profiles, glucose and insulin levels, and insulin resistance was estimated by homeostasis model assessment. RESULTS: Vitamin D deficiency was present in 37 of the 73 patients (50.7%). As defined by revised Adult Treatment Panel III criteria, 46 of the 73 obese patients (63%) had the metabolic syndrome. Vitamin D deficiency was more prevalent in morbidly obese patients presenting with the metabolic syndrome, compared with those who did not achieve the criteria for this syndrome (60.9% vs. 33.3% respectively, P = 0.023). When serum concentrations of 25-hydroxyvitamin D were categorized in tertiles, there was an association of the prevalence of the metabolic syndrome with the former (P = 0.038). Serum high-density lipoprotein cholesterol concentrations were lower (37.0+/-7.8 mg/dl vs. 44.9+/-8.7 mg/dl, P = 0.003), and triglycerides levels were higher (163.3+/-81.5 mg/dl vs. 95.1+/-24.2 mg/dl, P = 0.001) in the vitamin D-deficient group. CONCLUSION: Vitamin D deficiency is associated with the metabolic syndrome in morbidly obese patients.