Association between umbilical cord vitamin D levels and adverse neonatal outcomes.

OBJECTIVE: We investigated the associations between cord blood concentration of 25-hydroxyvitamin D [25(OH)D], neonatal outcomes, and the risk of hospitalization during the first year of life. METHODS: A total of 402 newborn infants and their mothers were prospectively enrolled and divided in four groups according to season of the year. We determined 25(OH)D serum concentrations from maternal-neonatal pairs at delivery by electrochemiluminescence immunoassay. Cut-offs at 25, 50, and 75 nmol/L defined vitamin D status, corresponding to deficiency, insufficiency, and sufficiency, respectively. Crude odds ratio (cOR) and 95% confidence intervals (CI) were estimated using logistic regression. RESULTS: Vitamin D severe deficiency (i.e., <25 nmol/L) was present in 18% of newborns. Cord blood severe deficiency was associated with an increased risk of preterm birth (cOR 3.6, 95% CI: 1.1-12.2), neonatal respiratory distress syndrome (cOR 5.9, 95% CI: 1.1-33.2), and increased risk of hospitalization during the first year of life because of acute respiratory infection (cOR 3.9, 95% CI: 1.4-10.6) or acute gastroenterocolitis (cOR 5.2, 95% CI: 1.4-19.1). CONCLUSION: Cord blood vitamin D deficiency is associated with increased risk of preterm birth, neonatal respiratory distress syndrome, and hospitalization during the first year of life.

Total parathyroidectomy with forearm autotransplantation as the treatment of choice for secondary hyperparathyroidism.

Chronic kidney disease-mineral and bone disease (CKD-MBD) is associated with uraemic bone disease, vascular calcification, reduced quality of life and reduced survival. This study evaluated the efficacy of parathyroidectomy (PTX) with autotransplantation in improving short-term and long-term outcomes. Dialysis patients who underwent PTX showed significantly more favourable biochemical parameters after PTX. These changes were accompanied by a lower coronary artery calcification score, reduced thickness of the intimae media and comparable bone mineral density measures compared with control dialysis patients who did not undergo PTX. Despite the risk of a substantially lower intact parathyroid hormone level postoperatively that might lead to adynamic bone disease, none of the patients reported clinical signs of this disease, such as bone pain or fractures. In conclusion, PTX with autotransplantation led to improvement of CKD-MBD so may be considered in patients with secondary hyperparathyroidism that is resistant to treatment with vitamin D analogues and calcimimetics.

Comparison of coronary artery calcification and some coronary artery calcification risk factors in patients on haemodialysis and in patients with type 2 diabetes.

Patients on haemodialysis (HD) and patients with type 2 diabetes are at high-risk for coronary artery calcification (CAC). The coronary artery calcium score (CACS), quantified by computed tomography, cannot be completely explained by traditional cardiovascular disease risk factors. CAC was measured in 45 non-diabetic chronic kidney disease patients on HD and in 45 matched type 2 diabetes patients without diabetic nephropathy. Serum calcium, phosphate, 25-hydroxyvitamin D (25[OH]D), alkaline phosphatase, intact parathyroid hormone (iPTH), fetuin-A, high-sensitivity C-reactive protein (hsCRP), albumin, homocysteine, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides and femoral neck bone mineral density were also measured. No differences were observed in patient distribution across the CACS risk categories between the two groups. Significant differences were observed in serum calcium, phosphate, 25(OH)D, alkaline phosphatase, iPTH, fetuin-A, hsCRP, homocysteine and triglycerides between the two patient groups. Further research into the diverse, numerous and often interlinked factors that influence CAC in different groups of patients is warranted.

High-dose cholecalciferol supplementation for vitamin D deficiency in haemodialysis patients.

Vitamin D deficiency, which is a recognized problem in haemodialysis (HD) patients, has been associated with higher all-cause mortality. There are no guidelines concerning vitamin D supplementation in HD patients. This study aimed to assess the effects of once-monthly supplementation with high-dose cholecalciferol (vitamin D(3)) in HD patients. Patients with 25-hydroxy vitamin D (25[OH]D) levels of < 75 nmol/l received 40,000 IU of cholecalciferol oncemonthly for 3 months in succession. Every 4 months, 25(OH)D levels were measured and, based on the findings, cholecalciferol therapy was continued for another cycle if necessary. Six cycles were completed in the 24-month study period. The majority of HD patients had mild or severe vitamin D deficiency at baseline. Monthly supplementation with cholecalciferol at 40,000 IU was well tolerated, safe and inexpensive. The treatment regime was effective for vitamin D insufficiency but did not prove to be enough to restore 25(OH)D levels in HD patients with mild or severe vitamin D deficiency.

Ischaemic stroke--impact of renal dysfunction on in-hospital mortality.

Renal dysfunction predicts mortality in patients with myocardial infarction but less is known about the impact of renal dysfunction on in-hospital mortality after ischaemic stroke. All 361 patients (185 men, 176 women; mean age 72.1 years) with ischaemic stroke and glomerular filtration rate (GFR) <90 ml/min/1.73 m2 were followed-up. GFR was calculated according to abbreviated modification of diet in renal disease (MDRD) formula. Stroke severity was determined by National Institutes of Health Stroke Scale (NIHSS). The mean GFR was 61.5 +/- 16.6 ml/min/1.73 m2. There were 49 (13.6%) in-hospital deaths. Patients who died had higher NIHSS (P = 0.0001), were older (P = 0.024), had lower GFR (P = 0.028), higher hs-C-reactive protein (P = 0.001) and lower albumin (P = 0.048). No differences in presence of diabetes and hypertension, cholesterol (total, HDL and LDL), triglycerides and BMI between patients who died or survived were found. With univariate analysis association between in-hospital mortality and NIHSS (P = 0.0001), GFR (P = 0.041), total cholesterol (P = 0.021) and LDL cholesterol (P = 0.034) was found. With Cox multivariable regression analysis of risk factors, NIHSS (P = 0.0001), GFR (P = 0.018), total cholesterol (P = 0.008) and LDL cholesterol (P = 0.011) were only predictors of in-hospital mortality. In patients with ischaemic stroke, decreased GFR was associated with higher in-hospital mortality.

Bone mineral density in patients beginning hemodialysis treatment.

BACKGROUND: Our study was designed to determine bone mineral density (BMD) in patients beginning hemodialysis (HD) treatment, a possible correlation with the duration of renal failure prior to treatment, a possible correlation with the basic disease and the association with the concentration of intact parathormone (iPTH). METHODS: Our prospective clinical trial included 50 patients beginning HD treatment. Cortical bone mineral density (BMDc) was measured at the left femoral neck and trabecular bone mineral density (BMDt) in the region of the lumbosacral spine. Bone mineral density (BMD) was measured by quantitative digital radiography using a Hologic 2000 plus device belonging to the third generation of densitometers based on dual-energy X-ray absorptiometry. RESULTS: In patients (PTS) beginning HD, the average BMDc was 82 +/- 15% of BMDc in a healthy population of corresponding age and sex. The average BMDt was 91 +/- 16% of BMDt in a healthy population of corresponding age and sex. The difference was statistically significant (p < 0.05). There is a negative correlation between iPTH and BMDc r = -0.34 (p < 0.02). Patients with chronic glomerulonephritis (GN) had a statistically significantly higher BMDc (g/cm(2)) (p < 0.01) than those with analgetic nephropathy (AN). PTS with AN have lower BMDc (g/cm(2), %) (p < 0.02) and BMDt (p < 0.005) than the rest of the PTS, iPTH in PTS with AN is higher than in the rest of the PTS (p < 0.05). CONCLUSIONS: In PTS at the beginning of HD, BMD is lower than in healthy people of corresponding age and sex. This means that BMD already decreases prior to HD. BMDc was statistically significantly lower than BMDt (p < 0.00005). PTS with AN have lower BMD than those with GN and all remaining PTS. A negative correlation between iPTH and BMDc was found.

Bone histomorphometry is still the golden standard for diagnosing renal osteodystrophy.

AIM: The clinical picture of renal osteodystrophy (RO) is very uncharacteristic. The diagnosis is made by means of biochemical indicators, intact parathormone (iPTH) concentration, bone X-rays, bone densitometry and particularly bone histomorphometry. The aim of our study was to establish whether a combination of non-invasive methods can bring us closer to the diagnosis as to avoid bone biopsy. PATIENTS AND METHODS: We chose 30 patients treated by chronic hemodialysis. Only 4 of them had no symptoms of RO. Biochemical parameters (Ca, P) and iPTH concentrations were determined. bone X-rays were taken (the parathyroid series), bone mineral density was measured by quantitative digital radiography (QDR), and bone biopsy specimens were taken for bone histomorphometry. The data were analyzed by the Statistica by StatSoft and SPSS computer programs. RESULTS: With respect to bone histomorphometry, 10 patients had osteitis fibrosa (OF), 15 had mixed osteodystrophy (MO), 5 adynamic bone disease (ABD). There was a good correlation of iPTH and alkaline phosphatase (AP) concentrations with histomorphometric parameters. There was also a correlation between radiological changes and histomorphometric parameters. After the analysis of discrimination using the SPSS computer program, taking only iPTH into consideration, 36.6% of patients were correctly classified according to their diagnosis. Considering iPTH and densitometry, 46.6% were classified correctly. Considering iPTH and radiological changes, 60% of patients were classified correctly. CONCLUSION: To diagnose 73.3% of patients correctly, it was necessary to consider the above mentioned non-invasive parameters, as well as AP, P, concentrations and the patient age. Histomorphometry remains the "golden standard" for diagnosing RO.

Brown tumor in association with secondary hyperparathyroidism. A case report and review of the literature.

Since 1993, our 34-year-old female patient was on replacement treatment with hemodialysis for terminal renal failure due to hypertensive nephropathy. She developed severe secondary hyperparathyroidism. In 1996, she presented with a brown tumor, localized in the region of the left maxillary sinus and at its front. The patient did not take phosphate binders and treatment with vitamin D was not possible due to the increased Ca x P product. She had no difficulties, so she did not desire a surgical parathyroidectomy. As she had trouble breathing through the nose, and because of the facial deformity due to the brown tumor, she decided to have the tumor removed surgically.

Patients with analgetic nephropathy on chronic hemodialysis have a high incidence of severe secondary hyperparathyroidism.

Between 1996 and 1997, 86 patients were treated for terminal renal failure by hemodialysis at Maribor Teaching Hospital. Among them were 12 with iPTH over 900 pg/ml and symptoms of bone disease. In these patients bone biopsy was carried out with the aim of determining the type of renal osteodystrophy (RO) and establishing a possible correlation with the clinical picture, with densitometry and laboratory results. Histomorphologically, 6 patients fulfilled the criteria for secondary hyperparathyroidism (HT) - 3 with analgetic nephropathy (AN), one with chronic pyelonephritis (CPN), one with vascular nephropathy (VN), one with chronic glomerulonephritis (CGN). Six patients fulfilled the criteria for mixed osteodystrophy (MO) - 3 AN, 2 CGN, one VN. According to laboratory findings and bone mineral density (BMD), a statistically significant difference between HT and MO was present only in AP (Table 1). The most frequent diagnosis in patients with iPTH >900 pg/ml was analgetic nephropathy.

Tumoral calcinosis in patients on hemodialysis. Case report and review of the literature.

Extraskeletal tumoral calcinosis occur in uremic patients with high calcium phosphorus (Ca x P) product and progressive secondary hyperparathyroidism. However, cases are also described in which this association cannot be confirmed. The influence of aluminum, vitamins D and K, alkalosis, magnesium and local lesions is described. The case of a female patient with tumoral calcinosis disappearing after parathyroidectomy is presented.

The effect of peroral calcitriol in small doses on mild secondary hyperparathyroidism in patients on hemodialysis.

Our prospective 1-year study comprises 93 patients of both sexes, various ages and various dialysis duration. Among them, 31 patients with a concentration of Ca in blood under 2.7 mmol/l, a concentration of P under 1.8 mmol/l and a concentration of PTHi over 65 pg/ml (group 0) received calcitriol 0.25 microgramx418p4The control group consisted of patients not receiving calcitriol and having normal Ca and P metabolism (group 1). The rest of the patients had a concentration of P over 1.8 mmol/l and could not be given calcitriol. A comparison of the dynamics of average plasmic concentrations of Ca, P, AP, PTHi and X-ray changes in group 0 and 1 at the beginning of the investigation and 1 year later was carried out. At the termination of the 1-year treatment, when compared to the initial state, a statistically significant increase in the concentration of Ca (p < 0.005) and in the concentration of P (p < 0.005) was noted in group 0. The average concentration of PTHi decreased to the desired level, the X-ray changes characteristic of secondary hyperparathyroidism progressed more slowly in group 0.