Changes In Serum Calcium Research Articles

Alterations in serum levels of calcium, vitamin D, phosphorus, and parathyroid hormone in patients with clinically confirmed familial hypercholesterolemia: a cross-sectional study.

Familial hypercholesterolemia (FH), an autosomal dominant disease, is associated with an increased risk of premature cardiovascular disease (CVD). This study aimed to examine the variations in serum levels of calcium, vitamin D, phosphorus, and parathyroid hormone (PTH) among FH patients, as these factors have been associated with an increased susceptibility to CVD. In this cross-sectional study, the authors used data from Isfahan FH registry. The Dutch Lipid Clinic Network (DLCN) criteria was used for diagnoses of FH patients. Control group included participants with hyperlipidemia and were unlikely FH according to DLCN criteria. All biochemical parameters were measured using standard methods. A total of 131 patients (mean age, 53.1 ± 12.2; male, 51.4%) were included in the analysis. Patients with FH had lower serum vitamin D levels compared with control groups in the unadjusted model (P= 0.028). The relationship between serum vitamin D and FH was not significant after adjustment for traditional risk factor (P= 0.184). No significant association was observed between FH and serum calcium (P= 0.886), phosphorus (P= 0.463), and PTH (P= 0.849). Besides, there was no significant association between LDL-C or total cholesterol and serum minerals in FH patients. This study found no significant changes in serum calcium, vitamin D, phosphorus, and PTH in patients with FH.

Analysis of changes in serum calcium and magnesium levels during plateletpheresis on different apheresis machines in healthy donors: A cross-sectional study

Abstract: BACKGROUND: The most common observed complication of plateletpheresis procedure is hypocalcemia due to citrate’s chelation of free calcium. Magnesium is also affected by citrate infusion. We have evaluated the impact of plateletpheresis on the total serum calcium (Ca++) and magnesium (Mg++) levels of the donor. MATERIALS AND METHODS: One hundred and thirty-seven healthy plateletpheresis donors were included in the study. Samples were collected from the donor at 0 min (baseline), 30 min, and 60 min, at the end of the procedure and 30 min after completion of the procedure. The pattern of changes in serum Ca++ and serum Mg++ levels at different time points for different apheresis machines (Fenwal Amicus, Fresenius COM.TEC, Spectra Optia, and Hemonetics MCS+) was studied. RESULTS: A significant decline in serum Ca++ and serum Mg++ levels from baseline to the end of the procedure was observed. This decline was observed maximum for Hemonetics MCS+. The baseline values were regained 30 min after completion of the procedure. Difference from baseline values 30 min after the procedure was lowest in amicus in the case of serum Ca++ and COM.TEC in case of serum Mg++. Twenty donors (14.60%) experienced adverse donor reactions. CONCLUSION: Serum calcium and serum magnesium levels decreased transiently during the procedure and regained normal values after 30 min of the completion of the plateletpheresis procedure on all four apheresis machines (whether based on continuous or intermittent centrifugation). Hence, it is concluded from our study that plateletpheresis is a well-tolerated and safe procedure.

Effects of active vitamin D analogs and calcimimetic agents on PTH and bone mineral biomarkers in hemodialysis patients with SHPT: a network meta-analysis.

Active vitamin D analogs and calcimimetic agents are primary drugs for patients with secondary hyperparathyroidism. Due to the different pharmacological mechanisms, they have different effects on the level of parathyroid hormone, serum calcium, phosphorus, and bone turnover biomarkers. This study aimed to evaluate the active vitamin D analogs and calcimimetic agents in hemodialysis patients with secondary hyperparathyroidism. We included randomized clinical trials of hemodialysis patients with secondary hyperparathyroidism, comparing active vitamin D analogs to calcimimetic agents or placebo/control. The primary outcome was the change of PTH level from baseline to end-up. The secondary outcome was the change in serum calcium, phosphorus, calcium-phosphorus product, and bone turnover biomarkers. A network meta-analysis method was applied to complete this study. The forest plots reflected statistical differences in the outcomes between active vitamin D analogs and calcimimetic agents. The SUCRA result presented the ranking of impact on the outcomes. Twenty-one randomized clinical trials with 4653 patients were included in this network meta-analysis. Global and splitting-node inconsistencies provided no evidence of inconsistency in this study. There was no statistical difference between two active vitamin D analogs and three calcimimetic agents in the PTH, and phosphorus levels changed. Considering serum calcium level, compared with placebo, calcitriol (9.73, 3.09 to 16.38) and paricalcitol (9.74, 3.87 to 15.60) increase serum calcium. However, cinacalcet (- 1.94, - 3.72 to - 0.15) and etelcalcetide (- 7.80, - 11.80 to - 3.80) reduced the serum calcium, even a joint use of cinacalcet with active vitamin D analogs (- 5.83, - 9.73 to - 1.93). Three calcimimetic agents decreased calcium levels much more than calcitriol and paricalcitol. The same type of drugs was not distinct, with each one affecting the change in calcium level. Cinacalcet reduced calcium-phosphorus product much more than paricalcitol (- 3.66, - 6.72 to - 0.60). Evocalcet decreased calcium-phosphorus product more than cinacalcet (- 5.64, - 8.91 to - 2.37), calcitriol (- 9.36, - 14.81 to - 3.92), and paricalcitol (- 9.30, - 13.78 to - 4.82). Compared with paricalcitol, cinacalcet significantly increases the level of ALP (24.50, 23.05 to 25.95) and bALP (0.67, 0.03 to 1.31). The incidence of gastrointestinal disorders in cinacacet (29.35, 1.71 to 504.98) and etelcalcetide (20.92, 1.20 to 365.68) was notably higher than in paricalcitol. Etelcalcetide (0.71, 0.53 to 0.96) and evocalcet (0.46, 0.33 to 0.64) presented a lower rate of gastrointestinal disorders than cinacalcet. Cinacalcet ranked first in adverse gastrointestinal, nervous, and respiratory reactions. The same kinds of agents perform similar efficacy on the level of PTH, serum calcium, phosphorus, and calcium-phosphorus product. Paricalcitol did not lead to more hypercalcemia than calcitriol. The calcium decrease induced by cinacalcet was not settled even by associating it with active vitamin D analogs. Cinacalcet and evocalcet were superior to calcitriol and paricacitol in reducing calcium-phosphorus product. Calcimimetics induced more gastrointestinal disorders than active vitamin D analogs, especially cinacalcet.

Serum Electrolytes and Calcium Levels in Neonates Receiving Phototherapy for Neonatal Jaundice

Background: Neonatal Jaundice (NJ) is one of the most common causes of neonatal admission. Phototherapy is an important treatment modality for NJ. However, this treatment modality may itself result in changes of different biochemical parameters. The study aimed to evaluate the changes in serum electrolytes (Sodium, potassium and chloride) and calcium in neonates receiving phototherapy for NJ. Materials and methods: One hundred and two term neonates admitted to the Special Care Newborn Unit, Chattogram Medical College Hospital for the management of NJ by phototherapy were enrolled in this prospective observational study. Serum bilirubin, sodium, potassium, chloride and calcium were measured before and after 48 hours of phototherapy and compared. Results: The mean gestational age and mean age of admission of the neonates were 38.6±0.6 weeks and 6.42 ± .67 day respectively. The mean sodium, potassium and calcium level before therapy was respectively, 138.4±1.8 mmol/L, 4.1±0.3 mmol/L and 8.8±0.3 mg/dl. There was significant decrease in the level of mean sodium (136.4±1.6 mmol/L), potassium (3.8 ± 0.3 mmol/L) and calcium (8.4±0.4 mg/dL) after phototherapy. All neonates had normal level of serum calcium, sodium, potassium and chloride before phototherapy. After 48 hours of phototherapy, 46 (45.1%) of them had abnormal values with the incidence hypocalcaemia, hyponatraemia and hypokalemia respectively in 21.6%, 25.5% and 10.8% of the neonates. Conclusion: Neonates undergoing phototherapy are at risk of developing hyponatraemia, hypokalaemia and hypocalcaemia. Closed monitoring is essential to observe the changes in sodium, potassium and calcium and should be managed accordingly. IAHS Medical Journal Volume 6(2) December 2023; 83-86

Impact of Surgical Parathyroidectomy on Craniofacial Morphology in Patients With Renal Failure.

Parathyroidectomy is beneficial in tertiary hyperparathyroidism (THPT) consequent to chronic renal failure. The craniofacial morphology of patients who undergo total parathyroidectomy and autologous transplantation (tPTX + AT) has not been widely studied. This study assessed the efficacy of tPTX + AT in THPT and evaluated possible improvements in craniofacial features. This retrospective analysis included patients who were diagnosed with medically refractory THPT and had undergone tPTX + AT between September 2013 and May 2021. The VAS was used to evaluate improvements in various symptoms including bone pain and pruritus. Changes in serum calcium, phosphorus, alkaline phosphatase, and intact parathyroid hormone (iPTH) levels were also assessed. The impact of the procedure was assessed by comparing two-photon X-ray bone mineral density measurements obtained 1 year before and after surgery. The VAS of pain and pruritus decreased significantly on the first postoperative day (P < 0.05). Calcium levels changed significantly (from 2.50 ± 0.22mmol/L to 2.10 ± 0.26mmol/L) on postoperative day 1 (P = 0.0000); iPTH levels also declined substantially on this day, reducing from 211.00 (122.10, 252.80) to 5.04 (2.96, 9.40) pmol/L. Bone mineral density increased significantly across various regions including the greater trochanter of the femur, intertrochanteric area, total hip, and third lumbar vertebra (P < 0.05). The angles between the upper incisor and mandibular plane and the lower lip and Ricketts E line (drawn from the tip of the nose to the soft tissue area) also improved (P = 0.043, P = 0.001). Total parathyroidectomy and autologous transplantation can rapidly alleviate bone pain and skin itching in THPT. It may also improve bone density and facial soft tissue.

Safety and efficacy of burosumab in improving phosphate metabolism, bone health, and quality of life in adolescents with X-linked hypophosphatemic rickets

Background and objectiveX-linked hypophosphatemic rickets (XLH) is due to loss-of-function mutations in the phosphate-regulating endopeptidase homologue on the X chromosome (PHEX) that lead to increased fibroblast growth factor 23 (FGF23) production. FGF23 excess causes renal phosphate wasting and insufficient 1,25-dihydroxyvitamin D (1,25(OH)2D) synthesis with reduced intestinal phosphate absorption, ultimately resulting in chronic hypophosphatemia.Children with XLH show typical skeletal lesions of rickets, deformities of the lower limbs, stunted growth with disproportionate short stature, bone pain, and physical dysfunctions.Burosumab, a fully human IgG1 monoclonal antibody that binds to FGF23 to inhibit its activity, is more effective to improve the biochemical and clinical signs of XLH than conventional treatment with phosphate supplements and vitamin D active metabolites. Data on adolescents with XLH during the transition period to young adulthood are few.In this prospective case series, we aimed to assess safety and efficacy of burosumab in adolescents with XLH who discontinued long-term conventional therapy. MethodsFive Caucasian adolescents (4 males, 1 female; mean age 15.4 ± 1.5 years) with XLH were recruited and switched from conventional treatment to burosumab (0.8–1.2 mg/kg, s. c. QW2). Burosumab was continued for 12–48 months and, once discontinued, patients were followed-up for 6–12 months. In all patients, serum calcium, phosphate, alkaline phosphatase (ALP), parathyroid hormone (PTH), and 1,25(OH)2D levels, and renal tubular reabsorption of phosphate (TmP/GFR) values were assessed at entry and during burosumab. Intact FGF23 plasma levels were measured at entry. Patient-reported outcomes (PROs) were assessed at entry and every 3–6 months to evaluate the impact of low extremity pain, stiffness, and difficulties performing daily activities. ResultsAt entry, all patients showed hypophosphatemia, increased intact FGF23 levels, reduced TmP/GFR, insufficient 1,25(OH)2D levels, and in four out of five increased ALP levels. Two patients had radiological signs of rickets. During burosumab, all patients showed a significant increase in serum phosphate and 1,25(OH)2D levels, and in TmP/GFR values (P < 0.05 - P < 0.0001). Serum ALP levels significantly declined (P < 0.05) to normal values. No changes of serum calcium and PTH levels (PNS) were found during burosumab. PROs significantly improved (P < 0.02 - P < 0.0001) in all patients. Four patients discontinued burosumab when they turned 18 or 19, whereas one continued the treatment since he was still younger than 18 during the study period. Four patients who suspended burosumab showed a rapid decline in serum phosphate and 1,25(OH)2D levels and in TmP/GFR values; serum ALP levels increased, and PROs progressively worsened with a significant reduction in quality of life. These consequences were not observed in the patient who continued burosumab treatment. DiscussionOur data showed that conventional treatment improved only in part the signs and symptoms of XLH. Burosumab was well tolerated and was effective in improving phosphate metabolism, bone health, and PROs. All the benefits of burosumab were lost after its discontinuation. These results suggested that continuing burosumab is required to achieve and maintain the clinical benefits of the treatment during the transition to young adulthood in patients with XLH.

Correlation of serum vitamin D level before surgery with hypocalcemia after total thyroidectomy

Background. Hypocalcemia is a common complication of total thyroidectomy. It has many consequences for the health of patients and negatively affects the patient’s quality of life. The purpose of this study was to investigate the predictive role of vitamin D serum levels before total thyroidectomy in the occurrence of hypocalcemia. Methods. This cross-sectional study was conducted on 82 patients who were candidates for total thyroidectomy surgery and referred to 5 Azar Hospital in Gorgan in 2022. Demographic information, laboratory variables, and clinical symptoms of hypocalcemia before surgery, and 24 hours and two weeks after surgery were collected using a checklist. Data were analyzed with SPSS18 software, independent t-tests, U-Man-Whitney, Wilcoxon, paired t-tests, and a Chi-square test at a significance level of 0.05. Results. The mean serum calcium level was significantly reduced 24 hours and two weeks after surgery. The average serum level of phosphorus also decreased significantly 24 hours after surgery. About 32.9% showed symptoms of hypocalcemia 24 hours after surgery. Hypocalcemia was not related to the serum vitamin D level. The mean serum calcium level was significantly lower in patients with hypocalcemic symptoms. The average parathyroid hormone one day after surgery was significantly higher in patients with normal calcium levels. Conclusion. Vitamin D serum level before total thyroidectomy is not related to hypocalcemia after total thyroidectomy. Serum levels of parathyroid hormone and phosphorus are related to serum calcium changes after surgery. Practical Implications. Serum vitamin D levels before thyroidectomy cannot predict hypocalcemia after total thyroidectomy. Serum levels of parathyroid hormone and phosphorus are related to serum calcium changes after surgery. Therefore, long-term follow-up of calcium, vitamin D, parathyroid hormone, and phosphorus levels is recommended for these patients.

Changes in Nutritional Outcomes After Roux-en-Y Gastric Bypass: A Systematic Review and Meta-Analysis.

Bariatric surgery (BS) is the most effective treatment for severe obesity and it has beneficial effects on glycemic control and metabolism outcomes. However, the effects of BS on nutritional outcomes are controversial. Therefore, we aimed to evaluate the changes in several nutritional outcomes after Roux-en-Y gastric bypass (RYGB). A comprehensive search was performed using the following databases: PubMed, Embase, Web of Science, Cochrane Library, WanFang and Chinese National Knowledge Infrastructure. The following outcomes were evaluated: vitamin A, 25-hydroxyvitamin D [25(OH)D], calcium, phosphorus, parathormone (PTH), iron, ferritin, vitamin B12, folate, and zinc. The pooled outcomes were expressed as standard mean difference (SMD) and 95% confidence interval (CI) using a random effects model. Fifty-six studies including 5645 individuals with obesity met the inclusion criteria. Serum 25(OH)D (SMD = 0.78, 95%CI 0.38 to 1.20, P < 0.001), phosphorus (SMD = 0.48, 95%CI 0.22 to 0.74, P < 0.001), PTH (SMD = 0.35, 95%CI 0.11 to 0.59, P = 0.005), vitamin B12 (SMD = 1.11, 95%CI 0.41 to 1.80, P = 0.002), and folate (SMD = 1.53, 95%CI 0.77 to 2.28, P < 0.001) significantly increased after RYGB compared with the baseline. Serum ferritin (SMD = - 1.67, 95%CI - 2.57 to - 0.77, P < 0.001), vitamin A (SMD = - 0.64, 95%CI - 0.99 to - 0.29, P < 0.001), and plasma zinc (SMD = - 0.58, 95%CI - 1.09 to - 0.06, P = 0.027) significantly decreased after RYGB. No significant changes in serum calcium (SMD = - 0.14, 95%CI - 0.40 to 0.11, P = 0.219) and iron (SMD = 0.26, 95%CI - 0.11 to 0.64, P = 0.165) were observed after RYGB. Despite the increased levels of 25(OH)D, phosphorus, vitamin B12 and folate, this meta-analysis revealed the unfavorable nutritional consequences after RYGB.

Hypophosphatemia and Type-2 Diabetes Mellitus: A Review

Type-2 diabetes is a global public health crisis that threatens the economies of all nations, particularly developing countries. Type-2 diabetes mellitus has been suggested to be the most common endocrine disorder associated with several metabolic disturbances including changes in serum calcium, zinc, magnesium, or phosphate. Moreover, those who have poor glycemic control and longtime diabetes mellitus are more likely to decrease the blood phosphate level. Low serum phosphate level may be associated with morbidity and mortality from cardiovascular disease in these patients. So, the findings of this study may suggest that serum phosphate is an important screening parameter in type-2 diabetic patients especially who have poor glycemic control and longtime diabetes mellitus. Eastern Med Coll J. July 2023; 8 (2): 45-50

A Randomized Control Trial to Assess the Efficacy and Safety of Manna Go Grains to Promote Growth, Immunity, and Well-Being in Children

Objective: Nutrition in school-going children is crucial for their lifetime. India witnesses macro and micronutrient deficiencies in school-going children. The present study aims to evaluate the safety and efficacy of Manna go grains in promoting and improving growth, immunity, and well-being in children.&#x0D; Method: This was a 90-day randomized, controlled, parallel-arm clinical trial. 6-12 years old apparently healthy sixty-two children were randomized either into a test (Manna go grains plus milk) or a control group (milk) in a 1:1 ratio. We assessed changes in growth, immunity, appetite, and overall well-being before and after treatment.&#x0D; Result: The test group showed a significant increase in height, weight, height to age, and weight to age Z score and percentile, which was greater than the control group. There was significantly more improvement in VO2 max and appetite of children in the test group was observed as compared to the control group. A significant reduction in recurrent URTI episodes, sick days, recovery days, and missed school days was observed in the test group compared to the control. Memory questionnaire scores also increased significantly by 75% and 27.61% in the test and control groups. Test group parents reported significantly better growth, stamina, and immunity than the control group. There was clinically and statistically insignificant change in CBC, serum iron, serum calcium, and immunity markers like CD3, CD4, CD8, and IgG in both groups.&#x0D; Conclusion: Thus, Manna Go grains are thought to be a good candidate as a supplement for potentially stimulating growth and development in children and promoting their well-being.

Phosphorus balance calculator: an individualized tool for treatment of hyperphosphatemia in hemodialysis patients.

Lack of evaluations of the dietary phosphorus and dialysis phosphorus removal in daily clinical practice are common obstacles to assessing phosphorus balance and controlling phosphorus in hemodialysis patients. We aimed to investigate whether individualized therapy using a phosphorus balance calculator improves phosphorus control. A randomized, open-label, multicenter, 4-week clinical trial was conducted. A total of 119 maintenance hemodialysis patients aged 18-85years old and with serum phosphorus level >1.45mmol/L from three university teaching hospitals in Shanghai were enrolled. Patients were randomized in a 1:1 ratio to individualized therapy (n=60) or conventional therapy (n=59). The primary outcome was the serum phosphorus concentration after 4-week treatment. Secondary outcomes included the serum calcium and parathyroid hormone (PTH) concentrations, changes in serum phosphorus, calcium and PTH concentrations, and the proportion of patients achieving target ranges of serum phosphorus, calcium and PTH after 4-week treatment. Among 119 randomized participants [mean age 62years; 68 male (57%)], 116 completed the trial. Using the phosphorus balance calculator, the individualized group achieved a better phosphorus balance state and significantly reduced serum phosphorus (1.62±0.45mmol/L versus 1.85±0.45mmol/L, P=.006), increased the proportions of patients achieving target serum phosphorus range (41% versus 18%, P=.006) and had greater adjusted mean difference in change in serum phosphorus over the 4weeks (-0.47 versus -0.23mmol/L, P=.010) when compared with conventional therapy. No significant changes were observed in serum calcium and PTH levels, the proportion of patients achieving target serum calcium or PTH levels, or the adjusted mean difference of serum calcium and PTH levels over the treatment period. Phosphorus balance calculator was proved to improve serum phosphorus control in patients undergoing maintenance hemodialysis, offering a new tool for managing hyperphosphatemia.

Analysis of serum calcium change trajectories and prognostic factors in patients with acute type A aortic dissection

ObjectivesThis study aimed to analyze the correlation between serum calcium changes and short-term prognosis of patients with acute type A aortic dissection.MethodsPatients who underwent acute type A aortic dissection surgery at Fujian Heart Medical Center between June 2019 and June 2021 were retrospectively analyzed.ResultsA total of 383 patients were enrolled. According to the changing track of serum calcium in patients after acute type A aortic dissection, three potential category tracks were determined: high-level (n = 85), medium-level (n = 259), and continuous low-level groups (n = 39). Using the medium-level group as the control, regression analysis showed that poor prognosis risk was increased in the group with continuous low serum calcium (odds ratio = 2.454, P < 0.05) and in the group with continuous low serum calcium > 48 h (odds ratio = 3.595, P < 0.05). Age (odds ratio = 1.063, P < 0.001), body mass index (odds ratio = 1.138, P < 0.05), hypertension (odds ratio = 3.697, P < 0.05), and the highest lactic acid within 72 h after surgery(odds ratio = 1.093, P < 0.05) were independent risk factors for poor prognosis after aortic dissection.ConclusionContinuous low serum calcium was an independent predictor of poor prognosis in patients with acute type A aortic dissection.

Laparoscopic minigastric bypass as a revisional choice for failed restrictive bariatric procedure and its metabolic impact

Background Restrictive bariatric procedures, like laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG), are associated with an increased risk of long-term failure. The efficacy of One-anastomosis gastric bypass (OAGB) has been described in primary and revisional settings, with a lack of Egyptian studies regarding OAGB as a revisional surgery. Herein, we describe our experience regarding 1-year outcomes of OAGB as a revisional surgery after failed LSG or LAGB. Patients and methods Fifty patients with failed LSG or LAGB were enrolled in this prospective study. All cases underwent laparoscopic OAGB, and its effects on weight loss and obesity-related comorbidities were noticed after 3, 6, and 12 months. Results The duration of the operation ranged between 45 and 120 min Postoperative complications included leakage (2%), hemorrhage (2%), and port site infection (2%). OAGB as a revisional surgery led to a significant and effective weight loss, as the percent of excess weight loss (%EWL) had mean values of 23.72%, 51.54%, and 80.25% at the scheduled visits, respectively. The procedure was associated with a significant rise in hemoglobin and albumin, significant decline in blood sugar, glycosylated hemoglobin, vitamin B12, and most lipid profile parameters, with no significant changes in serum calcium and high-density lipoproteins. Beneficial effects (remission or improvement) were noticed in 88.9% of diabetic cases, 80% of hypertensive cases, and 100% of reflux cases at one-year follow-up visit. Conclusion Laparoscopic OAGB as a revisional surgery is a safe and efficacious procedure in the management of patients with failed previous restrictive procedures like LSG and LAGB.

Calcitriol Versus Calcitriol and Low Dose Cinacalcet for Treating Severe Secondary Hyperparathyroidism in Hemodialysis Patients: A Randomized Clinical Trial

Background: Secondary hyperparathyroidism is prevalent among hemodialysis patients associated with vascular and skeletal complications. Thus, treatment is required, specially before kidney transplantation. Objectives: This study aimed to compare the efficacy of calcitriol and cinacalcet versus standard-dose calcitriol in treating severe secondary hyperparathyroidism in hemodialysis patients. Methods: This randomized clinical trial was conducted on 70 hemodialysis patients with severe secondary hyperparathyroidism who were randomly allocated to two intervention groups. Group A received calcitriol 1mg PO every other night, and group B took calcitriol 1mg PO every other night and cinacalcet 30mg PO daily. The improvement of laboratory parameters was investigated 3 and 6 months after the intervention. Results: There was no significant difference between the two groups regarding age, sex, body mass index, and duration of dialysis (P &gt; 0.05). In group A, serum levels of calcium (P &lt; 0.001) and parathyroid hormone (PTH) (P &lt; 0.001) were significantly reduced compared to baseline. However, phosphorus (P = 0.175) and albumin (P = 0.143) serum levels showed no significant changes. In group B, calcium (P = 0.001), PTH (P &lt; 0.001), and serum phosphorus (P &lt; 0.001) levels were significantly decreased after the intervention. Nevertheless, serum albumin levels showed no significant changes from baseline (P = 0.061). Changes in serum phosphorus (P &lt; 0.001) and PTH levels (P &lt; 0.001) were significantly different between the groups. However, changes in serum calcium (P = 0.062) and albumin levels (P = 0.773) were not significantly different (Wilcoxon signed-rank test). Conclusions: The results of this study showed that treatment with cinacalcet and calcitriol was more effective than calcitriol alone without any side effects.

Protective effect and possible mechanisms of resveratrol in animal models of osteoporosis: A preclinical systematic review and meta-analysis.

Resveratrol (RES) has extensively been utilized to treat osteoporosis (OP) in animal models. However, the anti-OP effects of RES have not been tested during clinical application due to the lack of evidence and poor knowledge of the underlying mechanisms. Moreover, there is little preclinical evidence to support the use of RES in the management of OP. In the present paper, we conducted a preclinical systematic review and meta-analysis to assess the efficacy of RES in animal OP models. The potential mechanisms underlying the efficacy of RES against OP were summarized. The online databases PubMed, CNKI, EMBASE, Wanfang, Web of Science, Chinese Biomedical Literature, Cochrane Library, and Chinese VIP were retrieved from inception to December 2021. The CAMARADES 10-item quality checklist was utilized to assess the risk of bias of the included studies. STATA 12.0 software was employed to analyze the data. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Thirteen studies containing 248 animals were included yielding a mean risk of bias score of 5.54 (range 4-7). The pooled estimates showed that the administration of RES could significantly elevate the bone mineral density (BMD) both at femur (SMD = 2.536; 95% CI = 1.950-3.122; p < 0.001) and lumbar spine (SMD = 1.363; 95% CI = 0894-1.832; p < 0.001), bone volume over total volume (BV/TV) (SMD = 2.543; 95% CI = 2.023-3.062; p < 0.001), trabecular linear density (Tb.N) (SMD = 2.724; 95% CI = 2.186-3.262; p < 0.001) and trabecular thickness (Tb.Th) (SMD = 1.745; 95% CI = 1.294-2.196; p < 0.001), while serum phosphorus (S-P) (SMD = -2.168; 95% CI = -2.753 to -1.583; p < 0.001) and trabecular separation (Tb.Sp) (SMD = -2.856; 95% CI = -4.218 to -1.494; p < 0.001) were significantly reduced in animal OP models. No significant change in serum calcium (S-Ca) (SMD = -2.448; 95% CI = -5.255-0.360; p = 0.087) was observed after RES treatment. Furthermore, RES could significantly improve the bone biomechanical indexes: bone maximum load (BML) (SMD = 2.563; 95% CI = 1.827-3.299; p < 0.001) and connectivity density (Conn.D) (SMD = 1.512; 95% CI = 0.909-2.116; p < 0.001) and decrease the structural model index (SMI) (SMD = -2.522; 95% CI = -3.243 to -1.801; p < 0.001). Overall, the present study revealed that RES has huge prospects as a medicine or dietary supplement for the clinical treatment of OP. High-quality studies with stringent designs and larger sample sizes are warranted to substantiate our conclusion.

#2635 ASSOCIATION BETWEEN PLASMA LYSO-GB3 LEVELS AND BONE MINERAL DENSITY IN PATIENTS WITH FABRY DISEASE

Abstract Background and Aims Fabry disease is a rare X-linked genetic disorder that contributes to various clinical manifestations including cardiac hypertrophy, renal dysfunction, cerebrovascular disease, angiokeratoma, and anhidrosis. Several previous reports showed that male patients with Fabry disease had decreased bone mineral density (BMD). However, the association of BMD with clinical characteristics and biomarkers of organ damage in patients with Fabry disease has not been sufficiently studied. Therefore, we aimed to investigate their associations in patients with Fabry disease. Method Patients with Fabry disease who attended our hospital from January 2008 to June 2021 were included in this study. Patients without enough clinical and laboratory data were excluded from the present study. The remaining fifteen patients were assessed in this study. We examined clinical characteristics, biomarkers including blood globotriaosylsphingosine (lyso-Gb3) levels, and BMD, and compared them between male and female patients. We measured the lumbar spine and femoral BMD by dual-energy bone X-ray absorptiometry and calculated the Z-score. Furthermore, we also examined ΔBMD, defined as the two-year change in the Z-score, for ten patients who underwent BMD measurement before and after starting ERT. Because two patients already had received ERT, two did not undergo BMD measurement, and one took an anti-osteoporotic agent, they were excluded from the analysis. Results Both lumbar spine BMD and femoral BMD decreased in male patients, while they were preserved in female patients (lumbar spine Z-score: -1.9 ± 2.0 versus 0.8 ± 0.8, p &amp;lt; 0.05; femoral Z-score: -1.0 ± 1.4 versus 0.6 ± 0.6, p &amp;lt; 0.05) among all the study patients. Lumbar spine and femoral BMD showed a significantly negative correlation with blood lyso-Gb3 levels. Moreover, blood lyso-Gb3 levels were significantly correlated with the lumbar spine BMD (r = -0.92; p &amp;lt; 0.01) and femoral BMD (r = -0.91; p &amp;lt; 0.01) in male patients. On the other hand, there was no significant correlation of blood lyso-Gb3 levels with the lumbar spine BMD (r = 0.66, p = 0.18) and femoral BMD (r = 0.11; p = 0.99) in female patients. After starting ERT, blood lyso-Gb3 levels were significantly reduced in both male and female patients. The lumbar spine ΔBMD in male patients improved whereas that in female patients remained unchanged despite no changes in kidney function and serum calcium and phosphate levels. Conclusion Our findings suggested that lumbar spine BMD and femoral BMD decreased in male patients with Fabry disease possibly due to the deposition of lyso-Gb3 in bone tissue and ERT could improve BMD in these patients.

Safety and efficacy of continuous renal replacement therapy for children less than 10 kg using standard adult machines

Continuous Renal Replacement Therapy (CRRT) machines are used off-label in patients less than 20 kg. Infant and neonates-dedicated CRRT machines are making their way into current practice, but these machines are available only in select centres. This study assesses the safety and efficacy of CRRT using adult CRRT machines in children ≤ 10 kg and to determines the factors affecting the circuit life in these children. Design: Retrospective cohort study of children ≤ 10 kg who received CRRT (January 2010-January 2018) at a PICU in a tertiary care centre in London, UK. Primary diagnosis, markers for illness severity, CRRT characteristics, length of PICU admission and survival to PICU discharge were collected. Descriptive analysis compared survivors and non-survivors. A subgroup analysis compared children ≤ 5 kg to children 5–10 kg. Fifty-one patients ≤ 10 kg received 10,328 h of CRRT, with median weight of 5 kg. 52.94% survived to hospital discharge. Median circuit life was 44 h (IQR 24–68). Bleeding episodes occurred with 6.7% of sessions and hypotension for 11.9%. Analysis of efficacy showed a reduction in fluid overload at 48 h (P = 0.0002) and serum creatinine at 24 and 48 h (P = 0.001). Blood priming was deemed to be safe as serum potassium decreased at 4 h (P = 0.005); there was no significant change in serum calcium. Survivors had a lower PIM2 score at PICU admission (P < 0.001) and had longer PICU length of stay (P < 0.001). Conclusion: Pending neonatal and infant dedicated CRRT machines, CRRT can be safely and effectively applied to children weighing ≤ 10 kg using adult-sized CRRT machines.What is Known:• Continuous Renal Replacement Therapy can be used for a variety of renal and non-renal indications to improve outcomes for children in the paediatric intensive care unit. These include, persistent oliguria, fluid overload, hyperkalaemia, metabolic acidosis, hyperlactatemia, hyperammonaemia, and hepatic encephalopathy.• Young children ≤ 10 kg are most often treated using standard adult machines, off-label. This potentially places them at risk of side effects due to high extracorporeal circuit volumes, relatively higher blood flows, and difficulty in achieving vascular access.What is New:• This study found that standard adult machines were effective in reducing fluid overload and creatinine in children ≤ 10 kg. This study also assessed safety of blood priming in this group and found no evidence of an acute fall in haemoglobin or calcium, and a fall in serum potassium by a median of 0.3 mmol/L. The frequency of bleeding episodes was 6.7%, and hypotension requiring vasopressors or fluid resuscitation occurred with 11.9% of treatment sessions.• These findings suggest that adult CRRT machines are sufficiently safe and efficacious for routine use in PICU for children ≤ 10 kg and suggest that further research is undertaken, regarding the routine rollout of dedicated machines.

Controlled randomized open label clinical study comparing the safety and efficacy of loading schedules in vitamin D deficient patients

Rapidly restoring vitamin D levels to normal might be desirable in certain clinical situations. Larger doses of supplementation, have been shown to increase bone loss and the risk of falls. The optimal way to perform vitamin D loading safely and effectively is still not well elucidated. Our study was aimed to assess the safety and efficacy of two oral vitamin D loading protocols. Sixty-nine subjects with vitamin D deficiency (25OH-vitamin D (25(OH)D) < 20 ng/ml) were included. Thirty-five participants received 30 000 IU of vitamin D3 per week for 10 weeks (group Slower Loading Dose (SLD)) and thirty-four received 30 000 IU twice weekly for 5 weeks (group Moderate Loading Dose (MLD)) resulting in a loading dose of 300 000 IU for all subjects. Following this initial loading phase, both groups received 30 000 IU biweekly for 4 weeks to test whether the recommended daily vitamin D supplementation in range of 2000 IU dose-equivalent could maintain the achieved levels. Seventy-nine percent of those subjects treated in group SLD and everyone in group MLD achieved a 25(OH)D level of 30 ng/ml, which is the lower limit of the recommended normal range in Hungary. The mean increase in 25(OH)D was significantly higher in group MLD than in group SLD (38.6 ± 1.80 ng/ml vs 46,6 ± 1.80 ng/ml). No significant decrease was observed with the administration of the maintenance dose. There were no clinically significant changes in serum or urine calcium, and bone biomarkers in either group. Both protocols were found to be safe and effective, but the five-week dosing caused a significantly greater increase in 25(OH)D. A maintenance dose applied for four weeks after the loading protocol did not raise 25(OH)D levels further but maintained the achieved increase. The administration of 30 000 IU of vitamin D3 twice weekly for five weeks is a rapid, effective and safe way to treat vitamin D deficiency in vitamin D deficient patients.

Changes of serum calcium and bone turnover markers in maintenance hemodialysis patients treated with denosumab

A total of 20 patients (8 males and 12 females) aged (64.8±13.9) years who underwent regular hemodialysis and had bone loss or osteoporosis in Peking University People's Hospital from July to December 2021 were recruited. Sixty milligrams of denosumab were given subcutaneously. The average serum calcium decreased by 0.31 mmol/L and 40% (8/20) of the patients had hypocalcemia one month after treatment. The markers of bone turnover began to decrease 3 days after treatment, and continued to decrease until 5 months after denosumab medication. Multivariate logistic regression analysis failed to detect any independent risk factor for hypocalcemia (R2=0.516, P=0.021). Therefore, denosumab can significantly inhibit bone turnover in hemodialysis patients, however, patients with denosumab medication are more prone to hypocalcemia.

Evaluation of bone density and skeletal muscle mass after sleeve gastrectomy using computed tomography method

IntroductionSleeve gastrectomy is the most common surgical procedure to reduce weight and treat metabolic complications in patients with moderate-to-severe obesity; however, it affects the musculoskeletal system. Dual-energy X-ray absorptiometry (DXA), which is commonly used to measure bone mineral density (BMD), may be affected by excess fat tissue around the bones, interrupting BMD measurement. Due to the strong correlation between DXA and the Hounsfield units (HU) obtained from computed tomography (CT) scans, BMD assessment using clinical abdominal CT scans has been useful. To date, there has been no report of detailed CT evaluation in patients with severe obesity after sleeve gastrectomy. ObjectiveThis study investigated the effect of sleeve gastrectomy in severely obese patients on bone and psoas muscle density, and cross-sectional area using retrospective clinical CT scans. MethodsThis was a retrospective observational study that included 86 patients (35 males and 51 females) who underwent sleeve gastrectomy between March 2012 and May 2019. Patients' clinical data (age at the time of surgery, sex, body weight, body mass index (BMI), comorbidities, and preoperative and postoperative blood test results, HU of the lumbar spine and psoas muscle and psoas muscle mass index (PMI)) were evaluated. ResultsThe mean age at the time of surgery was 43 years, and the body weight and BMI significantly reduced (p < 0.01) after surgery. The mean hemoglobin A1c level showed significant improvement in males and females. Serum calcium and phosphorus levels remained unchanged before and after surgery. In CT analysis, HU of the lumbar spine and psoas muscle showed no significant decrease, but PMI showed a significant decrease (p < 0.01). ConclusionsSleeve gastrectomy could dramatically improve anthropometric measures without causing changes in serum calcium and phosphorus levels. Preoperative and postoperative abdominal CT revealed no significant difference in the bone and psoas muscle density, and the psoas muscle mass was significantly decreased after sleeve gastrectomy.