Total Ca Levels Research Articles

250 Effects of premix carriers rich in iron, calcium, or fiber on growth performance of early-growing pigs

Abstract The study was to evaluate the effect of premix carriers rich in iron (sand), calcium (limestone), or fiber (rice hull) on growth performance of early-growing pigs. A total of 215 pigs [initial body weight (BW) = 39.90 ± 5.06 kg) were randomly allotted to 3 dietary treatments containing 2% of different premix carriers: sand, limestone, or rice hull (30% crude fiber) using initial BW and sex as blocks (5 to 6 pigs per pen, 14 pens per treatment). The total Ca in sand, limestone, and rice hull were 4.28, 39.52, and 0.27 %, respectively, with Fe levels of 2.39, 0.20, and 0.05%, respectively. The analyzed total Ca level of the experimental diet containing sand, limestone, or rice hull was 0.69, 0.71, or 1.88 %, the analyzed total P level was 0.49, 0.49, or 0.48 %, and the analyzed total Fe level was 305, 633, or 347 ppm, respectively with 144 ppm of Fe from FeSO4·H2O in each diet. During the 28 d of the experiment, BW, feed disappearance, and fecal scores (ranging from 0 to 3 with 3 indicating watery feces) were recorded. Blood and feces were collected at the end of the experiment to measure the ATTD of dry matter (DM) and CP, serum iron concentration, hemoglobin, and red blood cell count. Data were analyzed by ANOVA using the Mixed Procedure of SAS with different premix carriers as the fixed effect. Limestone reduced the average daily gain (ADG; P < 0.05, 0.871 vs. 0.965 and 0.935 kg/d), increased feed conversion ratio (FCR; P < 0.05, 2.55 vs. 2.33 and 2.36), and aggravated diarrhea severity as reflected by greater fecal scores (P < 0.05, 1.53 vs. 1.18 and 1.19) compared with sand and rice hull as carriers. The ATTD of both DM and CP in pigs fed a premix with sand as a carrier were greater than that in rice hull- or limestone-treated pigs (P < 0.05, DM: 86.7 vs. 77.7 or 74.1%; CP: 86.1 vs. 75.0 or 73.3%). Furthermore, pigs fed a premix containing sand exhibited the greatest serum iron concentrations among treatment groups (sand, limestone, and rice hull: 2.81, 1.93, and 1.69 mg/L). However, no significant difference was observed in red blood cell count or hemoglobin concentrations among groups. In sum, excessive limestone in premix can negatively affect growth performance and fecal consistency, whereas using sand rich in iron as a carrier in premix exerted minimal impact on nutrient digestibility as opposed to limestone or rice hull.

Optimizing Soil Management for Sustainable Viticulture: Insights from a Rendzic Leptosol Vineyard in the Nitra Wine Region, Slovakia

Properly chosen soil management practices can stabilize the nutrient regime in the soil, including the mobility and bioavailability of hazardous elements. This study aimed to identify the optimal soil management practices in a productive vineyard on Rendzic Leptosol in the Nitra wine region (Slovakia). Soil samples were collected each spring from two depths, 0–30 cm, and 30–60 cm, with the following treatments: T—soil tillage, P + FYM—plowed farmyard manure, G—grass strips, G + NPK1—first-level fertilization, and G + NPK2—second-level fertilization, from 2019 to 2023. The results indicated that more pronounced changes in soil properties occurred in the 0–30 cm layer. Higher NPK rates significantly affected soil sorption capacity and decreased soil pH when compared to other treatments. While G + NPK2 showed the highest storage of total N, S, P, K, and available P and K, it exhibited the lowest levels of total and available Ca. The T treatment displayed the lowest storage of C, N, S, P, and available K. In terms of hazardous metals (Cr, Ni, Pb, and Zn) none exceeded the limiting values in any of the soil management practices. However, in the 0–30 cm layer, Cu concentrations exceeded the limits set by Slovak Republic regulations in the T, P + FYM, G, G + NPK1, and G + NPK2 treatments by 62.6, 73.7, 70.2, 82.1, and 102.9 mg kg−1, respectively. Additionally, as total C increased, Cr concentration was observed to decrease with correlation (r = −0.46). Positive correlations were found between total C and Zn, as well as CaCO3 and Zn in the 0–30 layer.

#3724 CHANGES IN CARDIOVASCULAR CALCIFICATION AFTER PARATHYROIDECTOMY IN DIALYSIS-DEPENDENT PATIENTS

Abstract Background and Aims Vascular calcification (VC) is common in patients with end stage kidney disease on dialysis and with secondary hyperparathyroidism (SHPT). There is a lack of knowledge regarding dynamics of VC after surgical treatment of SHPT. We aimed to evaluate evolution of coronary artery calcification (CAC) and abdominal aortic calcification (AAC) after parathyroidectomy (PTx) in dialysis patients with SHPT. Method The prospective cohort study included 33 dialysis-dependent patients (mean age of 50±13 years) with severe SHPT who underwent subtotal (n = 16) or total PTx with autotransplantation of parathyroid tissue (n = 17). Cardiac computed tomography scan (quantification of coronary calcium by Agatston method) and lateral lumbar X-ray (semi-quantitative Kauppila score) were used to assess prevalence of VC before and 18 months after surgery. Levels of serum total calcium, phosphorus, parathyroid hormone (PTH), and alkaline phosphatase (AP) before and 18 months after surgery were also evaluated. Results In our cohort median dialysis vintage before surgery was 71 [Q1-Q3: 29; 136] months, total serum Ca was 2.47±0.23 mmol/l, median PTH was 139 [Q1-Q3: 90; 161] pg/ml. Prevalence of CAC before PTx was 79% (n = 26), and 61% (n = 20) of patients had AAC. Of note, 54.5% of the patients had severe coronary calcification (>400 AU), while only 12% were considered to have severe calcification using Kauppila score (>12). We observed moderate positive correlation between CAC and AAC scores (Spearman's ρ = 0.699 [95% CI: 0.48; 0.84], р<0.0001). Both CAC and AAC scores correlated moderately with age of the patients (ρ = 0.57 [95% CI: 0.3; 0.76], р = 0.0002, and ρ = 0.64 [95% CI: 0.39; 0.8], р<0.0001, respectively), AAC had weak correlation with their dialysis vintage (ρ = 0.45 [95% CI: 0.14; 0.68], р = 0.005. Median of baseline CAC was 458 [Q1-Q3: 23; 1585] AU, after 18 months - 491 [Q1-Q3: 58; 1956] AU, no statistically significant differences were observed (p = 0.91, Wilcoxon test). We did not find statistically significant differences between median of Kauppila scores before and after PTx as well: 3 [Q1-Q3: 0; 10] and 2 [Q1-Q3: 0; 10], correspondingly, p = 0.17 (Wilcoxon test) – Fig. 1. As it can be seen from Fig. 1, dynamics of both CAC and AAC values before and after PTx varied markedly across subjects. To investigate the factors that can promote VC we divided patients into 2 groups based on dynamics of САС (as the most accurate assessment method) 18 months after surgery: group 1 with CAC progression of more than 50 AU (n = 9) and group 2 with regression or progression less than 50 AU (n = 24). Patients who had progression of coronary calcification by the end of the follow-up had higher age (59±11 vs 46±12 years in 2nd group, p = 0.0128) higher serum calcium levels (2.57±0.24 vs 2.29±0.32 mmol/l in 2nd group, p = 0.0267), and higher AP levels at follow-up (69.8 [Q1-Q3: 62.8, 96.0] vs 51.7 [Q1-Q3: 41.4; 57.1] U/ml in 2nd group, p = 0.003). Univariate analysis showed no significant differences between groups comparing dialysis vintage (p = 0.53), phosphate levels (p = 0.54), PTH levels (p = 0.32). In addition, CAC progression risk was not associated with type of surgery (total vs subtotal PTx RR = 1.11 [95% CI: 0.71; 1.8], OR = 1.48 [95% CI: 0.3; 5.7], p = 0.708). Conclusion Prevalence of vascular calcification in dialysis-dependent patients with severe SHPT is high. Progression of CAC by 18 months after PTx was associated with higher age of the patients, higher follow-up levels of serum total Ca and AP.

Pattern of biochemical markers of mineral and bone disorders in kidney transplant recipients: real-world data

There is a lack of studies providing comprehensive data on the prevalence of mineral and bone disorders (MBD) laboratory abnormalities after kidney transplantation in Russia. to obtain real-world data on the prevalence of the main mineral abnormalities among kidney transplant recipients and to revise their concomitant MBD therapy. This cross-sectional study included 236 patients with successful kidney transplantation. Their serum intact parathyroid hormone (iPTH), total calcium (Ca), phosphorus (P), and alkaline phosphatase (ALP) levels were measured. Only 6.2% of our cohort had all laboratory parameters within the target range, whereas persistent HPT along with hypercalcemia was noted in almost one third of the patients (31%). Normal iPTH levels were observed in 13% cases; 84% of the patients had hyperparathyroidism. The fraction of patients with target iPTH did not differ between the groups with normal and decreased estimated glomerular filtration rate (eGFR) (p=0.118). Hypercalcemia was observed in 29% cases. The serum P level varied significantly in groups with different eGFR (p<0.0001), increasing with declining graft function. Furthermore, 40.7% of patients had ALP above the target range. While 123 patients received active vitamin D (alfacalcidol), 33 received monotherapy with inactive vitamin D (cholecalciferol). The control group consisted of 57 medication-naïve patients. The serum total Ca level varied significantly between the groups (p=0.0006), being higher in patients supplemented with cholecalciferol. The fraction of patients with normocalcemia was lowest in the cholecalciferol group (chi-square, р=0.0018). The prevalence of biochemical abnormalities after kidney transplantation is high. Alfacalcidol usage may be safer than using cholecalciferol to prevent hypercalcemia development.

A Parathyroid Hormone–Guided Calcium and Calcitriol Supplementation Protocol Reduces Hypocalcemia-Related Readmissions Following Total Thyroidectomy

ObjectiveTo determine the effect of a 4-hour postoperative serum parathyroid hormone (PTH)–guided calcium (Ca) and calcitriol supplementation protocol on the incidence of hypocalcemia and hospital readmissions in patients undergoing total thyroidectomy. MethodsThis was a single-institution, retrospective chart review of patients who underwent total thyroidectomy; 148 and 389 of the patients underwent surgery prior to and after the protocol implementation, respectively. The risk of hypocalcemia was stratified as low (PTH level of >30 pg/mL), medium (15-30 pg/mL), and high (<15 pg/mL), using serum PTH values obtained 4 hours postoperatively. Hypocalcemia was defined as a total serum Ca level of <8 mg/dL. Baseline demographic and operative characteristics and postoperative outcome were recorded for both groups. The Fisher exact test and Wilcoxon rank sum test were used to compare the characteristics of the 2 groups. A multivariate logistic regression model was applied to account for potentially confounding variables. ResultsPostoperative hypocalcemia occurred significantly less frequently in the protocol group compared with that in the preprotocol group (10.3% vs 20.9%, P = .002). The reduction in hypocalcemia in the protocol group was observed in both patients with (16.3% vs 25.6%) and without (8.4% vs 19.3%) cervical lymph node dissection. The protocol group had a significantly lower incidence of hospital readmission events than the preprotocol group (1.0% vs 4.7%, P = .013). ConclusionCompared with a historical cohort, a PTH-guided protocol for Ca and calcitriol supplementation significantly reduces the postoperative hypocalcemia and hospital readmission rates in patients undergoing total thyroidectomy.

Calcium carbonate-enriched pumpkin affects calcium status in ovariectomized rats

Calcium carbonate (CaCO3)-enriched pumpkin may serve as a good source of calcium for patients diagnosed with osteoporosis. In this study, we aimed to determine the effect of CaCO3-enriched pumpkin on Ca status in ovariectomized rats. The study included 40 female Wistar rats divided into five groups (n = 8). One group was fed with a standard diet (control group), while the other four groups were ovariectomized and received a standard diet (control ovariectomized group), or a diet containing CaCO3-enriched pumpkin, alendronate, or both. The nutritional intervention lasted 12 weeks, and then the rats were euthanized. Tissue and blood samples were collected and assessed for the levels of total Ca, estradiol, parathyroid hormone, and procollagen type I N propeptide. In addition, a histological analysis was performed on femurs. The results of the study suggest that CaCO3-enriched pumpkin can increase Ca content in femurs and improve bone recovery in ovariectomized rats. Furthermore, enriched pumpkin contributes to Ca accumulation in the kidneys, and this effect is more pronounced in combination with alendronate.

Changes in oxalic acid and mineral contents of tomato plant under salinity stress

The synthesis of oxalic acid in the plant and its relations with other minerals in plant biochemistry were investigated under saline growing conditions. The effects of NaCl salt applied to the nutrient solution at concentrations of 0, 25, 50 and 75 mM on the mineral nutrients and oxalic acid contents of the leaves, roots and fruits of the tomato plant were examined. NaCl applied to the soil significantly decreased the vegetative, root and fruit dry matter amounts of the tomato plant and the N, P, K, Ca, Mg, Fe, Mn, Zn and Cu contents in these parts of the plant. The oxalic acid content of the plant also decreased with increasing salt concentration. Ca and oxalic acid contents of the plant were determined at different levels in the vegetative, root and fruit organs of the plant. Depending on the applied NaCl levels, significant decreases were recorded in the total and soluble oxalic acid and Ca levels of the plant. Physiologically effective oxalic acid in tomato plant was recorded only in fruits with low Ca content. The data confirm the effect of salinity on Ca nutrition and show the effects of ion interaction on oxalic acid synthesis in plants.

MO812: Risk Factors of Long-Term Hypocalcemia After Parathyroidectomy in Dialysis-Dependent Patients

Abstract BACKGROUND AND AIMS Surgical treatment of secondary hyperparathyroidism (SHPT) is often followed by long-term hypocalcemia, also known as a hungry bone syndrome. We aimed to evaluate the prevalence and risk factors of prolonged hypocalcemia after parathyroidectomy (PTx) for SHPT in dialysis-dependent patients. METHOD The retrospective study included 1711 analyses for total serum calcium (Ca) obtained from 372 patients who underwent PTx (either subtotal or total PTx with autotransplantation of parathyroid tissue) for SHPT between 2011 and 2019 in a tertiary care centre of endocrine surgery. The median age of the patients was 50 (IQR 40–57) years, and the median dialysis duration was 82 (IQR 48–134) months. Preoperative parathyroid hormone level was 136 pmol/L (IQR 99.4–210.4), total serum Ca was 2.43 mmol/L (IQR 2.26–2.57) and alkaline phosphatase (AP) was 183 IU/L (IQR 129–395). Follow-up period after surgery ranged from 3 months to 6 years. Postoperative hypocalcemia was defined as a total serum Ca level &amp;lt;2.1 mmol/L, severe hypocalcemia—&amp;lt;1.9 mmol/L. To identify possible risk factors, we took total serum Ca level &amp;lt;2.1 mmol/L after 12 months from PTx as the endpoint. RESULTS Hypocalcemia was registered at least once in 81.5% (n = 303), severe hypocalcemiain 59.1% (n = 224) of the patients in the postoperative period. The prevalence of hypocalcemia and severe hypocalcemia gradually decreased from 3 to 24 months post-PTx and remained relatively stable thereafter (Figure 1). The fraction of patients with moderate hypocalcemia (total serum Ca 1.9–2.1 mmol/L) varied from 17% to 41% during 3–60 months of follow-up. Twelve months after surgery, 53.2% (150 of 282) of the patients had a total Ca level &amp;lt;2.1 mmol/L. Univariate analysis showed no association of hypocalcemia with age (P = .997), sex (P = .17), dialysis vintage (P = .32), modality of treatment (HD/PD, P = .74), type of surgery (P = .29) or use of calcimimetics before surgery (P = .89). Pre-operative parathyroid hormone (P = .55), total Ca (P = .089) and β-crosslaps (P = .69) levels were not associated with an increased risk of hypocalcemia as well. However, low preoperative (P = .037) and postoperative (P = .0092) ionized Ca and high preoperative AP (P = 0.014) levels were associated with an increased risk of long-term postoperative hypocalcemia. Multivariate analysis discovered postoperative ionized Ca as the only independent predictor of prolonged postoperative hypocalcemia [OR = 0.022 (95% confidence interval 0.001–0.356); P = 0.007]. CONCLUSION We identified a high prevalence of moderate and severe hypocalcemia in the long-term period after PTx in dialysis-dependent patients. Total serum Ca levels return to a normal range at 24 months post-PTx in approximately half of the patients. Patients with low preoperative and postoperative serum ionized Ca and high preoperative AP levels are more likely to have persistent hungry bone syndrome after PTx. Immediate postoperative ionized calcium level is the only independent predictor of long-term hypocalcemia after PTx for SHPT.

Mineral Bone Disorders in Hemodialysis Patients in the West of Libya

Background and Objectives: Chronic kidney disease (CKD) is affecting 5%–10% of the world population. As kidney function declines, there is progressive deterioration in minerals homeostasis manifesting as disruption of serum and tissue concentrations of phosphorus, calcium (Ca), and parathyroid hormone (PTH). CKD-mineral bone disorder (CKD-MBD) is a systemic disorder of mineral and bone metabolism manifested by any or a combination of the following: abnormalities of Ca, phosphorus, PTH, Vitamin D metabolism, abnormalities of bone turnover, and vascular or soft-tissue calcification, associated with fractures, cardiovascular disease, and mortality in CKD patients. The study aims to identify the prevalence and pattern of CKD-MBD among hemodialysis patients in the west of Libya. Patients and Methods: A cross-sectional study was carried out on 186 regular hemodialysis patients from five hemodialysis centers in the west of Tripoli-Libya District. All patients were investigated for complete blood count, blood sugar, serum albumin, blood urea, serum creatinine, total Ca level, serum phosphate, serum alkaline phosphatase, and serum intact PTH (iPTH) level. Results: According to the Kidney Disease Outcomes Quality (KDOQ) iPTH level guideline, 88.10% of the studied patients had metabolic bone disorders, and 39.80% showed low bone turnover. About 48.40% were high bone turnover; only 11.80% of studied patients were within the target range according to the KDOQ Initiative guidelines. About 40.36% of studied patients had low calcium levels (below 8.5 mg%), and 35.48% had high phosphorus levels (more than 5.5 mg%). About 61.10% of high bone turnover patients complain of bone pain and 50.50% complain of muscle weakness. Among low bone turnover patients, 36.48% had no symptoms, and 28.38% were complaining of both muscle weakness and bone pain. Conclusions: The prevalence of MBDs among studied patients with abnormal PTH levels is 87.6%, distributed as 39.2% in abnormal low PTH (low bone turnover), and 48.4% in abnormal high PTH (high bone turnover).

Reference Intervals and Regularity Analysis of Biochemical Makers in 3-Year-Old Children

The reference intervals of biochemical markers were significantly affected by age and gender, especially in minors. In recent years, many provinces and regions in China had established reference intervals for children's hematological indicators. Without considering the instruments and reagents, the reference interval will also be affected by the region, economic development, eating habits, and other factors. Therefore, the reference interval of any hematological indicators is not necessarily a fixed range, it changes with certain factors. In our study, we analyzed the changes of biochemical markers in different serum total Ca and 25-OH-D concentrations, and established the reference intervals of biochemical markers in 3-year-old children, explored the change trend of biochemical markers with different serum total Ca and 25-OH-D concentration. Data was collected from 226 cases of 3-year-old children for biochemical markers, in the Chinese PLA General Hospital in August 2015. The data were divided into a high-level group (serum total Ca > 2.63 mmol/L and 25-OH-D > 40.81 ng/mL) and a low-level group (serum total Ca < 2.54 mmol/L and 25-OH-D < 32.64 ng/mL) according to serum total Ca and 25-OH-D levels for comparison. The change trend of biochemical markers was compared according to serum total Ca and 25-OH-D level. The Glu levels in boys were significantly higher than that in girls, but CHO and LDL-C in girls were significantly higher than that in boys. The reference intervals of ATL (5.6 - 22.1 U/L), ALB (44.8 - 55.2 g/L), TP (62.7 - 83.1 g/L), ALP (154.4 - 379.7 U/L), GGT (7.2 - 15.9 U/L), Glu (boys: 4.08 - 5.91 mmol/L; girls: 4.05 - 5.37 mmol/L), UREA (2.7 - 6.3 mmol/L), CREA (26.4 - 46.8 µmol/L), UA (182.4 - 400.2 µmol/L), TG (0.43 - 1.67 mmol/L), CHO (boys: 3.19 - 5.96 mmol/L; girls: 3.03 - 6.51 mmol/L), HDL-C (0.98 - 2.24 mmol/L), LDL-C (boys: 1.30 - 3.64 mmol/L; girls: 1.24 - 4.27 mmol/L), total Ca (2.34 - 2.85 mmol/L), PHOS (1.38 - 2.06 mmol/L), Mg (0.83 - 1.06 mmol/L), osteocalcin (41.64 - 91.92 ng/mL), PTH (12.08 - 43.06 pg/mL), 25-OH-D (19.66 - 56.37 ng/mL), β-CrossLaps (0.82 - 1.88 ng/mL), TP1NP (357.9 - 1025.7 μg/L) were established. ALT, TP, ALB, GGT, Glu, CHO, HDL-C, LDL-C, UREA, CREA, PHOS, Mg, and ALP in high level group were significantly higher than those in low level group. There was no significant difference in TG, UA, TP1NP, osteocalcin, PTH and β-CrossLaps between high level group and low-level group. With the increase of serum total Ca and 25-OH-D levels, most of the biochemical markers had a gradually increasing trend. However, biochemical markers of bone (TP1NP, osteocalcin, PTH, β-CrossLaps) showed different trends. This study established the reference intervals of biochemical markers of 3-year-old children. The changes of serum total Ca and 25-OH-D levels in children reflected the changes of glucose and lipid metabolism, liver and kidney function markers, and indirectly reflected the growth and development of children and various organ functions. Maintaining high levels of serum total Ca and 25-OH-D can promote the growth and development of children.

Reduced concentrations of limestone and monocalcium phosphate in diets without or with microbial phytase did not influence gastric pH, fecal score, or growth performance, but reduced bone ash and serum albumin in weanling pigs.

An experiment was conducted to test the hypothesis that reducing limestone and monocalcium phosphate in diets for weanling pigs by lowering the concentration of Ca and P or by including microbial phytase in the diet will reduce stomach pH and fecal score and will improve growth performance of pigs. A total of 160 weanling pigs (5.75 ± 1.04 kg) were allotted to four corn-soybean meal-based diets in a completely randomized design with five pigs per pen. Diets for phase 1 (d 1 to 15) were formulated using a 2 × 2 factorial design with 2 concentrations of Ca and P (adequate or deficient levels of total Ca and digestible P) and 2 inclusion levels of phytase (0 or 2,000 units/kg feed). Phytase was assumed to release 0.16% total Ca and 0.11% digestible P. Common diets were fed in phases 2 (d 16 to 21) and 3 (d 22 to 35). Fecal scores were recorded in phase 1 and on d 15, gastric pH was measured and a blood sample and the right femur were collected from one pig per pen. Growth performance data were recorded within each phase. Results indicated that in phase 1, at deficient dietary Ca and P, pigs fed the diet with phytase had greater (P < 0.05) average daily gain (ADG) and gain to feed (G:F) compared with pigs fed the diet without phytase, but in diets with adequate levels of Ca and P, no effect of phytase inclusion was observed (interaction, P < 0.05). Without phytase, pigs fed the diet with deficient Ca and P had reduced (P < 0.05) G:F compared with pigs fed the diet with adequate Ca and P, but if phytase was included, there was no effect of Ca and P on G:F (interaction, P < 0.05). For phases 2 and 3, and from d 1 to 35, no differences among dietary treatments were observed for ADG or G:F. Bone ash was greater (P < 0.05) in pigs fed diets with adequate Ca and P than in pigs fed diets with deficient Ca and P, but no effect of phytase inclusion was observed on bone ash. Concentrations of Ca and P did not affect stomach pH or fecal score, but pigs fed diets with phytase tended (P < 0.10) to have reduced stomach pH and fecal score compared with pigs fed diets without phytase. Pigs fed diets with adequate Ca and P had greater (P < 0.05) albumin in serum than pigs fed the Ca- and P-deficient diets. In conclusion, phytase inclusion in phase 1 diets may reduce diarrhea, but lowering Ca and P does not reduce stomach pH or fecal score and decreases bone ash, although growth performance during the entire weanling period is not affected.

MO579POST-TRANSPLANT HYPERCALCEMIA AND VITAMIN D SUPPLEMENTATION

Abstract Background and Aims Post-transplant hypercalcemia is common after successful kidney transplantation in patients with chronic kidney disease (CKD) and can be partially explained by the side effects of concomitant therapy. We aimed to evaluate the prevalence of hypercalcemia among recipients of kidney transplant and its relationship with vitamin D supplementation. Method We performed a cross-sectional study of 236 patients underwent successful kidney transplantation in our clinic. Median age was 49 [Q1-Q3: 39; 58] years, mean estimated glomerular filtration rate (eGFR) was 51,1±21,8 ml/min/1,73 m2. Most of the patients received hemo- or peritoneal dialysis treatment, pre-emptive transplantation was performed in 6% cases. For those previously received dialysis, median duration of any type of dialysis was 21 [Q1-Q3: 11; 36] months. Median time after transplantation reached 42 [Q1-Q3: 19; 75] months. Target range for total serum Ca was defined according to National guidelines on CKD-MBD as 2,1 - 2,5 mmol/l. Results In our cohort median serum total Ca level was 2,41 [Q1-Q3: 2,36; 2,56] mmol/l. Hypercalcemia was encountered in 21% (7 of 33) cases during the first year after transplantation and in 30% (61 of 203) – after first year. Serum total Ca weakly correlated with iPTH (ρ= 0,282 [95%CI: 0,15; 0,4], р&amp;lt;0,0001), alkaline phosphatase (ρ=0,181 [95%CI: 0,05; 0,31], р=0,006) and total duration of renal replacement therapy (dialysis + transplantation) - ρ=0,2 [95%CI: 0,07; 0,32], р=0,002. We did not observe statistically significant correlations between serum total Ca and eGFR (p=0,132), total Ca level and time after transplantation (p=0,06). Total Ca levels did not differ in groups with different eGFR (p=0,04 in Kruskall-Wallis test, but no statistically significant differences after correction for multiply comparisons). Data on concomitant therapy were available for 230 patients. 173 of 230 recipients received any therapy of CKD-MBD. Of them, 123 patients took only active vitamin D (alfacalcidol), 33 patients received monotherapy with inactive vitamin D (cholecalciferol). 57 patients not taking any medications were the control group. Serum total Ca level varied significantly between groups (p=0,0006, Kruskall-Wallis test), being higher in patients supplemented with cholecalciferol - fig.1. Meanwhile, iPHT (p=0,171), serum phosphorus (p=0,563) and alkaline phosphatase levels did not differ in these three groups. Fraction of patients with normocalcemia was the lowest in cholecalciferol group (χ2, р=0,0018) - fig. 2. Conclusion We observed a high prevalence of hypercalcemia in kidney transplant patients, that was not associated with transplant function or time after transplantation. Our data suggest usage of active vitamin D to be safer than cholecalciferol to prevent hypercalcemia development in renal allograft recipients.

MO587PREVALENCE OF MINERAL AND BONE DISORDERS MAKERS AMONG RECIPIENTS OF KIDNEY TRANSPLANT: SINGLE-CENTER EXPERIENCE

Abstract Background and Aims Mineral and bone disorders (MBD) are common after successful kidney transplantation in patients with chronic kidney disease (CKD). We aimed to evaluate the prevalence of biochemical abnormalities among recipients of kidney transplant. Method We performed a cross-sectional study of 236 patients underwent successful kidney transplantation in our clinic between 2007 and 2019. Median age was 49 [Q1-Q3: 39; 58] years, mean estimated glomerular filtration rate (eGFR) was 51,1±21,8 ml/min/1,73 m2. Most of the patients received hemo- or peritoneal dialysis treatment, pre-emptive transplantation was performed in 6% cases. For those previously received dialysis, median duration of any type of dialysis was 21 [Q1-Q3: 11; 36] months. Median time after transplantation reached 42 [Q1-Q3: 19; 75] months. We evaluated serum intact parathyroid hormone (iPTH), total calcium (Ca), phosphorus (P) and alkaline phosphatase (AP) levels. Target ranges were defined according to National guidelines on CKD-MBD as follows: 2,1 - 2,5 mmol/l for total Ca, 0,87 – 1,49 mmol/l for P; normal AP level is defined considering a gender (53-128 Е/l for men, 42-98 Е/l for women). Target iPTH level for optimal and slightly decreased transplant function (corresponding chronic kidney diasease (CKD) stage 3T) was defined as 35-70 pg/ml, for eGFR corresponding CKD 4T – as 70-110 pg/ml, for CKD 5T – as 70-150 pg/ml. Results In our cohort normal iPTH level was observed only in 13% cases, whereas 84% of the patients had hyperparathyroidism. iPTH inversely correlated with eGFR (ρ= -0,454 [95%CI: -0,55; -0,34], р&amp;lt;0,0001 – fig.1) and its level differed significantly between groups with different CKD stage (р&amp;lt;0,0001, Kruskall-Wallis test) – fig.2. However, fraction of patients with target iPTH did not differ in recipient groups with normal and decreased eGFR (p=0,118). Hypercalcaemia was observed in 29% cases; there was a weak correlation of serum total Ca level with iPTH (ρ= 0,282 [95%CI: 0,15; 0,4], р&amp;lt;0,0001) and AP (ρ=0,181 [95%CI: 0,05; 0,31], р=0,006) – fig.3. Hypophosphatemia was seen much more frequently during the first year after transplantation than in long-term period (30,3% vs 6,4% respectively, р=0,0002). Serum P level varied significantly in groups with different eGFR (p&amp;lt;0,0001, Kruskall-Wallis test), increasing in parallel with declining of transplant function – fig.4. The percentage of patients within a target range of AP amounted to 54%, above the target range – 40,7%. In total, only 6,8% of our cohort had all laboratory parameters within the target range. Conclusion We observed a high prevalence of biochemical abnormalities in kidney transplant patients confirming that transplantation itself does not cure mineral and bone disorders in CKD patients.

Extreme Secretion of PTHrP From a Pancreatic Neuroendocrine Tumor, A Shift From Severe Hypercalcemia to Hypocalcemia

Background: PTHrP-secreting pancreatic neuroendocrine tumors (PNET) are a recognized cause of malignancy associated hypercalcemia. Herein, we report a case of severe hypercalcemia due to an extreme elevation of PTHrP from a PNET, where after treatment of the hypercalcemia, symptomatic hypocalcemia occurred. Clinical Case: A 59 year-old-woman with a recurrent PNET with liver metastases undergoing an evaluation for multi-visceral transplant presented with acute confusion, nausea and vomiting. Diagnostic testing identified an extreme elevation of total calcium (Ca) [>20.1 mg/dL (8.5 - 10.2)] from two different samples [serum albumin 4.1 g/dL (3.9 - 4.9)]. The total Ca level one month earlier was 8.3 mg/dL with a serum albumin of 3.1 g/dL. Total Ca measurements were performed with the Ca Gen.2 assay on a cobas c702 chemistry analyzer (Roche Diagnostics). Results greater than the analytical measurement range (0.8 – 20.1 mg/dL) were diluted with saline and confirmed (22.6 mg/dL). A Radiometer ABL 800 Flex blood gas analyzer was used to determine the ionized Ca concentration [2.94 mmol/L (1.08 - 1.30)]. Upon presentation the serum creatinine (Cr) was 2.07 mg/dL (0.58 - 0.96); eGFR utilizing the MDRD equation 24 mL/min/1.73m2; baseline serum Cr 0.78 mg/dL. Her serum 25-OH vitamin D was 31 ng/mL (31.0 - 80.0), PTH 12 pg/mL (15 - 65), phosphate 4.3 mg/dL (2.7 - 4.8) and 1, 25-OH vitamin D 39.1 (15.0 - 60.0). PTHrP measurements were performed by ARUP Laboratories via liquid chromatography tandem mass spectrometry (LC-MS/MS) and resulted in a reported value of >2500 pmol/L (0.0 - 3.4). Her symptoms resolved and the corrected Ca gradually decreased to 8 mg/dL after treatment with IV fluids, calcitonin 200 units sc every 12 hours for 48 hours, 60 mg IV pamidronate, and five sessions of hemodialysis. Within thirteen days of receiving pamidronate, her corrected Ca slowly increased to 12mg/dL; thus, she received a single dose of 120 mg sc denosumab. Nine days later, the patient developed symptomatic hypocalcemia (7.3 mg/dL) manifested by paresthesia in the hands and feet and perioral numbness. She then received multiple doses of oral and intravenous Ca along with 50,000 units of oral ergocalciferol twice weekly. The corrected Ca normalized (8.1 mg/dL) and symptoms resolved. The patient was discharged with plans for future treatment of her underlying malignancy. Conclusion: This is the first report of a PNET producing an extreme elevation of PTHrP of higher than 2500 pmol/L, resulting in a concordant extreme elevation of total calcium within a month of documented normocalcemia. Treatment of hypercalcemia with denosumab may result in the development of hypocalcemia requiring treatment.

Vertebral column adaptations in juvenile Atlantic salmon Salmo salar, L. as a response to dietary phosphorus

Deficiency in dietary phosphorus (P) is considered as a nutritional risk factor for the development of vertebral column deformities in farmed Atlantic salmon Salmo salar, L. This mono-factorial study examines how 11-week deficiency and excess of dietary P influence the structure and microstructure of the vertebral bodies in juvenile, freshwater stages of Atlantic salmon. Animals were fed continuously with three diets containing different levels of total P (tP) and soluble P (sP), respectively: low P (LP) = 6.8 g/kg tP, 3.5 g/kg sP, regular P (RP) = 10.0 g/kg tP, 5.6 g/kg sP, and high P (HP) = 13.0 g/kg tP, 9.3 g/kg sP. Animals were analysed for plasma and bone mineral content, vertebral column deformities (x-ray), vertebral centra stiffness, bone mineralisation pattern and vertebral body microanatomy (cells and connective tissue structures). A low (background) level of deformities was observed on a gross morphological level but no increase and no specific type of vertebral column deformity was associated with either of the three groups. While feed intake was comparable among all diet groups animals fed LP showed a 50% reduction in total calcium (Ca) and P content in abdominal vertebrae and opercula. Regular P and HP animals showed similar levels of total Ca and P in abdominal vertebrae and opercula. Animals in all diet groups showed well-developed vertebral bodies. Low P animals had vertebral centra, neural and haemal arches with large areas of non-mineralised bone. Vertebral centra stiffness in LP animals was reduced accordingly. Regular P and HP animals showed comparable values for vertebral centra stiffness. Non-mineralised vertebral body end plates of LP animals developed a slight inward bending and intervertebral ligaments increased in length and thickness. The cellular and extracellular components of the intervertebral joints remained intact without structural alterations that would indicate the development of vertebral centra compression or fusion. Animals from all three diet groups showed active osteoblasts at the vertebral body growth zone. Despite the three-fold decline in plasma inorganic P in LP animals growth continued at the same rate as in RP and HP animals. It is discussed whether the use of a P-reduced diet under a continuous feeding regime can maintain growth without adverse effects for animal health and welfare. This study further discusses that a HP diet relative to an RP diet has no beneficial effect concerning bone formation, bone mineralisation, growth and prevention of vertebral centra deformities in Atlantic salmon parr.

Effect of eggshell temperatures on hatching performance, egg production, and bone morphology of laying hens

The present study aims to evaluate the effect of lower or higher eggshell temperatures from days 7 to 21 on hatching performance, bone and blood parameters, and egg production along with the age of laying chickens. A total of 3150 eggs obtained from a white egg-type breeder were divided randomly into 3 groups of 1050 eggs. From 7 to 21 days, eggs were incubated at one of three eggshell temperatures: Control (IC) 37.5 °C, low (IL) 36.9 °C, and high (IH) 38.5 °C. At hatch, chicks were weighed, and blood was collected to measure total Ca, inorganic P, and ALP level weights, dimensions, and ash contents of femur, humerus, and tibia were obtained. A total of 240 chicks from each incubation temperature were reared up to 58 weeks. The results showed that hatchability was similar among the eggshell temperature groups. The IL chicks had the heaviest chick weight and yolk free chick weight. The IH group had reduced chick weight compared to IL and IC but increased lengths of tibia and humerus, ash contents of tibia and femur, and blood Ca levels at the day of the hatch. Laying hens from the IH group had impaired body weight during the laying cycle. At 58 weeks, there was no effect of eggshell temperature on egg production, bone length, and width. IH hens had lower tibia ash and serum Ca but higher P and ALP levels compared to IL and IC groups. However, bone mineral content and mineral density were similar for hens from different eggshell temperature groups. In conclusion, it appeared that although chicks from the IH group had reduced chick weight, they had improved bone morphology and ash content of bones compared to IC and IL at hatch. However, IH hens could not maintain the higher ash content during the grow-out and laying periods. The results indicate that the positive effect of IH incubation temperature on bone morphological measurements and ash content of tibia would not be long term.

Clinical phenotypes of primary hyperparathyroidism in hospitalized patients who underwent parathyroidectomy.

ObjectiveThe aim of our study was to investigate the distribution of the PHPT clinical manifestations and biochemical features in patients who underwent parathyroidectomy.Materials and methodsMedical records of 449 patients from three Medical Centers (Saint-Petersburg, Russia), hospitalized during a period from 2011 to 2018, were reviewed. History and anthropometric data, laboratory results (iPTH, total and iCa, phosphorus, ALP, 24-h urinary calcium, 25(OH)D) and imaging data (ultrasonography, scintigraphy, CT/MRI scan, DXA) were analyzed.ResultsThree hundred ninety-four patients were included in the final analysis. Median age was 60 years with 94.2% being women. Symptomatic disease was evident in 222 (56.4%) patients, asymptomatic in 172 (43.6%). Skeletal involvement was more common for women, while frequency of other manifestations did not differ in both genders. There was no difference between symptomatic and asymptomatic patients in age. Serum iPTH level was higher in symptomatic patients (202.9 and 181.0 pg/mL, P = 0.022). Serum 25(OH)D level was estimated in few patients and negatively correlated with PTH (r = ¯0.294, P = 0.005), iCa (r = ¯0.268, P = 0.010) and total Ca (r = ¯0.284, P = 0.014) levels. Manifestations of CVD were observed in 67.7% of cases and affected equally both symptomatic and asymptomatic patients (70.7 and 63.4%, P = 0.076). Both age and BMI were higher in patients with CVD, whether or not they were symptomatic (62 and 53 years, P < 0.0001; 30.4 vs 26.0 kg/m2, P < 0.0001, respectively).ConclusionsThis experience illustrates that symptomatic phenotype is still the most common form of PHPT.

Landform affects the distribution of mineral nutrients in the tropical peats: a case study in a peatland of Siak, Indonesia

ABSTRACT Most peatlands in Indonesia border mineral upland, yet research reporting the effects of the presence of mineral upland on the distribution of mineral nutrients are limited. We collected multiple samples in surface layers from a peatland located between the Siak River and a mineral upland in Riau Province, Indonesia and measured electrical conductivity, pH, and exchangeable Ca2+, Mg2+, K+, and Na+. Transects were investigated for ash content and chemical composition of its profiles. Although electrical conductivity (183 ± 79 μS cm–1) and pH values (3.7 ± 0.3) were similar at surface layers, exchangeable Ca2+ (especially near the mineral upland) and Mg2+ were high at 0–15 cm deep (8.3 ± 5.1 cmolc kg–1 and 2.7 ± 1.1 cmolc kg–1, respectively) and tended to decline in the lower layers. Exchangeable K+ and Na+ did not show a clear trend, probably because of weaker bonding with peat material. High ash content (>10%) was found more frequently alongside the mineral upland than by the riverbank. In the profiles near the mineral upland, total Ca, Mg, Al, and Fe levels in the surface layer were higher (4.5 ± 0.3 g kg–1, 0.9 ± 0.0 g kg–1, 3.0 ± 0.5 g kg–1, and 1.6 ± 0.5 g kg–1, respectively), than those near the riverbank, which were 1.7 ± 0.7 g kg–1, 0.5 ± 0.2 g kg–1, 1.4 ± 0.3 g kg–1, and 0.6 ± 0.3 g kg–1, respectively. Based on the distribution of ash, exchangeable Ca2+ and Mg2+, and total Ca, Mg, Al, and Fe content, the present study suggests that the presence of the mineral upland nutritionally enriches the peat with Ca, Mg, and Fe. The influence of landform should be considered for a comprehensive understanding of nutrients sources in peatlands.

Plant Nutrient Availability and pH of Biochars and Their Fractions, with the Possible Use as a Component in a Growing Media

Biochar has the potential to be used as a growing media component, and therefore plays a role in reducing peat usage. It has unique properties apart from the ability to sequester carbon. Here we investigated the nutrient contents of four commercial biochars and their fractions. The biochars’ feedstock was wood waste, except for one with paper fibres and husk. The fine or finer fractions in wood waste biochars contained higher levels of nutrients that were available to plants. The coarse fraction of the biochar derived from husk and paper fibre feedstock had a higher level of total N, P and K in contrast to the other three biochars. The pH of the finer fraction (pH of 9.08) was also higher compared with coarse fraction (pH of 8.71). It is important that when biochar a is used as a component of a peat based growing media, particle size information should be provided, as fractions from the same biochar can have different levels of total extractable nutrients and pH levels. If biochar is used to replace or reduce lime application rates of a peat-biochar mixtures, one must take into account the levels of total and extractable Ca and Mg levels, as these can vary. The variation of these elements was not only between biochars’ feedstocks, even at similar pH-values, but within different fractions in the same biochar. We concluded that biochars should be characterized from the feedstock as well as from the particle size aspect, as it could have a profound effect on nutrient availability of Ca and Mg. This could lead to nutrient imbalances in cultivating plants on substrate mixtures. In addition to nutrient ratios, the suitable pH-level for a given grown species should be adjusted.

Circulating calcium levels and the risk of type 2 diabetes: a systematic review and meta-analysis

Abnormal Ca homeostasis has been associated with impaired glucose metabolism. However, the epidemiological evidence is controversial. We aimed to assess the association between circulating Ca levels and the risk of type 2 diabetes mellitus (T2DM) or abnormal glucose homeostasis through conducting a systematic review and meta-analysis. Eligible studies were identified by searching electronic database (PubMed, Embase and Google Scholar) and related references with de novo results from primary studies up to December 2018. A random-effects meta-analysis was performed to estimate the weighted relative risks (RR) and 95 % CI for the associations. The search yielded twenty eligible publications with eight cohort studies identified for the meta-analysis, which included a total of 89 165 participants. Comparing the highest with the lowest category of albumin-adjusted serum Ca, the pooled RR was 1·14 (95 % CI 1·05, 1·24) for T2DM (n 51 489). Similarly, serum total Ca was associated with incident T2DM (RR 1·25; 95 % CI 1·10, 1·42) (n 64 502). Additionally, the adjusted RR for 1 mg/dl increments in albumin-adjusted serum Ca or serum total Ca levels was 1·16 (95 % CI 1·07, 1·27) and 1·19 (95 % CI 1·11, 1·28), respectively. The observed associations remained with the inclusion of a cohort study with ionised Ca as the exposure. However, data pooled from neither case-control (n 4) nor cross-sectional (n 8) studies manifested a significant correlation between circulating Ca and glucose homeostasis. In conclusion, accumulated data from the cohort studies suggest that higher circulating Ca levels are associated with an augmented risk of T2DM.