Serum Calcium Phosphorus Research Articles

THE EFFECT OF LIVERIA® ON SOME HEMATOLOGICAL AND BIOCHEMICAL PARAMETERS OF TREATED BUFFALO CALVES

The effect of intramuscular injection of Liveria® at a dose of 1ml/20kg body weight on hematological and biochemical parameters was investigated in fifteen apparently healthy buffalo calves of our local breed, 2-3 months age old, with average body weight 53-72 Kg in especial farm at Dakahlia Governorate. Buffalo were divided into three groups, each group five animals. The first group was injected with saline I/M (1ml/20kg) and lefted without any drug (the controlled animals). The second group was injected intramuscular by Liveria® (1ml/20 kg body weight). The third group was injected three successive intramuscular doses by Liveria (1ml/20 kg body weight) for three days. Hematological (RBCs- WBCs-Hb), biochemical aspects (total protein- albumin- globulin- serum: ALT, AST and ALP) and some minerals concentration (Ca, P and Na) were evaluated. The results showed that the administration of Liveria in calves caused a significant decrease in total erythrocytic count, haemoglobin concentration, total leukocytic count, total protein, albumin and serum AST with a significant increase also in serum calcium and inorganic phosphorus. Moreover, no changes in ALT, ALP activities and globulin level. Therefore, it was concluded that a single dose of Liveria® at dose rate (1ml /20 kg body weight) induced a significant improvement in some heamatological and biochemical parameters of treated calves

Application of pressure-derived myocardial fractional flow reserve in chronic hemodialysis patients

BackgroundAlthough fractional flow reserve (FFR) measurements during coronary angiography are performed in routine clinical practice, few studies have evaluated FFR measurements in dialysis patients. MethodsWe retrospectively studied 42 hemodialysis patients with suspected or known coronary artery disease (CAD) who underwent stress myocardial perfusion imaging and coronary angiography with FFR measurements for 61 coronary lesions. The cut-off value for FFR to detect myocardial ischemia was determined by receiver operating characteristic (ROC) curve analysis. ResultsThere were 61 coronary vessels measured by FFR. The FFR range was 0.34–0.93 with a mean of 0.74±0.13. The ROC curve analysis revealed that the best cut-off value of FFR for detecting myocardial ischemia was 0.76 (p<0.0001), with 70% sensitivity, 86% specificity, and 76% accuracy for myocardial ischemia. Compared with patients who had positive myocardial ischemia and an FFR≤0.76, those who had negative myocardial ischemia despite an FFR≤0.76 had less left ventricular (LV) mass index, whereas patients who had positive myocardial ischemia despite an FFR>0.76 had greater LV mass indexor serum calcium-phosphorus product. ConclusionsThe cut-off value of FFR for myocardial ischemia in chronic hemodialysis patients is similar to that in other CAD patients. However, caution is necessary when FFR measurements are applied to dialysis patients with significantly increased LV mass index or serum calcium-phosphorus product.

Toxic Effects of Ochratoxin A on Calcium Metabolism during Chick Embryo Developmentand in Hatched Chicks

The present study was carried out to study the effect of in-ovo ochratoxin A (OTA) injection in Highline layer eggs on calcium metabolism and blood biochemical parameters of embryos and after the hatch. At day 10 of embryonic development, one hundred and sixty-two fertile eggs were individually weighed and divided into two equal treatments. The first treatment (control) consisted of the individual injection of fertile eggs with 50 µL sodium carbonate. In the second treatment (OTA), fertile eggs were individually injected with 12.5 ng OTA dissolved in 50 µL sodium carbonate. On days 12, 14, and 16 of incubation and at the hatch, serum calcium and inorganic phosphorus concentrations were lower (p<0.05), while sodium, alkaline phosphatase and triiodothyronine concentrations were higher (p<0.05) in the OTA-injected eggs compared with the controls. Serum potassium concentration was not affected (p<0.05) by OTA treatment. Lower calcium and phosphorus levels were determined (p<0.05) in the allantoic fluid of OTA-injected eggs compared with the controls. On days 12, 14, and 16 of incubation and at the hatch, lower whole body and yolk calcium and phosphorus, but not sodium levels, were measured (p<0.05) in the OTA treatment compared with the controls. In conclusion, the injection of eggs with OTA reduced blood calcium and phosphorus levels, which were associated with reduced whole body and yolk content from these electrolytes. Therefore, ochratoxin A had a negative effect on calcium metabolism.

Hypocalcemia—Cow-level prevalence and preventive strategies in German dairy herds

Hypocalcemia around calving is considered a gateway disease that can lead to health disorders and decreased milk production. The objective of this cross-sectional study was to evaluate the prevalence of clinical and subclinical hypocalcemia 0 to 48 h after calving. Blood samples were drawn from 12 animals of each dairy farm (n = 115) and analyzed for serum calcium, magnesium, and phosphorus concentration. Cows not affected clinically but with a serum calcium concentration below 2.0 mmol/L were characterized as subclinical hypocalcemic animals. Recumbent cows with a serum calcium concentration below 2.0 mmol/L were defined as cows suffering from clinical milk fever. Herds were classified into negative (0 to 2/12), borderline (3 to 5/12), and positive (≥6/12) according to the number of animals with hypocalcemia. Strategies to control hypocalcemia were documented. Prevalence of clinical milk fever was 1.4, 5.7, and 16.1% for second, third, and ≥fourth parity cows, respectively. None of the cows in first lactation were suffering from clinical milk fever. Based on the threshold of 2.0 mmol/L, 5.7, 29.0, 49.4, and 60.4% of cows in first, second, third, and ≥fourth lactation were suffering from subclinical hypocalcemia, respectively. Fourteen, 51, and 50 herds were classified as negative, borderline, and positive, respectively. A positive association was observed between serum calcium and serum phosphorus concentration. Serum calcium and magnesium concentration were negatively associated. Only 50 of 115 farms had a control strategy implemented to avoid hypocalcemia. Most common was the use of oral calcium products (40/115 herds), followed by feeding of anionic salts in the close-up diet (10/115 herds). These results indicate that the prevalence of clinical and subclinical hypocalcemia in German dairy herds was high and that an active control strategy was not implemented on all farms. The negative association between calcium and magnesium warrants further research regarding the physiological regulation of these 2 minerals around parturition.

Synergistic Effects of Genistein and Zinc on Bone Metabolism and the Femoral Metaphyseal Histomorphology in the Ovariectomized Rats.

In this study, we evaluated the synergistic effects of genistein and zinc on bone metabolism, bone mineral density, and the femoral metaphyseal histomorphology in the ovariectomized rats. Sixty female Sprague-Dawley rats, aged 13weeks, were divided into sham-operated group (SHAM), ovariectomized group (OVX), genistein-treated group (OVX-Gen), zinc-treated group (OVX-Zn), genistein combined zinc-treated group (OVX-Gen-Zn), and 17β-estradiol-treated group (OVX-E) (n=10). Genistein, zinc, and 17β-estradiol injections were started immediately after OVX and continued for 10weeks. The OVX-Gen group was subcutaneous injections of genistein (5mg/kg once every day). The OVX-Zn group was given intragastric ZnSO4 (0.25mg/kg once every day) after bilateral ovariectomy. The OVX-Gen-Zn group was subcutaneous injections of genistein (5mg/kg), at the same time intragastric ZnSO4 (0.25mg/kg once every day). OVX-E group were intraperitoneally injected with 17β-estradiol (10μg/kg) once every other day. The results showed that genistein and zinc did not alter body weight in OVX rats. The soluble ZnSO4 had no effect to uterus weight loss. Genistein and zinc supplementation significantly increased the BMD of the femur and lumbar spine in OVX rats (P<0.05, vs. OVX control group). The BMD of the lumbar spine and femur in the OVX-Gen-Zn group is higher than that in the OVX-Gen and OVX-Zn groups (P<0.05), and there were no differences of BMD among the OVX-Gen-Zn, OVX-E, and SHAM groups (P>0.05). The femoral metaphyseal morphology and bone histomorphometric parameters revealed that the trabecular volume and thickness in the OVX-Gen-Zn and OVX-E groups were similar to that of SHAM group, and the OVX-Gen-Zn group had more trabecular volume than the OVX-Gen and OVX-Zn groups. Serum zinc was found to be significantly reduced in the OVX group when compared with SHAM. Serum zinc levels were enhanced in the OVX-Zn, OVX-Gen-Zn, and OVX-E groups and restored to normal levels. Serum calcium and serum phosphorus in the OVX-Gen-Zn group was greater than that in the OVX-Gen and OVX-Zn groups (P<0.05); the serum calcium, phosphorus, and ALP in the OVX-Gen-Zn group were similar to that of SHAM and OVX-E groups (P>0.05). The OVX group had higher osteocalcin, CTX, and RANKL than the SHAM group (P<0.01). They were lower in the OVX-Gen and OVX-Zn groups (P<0.05), and they were significantly lower in the OVX-Gen-Zn and OVX-E groups, than in the OVX group. There were no significant differences of osteocalcin, CTX, and RANKL among the OVX-Gen-Zn, OVX-E, and SHAM groups (P>0.05). OPG and OPG/RANKL ratios were significantly higher in the OVX-Gen and OVX-Zn groups than that in the OVX group (P<0.05). The OPG and OPG/RANKL ratio in the OVX-Gen-Zn group is higher than that in the OVX-Gen and OVX-Zn groups (P<0.05, vs. OVX-Gen group; P<0.01, vs. OVX-Zn group). The differences of the OPG and OPG/RANKL ratios between the OVX-Gen-Zn, OVX-E, and the SHAM groups were not significant (P>0.05). The results above indicate that the genistein and zinc have synergistic effects on both stimulation of bone formation and suppression of bone resorption in ovariectomized rats, thereby increasing bone mass.

Primary hyperparathyroidism: insights from the Indian PHPT registry.

The presentation of primary hyperparathyroidism (PHPT) is variable throughout the world. The present study explored retrospective data submitted to the Indian PHPT registry ( http://www.indianphptregistry.com ) between July 2005 and June 2015 from 5 centres covering four different geographical regions. The clinical, biochemical, radiological and histopathological characteristics of PHPT patients across India were analysed for similarity and variability across the centres. A total of 464 subjects (137 men and 327 women) with histopathologically proven PHPT were analysed. The mean age was 41±14years with a female:male ratio of 2.4:1. The majority (95%) of patients were symptomatic. Common clinical manifestations among all the centres were weakness and fatigability (58.7%), bone pain (56%), renal stone disease (31%), pancreatitis (12.3%) and gallstone disease (11%). Mean serum calcium, parathyroid hormone and inorganic phosphorus levels were 11.9±1.6mg/dL, 752.4±735.2pg/mL and 2.8±0.9mg/dL, respectively. Sestamibi scanning had better sensitivity than ultrasonography in the localisation of parathyroid adenoma; however, when these two modalities were combined, 93% of the cases were correctly localised. Mean parathyroid adenoma weight was 5.6±6.5g (0.1-54g). It was concluded that the majority of PHPT patients within India are still mainly symptomatic with >50% of patients presenting with bone disease and one-third with renal impairment. Compared to Western countries, Indian patients with PHPT are younger, biochemical abnormalities are more severe, and adenoma weight is higher. As our observation is largely derived from a tertiary care hospital (no routine screening of serum calcium level), the results do not reflect racial differences in susceptibility to PHPT.

Study of Serum Calcium and Serum Phosphorus Levels in Patients of Thalassemia Receiving Repeated Blood Transfusion

Study of Serum Calcium and Serum Phosphorus Levels in Patients of Thalassemia Receiving Repeated Blood Transfusion

Clinical Epidemiology of Mineral Bone Disorder Markers in Prevalent Hemodialysis Patients in the Xinjiang Uyghur Autonomous Region in China.

We investigated the clinical epidemiology of mineral bone disorder markers in prevalent hemodialysis (HD) patients in Xinjiang, the largest province in China. Data were obtained from 59 hospitals. A total of 3725 patients tracked from January 1 to December 31, 2014, were enrolled. Serum calcium (Ca) levels, phosphorus (P) levels, and intact parathyroid hormone (iPTH) levels were analyzed. Serum Ca levels were lower compared to the International Dialysis Outcomes and Practice Patterns Study (DOPPS4) and the Chinese DOPPS. The hypercalcemia rate was similar to DOPPS4 and lower than in the Chinese DOPPS. Serum P levels were higher than in DOPPS4 and lower than those in the Chinese DOPPS. Hyperphosphatemia rates were higher than DOPPS4 and lower than Chinese DOPPS. Serum iPTH levels were higher than in DOPPS4 and the Chinese DOPPS. We demonstrated higher serum P and iPTH levels in Xinjiang HD patients than in the DOPPS4 and Chinese DOPPS. In contrast, serum Ca levels were lower than the other two studies. High hypocalcemia and hyperphosphatemia rates may suggest that HD services in Xinjiang are inadequate. A multidiscipline chronic kidney disease (CKD) care program needs to be established to improve chronic kidney disease-mineral and bone disorder (CKD-MBD) target achievement in Xinjiang.

Heart Rate Variability Predicts Major Adverse Cardiovascular Events and Hospitalization in Maintenance Hemodialysis Patients

Background/Aims: Heart rate variability (HRV) has been linked to mortality in maintenance hemodialysis (HD) patients, but it is less clear whether HRV is associated with major adverse cardiovascular events (MACEs) and hospitalization. Methods: This study enrolled 179 maintenance HD patients. HRV was measured to assess its prognostic significance in relation to MACEs and hospitalization. Results: During the follow-up period of 33.3 ± 6.7 months, 36 (20.1%) patients had a MACE, and 98 (54.7%) experienced hospitalization. In multivariate adjusted Cox regression analysis, low very low frequency (VLF) power (hazard ratio [HR], 0.727; 95% confidence interval [CI], 0.624–0.848; p < 0.001), a history of coronary artery disease, high ultrafiltration rate, the use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, and the use of beta-blockers were all significantly associated with MACEs. Low VLF power (HR, 0.873; 95% CI, 0.785–0.971; p = 0.012), low serum albumin, low serum creatinine, low Kt/V levels, and high serum calcium-phosphorus product levels significantly predicted hospitalization in maintenance HD patients. Conclusions: Reduced VLF power is linked to an increased risk of MACEs and hospitalization in maintenance HD patients. Assessing cardiac autonomic function through HRV is of pivotal prognostic significance for this patient population.

The changes of electrolytes in serum and urine in children with neurally mediated syncope cured by oral rehydration salts

ObjectiveTo detect the changes of electrolytes in serum and urine in children with nerve mediated syncope (NMS) cured by oral rehydration salts (ORS). MethodFrom May 2014 to April 2015, 135 patients with symptoms like unexplained syncope and presyncope were administrated in our hospital, including 60 boys and 75 girls, aged between 4 and 16 (10.2±2.7) years. After head-up tilt test (HUTT), their electrolytes in serum and urine were examined. Those who were positive to the HUTT received ORS and health education, while others were only treated by health education. With the period of subsequent visit arranging 21–154 (42.6±27.7) days, the improvement of their clinical manifestation were inquired and electrolytes in serum and urine were re-tested. Result(1) The total effective percentage of ORS treatment was 63.0%, and the negative conversion rate of HUTT was 48.2%. (2) In the first time of visit to hospital, there was no statistical significance between the HUTT-positive and the HUTT- negative in serum electrolytes, 24-h urine electrolytes and 24-h urine volume (P>0.05). (3) In the return visit to hospital, the serum calcium and serum phosphorus in the HUTT-positive were higher than those in the HUTT-negative (P<0.05). (4) With the intake of ORS, 24-h urine sodium, 24-h urine chlorine and 24-h urine volume were improved than pre-treatment (P<0.05 or 0.01). ConclusionORS was an effective treatment to the NMS children, with 24-h urine volume and urine chloride increasing.

Effect of supplementation of bypass fat on biochemical profile in dairy cows

The present investigation was undertaken with the objective to evaluate the effect of supplementation of bypass fat on biochemical profile in dairy cows. Total 12 healthy advanced pregnant cows (10 days before expected parturition) were selected and divided randomly into two equal groups. One group (Group I) of 6 cows was kept without supplementation of bypass fat and given only basal diet as a control group. The second group (Group II) of 6 cows was supplemented with rumen bypass fat (Extra Energy Plus) @ 100 g per animal per day along with basal diet for the period of 4 weeks after parturition. Blood biochemical parameters such as plasma glucose, serum cholesterol, serum triglyceride, serum calcium and serum phosphorus were estimated in all the animals before supplementation ('0' day) and on 7 th , 14 th , 21 st and 30 th day after supplementation. The supplementation of rumen bypass fat (Group II), maintained the levels of plasma glucose, serum cholesterol, serum triglyceride, serum calcium and serum phosphorus within normal range, whereas, in non supplemented group (Group I), plasma glucose and serum phosphorus levels decreased and serum triglyceride level increased significantly. The present study concluded that supplementation of rumen bypass fat proved beneficial in fulfilling the energy demand for production and prevented the cows entering into negative energy balance during early midlactation.

Conversion of oral alfacalcidol to oral calcitriol in the treatment of secondary hyperparathyroidism in chronic hemodialysis patients.

The optimal vitamin D3 therapy for the treatment of secondary hyperparathyroidism (SHPT) in chronic hemodialysis patients is still controversial. Recent studies suggest that uremia in end-stage renal disease is associated with enzymatic hepatic dysfunction altering 25-hydroxylation of vitamin D3. The goal of our study was to compare the efficacy of calcitriol, the fully hydroxylated active form of vitamin D3, to alfacalcidol which needs 25-hydroxylation to be effective, for the treatment of SHPT in chronic hemodialysis patients. We retrospectively reviewed 45 chronic hemodialysis patients who were switched from oral alfacalcidol to oral calcitriol for the treatment of SHPT. Parathyroid hormone (PTH), serum calcium and serum phosphorus levels were compared pre- and post-conversion using paired Student's t tests. The mean dose of active vitamin D3 decreased from 3.50mcg/week at baseline to 2.86mcg (P<0001) after the switch from alfacalcidol to calcitriol. PTH significantly decreased from 94.4 to 82.6pmol/L (-11.8pmol/L, P=0.02). The mean corrected calcium increased from 2.17 to 2.25mmol/L (+0.08mmol/L, P<0.001) without any clinically significant hypercalcemia, and phosphorus levels were stable. Results were similar in a subgroup of patients (n=17) for whom the medication was administrated during the hemodialysis session, ensuring a complete compliance. According to our study, calcitriol in equal dosage is more effective than alfacalcidol in lowering serum PTH level in chronic hemodialysis patients. This suggests that calcitriol may be the optimal active vitamin D3 for the treatment of SHPT in chronic hemodialysis patients.

Combined Effects of Phytoestrogen Genistein and Silicon on Ovariectomy-Induced Bone Loss in Rat.

This study was performed to evaluate the effect of concomitant supplementation of genistein and silicon on bone mineral density and bone metabolism-related markers in ovariectomized rat. Three-month-old Sprague Dawley female rats were subjected to bilateral ovariectomy (OVX) or sham surgery, and then the OVX rats were randomly divided into four groups: OVX-GEN, OVX-Si, OVX-GEN-Si, and OVX. Genistein and silicon supplementation was started immediately after OVX and continued for 10weeks. In the OVX-GEN group, 5mg genistein per gram body weight was injected subcutaneously. The OVX-Si group was given soluble silicon daily in demineralized water (Si 20mg/kg body weight/day). The OVX-GEN-Si group was given subcutaneous injections of 5mg genistein per gram body weight, at the same time, given soluble silicon daily (Si 20mg/kg body weight/day). The results showed that the genistein supplementation in the OVX rats significantly prevented the loss of uterus weight; however, the silicon supplementation showed no effect on the uterus weight loss. The lumbar spine and femur bone mineral density was significantly decreased after OVX surgery; however, this decrease was inhibited by the genistein and/or silicon, and the BMD of the lumbar spine and femur was the highest in the OVX-GEN-Si-treated group. Histomorphometric analyses showed that the supplementation of genistein and/or silicon restored bone volume and trabecular thickness of femoral trabecular bone in the OVX group. Besides, the treatment with genistein and silicon for 10weeks increased the serum levels of calcium and phosphorus in the OVX rats; serum calcium and serum phosphorus in the OVX-GEN-Si group were higher than those in the OVX-GEN and OVX-Si group (P<0.05). At the same time, the treatment with genistein and/or silicon decreased serum alkaline phosphatase (ALP) and osteocalcin, which were increased by ovariectomy; serum ALP and osteocalcin in the OVX-GEN-Si group were lower than those in the OVX-GEN and OVX-Si groups (P<0.05). The results above indicate that genistein and silicon have synergistic effects on bone formation in ovariectomized rats.

Оценка кальций-фосфорного обмена и маркеров метаболизма костной ткани в комплексном лечении пациентов с хроническим генерализованным пародонтитом тяжелой степени

&lt;p class="p1"&gt;&lt;span class="s1"&gt;The serum calcium-phosphorus balance and bone metabolism markers estimation in 72 patients with severe chronic generalized periodontitis and 20 patients of control healthy group at the age of 25 to 55 was performed. A comprehensive laboratory mineral balance study plays an important role in modern diagnostics of periodontal diseases and allows not only to determine the process of bone destruction activity, but also to control the periodontal treatment ef ciency. The rst examination revealed that 19,4% patients with severe periodontitis had low level of serum ionized calcium, its level being 1,05 mmol/l and less. The Drug-induced management of such patients included prescribing osteogenon in their preoperative period which resulted in 12,61% calcium levels increase within 2 months of osteogenon taking. Thus, adding osteogenon to severe periodontitis combination therapy leads to ionized calcium low level recovery in patients’ serum, bene ts bone regeneration and clinical stabilization of periodontal tissues process due to this medicine active components: hydroxyl apatite and ossein, represented by different growth factors, having a direct impact on bone tissue. &lt;/span&gt;&lt;/p&gt;

EFFICACY AND SAFETY OF SEVELAMER CARBONATE VERSUS CALCIUM ACETATE IN PATIENTS WITH CHRONIC RENAL DISEASE ON DIALYSIS

Purpose: Powdered sevelamer carbonate is a new phosphate binder with unproven therapeutic benefit in Indian population. Hence, we aimed to compare its efficacy and safety with calcium acetate in patients with Chronic Renal Disease on hemodialysis. Methods : This was a randomized, prospective, cross over and open labeled study, conducted in the Department of Nephrology, Christian Medical College and Hospital, Ludhiana. Fifty patients were included in data analysis and were randomization into two groups, A & B. Group A patients first received powdered sevelamer carbonate for 4 weeks (n= 25) followed by 1 week of washout and calcium acetate for the next 4 weeks (n=25). Group B: vice-versa. Serum phosphorus, calcium, C-reactive protein (CRP), total cholesterol, triglycerides (TGs) and low density lipoprotein (LDL) levels were performed before and after each drug was administered. Results : Mean baseline serum phosphorus and calcium phosphorus product in group A, reduced from 6.59 ± 0.31mg/dl & 53.18 ± 2.5mg 2 /dl 2 to 5.26± 0.33mg/dl & 44.76mg 2 /dl 2 respectively. In group B these reduced from 6.42±0.33 mg/dl & 52.06±2.5 mg 2 /dl 2 to 5.44±0.3 mg/dl & 44.5mg 2 /dl 2 respectively. The reduction in these values in both groups was statistically significant ( p <0.05). Reductions in serum CRP, total cholesterol, triglycerides and low density lipoprotein (LDL) levels were not statistically significant in either group. Conclusion : Powdered sevelamer carbonate and calcium acetate are equally efficacious with no serious adverse effects. Both the drugs were well tolerated. Hence, powdered sevelamer carbonate can be a useful alternate to calcium based binders in Indian patients. Keywords : powdered sevelamer carbonate, calcium acetate

Interventions for metabolic bone disease in children with chronic kidney disease.

Bone disease is common in children with chronic kidney disease (CKD) and when untreated may result in bone deformities, bone pain, fractures and reduced growth rates. This is an update of a review first published in 2010. This review aimed to examine the benefits (improved growth rates, reduced risk of bone fractures and deformities, reduction in PTH levels) and harms (hypercalcaemia, blood vessel calcification, deterioration in kidney function) of interventions (including vitamin D preparations and phosphate binders) for the prevention and treatment of metabolic bone disease in children with CKD. We searched the Cochrane Kidney and Transplant Specialised Register to 8 September 2015 through contact with the Trial's Search Co-ordinator using search terms relevant for this review. We included randomised controlled trials (RCTs) comparing different interventions used to prevent or treat bone disease in children with CKD stages 2 to 5D. Data were assessed for study eligibility, risk of bias and extracted independently by two authors. Results were reported as risk ratios (RR) or risk differences (RD) with 95% confidence intervals (CI) for dichotomous outcomes. For continuous outcomes the mean difference (MD) or standardised mean difference (SMD) with 95% confidence intervals (CI) was used. Statistical analyses were performed using the random-effects model. This review included 18 studies (576 children); three new studies were added for this update. Adequate sequence generation and allocation concealment were reported in 12 and 11 studies respectively. Only four studies reported blinding of children, investigators or outcome assessors. Nine studies were at low risk of attrition bias and 12 studies were at low risk of selective reporting bias.Eight different interventions were compared. Two studies compared intraperitoneal (IP) with oral calcitriol. PTH levels were significantly lower with IP compared with oral calcitriol (1 study: MD -501.00 pg/mL, 95% CI -721.54 to -280.46) but the number of children with abnormal bone histology did not differ between treatments. Three studies compared intermittent with daily oral calcitriol. The change in mean height SDS (1 study: MD 0.13, 95% CI -0.22 to 0.48) and the percentage fall in parathyroid hormone (PTH) levels at eight weeks (1 study: MD -5.50%, 95% CI -32.37 to 21.37) and 12 months (1 study: MD -6.00% 95% CI -25.27 to 13.27) did not differ between treatments.Four studies compared active vitamin D preparations (calcitriol, paricalcitol, 1α-hydroxyvitamin D) with placebo or no specific treatment. One study reported vitamin D preparations significantly reduced PTH levels (-55.00 pmol/L, 95% CI -83.03 to -26.97). There was no significant difference in hypercalcaemia risk with vitamin D preparations compared with placebo or no specific treatment (4 studies, 103 children: RD 0.08 mg/dL, 95% CI -0.08 to 0.24). However, there was heterogeneity (I(2) = 55%) with one study showing a significantly greater risk of hypercalcaemia with intravenous (IV) calcitriol administration. Two studies (97 children) compared calcitriol with other vitamin D preparations and both found no significant differences in growth between preparations.Two studies compared ergocalciferol in patients with CKD and vitamin D deficiency. Elevated PTH levels developed significantly later in ergocalciferol treated children (1 study: hazard ratio 0.30, 95% CI 0.09 to 0.93) though the number with elevated PTH levels did not differ between groups (1 study, 40 children: RR 0.33, 95% CI 0.11 to 1.05).Two studies compared calcium carbonate with aluminium hydroxide as phosphate binders. One study (17 children: MD -0.86 SDS, 95% CI -2.24 to 0.52) reported no significant difference in mean final height SDS between treatments. Three studies compared sevelamer with calcium-containing phosphate binders. There were no significant differences in the final calcium, phosphorus or PTH levels between binders. More episodes of hypercalcaemia occurred with calcium-containing binders. One study reported no significant differences between calcitriol and doxercalciferol in bone histology or biochemical parameters. Bone disease, assessed by changes in PTH levels, is improved by all vitamin D preparations. However, no consistent differences between routes of administration, frequencies of dosing or vitamin D preparations were demonstrated. Although fewer episodes of high calcium levels occurred with the non-calcium-containing phosphate binder, sevelamer, compared with calcium-containing binders, there were no differences in serum phosphorus and calcium overall and phosphorus values were reduced to similar extents. All studies were small with few data available on patient-centred outcomes (growth, bone deformities) and limited data on biochemical parameters or bone histology resulting in considerable imprecision of results thus limiting the applicability to the care of children with CKD.

Efficacy and safety of nicotinamide in the management of hyperphosphatemia in pediatric patients on regular hemodialysis.

Hyperphosphatemia is a common problem in patients with end-stage renal disease (ESRD) who are on maintenance hemodialysis (HD) and contributes to the development of secondary hyperparathyroidism and cardiovascular complications. Nicotinamide (NAM) has been shown in some studies to inhibit intestinal and renal sodium/phosphorus co-transporters and reduce serum phosphorus levels. We have therefore evaluated the efficacy and safety of NAM as adjunctive therapy to calcium-based phosphate binders to control hyperphosphatemia in hemodialysis patients. Sixty pediatric HD outpatients were randomly divided into two equally sized groups (30 children each). One group received calcium-based phosphate binder (control group), and the other received both the calcium-based phosphate binder + NAM at a dose of 100mg twice or three times daily (nicotinamide group). Both groups were followed for a 6-month period. Over the 6-month treatment period, children in the NAM group showed a significant decline in the levels of serum phosphorus (p = 0.0001), serum calcium-phosphorus (Ca × P; p = 0.0001) product and parathyroid hormone (p = 0.02) versus baseline values and those of the control group. After 6 months of NAM treatment, the mean serum high-density lipoprotein cholesterol levels had increased significantly (p = 0.01), and the median serum triglyceride levels had decreased (p = 0.009). There was no significant change in any of these parameters among the children of the control group. The major adverse events associated with the NAM therapy were diarrhea, flushing and nausea. The addition of NAM to therapy with phosphate binders is effective in lowering phosphorus levels and has a beneficial effect on the lipid profile with only mild side effects.

Efficacy and safety of active vitamin D3 supplement in maintenance hemodialysis patients: a meta-analysis

To evaluate the efficacy and safety of active vitamin D3 treatment in maintenance hemodialysis patients (MHD). We conducted a comprehensive search of the following databases: PubMed, Embase, Google scholar, CNKI, VIP, Wanfang data and CBM, to identify randomized controlled trials (RCTs) of active vitamin D3 supplementation in MHD patients up to November 2014. Meanwhile, we manually searched the reference lists of identified studies. The selection of studies, assessment of methodological quality and data extraction were performed independently by two researchers. Statistical analyses were performed using RevMan software, version 5.0. A total of 10 trials were included. There was a significant improvement in serum albumin (ALB) and an associated decline in PTH, alkaline phosphatase (ALP), C-reactive protein (CRP) and interleukin-6 (IL-6) in active vitamin D3-treated group (standardized mean difference (SMD) or weighted mean difference (95% CI): 0.47 (0.06, 0.88), -2.49 (-3.96, -1.02), -50.55 (-83.91, -17.19), -1.53 (-1.93, -1.12) and -4.71 (-7.48, -1.94), respectively). There was no statistical difference in the incidence of hyperphosphatemia, adverse events and mortality between the treatment and control group (RR (95% CI): 1.31 (0.96, 1.79), 0.85 (0.55, 1.32), 1.49 (0.80, 2.74), respectively). But there was a significant increase in serum calcium and calcium-phosphorus product in treatment group (RR (95% CI): 2.10 (1.18, 3.75) and 3.65 (1.45, 9.17), respectively). Currently available evidence suggests that active vitamin D3 is effective in treating secondary hyperparathyroidism, renal osteodystrophy, and improving malnutrition and microinflammation in MHD patients, without obvious adverse events. However, the occurrence of calcium and phosphate abnormalities should be closely monitored.

Effect of low-calcium dialysate on low-turnover renal osteodystrophy in elderly patients with maintenance hemodialysis

Objective To study the effects of low-calcium dialysate on the calcium-phosphorus metabolism, parathyroid function and vascular calcifications in elderly patients with low turnover renal osteodystrophy undergoing maintenance hemodialysis (MHD). Methods 80 MHD elderly patients (aged≥60 years) who were in stable condition over 6 months and with two consecutive serum intact parathyroid hormone (iPTH) <100 ng/L were observed for 12 months and randomly classified into the control group (calcium 1.50 mmol/L of dialysate, n=40) and the treatment group (calcium 1.25 mmol/L of dialysate, n=40). The changes of serum iPTH, calcium, phosphorus, calcium and phosphorus product and other indicators as well as related adverse reactions were observed and recorded before and 1, 3, 6 and 12 months after treatment. In addition, the intima-media thickness (IMT) of carotid artery and abdominal aorta calcification score (AACS) were measured in the patients before and 6 and 12 months after treatment. Results In the treatment group, serum corrected calcium, phosphorus, and calcium-phosphate product began to decline after 1 month and a further decline at 3 months later, and serum iPTH level was significantly increased after 1 month and gradually increased at 3 months later. The above markers were stabilized after 6 months of treatment, and there were significant differences in the changes of the above markers before and after treatment (all P 0.05). Conclusions The low calcium dialysate (1.25 mmol/L) can prominently control the levels of serum calcium, phosphorus and calcium-phosphorus product, effectively improve the over-suppressed parathyroid function and vascular calcifications, and has a good security in elderly MHD patients with serum iPTH concentration <100 ng/L. Key words: Kidney failure, chronic; Hemodia filtration; Parathyroid hormone; Hemodialysis solutions

Prognostic Value of Serum Gamma-Glutamyltransferase, Calcium, and Inorganic Phosphorus Levels in Short-Term Mortality of Patients with Acute Coronary Syndrome

Amac: GGT, LDL-kolesterolun oksidasyon basamaklarindaki rolunden dolayi proaterojenik bir molekuldur; ayrica glutatyon metabolizmasi ile iliskili olup oksidatif stres icin bir biomarkir olarak dusunulebilir. Serum inorganik fosfor duzeyleri de kardiyovaskuler olay ve mortalite icin bagimsiz bir risk faktoru olsarak kabul edilmektedir. Biz de calismamizda akut koroner sendromlu hastalarda erken mortalite ile serum GGT, Ca, P degerlerinin iliskisini arastirdik.