Half of dialysis patients fail to receive life-saving vitamin An article published online in advance of the April issue of the Journal of the American Society of Nephrology (www.jasn.org) found that administering injectable vitamin D to chronic kidney failure patients who are undergoing dialysis significantly improves survival. The annual mortality rate of dialysis patients is currently 20 percent in the United States, due mainly to cardiovascular disease.
Because individuals with failing kidneys cannot effectively utilize vitamin D provided by the diet, injections have been recommended, but only for those with hyperparathyroidism meaning that about half of those receiving dialysis are lacking in the vitamin. The current research sought to determine the impact on survival of vitamin D injections in dialysis patients.
Director of clinical research at Massachusetts General Hospital, Ravi Thadhani, MD, and researchers from Fresenius Medical Care North America analyzed information from 51,037 patients who received dialysis at Fresenius centers beginning in 1996 to 1999. Activated injectable vitamin D was received by 37,173 of the patients in this study, while the remaining 13,864 subjects did not receive the vitamin.
After two years of dialysis, 76 percent of those who received vitamin D injections were still living, compared to 59 percent of patients who did not receive the vitamin. Elevation of calcium or phosphorus secondary to treatment with vitamin D did not adversely impact survival in those who received it. Cardiovascular mortality of those who received no vitamin D was nearly double that of those who received it.
Dr Thadhani stated, "We've been administering vitamin D injections for decades, but the potential benefit on survival has never been studied. This finding was a surprise and should force us to think more broadly about who should be treated. While these results need to be verified, we at least need to be more aggressive in treating people that meet the current criteria. Thereafter we need to investigate what is the mechanism conferring this survival benefit. We are actively pursuing that with a focus on the effects on cardiovascular disease."
Kidney Disease For many years, the Centers for Disease Control (CDC) has listed kidney disease as one of the top 10 causes of death by disease in the United States . Kidney disease also plays a significant role in hypertension and diabetes, two other diseases that are also included on the CDC's list of top ten causes of death each year. End-stage renal (kidney) disease (ESRD) is growing at a rate of 4-8% each year in the United States. Someone with advanced ESRD may require either therapeutic or regular dialysis, or both, and may eventually require a kidney transplant to save his or her life.
For patients who are in a predialysis stage, are undergoing dialysis, or are post-transplant, nutritional supplementation with L-carnitine that has been lost during dialysis may reduce the side effects of common renal problems, such as cardiomyopathy and blood platelet aggregation, and may also help improve the patient's perception of their overall quality of life. L-carnitine is an amino acid that has shown effectiveness in providing cellular energy in both healthy individuals and those with chronic diseases.
General muscle weakness is a common complaint among patients undergoing hemodialysis. One study that measured the serum amount of L-carnitine found that hemodialysis lowered L-carnitine levels and posed new problems for patients (Wanic-Kossowska et al. 1998). This study measured muscle atrophy via nerve conduction and velocity testing and found indications of "neurogenic atrophy of the muscles." This well-known type of muscle weakness was further studied by doctors in Japan who reported that low dosages of L-carnitine (500 mg daily) showed improvement in two-thirds of 30 patients who were studied for 12 weeks. The patients reported less muscle weakness, general fatigue, and cramps and aches. This study concluded that low doses of L-carnitine could improve muscle weakness and should be considered as a prolonged adjuvant therapy for dialysis patients (Sakurauchi et al. 1998).
Taurine is abundant in the brain, heart, gallbladder, and kidneys and plays an important role in health and disease in these organs. Taurine is an amino acid that has been shown to protect against experimentally induced lipid peroxidation of the renal glomerular and tubular cells and may alleviate tubular disorders such as glomerular impairment (Trachtman et al. 1996). It is also thought to lower blood pressure by balancing the ratio of sodium to potassium in the blood.
A major cause of aging is the deterioration of the energy-producing components of the cell which results in reduced cellular metabolic activity, the accumulation of cellular debris, and eventual death of the cell.
The amino acid L-carnitine helps to maintain cellular energy metabolism by assisting in the transport of fat through the cell membrane and into the mitochondria within the cell, where these fats are oxidized to produce the cellular energy ATP.
Taurine is a conditionally essential amino acid produced from cysteine by the body and found abundantly in the body, particularly throughout the excitable tissues of the central nervous system, where it is thought to have a regulating influence. However, taurine is deficient in many diets and may be considered conditionally essential under certain circumstances.
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