Vitamin status of pediatric patients receiving long-term peritoneal dialysis

Article Abstract:

Dialysis is a procedure that is used to treat patients with kidney failure. During dialysis, water soluble substances and wastes are removed from the blood. However, this procedure can lead to a depletion of water soluble vitamins such as vitamin B-6, vitamin C, and folic acid. Previous studies have reported that vitamin B-6 deficiency is common in patients with kidney failure and that dialysis increases the loss of vitamin B-6 from the body. Adult patients requiring dialysis need to take extra vitamin C, B-6, and folic acid to prevent vitamin deficiencies. In contrast to the water soluble vitamins, blood levels of vitamins that are not water soluble may increase during dialysis. It has been reported that blood levels of vitamin A increase in adult patients undergoing dialysis. To determine the effects of dialysis on blood vitamin levels in children, eight dialysis patients (average age of 10 years) and six healthy children of similar age were studied. Blood levels of folic acid and vitamin A, B-1, B-2, B-6, B-12, and C were measured in each subject. The amount of each vitamin consumed on a daily basis was estimated based on the vitamin content of the foods that were eaten. Also, the dialysis patients received daily supplements of vitamin C (60 milligrams, mg), B-1 (1.5 mg), B-2 (1.7 mg), B-6 (10 mg), and folic acid (0.8 mg). The dialysis patients had higher blood levels of vitamin A, B-1, B-2, and folic acid than the children who were not on dialysis. These findings indicate that vitamin supplements are effective in maintaining normal or higher than normal blood levels of water soluble vitamins in patients requiring dialysis. No patients developed symptoms of vitamin toxicity. Supplementation with preparations formulated for adult dialysis patients (without vitamin A) are recommended for children undergoing dialysis. However, the long-term requirements of these pediatric patients still need to be determined. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Vitamin metabolism, Peritoneal dialysis, Continuous ambulatory peritoneal dialysis

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Optimal dietary substitution of racemic ketoanalogues for isoleucine in growing normal and uremic rats

Article Abstract:

Restriction of protein in the diet appears to slow the deterioration of kidney function in patients with kidney disease. This has led to the use of low-protein diets supplemented with amino acid ketoanalogues, which are structural equivalents of amino acids (protein building blocks) minus the nitrogen-containing amino group. This is useful because the ketoanalogues provide the unique structures for which amino acids are needed. The actual practice of ketoanalogue (KA) supplementation has been difficult to implement and evaluate, in part because of problems in assessing whether patients followed the diet. Also, poor growth rates in uremic children (who have toxic levels of nitrogen in the blood due to loss of kidney function) have resulted, suggesting that the KA diets were nutritionally inadequate. The possibility that use of inadequate amounts of KA has been part of the problem was investigated by studying the growth rate and nitrogen metabolism of rats fed different doses of KA. The KA for isoleucine, an essential amino acid, was used; it is available only in the racemic form, so only half of any given amount is actually usable for metabolic reactions. When KA was substituted 1:1 for its amino acid isoleucine, both normal and uremic rats lost their appetites, had stunted growth, and had poor nitrogen balances (indicating that protein losses exceeded protein gains). Supplementation in a 2:1 ratio (KA for isoleucine) partially improved these problems, and 3:1 supplementation improved growth to the levels achieved with isoleucine alone in uremic, but not normal rats. This study indicates that in rats, isoleucine can be replaced by its racemic KA at one-third efficiency, which is probably more effective in uremic than normal subjects. Further study is needed before this approach can be applied to human subjects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Human nutrition, Protein metabolism, Diet therapy, Kidney diseases, Amino acids, Low-protein diet, Protein restricted diet, Amino acids in human nutrition, Uremia

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