Association between blood cadmium levels and malnutrition in peritoneal dialysis

Hsu, Ching‐Wei; Lin, Jing; Lin-Tan, Dan-Tzu; Huang, Wen‐Hung; Chen, Kuan‐Hsing; Yen, Tzung‐Hai

doi:10.1186/1471-2369-15-17

Cited by 8 publications

(7 citation statements)

References 40 publications

(65 reference statements)

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“…Moreover, our study of peritoneal dialysis patients indicated elevated BCL was associated with malnutrition. 21 Malnutrition and inflammation may predispose ESRD patients to protein-energy wasting and thereby increase the risk of mortality, 18 , 22 and this may explain why cadmium exposure increases the risk of mortality in such patients. Therefore, regular BCL measurements may help assess the presence of protein-energy wasting, and may help reduce mortality in MHD patients.…”

Section: Discussionmentioning

confidence: 99%

Effect of Blood Cadmium Level on Mortality in Patients Undergoing Maintenance Hemodialysis

et al. 2015

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Previous studies of general populations indicated environmental exposure to low-level cadmium increases mortality. However, the effect of cadmium exposure on maintenance hemodialysis (MHD) patients is unclear.A total of 937 MHD patients from 3 centers in Taiwan were enrolled in this 36-month observational study. Patients were stratified by baseline blood cadmium level (BCL) into 3 groups: high BCL (>0.521 μg/L; n = 312), intermediate BCL (0.286−0.521 μg/L; n = 313), and low BCL (<0.286 μg/L; n = 312). The mortality rates and causes of death were analyzed.The analytic results demonstrated patients in the high BCL group had a significantly higher prevalence of malnutrition and inflammation than patients in the low and intermediate BCL groups. After 3 years of follow-up, 164 (17.5%) patients died and the major cause of death was cardiovascular disease. A Cox multivariate analysis indicated the high BCL group had increased hazard ratios (HRs) for all-cause mortality (HR = 1.72; 95% confidence interval [CI]: 1.14–2.63; P = 0.018), cardiovascular-related mortality (HR = 1.85; 95% CI: 1.09–3.23; P = 0.032), and infection-related mortality (HR = 2.27; 95% CI: 1.12–4.55; P = 0.035). A Cox multivariate analysis of MHD patients who never smoked (n = 767) indicated the high BCL group had increased HRs for all-cause mortality (HR = 1.67; 95% CI: 1.04–2.63; P = 0.048) and cardiovascular-related mortality (HR = 2.08; 95% CI: 1.08–4.00; P = 0.044).In conclusion, BCL is an important determinant of mortality in MHD patients. Therefore, MHD patients should avoid cadmium exposure as much as possible, such as tobacco smoking and eating cadmium-containing foods.

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Section: Discussionmentioning

confidence: 99%

Effect of Blood Cadmium Level on Mortality in Patients Undergoing Maintenance Hemodialysis

et al. 2015

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“…All study patients were recruited between July 1 and December 31, 2015 from the Chang Gung Memorial Hospital, Linkou, Taiwan. Only patients undergoing chronic peritoneal dialysis for more than 6 months were enrolled, after excluding those with malignancies [ 10 ], active infectious diseases, hospitalizations, or surgery in the past 3 months, or lead [ 11 ] or cadmium [ 12 ] intoxication. The peritoneal dialysis prescription for each patient was based on the peritoneal membrane characteristics as determined by the peritoneal equilibration tests, with intermittent therapies used primarily for patients with high transport characteristics and continuous therapies for those with average or low transport characteristics.…”

Section: Methodsmentioning

confidence: 99%

Oral Tori in Chronic Peritoneal Dialysis Patients

Hsu¹,

Hsu²,

Chang³

et al. 2016

PLoS ONE

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BackgroundThe pathogenesis of oral tori has long been debated and is thought to be the product of both genetic and environmental factors, including occlusal forces. Another proposed mechanism for oral tori is the combination of biomechanical forces, particularly in the oral cavity, combined with cortical bone loss and trabecular expansion, as one might see in the early stages of primary hyperparathyroidism. This study investigated the epidemiology of torus palatinus (TP) and torus mandibularis (TM) in peritoneal dialysis patients, and analyzed the influences of hyperparathyroidism on the formation of oral tori.MethodIn total, 134 peritoneal dialysis patients were recruited between July 1 and December 31, 2015 for dental examinations for this study. Patients were categorized into two subgroups based on the presence or absence of oral tori. Demographic, hematological, biochemical, and dialysis-related data were obtained for analysis.ResultsThe prevalence of oral tori in our sample group was high at 42.5% (57 of 134), and most patients with oral tori were female (61.4%). The most common location of tori was TP (80.7%), followed by TP and TM (14.0%), then TM (5.3%). All 54 TP cases were at the midline, and most were <2 cm (59.3%), flat (53.7%), and located in the premolar region (40.7%). Of the 11 TM cases, all were bilateral and symmetric, mostly <2 cm (81.9%), lobular (45.4%), and located at premolar region (63.6%). Interestingly, patients with oral tori had slightly lower serum levels of intact parathyroid hormones than those without oral tori, but the difference was not statistically significant (317.3±292.0 versus 430.1±492.6 pg/mL, P = 0.126). In addition, patients with oral tori did not differ from patients without tori in inflammatory variables such as serum high sensitivity C-reactive protein levels (6.6±8.2 versus 10.3±20.2 mg/L, P = 0.147) or nutritional variables such as serum albumin levels (3.79±0.38 versus 3.77±0.45 g/dL, P = 0.790). Furthermore, there were no differences between patients with and without oral tori in dialysis adequacy (weekly Kt/Vurea, 2.14±0.39 versus 2.11±0.33, P = 0.533; weekly creatinine clearance rate, 59.31±17.58 versus 58.57±13.20 L/1.73 m2, P = 0.781), or peritoneal membrane transporter characteristics (P = 0.098).ConclusionSecondary hyperparathyroidism does not contribute to the formation of tori in peritoneal dialysis patients. Further studies are warranted.

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“…This observational study included 119 patients. All patients who agreed to participate in this study were enrolled, excluding those with malignancies [ 24 ], active infectious diseases, hospitalizations, or surgery or kidney transplants in the past 3 months and those on hemodialysis for less than 3 months or intoxicated by lead [ 25 , 26 ] or cadmium [ 27 , 28 ]. All enrolled patients underwent 4 hours of hemodialysis, 3 times a week.…”

Section: Methodsmentioning

confidence: 99%

Oral Tori in Chronic Hemodialysis Patients

Chao

Yang

Huang

et al. 2015

BioMed Research International

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Background. This study investigated the epidemiology of torus palatinus (TP) and torus mandibularis (TM) in hemodialysis patients and analyzed the influences of hyperparathyroidism on the formation of oral tori. Method. During 2013, 119 hemodialysis patients were recruited for dental examinations for this study. Results. The prevalence of oral tori in our sample group was high at 33.6% (40 of 119). The most common location of tori was TP (70.0%), followed by TM (20.0%), and then both TP and TM (10.0%). Of the 40 tori cases, most (67.5%) were <2 cm in size; moreover, the majority (52.5%) were flat in shape. In symmetry, most (70.0%) occurred in the midline, followed by bilateral sides (20.0%). Notably, the levels of intact parathyroid hormone did not differ in patients with or without tori (P = 0.611). Furthermore, patients with tori did not differ from patients without tori in inflammatory variables such as log high-sensitivity C-reactive protein (P = 1.000) or nutritional variables such as albumin (P = 0.247). Finally, there were no differences between patients with and without tori in adequacy of dialysis (P = 0.577). Conclusions. Neither hyperparathyroidism nor inflammation malnutrition syndrome was found to contribute to the formation of oral tori in chronic hemodialysis patients. Further studies are warranted.

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Association between blood cadmium levels and malnutrition in peritoneal dialysis

Cited by 8 publications

References 40 publications

Effect of Blood Cadmium Level on Mortality in Patients Undergoing Maintenance Hemodialysis

Effect of Blood Cadmium Level on Mortality in Patients Undergoing Maintenance Hemodialysis

Oral Tori in Chronic Peritoneal Dialysis Patients

Oral Tori in Chronic Hemodialysis Patients

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