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N Cano - One of the best experts on this subject based on the ideXlab platform.
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use of a renal specific oral supplement by haemodialysis patients with low protein Intake does not increase the need for Phosphate binders and may prevent a decline in nutritional status and quality of life
Nephrology Dialysis Transplantation, 2008Co-Authors: Denis Fouque, Jane Mckenzie, Renee De Mutsert, Raymond Azar, Daniel Teta, Mathias Plauth, N CanoAbstract:Background. Protein-energy wasting is a frequent and debilitating condition in maintenance dialysis. We randomly tested if an energy-dense, Phosphate-restricted, renal-specific oral supplement couldmaintain adequate nutritional Intake and prevent malnutrition in maintenance haemodialysis patients with insufficient Intake. Methods. Eighty-six patients were assigned to a standard care (CTRL) group or were prescribed two 125-ml packs of Renilon 7.5 R daily for 3 months (SUPP). Dietary Intake, serum (S) albumin, prealbumin, protein nitrogen appearance(nPNA), C-reactive protein, subjective global assessment(SGA) and quality of life (QOL) were recorded at baseline and after 3 months. Results. While intention to treat analysis (ITT) did not reveal strong statistically significant changes in dietary Intake between groups, per protocol (PP) analysis showed that theSUPP group increased protein (P < 0.01) and energy (P <0.01) Intakes. In contrast, protein and energy Intakes further deteriorated in the CTRL group (PP). Although there was no difference in serum albumin and prealbumin changes between groups, in the total population serum albumin and prealbumin changes were positively associated with the increment in protein Intake (r = 0.29, P = 0.01 and r = 0.27, P = 0.02, respectively). The SUPP group did not increase Phosphate Intake, phosphataemia remained unaffected, and the use of Phosphate binders remained stable or decreased. The SUPP group exhibited improved SGA and QOL (P < 0.05). Conclusion. This study shows that providing maintenance haemodialysis patientswith insufficient Intake with a renal- specific oral supplement may prevent deterioration in nutritional indices and QOL without increasing the need for Phosphate binders.
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use of a renal specific oral supplement by haemodialysis patients with low protein Intake does not increase the need for Phosphate binders and may prevent a decline in nutritional status and quality of life
Nephrology Dialysis Transplantation, 2008Co-Authors: Denis Fouque, Jane Mckenzie, Renee De Mutsert, Raymond Azar, Daniel Teta, Mathias Plauth, N CanoAbstract:Background. Protein-energy wasting is a frequent and debilitating condition in maintenance dialysis. We randomly tested if an energy-dense, Phosphate-restricted, renal-specific oral supplement couldmaintain adequate nutritional Intake and prevent malnutrition in maintenance haemodialysis patients with insufficient Intake. Methods. Eighty-six patients were assigned to a standard care (CTRL) group or were prescribed two 125-ml packs of Renilon 7.5 R daily for 3 months (SUPP). Dietary Intake, serum (S) albumin, prealbumin, protein nitrogen appearance(nPNA), C-reactive protein, subjective global assessment(SGA) and quality of life (QOL) were recorded at baseline and after 3 months. Results. While intention to treat analysis (ITT) did not reveal strong statistically significant changes in dietary Intake between groups, per protocol (PP) analysis showed that theSUPP group increased protein (P < 0.01) and energy (P <0.01) Intakes. In contrast, protein and energy Intakes further deteriorated in the CTRL group (PP). Although there was no difference in serum albumin and prealbumin changes between groups, in the total population serum albumin and prealbumin changes were positively associated with the increment in protein Intake (r = 0.29, P = 0.01 and r = 0.27, P = 0.02, respectively). The SUPP group did not increase Phosphate Intake, phosphataemia remained unaffected, and the use of Phosphate binders remained stable or decreased. The SUPP group exhibited improved SGA and QOL (P < 0.05). Conclusion. This study shows that providing maintenance haemodialysis patientswith insufficient Intake with a renal- specific oral supplement may prevent deterioration in nutritional indices and QOL without increasing the need for Phosphate binders.
Carsten A Wagner - One of the best experts on this subject based on the ideXlab platform.
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The Phosphate transporter NaPi-IIa determines the rapid renal adaptation to dietary Phosphate Intake in mouse irrespective of persistently high FGF23 levels
Pflügers Archiv - European Journal of Physiology, 2013Co-Authors: Soline Bourgeois, Jürg Biber, Heini Murer, Gerti Stange, Paola Capuano, Reto Mühlemann, Carsten A WagnerAbstract:Renal reabsorption of inorganic Phosphate (Pi) is mediated by the Phosphate transporters NaPi-IIa, NaPi-IIc, and Pit-2 in the proximal tubule brush border membrane (BBM). Dietary Pi Intake regulates these transporters; however, the contribution of the specific isoforms to the rapid and slow phase is not fully clarified. Moreover, the regulation of PTH and FGF23, two major phosphaturic hormones, during the adaptive phase has not been correlated. C57/BL6 and NaPi-IIa^−/− mice received 5 days either 1.2 % (HPD) or 0.1 % (LPD) Pi-containing diets. Thereafter, some mice were acutely switched to LPD or HPD. Plasma Pi concentrations were similar under chronic diets, but lower when mice were acutely switched to LPD. Urinary Pi excretion was similar in C57/BL6 and NaPi-IIa^−/− mice under HPD. During chronic LPD, NaPi-IIa^−/− mice lost Phosphate in urine compensated by higher intestinal Pi absorption. During the acute HPD-to-LPD switch, NaPi-IIa^−/− mice exhibited a delayed decrease in urinary Pi excretion. PTH was acutely regulated by low dietary Pi Intake. FGF23 did not respond to low Pi Intake within 8 h whereas the phospho-adaptator protein FRS2 α necessary for FGF-receptor cell signaling was downregulated. BBM Pi transport activity and NaPi-IIa but not NaPi-IIc and Pit-2 abundance acutely adapted to diets in C57/BL6 mice. In NaPi-IIa^−/−, Pi transport activity was low and did not adapt. Thus, NaPi-IIa mediates the fast adaptation to Pi Intake and is upregulated during the adaptation to low Pi despite persistently high FGF23 levels. The sensitivity to FGF23 may be regulated by adapting FRS2α abundance and phosphorylation.
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the renal na Phosphate cotransporter napi iia is internalized via the receptor mediated endocytic route in response to parathyroid hormone
Kidney International, 2006Co-Authors: Desa Bacic, Jürg Biber, Heini Murer, Brigitte Kaissling, M Lehir, Carsten A WagnerAbstract:The major renal Na + /Phosphate cotransporter, NaPi-IIa, is regulated by a number of factors including parathyroid hormone (PTH), dopamine, and dietary Phosphate Intake. PTH induces the acute internalization of NaPi-IIa from the brush border membrane (BBM) and its routing to and subsequent degradation in lysosomes. Previous work indicated that megalin, part of the apical receptor-mediated endocytic apparatus, may play a role in the PTH-induced removal of NaPi-IIa. Here we examined in rats the time-dependent internalization route of NaPi-IIa after acute PTH application using immunohistochemistry and markers of several endocytic compartments. NaPi-IIa removal from the BBM was detectable as early as 5 min after PTH injection. After 10–15 min, NaPi-IIa was localized in subapical compartments positive for clathrin. Shortly thereafter, NaPi-IIa appeared in endosomes stained for EEA1 (early endosomal antigen 1). After 45–60 min, NaPi-IIa was found in late endosomes/lysosomes marked with lgp120. In contrast, no change in the subcellular localization of megalin and the Na + /H + exchanger NHE3 was detected up to 60 min after PTH injection. To further characterize the internalization route, insulin, as a marker for receptor-mediated endocytosis, and horseradish peroxidase (HRP) and fluorescein isothiocyanate (FITC)-dextran (10 kDa), as markers for fluid-phase mediated endocytosis, were used. NaPi-IIa colocalized with insulin 5–30 min after PTH injection but did not overlap with HRP or FITC-dextran. These results demonstrate a distinct internalization route of NaPi-IIa in response to acute PTH application that may involve the receptor-mediated endocytic pathway including clathrin-coated vesicles and EEA1-positive early endosomes, and routes NaPi-IIa to lysosomes for degradation.
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involvement of the mapk kinase pathway in the pth mediated regulation of the proximal tubule type iia na pi cotransporter in mouse kidney
Pflügers Archiv: European Journal of Physiology, 2003Co-Authors: Desa Bacic, Jürg Biber, Heini Murer, Brigitte Kaissling, Nicole Schulz, Carsten A WagnerAbstract:Reabsorption of Phosphate in the proximal tubule is mainly mediated by the type IIa Na+/Pi cotransporter (NaPi-IIa) and tightly regulated by a variety of factors including dietary Phosphate Intake and parathyroid hormone (PTH). PTH signals through both apical and basolateral PTH receptors and induces the rapid internalization and subsequent degradation of NaPi-IIa. At least two signalling cascades can be activated by PTH: the PLC/PKC and the cAMP/PKA pathways. Recent evidence from OK cell culture suggested the involvement of MAPK kinases in the PTH action. Here we used freshly isolated coronal mouse kidney slices and incubated them in a physiological buffer in the absence and presence of PTH with inhibitors and activators of the various signalling cascades to further study the events leading to internalization of NaPi-IIa. No alterations in the pattern of immunostaining for α-tubulin, actin and several brush border membrane proteins demonstrated intactness of the slices over the experimental period. Application of PTH (100 nM) induced a strong decrease of NaPi-IIa brush border staining and internalization after 45 min of incubation. The localization of the Na+/sulphate cotransporter (NaSi), however, was not affected. The internalization of NaPi-IIa could be completely prevented by the PKC inhibitor chelerythrine (1 µM) or the MAPK-kinase (ERK1/2) inhibitor PD098059 (20 µM). Without PTH both inhibitors alone had no effect. PTH induced phosphorylation of the ERK1/2 MAPK-kinases which was prevented by PD 098059. Separate activation of the cAMP/PKA pathway by 8-Br-cAMP was completely prevented by PD098059 whereas activation of the PLC/PKC pathway by the PKC activator 1,2-dioctanoyl-sn-glycerol (DOG) and the PKG pathway by 8-Br-cGMP induced internalization of NaPi-IIa which could be only partly blocked by PD 098059. Inhibition by SB203580 or activation by anisomycin of the p38 kinase pathway had no influence on NaPi-IIa localization under control conditions or after PTH stimulation. Furthermore, the PTH-induced decrease in NaPi-IIa protein could be reduced by PD 098059. These results suggest that the ERK1/2 MAPK kinase pathway plays a central role in the signalling of PTH leading to specific internalization and subsequent degradation of the type II NaPi-IIa cotransporter in the proximal tubule.
Denis Fouque - One of the best experts on this subject based on the ideXlab platform.
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use of a renal specific oral supplement by haemodialysis patients with low protein Intake does not increase the need for Phosphate binders and may prevent a decline in nutritional status and quality of life
Nephrology Dialysis Transplantation, 2008Co-Authors: Denis Fouque, Jane Mckenzie, Renee De Mutsert, Raymond Azar, Daniel Teta, Mathias Plauth, N CanoAbstract:Background. Protein-energy wasting is a frequent and debilitating condition in maintenance dialysis. We randomly tested if an energy-dense, Phosphate-restricted, renal-specific oral supplement couldmaintain adequate nutritional Intake and prevent malnutrition in maintenance haemodialysis patients with insufficient Intake. Methods. Eighty-six patients were assigned to a standard care (CTRL) group or were prescribed two 125-ml packs of Renilon 7.5 R daily for 3 months (SUPP). Dietary Intake, serum (S) albumin, prealbumin, protein nitrogen appearance(nPNA), C-reactive protein, subjective global assessment(SGA) and quality of life (QOL) were recorded at baseline and after 3 months. Results. While intention to treat analysis (ITT) did not reveal strong statistically significant changes in dietary Intake between groups, per protocol (PP) analysis showed that theSUPP group increased protein (P < 0.01) and energy (P <0.01) Intakes. In contrast, protein and energy Intakes further deteriorated in the CTRL group (PP). Although there was no difference in serum albumin and prealbumin changes between groups, in the total population serum albumin and prealbumin changes were positively associated with the increment in protein Intake (r = 0.29, P = 0.01 and r = 0.27, P = 0.02, respectively). The SUPP group did not increase Phosphate Intake, phosphataemia remained unaffected, and the use of Phosphate binders remained stable or decreased. The SUPP group exhibited improved SGA and QOL (P < 0.05). Conclusion. This study shows that providing maintenance haemodialysis patientswith insufficient Intake with a renal- specific oral supplement may prevent deterioration in nutritional indices and QOL without increasing the need for Phosphate binders.
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use of a renal specific oral supplement by haemodialysis patients with low protein Intake does not increase the need for Phosphate binders and may prevent a decline in nutritional status and quality of life
Nephrology Dialysis Transplantation, 2008Co-Authors: Denis Fouque, Jane Mckenzie, Renee De Mutsert, Raymond Azar, Daniel Teta, Mathias Plauth, N CanoAbstract:Background. Protein-energy wasting is a frequent and debilitating condition in maintenance dialysis. We randomly tested if an energy-dense, Phosphate-restricted, renal-specific oral supplement couldmaintain adequate nutritional Intake and prevent malnutrition in maintenance haemodialysis patients with insufficient Intake. Methods. Eighty-six patients were assigned to a standard care (CTRL) group or were prescribed two 125-ml packs of Renilon 7.5 R daily for 3 months (SUPP). Dietary Intake, serum (S) albumin, prealbumin, protein nitrogen appearance(nPNA), C-reactive protein, subjective global assessment(SGA) and quality of life (QOL) were recorded at baseline and after 3 months. Results. While intention to treat analysis (ITT) did not reveal strong statistically significant changes in dietary Intake between groups, per protocol (PP) analysis showed that theSUPP group increased protein (P < 0.01) and energy (P <0.01) Intakes. In contrast, protein and energy Intakes further deteriorated in the CTRL group (PP). Although there was no difference in serum albumin and prealbumin changes between groups, in the total population serum albumin and prealbumin changes were positively associated with the increment in protein Intake (r = 0.29, P = 0.01 and r = 0.27, P = 0.02, respectively). The SUPP group did not increase Phosphate Intake, phosphataemia remained unaffected, and the use of Phosphate binders remained stable or decreased. The SUPP group exhibited improved SGA and QOL (P < 0.05). Conclusion. This study shows that providing maintenance haemodialysis patientswith insufficient Intake with a renal- specific oral supplement may prevent deterioration in nutritional indices and QOL without increasing the need for Phosphate binders.
Jean Bernard Gouyon - One of the best experts on this subject based on the ideXlab platform.
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initial amino acid Intake influences phosphorus and calcium homeostasis in preterm infants it is time to change the composition of the early parenteral nutrition
PLOS ONE, 2013Co-Authors: Francesco Bonsante, Silvia Iacobelli, Giuseppe Latorre, Jacques Rigo, Claudio De Felice, Pierreyves Robillard, Jean Bernard GouyonAbstract:Background: Early aggressive parenteral nutrition (PN), consisting of caloric and nitrogen Intake soon after birth, is currently proposed for the premature baby. Some electrolyte disturbances, such as hypoPhosphatemia and hypercalcemia, considered unusual in early life, were recently described while using this PN approach. We hypothesize that, due to its impact on cell metabolism, the initial amino acid (AA) amount may specifically influence the metabolism of phosphorus, and consequently of calcium. We aim to evaluate the influence of AA Intake on calcium-phosphorus metabolism, and to create a calculation tool to estimate phosphorus needs. Methods: Prospective observational study. Phosphate and calcium plasma concentrations and calcium balance were evaluated daily during the first week of life in very preterm infants, and their relationship with nutrition was studied. For this purpose, infants were divided into three groups: high, medium and low AA Intake (HAA, MAA, LAA). A calculation formula to assess phosphorus needs was elaborated, with a theoretical model based on AA and calcium Intake, and the cumulative deficit of Phosphate Intake was estimated. Results: 154 infants were included. HypoPhosphatemia (12.5%) and hypercalcemia (9.8%) were more frequent in the HAA than in the MAA (4.6% and 4.8%) and in the LAA group (0% and 1.9%); both p<0.001. Discussion: Calcium-phosphorus homeostasis was influenced by the early AA Intake. We propose to consider phosphorus and calcium imbalances as being part of a syndrome, related to incomplete provision of nutrients after the abrupt discontinuation of the placental nutrition at birth (PI-ReFeeding syndrome). We provide a simple tool to calculate the optimal Phosphate Intake. The early introduction of AA in the PN soon after birth might be completed by an early Intake of phosphorus, since AA and phosphorus are (along with potassium) the main determinants of cellular growth.
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initial amino acid Intake influences phosphorus and calcium homeostasis in preterm infants it is time to change the composition of the early parenteral nutrition
PLOS ONE, 2013Co-Authors: Francesco Bonsante, Silvia Iacobelli, Giuseppe Latorre, Jacques Rigo, Claudio De Felice, Pierreyves Robillard, Jean Bernard GouyonAbstract:Background: Early aggressive parenteral nutrition (PN), consisting of caloric and nitrogen Intake soon after birth, is currently proposed for the premature baby. Some electrolyte disturbances, such as hypoPhosphatemia and hypercalcemia, considered unusual in early life, were recently described while using this PN approach. We hypothesize that, due to its impact on cell metabolism, the initial amino acid (AA) amount may specifically influence the metabolism of phosphorus, and consequently of calcium. We aim to evaluate the influence of AA Intake on calcium-phosphorus metabolism, and to create a calculation tool to estimate phosphorus needs. Methods: Prospective observational study. Phosphate and calcium plasma concentrations and calcium balance were evaluated daily during the first week of life in very preterm infants, and their relationship with nutrition was studied. For this purpose, infants were divided into three groups: high, medium and low AA Intake (HAA, MAA, LAA). A calculation formula to assess phosphorus needs was elaborated, with a theoretical model based on AA and calcium Intake, and the cumulative deficit of Phosphate Intake was estimated. Results: 154 infants were included. HypoPhosphatemia (12.5%) and hypercalcemia (9.8%) were more frequent in the HAA than in the MAA (4.6% and 4.8%) and in the LAA group (0% and 1.9%); both p<0.001. Discussion: Calcium-phosphorus homeostasis was influenced by the early AA Intake. We propose to consider phosphorus and calcium imbalances as being part of a syndrome, related to incomplete provision of nutrients after the abrupt discontinuation of the placental nutrition at birth (PI-ReFeeding syndrome). We provide a simple tool to calculate the optimal Phosphate Intake. The early introduction of AA in the PN soon after birth might be completed by an early Intake of phosphorus, since AA and phosphorus are (along with potassium) the main determinants of cellular growth.
Daniel Teta - One of the best experts on this subject based on the ideXlab platform.
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use of a renal specific oral supplement by haemodialysis patients with low protein Intake does not increase the need for Phosphate binders and may prevent a decline in nutritional status and quality of life
Nephrology Dialysis Transplantation, 2008Co-Authors: Denis Fouque, Jane Mckenzie, Renee De Mutsert, Raymond Azar, Daniel Teta, Mathias Plauth, N CanoAbstract:Background. Protein-energy wasting is a frequent and debilitating condition in maintenance dialysis. We randomly tested if an energy-dense, Phosphate-restricted, renal-specific oral supplement couldmaintain adequate nutritional Intake and prevent malnutrition in maintenance haemodialysis patients with insufficient Intake. Methods. Eighty-six patients were assigned to a standard care (CTRL) group or were prescribed two 125-ml packs of Renilon 7.5 R daily for 3 months (SUPP). Dietary Intake, serum (S) albumin, prealbumin, protein nitrogen appearance(nPNA), C-reactive protein, subjective global assessment(SGA) and quality of life (QOL) were recorded at baseline and after 3 months. Results. While intention to treat analysis (ITT) did not reveal strong statistically significant changes in dietary Intake between groups, per protocol (PP) analysis showed that theSUPP group increased protein (P < 0.01) and energy (P <0.01) Intakes. In contrast, protein and energy Intakes further deteriorated in the CTRL group (PP). Although there was no difference in serum albumin and prealbumin changes between groups, in the total population serum albumin and prealbumin changes were positively associated with the increment in protein Intake (r = 0.29, P = 0.01 and r = 0.27, P = 0.02, respectively). The SUPP group did not increase Phosphate Intake, phosphataemia remained unaffected, and the use of Phosphate binders remained stable or decreased. The SUPP group exhibited improved SGA and QOL (P < 0.05). Conclusion. This study shows that providing maintenance haemodialysis patientswith insufficient Intake with a renal- specific oral supplement may prevent deterioration in nutritional indices and QOL without increasing the need for Phosphate binders.
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use of a renal specific oral supplement by haemodialysis patients with low protein Intake does not increase the need for Phosphate binders and may prevent a decline in nutritional status and quality of life
Nephrology Dialysis Transplantation, 2008Co-Authors: Denis Fouque, Jane Mckenzie, Renee De Mutsert, Raymond Azar, Daniel Teta, Mathias Plauth, N CanoAbstract:Background. Protein-energy wasting is a frequent and debilitating condition in maintenance dialysis. We randomly tested if an energy-dense, Phosphate-restricted, renal-specific oral supplement couldmaintain adequate nutritional Intake and prevent malnutrition in maintenance haemodialysis patients with insufficient Intake. Methods. Eighty-six patients were assigned to a standard care (CTRL) group or were prescribed two 125-ml packs of Renilon 7.5 R daily for 3 months (SUPP). Dietary Intake, serum (S) albumin, prealbumin, protein nitrogen appearance(nPNA), C-reactive protein, subjective global assessment(SGA) and quality of life (QOL) were recorded at baseline and after 3 months. Results. While intention to treat analysis (ITT) did not reveal strong statistically significant changes in dietary Intake between groups, per protocol (PP) analysis showed that theSUPP group increased protein (P < 0.01) and energy (P <0.01) Intakes. In contrast, protein and energy Intakes further deteriorated in the CTRL group (PP). Although there was no difference in serum albumin and prealbumin changes between groups, in the total population serum albumin and prealbumin changes were positively associated with the increment in protein Intake (r = 0.29, P = 0.01 and r = 0.27, P = 0.02, respectively). The SUPP group did not increase Phosphate Intake, phosphataemia remained unaffected, and the use of Phosphate binders remained stable or decreased. The SUPP group exhibited improved SGA and QOL (P < 0.05). Conclusion. This study shows that providing maintenance haemodialysis patientswith insufficient Intake with a renal- specific oral supplement may prevent deterioration in nutritional indices and QOL without increasing the need for Phosphate binders.