Kidney disease patient health: Moderate alcohol and calcium help, obesity harms

November 19, 2010

1. Moderate Drinking Benefits Kidney Transplant Recipients
Modest Amounts of Alcohol Prevent Diabetes and Premature Death

Moderate alcohol consumption reduces one's risk for diabetes and premature death in the general population. To find if the same were true for stable kidney transplant recipients, Dorien Zelle (University Medical Center Groningen, the Netherlands) and her colleagues studied 600 renal transplant recipients who had their transplant more than one prior and followed them for several years post-transplant. Of these, 288 (48%) were abstainers, 94 (16%) sporadic drinkers, 210 (35%) had moderate alcohol intake, and 8 (1%) were heavy drinkers. Moderate alcohol drinkers were 67% less likely to develop diabetes than other types of drinkers/nondrinkers. During an average follow-up of seven years, moderate alcohol drinkers were 44% less likely to die than other types of drinkers/nondrinkers. The authors concluded that in contrast with common advice for kidney transplant recipients to refrain from drinking alcohol, drinking moderate amounts of alcohol appears to protect against diabetes and premature death in kidney transplant recipients, similar to the general population. "Quality of life in renal transplant recipients is under pressure by many threats, restrictions, and recommendations," said Ms. Zelle. "Our results indicate that one of the restraints on quality of life in stable renal transplant recipients may be released. There seems no reason to advise renal transplant recipients to abstain from alcohol post-transplant."

Study co-authors include Eva Corpeleijn, Ronald Stolk, MD, PhD, Jaap Homan vd heide, MD, Willem Van son, MD, PhD, Gerjan Navis, MD, PhD, and Stephan Bakker, MD, PhD (University Medical Center Groningen, the Netherlands).

Disclosures: The authors reported no financial disclosures.

The study abstract, "Moderate Alcohol Consumption Is Associated with Low Prevalence of Post-Transplant Diabetes and Reduced Risk for Mortality in Renal Transplant Recipients," [TH-PO941] will be presented as a poster on Thursday, November 18, 2010 from 10:00 AM - 12:00 PM MT in Exhibit Halls A & F of the Colorado Convention Center in Denver, CO. Embargo until Thursday, November 18, 2010 11:00 AM MT

2. Despite Recommendations, Low Dialysis Calcium Levels May Harm Patients
Dialysis Solutions Low in Calcium Increase Risk of Sudden Cardiac Arrest

Sudden cardiac arrest is the leading cause of death among kidney disease patients on dialysis. Because hardening of the blood vessels due to calcium deposits has been linked to increased cardiovascular deaths in dialysis patients, national guidelines recommend lowering the amount of calcium that patients receive from dialysis fluids. (Dialysis solution contains levels of minerals like potassium and calcium similar to their natural concentration in healthy blood.) Patrick Pun, MD, MHS (Duke University) and his colleagues found that lower concentrations of calcium in dialysis fluids may be linked to an increased risk of suffering from a sudden cardiac arrest. They compared the calcium concentrations in the dialysis fluids of 502 dialysis patients who experienced sudden cardiac arrest with 1,632 randomly selected dialysis patients who did not..The findings may help clinicians determine the optimal calcium concentration to include in dialysis solutions.

Study co-authors include Ruediger Lehrich, MD and John Paul Middleton, MD (Duke University).

Disclosures: Dr. Pun receives grants/research support from Satellite Health Care and Davita Clinical Research and is a scientific advisor for Genzyme. Dr. Middleton is a consultant for Genentech; receives grants/research support from Amgen, Merck, and Mitubishi Pharmaceuticals; receives honoraria from Merck, Shire, and Renal Advantage Inc.; and is a scientific advisor for the Journal of Human Hypertension and NiCox. Dr. Lehrich reported no financial disclosures.

The study abstract, "Sudden Cardiac Arrest Risk Associated with Low Calcium Dialysate in Hemodialysis Patients," [TH-FC035] will be presented as an oral presentation on Thursday, November 18 at 5:18 PM MT in Room 111 of the Colorado Convention Center in Denver, CO. Embargo until Thursday, November 18, 2010 6:15 PM MT

3. Obesity Can Lead to Early Deaths for Dialysis Patients Younger Than 65 Years
Obese Young Patients have a 1.5-Fold Increased Risk of Dying within 7 Years

In individuals with kidney disease, obesity can worsen kidney function and have harmful effects on the heart. However, many studies show better survival among obese dialysis patients. Ellen Hoogeveen, MD, PhD (Jeroen Bosch Hospital, in Den Bosch, the Netherlands) and her colleagues investigated whether the mortality risk of obesity differs between young (< 65 years old) versus elderly patients (≥ 65 years old). They studied 1,749 patients who recently started dialysis and divided them into groups based upon age and weight. Young patients (< 65 years old) who were obese had a 50% increased risk of dying within 7 years compared with normal-weight young patients. Obesity was not associated with increased mortality for elderly patients. "The effects of obesity on death in younger dialysis patients have not been well addressed," said Dr. Hoogeveen. "Identification of modifiable risk factors for survival opens the door to targeted prevention and is important to improve life expectancy."

Study co-authors include Renée de Mutsert, PhD, Nynke Halbesma, Friedo Dekker, PhD (Leiden University Medical Center, in Leiden, the Netherlands), and Elisabeth Boeschoten, MD, PhD (Hans Mak Institute, in Naarden, the Netherlands).

Disclosures: Dr. Boeschoten is a consultant for Amgen and Baxter and receives grants/research support from Abbott, Amgen, Baxter, Genzyme, Roche, and Shire. All other authors reported no financial disclosures.

The study abstract, "Obesity Is a Risk Factor for Mortality, Especially among Younger Dialysis Patients," [TH-PO487] will be presented as a poster on Thursday, November 18, 2010 from 10:00 AM - 12:00 PM MT in Exhibit Halls A & F of the Colorado Convention Center in Denver, CO. Embargo until Thursday, November 18, 2010 11:00 AM MT
ASN Renal Week 2010, the largest nephrology meeting of its kind, will provide a forum for 13,000 professionals to discuss the latest findings in renal research and engage in educational sessions related to advances in the care of patients with kidney and related disorders. Renal Week 2010 will take place November 16 - November 21 at the Colorado Convention Center in Denver, CO.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, the American Society of Nephrology (ASN) is the world's largest professional society devoted to the study of kidney disease. Comprised of 11,000 physicians and scientists, ASN continues to promote expert patient care, to advance medical research, and to educate the renal community. ASN also informs policymakers about issues of importance to kidney doctors and their patients. ASN funds research, and through its world-renowned meetings and first-class publications, disseminates information and educational tools that empower physicians.

American Society of Nephrology

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