WATER-SOLUBLE VITAMINS IN CHRONIC-HEMODIALYSIS PATIENTS AND NEED FOR SUPPLEMENTATION
WATER-SOLUBLE VITAMINS IN CHRONIC-HEMODIALYSIS PATIENTS AND NEED FOR SUPPLEMENTATION
复制标题
DOI：
10.1038/ki.1993.185
复制
发表时间：
1993-06-01
影响因子：
19.6
通讯作者：
FELLAY, G
中科院分区：
文献类型：
--
作者：
DESCOMBES, E;HANCK, AB;FELLAY, G
43名慢性血液透析患者在本研究之前只接受低剂量叶酸和抗坏血酸的补充，他们被前瞻性地研究了一年。在第一个月获得基线值后，增加透析后维生素补充剂的剂量以治疗发现维生素不足的患者，以确定使维生素水平正常化所需的口服透析后补充剂的最低剂量。根据我们的结果，没有系统补充生物素，核黄素或维生素B12。对于叶酸和维生素C，补充剂量低于许多透析单位规定的剂量，使大多数患者的维生素水平达到最佳；2 - 3mg /周（300 - 400mg /天）的叶酸和1000 - 1500mg /周（150 - 200mg /天）的维生素C被认为是足够的。根据血浆中吡哆醛-5-磷酸测定或红细胞中特异性酶活化测定（EGOTo和α - egot）判断，大多数（bb0 - 80%）未补充吡哆醇的患者存在严重的吡哆醇缺乏症；透析后补充盐酸吡哆醇至少100至150毫克/周（bbb15至20毫克/天）纠正这种缺陷。35%的患者红细胞中硫胺素依赖性转酮酶（ETKo）活性不足，21%的患者处于边缘状态，而10例缺乏ETKo的患者同时检测的全血硫胺素在正常范围内。这些结果表明，在尿毒症中，转酮醇酶活性不足可能与酶系统的抑制有关，而不是真正的维生素缺乏。长期补充200 - 300mg /周盐酸硫胺素（30 - 45mg /天）可使大多数患者的ETKo恢复到令人满意的水平；这种补充剂是否值得推荐还有待进一步研究。
Forty-three patients on chronic hemodialysis who before the present study had only received a low-dose supplement of folic and ascorbic acid were studied prospectively for one year. After baseline values were obtained in month one, increasing doses of postdialysis vitamin supplements were prescribed for the vitamins which were found to be insufficient in order to determine the minimal amount of oral postdialysis supplement necessary to normalize vitamin levels. According to our results no systematic supplement was indicated for biotin, riboflavin or vitamin B12. For folic acid and vitamin C, supplementation with lower doses than those prescribed in many dialysis units allowed optimal vitamin levels in the majority of patients; 2 to 3 mg/week (300 to 400 mug/day) of folic acid and of 1000 to 1500 mg/week (150 to 200 mg/day) of vitamin C was considered sufficient. A severe pyridoxine deficiency was present in most (> 80%) unsupplemented patients, either as judged by pyridoxal-5-phosphate determinations in plasma or determination of specific enzyme activation in erythrocytes (EGOTo and alpha-EGOT); a postdialysis supplement of at least 100 to 150 mg/week of pyridoxine hydrochloride (> 15 to 20 mg/day) corrects this deficiency. The activity of the thiamine-dependent enzyme transketolase in erythrocytes (ETKo) was insufficient in 35% and marginal in 21% of the patients, while whole blood thiamine determined simultaneously in 10 of the ETKo-deficient patients was within the normal range. These results suggest that in uremia insufficient transketolase activity may be related to inhibition of the enzymatic system rather than to true vitamin deficiency. On a long-term basis a supplement of 200 to 300 mg/week of thiamine hydrochloride (30 to 45 mg/day) restored ETKo to satisfactory levels in most patients; whether this supplement is to be recommended warrants further studies.