Erythropoietin-stimulating agent-resistant vitamin B(6) deficiency anemia in a pediatric patient on hemodialysis

Contribution of vitamin B 6 deficiency to anemia in children on regular hemodialysis

BACKGROUND

Anemia is prevalent among pediatric patients diagnosed with end-stage kidney disease (ESKD). In addition, erythropoiesis-stimulating agents (ESA) and iron supplementation are considered the cornerstones in the management of anemia. However, a significant proportion of patients remain anemic. Vitamin B6 plays a vital role in the biosynthesis of heme and may be deficient in children with chronic kidney disease (CKD), particularly those on regular hemodialysis (HD). We aimed to evaluate serum vitamin B6 concentration in those children and determine its correlation with anemia indices.

METHODS

The current cross-sectional study included 39 children on regular HD and 43 healthy controls. Clinical data were collected, including anthropometric measurements, blood pressure, iron, and erythropoietin therapy. Laboratory investigations included hemoglobin (Hb) indices, iron profile, and vitamin B6 level.

RESULTS

The median Hb level in our cohort was 10.5 g/dL, and nine patients had Hb levels at or above the target Hb of 11 g/dl. They had a median Serum Vitamin B6 concentration of 28.2 ng/ml (IQR = 22.8-52.9) compared to a median of 27.5 ng/ml(IQR = 20-34) in controls, with no substantial differences between both groups. There was no statistically significant correlation between vitamin B6 and Hb levels or erythropoietin dose.

CONCLUSION

It is evident that the majority of our patients did not meet the desired threshold for anemia control. However, it is noteworthy that the average hemoglobin (Hb) level approached the intended target. The incidence of Vitamin B6 deficiency was not found to be statistically significant within our study population. Therefore, we could not establish a correlation between vitamin B6 deficiency and anemia in children on HD.

Water-soluble vitamins and trace elements in children with chronic kidney disease stage 5d

Children receiving maintenance dialysis (chronic kidney disease (CKD) stage 5d) have unique risk factors for micronutrient deficiency or toxicity. Children receiving chronic dialysis often require specialized diet plans that may provide more than the recommended daily allowance (RDA) of water-soluble vitamins and micronutrients, with or without the addition of a kidney-friendly vitamin. The following is a comprehensive review of current literature on disorders of micronutrients in this population including those of water-soluble vitamins (vitamin C and vitamin B complexes) and trace elements (copper, selenium, and zinc) and has three areas of focus: (1) the risk factors and clinical presentations of disorders of micronutrients, both deficiency and toxicity, (2) the tools to evaluate micronutrient status, and (3) the central role of renal dietitians in optimizing nutritional status from a micronutrient perspective.

DNA vaccines targeting amyloid-β oligomer ameliorate cognitive deficits of aged APP/PS1/tau triple-transgenic mouse models of Alzheimer's disease

The amyloid-β (Aβ) oligomer, rather than the Aβ monomer, is considered to be the primary initiator of Alzheimer’s disease. It was hypothesized that p(Aβ3–10)10-MT, the recombinant Aβ3–10 gene vaccine of the Aβ oligomer has the potential to treat Alzheimer’s disease. In this study, we intramuscularly injected the p(Aβ3–10)10-MT vaccine into the left hindlimb of APP/PS1/tau triple-transgenic mice, which are a model for Alzheimer’s disease. Our results showed that the p(Aβ3–10)10-MT vaccine effectively reduced Aβ oligomer levels and plaque deposition in the cerebral cortex and hippocampus, decreased the levels tau protein variants, reduced synaptic loss, protected synaptic function, reduced neuron loss, and ameliorated memory impairment without causing any cerebral hemorrhaging. Therefore, this novel DNA vaccine, which is safe and highly effective in mouse models of Alzheimer’s disease, holds a lot of promise for the treatment of Alzheimer’s disease in humans.