1
|
Holden RM, Booth SL, Zimmerman D, Moist L, Norman PA, Day AG, Menard A, Fu X, Shea MK, Babiolakis CS, Nolan R, Turner ME, Ward E, Kaufmann M, Adams MA, Heyland DK. Inhibit progression of coronary artery calcification with vitamin K in hemodialysis patients (the iPACK-HD study): a randomized, placebo-controlled multi-center, pilot trial. Nephrol Dial Transplant 2022; 38:746-756. [PMID: 35641194 PMCID: PMC9976736 DOI: 10.1093/ndt/gfac191] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Vitamin K activates matrix Gla protein (MGP), a key inhibitor of vascular calcification. There is a high prevalence of sub-clinical vitamin K deficiency in patients with end-stage kidney disease. METHODS A parallel randomized placebo-controlled pilot trial was designed to determine whether 10 mg of phylloquinone thrice weekly versus placebo modifies coronary artery calcification progression over 12 months in patients requiring hemodialysis with a coronary artery calcium score (CAC) ≥30 Agatston Units (ClinicalTrials.gov identifier NCT01528800). The primary outcome was feasibility (recruitment rate, compliance with study medication, study completion and adherence overall to study protocol). CAC score was used to assess calcification at baseline and 12 months. Secondary objectives were to explore the impact of phylloquinone on vitamin K-related biomarkers (phylloquinone, dephospho-uncarboxylated MGP and the Gla-osteocalcin to Glu-osteocalcin ratio) and events of clinical interest. RESULTS A total of 86 patients with a CAC score ≥30 Agatston Units were randomized to either 10 mg of phylloquinone or a matching placebo three times per week. In all, 69 participants (80%) completed the trial. Recruitment rate (4.4 participants/month) and medication compliance (96%) met pre-defined feasibility criteria of ≥4.17 and ≥90%, respectively. Patients randomized to phylloquinone for 12 months had significantly reduced levels of dephospho-uncarboxylated MGP (86% reduction) and increased levels of phylloquinone and Gla-osteocalcin to Glu-osteocalcin ratio compared with placebo. There was no difference in the absolute or relative progression of coronary artery calcification between groups. CONCLUSION We demonstrated that phylloquinone treatment improves vitamin K status and that a fully powered randomized trial may be feasible.
Collapse
Affiliation(s)
| | - Sarah L Booth
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Deborah Zimmerman
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Louise Moist
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Patrick A Norman
- Kingston General Health Research Institute, Kingston Health Sciences Center, Kingston, Ontario, Canada,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Andrew G Day
- Kingston General Health Research Institute, Kingston Health Sciences Center, Kingston, Ontario, Canada,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada,Clinical Evaluation Research Unit, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada
| | - Alex Menard
- Department of Radiology, Queen's University, Kingston, Ontario, Canada
| | - Xueyan Fu
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - M Kyla Shea
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | | | - Robert Nolan
- Department of Radiology, Queen's University, Kingston, Ontario, Canada
| | - Mandy E Turner
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Ontario, Canada
| | - Emilie Ward
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Ontario, Canada
| | - Martin Kaufmann
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Ontario, Canada
| | - Michael A Adams
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Ontario, Canada
| | - Daren K Heyland
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada,Clinical Evaluation Research Unit, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada,Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
3
|
Babiolakis CS, Sharma S, Sayed N, Abunassar JG, Haseeb S, Abuzeid W. The effect of sex on door-to-balloon time in patients presenting with ST-elevation myocardial infarction and referred for primary percutaneous coronary intervention: A systematic review. Cardiovasc Revasc Med 2021; 37:120-127. [PMID: 34334335 DOI: 10.1016/j.carrev.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/19/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022]
Abstract
Timely reperfusion using primary percutaneous coronary intervention (pPCI) is the cornerstone of acute ST-elevation myocardial infarction (STEMI) management. We conducted a systematic review to examine the effect of sex on door-to-balloon (D2B) time and symptom-to-balloon (S2B) time. We observed longer D2B times and S2B times in female patients presenting with STEMI and referred for pPCI when compared to male patients. Future work is required to try and elucidate and mitigate sex-based front-line treatment delays for female STEMI patients.
Collapse
Affiliation(s)
- Corinne S Babiolakis
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Shubham Sharma
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Nawid Sayed
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Joseph G Abunassar
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Sohaib Haseeb
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811, Australia.
| | - Wael Abuzeid
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| |
Collapse
|
4
|
Mazzetti T, Hopman WM, Couture L, Christilaw E, Munroe J, Babiolakis CS, Adams MA, Holden RM. Phosphorus Consumption Within 1 Hour Prior to Blood Work and Associated Serum Levels of Phosphate, Calcium, and PTH in Adult Patients Receiving Hemodialysis Treatment. Can J Kidney Health Dis 2019; 6:2054358119856891. [PMID: 31285829 PMCID: PMC6601009 DOI: 10.1177/2054358119856891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/07/2019] [Indexed: 11/16/2022] Open
Abstract
Background While dietary intake is known to influence serum markers of chronic kidney disease-mineral and bone disorder (CKD-MBD), the effects of recent food and beverage intake, particularly phosphorus consumption on these serum markers (phosphate, calcium, and parathyroid hormone [PTH]), are unknown in hemodialysis patients. An understanding of these effects could have direct and important implications on the management of CKD-MBD. Objective To determine whether serum phosphate, calcium, and PTH levels were higher in hemodialysis patients who had consumed dietary phosphorus within 1 hour prior to their routine dialysis-related blood work (non-phosphorus-fasted) compared with patients who did not (phosphorus-fasted). Design Observational, cross-sectional study. Setting Kingston Health Sciences Center-Kingston General Hospital Site and its affiliated satellite hemodialysis units. Patients Two hundred fifty-four adult patients receiving outpatient hemodialysis treatment for end-stage kidney disease were recruited. Measurements The main measurements for this study included an assessment of dietary phosphorus intake as well as serum phosphate, calcium, PTH, albumin, Kt/V, and urea reduction ratio. Methods A direct patient interview was performed to assess dietary phosphorus intake within 1 hour prior to routine dialysis-related blood work. The Canadian Nutrient File was then used to estimate dietary phosphorus based on the specific foods and beverages (including portion sizes and brands where applicable) identified in the interview. Serum measures of phosphate, PTH, calcium, albumin, and dialysis adequacy (Kt/V and urea reduction ratio) were obtained from participants' routine dialysis-related blood work. Results Non-phosphorus-fasted participants had nonsignificantly higher serum PTH levels compared to phosphorus-fasted participants (61.2 ± 64.7 vs 47.9 ± 39.7, P = .05). Non-phosphorus-fasted participants with PTH levels at the Kidney Disease Improving Global Outcomes (KDIGO) "target" (between 15 and 60 pmol/L) had significantly higher serum phosphate levels relative to phosphorus-fasted participants (1.6 ± 0.3 vs 1.4 ± 0.4, P = .006). In non-phosphorus-fasted participants, there was a nonsignificant association between the number of items containing inorganic phosphate additives and higher levels of serum phosphate and lower levels of serum calcium. Limitations Some limitations include the cross-sectional nature of this study, self-reporting biases and estimates (as opposed to direct measurements) related to the dietary assessment, and the use of single (and not serial) assessments of serum measures. Conclusions Dietary phosphorus intake in close proximity to blood work may contribute to subtle alterations in some key serum CKD-MBD parameters in adult outpatient hemodialysis patients but may not meaningfully alter CKD-MBD management.
Collapse
Affiliation(s)
- Tom Mazzetti
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Wilma M Hopman
- Clinical Research Centre, Kingston Health Sciences Centre, Kingston General Hospital, ON, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Laura Couture
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Erin Christilaw
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Jenny Munroe
- Department of Renal Care, Kingston Health Sciences Centre, Kingston General Hospital, ON, Canada
| | | | - Michael A Adams
- Department of Biomedical and Molecular Science, Queen's University, Kingston, ON, Canada
| | - Rachel M Holden
- Department of Medicine, Queen's University, Kingston, ON, Canada.,Department of Biomedical and Molecular Science, Queen's University, Kingston, ON, Canada
| |
Collapse
|
5
|
Babiolakis CS, Kuk JL, Drake JDM. Differences in lumbopelvic control and occupational behaviours in female nurses with and without a recent history of low back pain due to back injury. Ergonomics 2014; 58:235-245. [PMID: 25400080 DOI: 10.1080/00140139.2014.968635] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Low back pain is highly prevalent in nurses. This study aimed to determine which physical fitness, physical activity (PA) and biomechanical characteristics most clearly distinguish between nurses with [recently injured (RInj)] and without [not recently injured (NRInj)] a recent back injury. Twenty-seven (8 RInj, 19 NRInj) female nurses completed questionnaires (pain, work, PA), physical fitness, biomechanical and low back discomfort measures, and wore an accelerometer for one work shift. Relative to NRInj nurses, RInj nurses exhibited reduced lumbopelvic control (41.4% more displayed a moderate loss of frontal plane position), less active occupational behaviours (less moderate PA; less patient lifts performed alone; more sitting and less standing time) and more than two times higher low back discomfort scores. Despite no physical fitness differences, the lumbopelvic control, occupational behaviours and discomfort measures differed between nurses with and without recent back injuries. It is unclear whether poor lumbopelvic control is causal or adaptive in RInj nurses and may require further investigation. Practitioner Summary: It is unclear which personal modifiable factors are most clearly associated with low back pain in nurses. Lumbopelvic control was the only performance-based measure to distinguish between nurses with and without recent back injuries. Future research may investigate whether reduced lumbopelvic control is causal or adaptive in recently injured nurses.
Collapse
Affiliation(s)
- Corinne S Babiolakis
- a School of Kinesiology & Health Science, York University , 4700 Keele Street, Toronto , ON , Canada M3J 1P3
| | | | | |
Collapse
|