International Urology and Nephrology 24 (4), pp. 4 5 3 - 457 (1992)
Vitamin B6 Requirements in Chronic Renal Failure M. MYDLiK, K. DERZSIOV.~, M. GUMAN, M. HREHOROVSK~ 4th Department of Medicine, University Hospital, Kogice, Czech and Slovak Federal Republic (Accepted August 29, 1991) According to our results the long-term daily oral supplementation of 6 mg vitamin B6 was sufficient for prevention of vitamin B6 deficiency in chronic renal failure, regular dialysis treatment and CAPD groups of patients. Haemodialysis and charcoal haemoperfusion have led to non-significant decrease of erythrocyte vitamin BG. A favourable effect was found of daily oral administration of 50 mg pyridoxine on electrophoretic mobility of peripheral blood lymphocytes and cellular immunity.
Vitamin B 6 deficiency in patients with chronic renal failure is caused by decreased amount in diet [5, 6, 10, 14, 15, 23], decreased absorption in small intestine and impaired transport through cell membrane [7], altered phosphorylation of pyridoxal on pyridoxal-5-phosphate [5, 7, 14], increased degradation of pyridoxal-5-phosphate or absorption in tissues [5, 23] and vitamin B 6 losses through dialysis membranes [2, 3, 5, 8, 15, 16]. Clinical symptoms of vitamin B 6 deficiency are not marked in patients on regular dialysis treatment. The symptoms are similar to those of the uraemic syndrome [5, 25]. Daily oral supplementation in patients on regular dialysis treatment and CAPD ranged from 0 to 20 mg/24 h [2, 3, 6, 8, 10, 14-16, 19-21]. Increased doses of vitamin B 8 (50-300 rag/24 h) were administered to increase plasma pyridoxal-5-phosphate concentration [8, 11, 17, 18, 24] and to combat impaired cellular immunity [4, 5, 7, 13, 22].
Material and methods
Thirty healthy blood donors, 20 patients with chronic renal failure without dialysis treatment, 30 patients on regular dialysis treatment and 10 patients on CAPD were the subjects of this study. Their age ranged from 19 to 40 years (mean 30.5 years). Clinical signs of vitamin B 6 deficiency were not present in all investigated patients. Pyridoxine was not administered in the group of patients with chronic renal failure without dialysis treatment. At the beginning of our study patients on regular dialysis treatment received daily 3 mg oral pyridoxine and after 3 months daily 6 mg. The CAPD group of patients during long-term study (12 months) were supplemented with daily 6 mg oral pyridoxine [19]. At the end of this study we administered to the regular dialyis treatment group daily oral doses of 50 mg pyridoxine for 3 months. Erythrocyte vitamin B 6 concentration was deterVSP, Utrecht Akadoniai Kiad6, Budapest
454
.VIydlik et al. : Vitamin B G in chronic renal failure
Table 1 Vitamin effect in patients on regular
Control group
CRF
RDT1
RDT2
14.54 -1- 1.45
20.98 • 2.04
20.45 __+2.76
12.57 4- 1.76
Vitamin effect (Vo)
C R F = chronic renal failure without dialysis R D T j = regular dialysis treatment; 3 mg pyridoxine m i n e d b y a n i n d i r e c t m e t h o d , i.e. b y d e t e r m i n a t i o n o f c a t a l y t i c a c t i v i t y o f e r y t h r o cyte a s p a r t a t e a m i n o t r a n s f e r a s e . P e r c e n t a g e i n c r e a s e o f e r y t h r o c y t e c a t a l y t i c activity o f a s p a r t a t e a m i n o t r a n s f e r a s e a f t e r a d d i t i o n o f p y r i d o x a l - 5 - p h o s p h a t e in v i t r o Table 2 Vitamin effect and parameters of cellular immunity in patients on regular dialysis treatment (6 mg pyridoxine before treatment and 50 mg after three months) R e g u l a r dialysis Parameter
Control group
1. Vitamin effect (~)
2. Percentage of
T lymphocyte E R F C
14.54 q- 1.45
62.3 8.1
3. Absolute number of T lymphocyte E R F C
1417 q- 390
4. Percentage of T lymphocyte
34.1 -F 13.0 L 859 __+319
A-ERFC 5. Absolute number of T lymphocyte A - E R F C
ERFC A-ERFC -~ p < ~p
Vitamin B6 Requirements in Chronic Renal Failure M. MYDLiK, K. DERZSIOV.~, M. GUMAN, M. HREHOROVSK~ 4th Department of Medicine, University Hospital, Kogice, Czech and Slovak Federal Republic (Accepted August 29, 1991) According to our results the long-term daily oral supplementation of 6 mg vitamin B6 was sufficient for prevention of vitamin B6 deficiency in chronic renal failure, regular dialysis treatment and CAPD groups of patients. Haemodialysis and charcoal haemoperfusion have led to non-significant decrease of erythrocyte vitamin BG. A favourable effect was found of daily oral administration of 50 mg pyridoxine on electrophoretic mobility of peripheral blood lymphocytes and cellular immunity.
Vitamin B 6 deficiency in patients with chronic renal failure is caused by decreased amount in diet [5, 6, 10, 14, 15, 23], decreased absorption in small intestine and impaired transport through cell membrane [7], altered phosphorylation of pyridoxal on pyridoxal-5-phosphate [5, 7, 14], increased degradation of pyridoxal-5-phosphate or absorption in tissues [5, 23] and vitamin B 6 losses through dialysis membranes [2, 3, 5, 8, 15, 16]. Clinical symptoms of vitamin B 6 deficiency are not marked in patients on regular dialysis treatment. The symptoms are similar to those of the uraemic syndrome [5, 25]. Daily oral supplementation in patients on regular dialysis treatment and CAPD ranged from 0 to 20 mg/24 h [2, 3, 6, 8, 10, 14-16, 19-21]. Increased doses of vitamin B 8 (50-300 rag/24 h) were administered to increase plasma pyridoxal-5-phosphate concentration [8, 11, 17, 18, 24] and to combat impaired cellular immunity [4, 5, 7, 13, 22].
Material and methods
Thirty healthy blood donors, 20 patients with chronic renal failure without dialysis treatment, 30 patients on regular dialysis treatment and 10 patients on CAPD were the subjects of this study. Their age ranged from 19 to 40 years (mean 30.5 years). Clinical signs of vitamin B 6 deficiency were not present in all investigated patients. Pyridoxine was not administered in the group of patients with chronic renal failure without dialysis treatment. At the beginning of our study patients on regular dialysis treatment received daily 3 mg oral pyridoxine and after 3 months daily 6 mg. The CAPD group of patients during long-term study (12 months) were supplemented with daily 6 mg oral pyridoxine [19]. At the end of this study we administered to the regular dialyis treatment group daily oral doses of 50 mg pyridoxine for 3 months. Erythrocyte vitamin B 6 concentration was deterVSP, Utrecht Akadoniai Kiad6, Budapest
454
.VIydlik et al. : Vitamin B G in chronic renal failure
Table 1 Vitamin effect in patients on regular
Control group
CRF
RDT1
RDT2
14.54 -1- 1.45
20.98 • 2.04
20.45 __+2.76
12.57 4- 1.76
Vitamin effect (Vo)
C R F = chronic renal failure without dialysis R D T j = regular dialysis treatment; 3 mg pyridoxine m i n e d b y a n i n d i r e c t m e t h o d , i.e. b y d e t e r m i n a t i o n o f c a t a l y t i c a c t i v i t y o f e r y t h r o cyte a s p a r t a t e a m i n o t r a n s f e r a s e . P e r c e n t a g e i n c r e a s e o f e r y t h r o c y t e c a t a l y t i c activity o f a s p a r t a t e a m i n o t r a n s f e r a s e a f t e r a d d i t i o n o f p y r i d o x a l - 5 - p h o s p h a t e in v i t r o Table 2 Vitamin effect and parameters of cellular immunity in patients on regular dialysis treatment (6 mg pyridoxine before treatment and 50 mg after three months) R e g u l a r dialysis Parameter
Control group
1. Vitamin effect (~)
2. Percentage of
T lymphocyte E R F C
14.54 q- 1.45
62.3 8.1
3. Absolute number of T lymphocyte E R F C
1417 q- 390
4. Percentage of T lymphocyte
34.1 -F 13.0 L 859 __+319
A-ERFC 5. Absolute number of T lymphocyte A - E R F C
ERFC A-ERFC -~ p < ~p
