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Vol. 36. Issue. 2.March - April 2016
Pages 89-216
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Vol. 36. Issue. 2.March - April 2016
Pages 89-216
Letter to the Editor – Comments on published articles
DOI: 10.1016/j.nefroe.2015.04.001
Open Access
Is there any association between overhydration and inflammation in dialysis patients?
¿Hay alguna relación entre la sobrehidratación y la inflamación en pacientes en diálisis?
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Mehmet Agillia,
Corresponding author
mehmetagilli@yahoo.com

Corresponding author.
, Tolga Doganb, Mustafa Ilker Inanc, Gonca Fidand
a Department of Biochemistry, Agri Military Hospital, Agri, Turkey
b Department of Internal Medicine, Gulhane Military Medical Academy, Ankara, Turkey
c Department of Chest Diseases, Girne Military Hospital, Girne, Cyprus
d Department of Infectious Diseases and Clinical Microbiology, Agri Military Hospital, Agri, Turkey
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Dear Editor,

In a recent issue of Nefrologia, we read the paper of Dr Vega and colleagues entitled “Study on overhydration in dialysis patients and its association with inflammation”.1 We thank for their valuable research evaluating hydration status and body composition in patients on haemodialysis and its relation to inflammation. They found an association between hydration status and low prealbumin (transthyretin) levels. We want to make some comments on transthyretin (TTR) which was assessed in their study.

Serum TTR has been reported to be a reliable outcome predictor in patients with kidney disease.2 Previous studies suggested that several factors can affect serum TTR levels. Disorders such as anorexia nervosa, bulimia nervosa, rheumatoid arthritis, ankylosing spondylitis, major depression, trauma, malignancy, protein losing enteropathy, Kawasaki disease, liver diseases, Helicobacter pylori infection and thyroid diseases were shown to alter serum TTR levels.3,4 Vega et al. did not mention these contributing diseases in their paper.

Several drugs such as anabolic steroids, corticosteroids, progestational agents, estrogens, antithyroid drugs and nonsteroidal antinflammatory drugs can alter serum TTR levels.5,6 Also, dietary supplements such as vitamin A, vitamin C, zinc and omega-3 fatty acids can alter these levels.7,8 In this respect, the authors should define whether the participants use any of these drugs and dietary supplements. In addition, alcohol usage is another confounder that should be described whether the participants use.9

Lastly, we think that body position is essential to state while taking blood specimen. It is recommended that blood specimens for measuring plasma proteins be taken after nearly 15–20min in the sitting position.5 Otherwise, concentrations should be evaluated with consideration of position. Lower levels are to be expected in bedridden patients.5 Therefore, interpretation of results with its current form seems problematic.

Mears and many researchers suggested that serum TTR concentration was not affected by hydration status.10 In this respect, authors’ claim as association between hydration status and low TTR levels seems suspicious irrespective of taking into account above contributing factors. Clarifying these concerns will provide clearer picture to the readers.

Conflict of interest

The authors declare no conflicts of interest.

References
[1]
A. Vega, B. Quiroga, S. Abad, C. Ruiz, J.M. Lopez-Gomez.
Study on overhydration in dialysis patients and its association with inflammation.
[2]
G.M. Chertow, K. Ackert, N.L. Lew, J.M. Lazarus, E.G. Lowrie.
Prealbumin is as important as albumin in the nutritional assessment of hemodialysis patients.
Kidney Int, 58 (2000), pp. 2512-2517
[3]
A. Aguilera, R. Codoceo, M.A. Bajo, J.J. Diez, G. del Peso, M. Pavone, et al.
Helicobacter pylori infection: a new cause of anorexia in peritoneal dialysis patients.
Perit Dial Int, 21 (2001), pp. S152-S156
[4]
G.M. Sullivan, J.J. Mann, M.A. Oquendo, E.S. Lo, T.B. Cooper, J.M. Gorman.
Low cerebrospinal fluid transthyretin levels in depression: correlations with suicidal ideation and low serotonin function.
Biol Psychiatry, 60 (2006), pp. 500-506
[5]
A. Myron Johnson, G. Merlini, J. Sheldon, K. Ichihara.
Clinical indications for plasma protein assays: transthyretin (prealbumin) in inflammation and malnutrition.
Clin Chem Lab Med, 45 (2007), pp. 419-426
[6]
J.H. Oppenheimer, S.C. Wener, M. Martinez.
Effect of prednisone on thyroxine-binding proteins.
J Clin Endocrinol Metab, 26 (1966), pp. 715-721
[7]
A. Gharekhani, M.R. Khatami, S. Dashti-Khavidaki, E. Razeghi, A. Abdollahi, S.S. Hashemi-Nazari, et al.
Effects of oral supplementation with omega-3 fatty acids on nutritional state and inflammatory markers in maintenance hemodialysis patients.
J Ren Nutr, 24 (2014), pp. 177-185
[8]
K. Zhang, L. Liu, X. Cheng, J. Dong, Q. Geng, L. Zuo.
Low levels of vitamin C in dialysis patients is associated with decreased prealbumin and increased C-reactive protein.
BMC Nephrol, 12 (2011), pp. 18
[9]
F.K. Beck, T.C. Rosenthal.
Prealbumin: a marker for nutritional evaluation.
Am Fam Physician, 65 (2002), pp. 1575-1578
[10]
E. Mears.
Outcomes of continuous process improvement of a nutritional care program incorporating serum prealbumin measurements.
Nutrition, 12 (1996), pp. 479-484
Copyright © 2015. Sociedad Española de Nefrología
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