Druml W, Schwarzenhofer M, Apsner R, Hörl W H
Third Department of Medicine, University of Vienna, Austria.
Miner Electrolyte Metab. 1998;24(4):220-6. doi: 10.1159/000057374.
Systematic investigations on the status of fat-soluble vitamins in patients with acute renal failure (ARF) are lacking and hence no recommendations for vitamin supply can be defined for these subjects. Thus we compared the status of fat-soluble vitamins, of transport molecules and some vitamin-dependent proteins in patients with ARF and healthy controls.
Nephrology unit of a university hospital.
Eight patients with ARF requiring hemodialysis therapy were investigated and 28 healthy volunteers served as controls. Plasma concentrations of retinol (vitamin A) and retinol-binding protein (RBP), 25-OH and 1,25-(OH)2 vitamin D3, of parathyroid hormone (PTH), of alpha-tocopherol (vitamin E) and of phylloquinone (vitamin K), osteocalcin and noncarboxylated osteocalcin, respectively, were measured and plasma lipoprotein fractions (as vitamin transport vehicle) were evaluated.
Vitamin A levels were decreased (p < 0.001), but RBP levels were normal in ARF patients. Vitamin D3 metabolites 25-OH and 1,25-(OH)2 vitamin D3 plasma levels were profoundly depressed, and PTH was elevated (p < 0.001). Vitamin E plasma concentration was reduced (p < 0.001) but this cannot be accounted for by decreased LDL cholesterol or triglyceride levels. In contrast, vitamin K plasma level was rather elevated in ARF patients with a broad range of individual values. Blood coagulation was normal but total and carboxylated osteocalcin were decreased. No correlation of vitamin K concentrations and any of the plasma lipoprotein fractions could be identified.
With the exception of vitamin K, profound deficiencies of fat-soluble vitamins develop in patients with ARF. Current recommendations for vitamin supplementation are inadequate and should be reevaluated for these patients.
目前缺乏对急性肾衰竭（ARF）患者脂溶性维生素状况的系统性研究，因此无法为这些患者确定维生素供应的建议。于是，我们比较了ARF患者与健康对照者脂溶性维生素、转运分子及一些维生素依赖性蛋白的状况。
某大学医院的肾病科。
对8例需要血液透析治疗的ARF患者进行了研究，并选取28名健康志愿者作为对照。分别测定了血浆视黄醇（维生素A）和视黄醇结合蛋白（RBP）、25-羟基维生素D3和1,25-二羟基维生素D3、甲状旁腺激素（PTH）、α-生育酚（维生素E）和叶绿醌（维生素K）、骨钙素和未羧化骨钙素的浓度，并评估了血浆脂蛋白组分（作为维生素转运载体）。
ARF患者的维生素A水平降低（p<0.001），但RBP水平正常。维生素D3代谢产物25-羟基维生素D3和1,25-二羟基维生素D3的血浆水平显著降低，而PTH升高（p<0.001）。维生素E的血浆浓度降低（p<0.001），但这不能用低密度脂蛋白胆固醇或甘油三酯水平降低来解释。相比之下，ARF患者的维生素K血浆水平相当高，个体值范围较广。凝血功能正常，但总骨钙素和羧化骨钙素降低。未发现维生素K浓度与任何血浆脂蛋白组分之间存在相关性。
除维生素K外，ARF患者会出现严重的脂溶性维生素缺乏。目前的维生素补充建议并不充分，应对这些患者重新进行评估。
