Dataset Information

Endogenous urinary glucocorticoid metabolites and mortality in prednisolone-treated renal transplant recipients.

ABSTRACT: BACKGROUND:Chronic corticosteroid treatment suppresses HPA-axis activity and might alter activity of 11? hydroxysteroid dehydrogenases (11?-HSD). We aimed to investigate whether the endogenous glucocorticoid production and 11?-HSD activities are altered in prednisolone-treated renal transplant recipients (RTR) compared with healthy controls and whether this has implications for long-term survival in RTR. METHODS:In a longitudinal cohort of 693 stable RTR and 275 healthy controls, 24-hour urinary cortisol, cortisone, tetrahydrocorisol (THF), allotetrahydrocortisol (alloTHF), and tetrahydrocortisone (THE) were measured using liquid chromatography tandem-mass spectrometry. Twenty-four-hour urinary excretion of cortisol and metabolites were used as measures of endogenous glucocorticoid production; (THF + alloTHF)/THE and cortisol/cortisone ratios were used as measures of 11?-HSD activity. RESULTS:Urinary cortisol and metabolite excretion were significantly lower in RTR compared with healthy controls (P < .001), whereas (THF + alloTHF)/THE and cortisol/cortisone ratios were significantly higher (P < .001 and P = .002). Lower total urinary metabolite excretion and higher urinary (THF + alloTHF)/THE ratios were associated with increased risk of mortality, independent of age, sex, estimated glomerular filtration rate, C-reactive protein, body surface area, and daily prednisolone dose, respectively. CONCLUSIONS:Endogenous glucocorticoid production and 11?-HSD activities are altered in prednisolone-treated RTR. Decreased total urinary endogenous glucocorticoid metabolite excretion and increased urinary (THF + alloTHF)/THE ratios are associated with increased risk of mortality.

SUBMITTER: Vulto A

PROVIDER: S-EPMC7216873 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Endogenous urinary glucocorticoid metabolites and mortality in prednisolone-treated renal transplant recipients.

Vulto Annet A Minović Isidor I de Vries Laura V LV Timmermans Arwin C AC van Faassen Martijn M Gomes Neto Antonio W AW Touw Daan J DJ de Jong Margriet F C MFC van Beek André P AP Dullaart Robin P F RPF Navis Gerjan G Kema Ido P IP Bakker Stephan J L SJL

Clinical transplantation 20200303 4

<h4>Background</h4>Chronic corticosteroid treatment suppresses HPA-axis activity and might alter activity of 11β hydroxysteroid dehydrogenases (11β-HSD). We aimed to investigate whether the endogenous glucocorticoid production and 11β-HSD activities are altered in prednisolone-treated renal transplant recipients (RTR) compared with healthy controls and whether this has implications for long-term survival in RTR.<h4>Methods</h4>In a longitudinal cohort of 693 stable RTR and 275 healthy controls, ...[more]

PMID: 32052523

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Project description:BackgroundRenal transplant recipients (RTRs) have a 6-fold higher risk of mortality than age- and sex-matched controls. Whether high consumption of ultra-processed foods is associated with survival in RTRs is unknown.ObjectivesWe aimed to study the association between high consumption of ultra-processed foods and all-cause mortality in stable RTRs.MethodsWe conducted a prospective cohort study in adult RTRs with a stable graft. Dietary intake was assessed using a validated 177-item FFQ. Food items were categorized according to the NOVA classification system and the proportion ultra-processed foods comprised of total food weight per day was calculated.ResultsWe included 632 stable RTRs (mean ± SD age: 53.0 ± 12.7 y, 57% men). Mean ± SD consumption of ultra-processed foods was 721 ± 341 g/d (28% of total weight of food intake), whereas the intake of unprocessed and minimally processed foods, processed culinary ingredients, and processed foods accounted for 57%, 1%, and 14%, respectively. During median follow-up of 5.4 y [IQR: 4.9-6.0 y], 129 (20%) RTRs died. In Cox regression analyses, ultra-processed foods were associated with all-cause mortality (HR per doubling of percentage of total weight: 2.13; 95% CI: 1.46, 3.10; P < 0.001), independently of potential confounders. This association was independent from the quality of the overall dietary pattern, expressed by the Mediterranean Diet Score (MDS) or Dietary Approaches to Stop Hypertension (DASH) score. When analyzing ultra-processed foods by groups, only sugar-sweetened beverages (HR: 1.21; 95% CI: 1.05, 1.39; P = 0.007), desserts (HR: 1.24; 95% CI: 1.02, 1.49; P = 0.03), and processed meats (HR: 1.87; 95% CI: 1.22, 2.86; P = 0.004) were associated with all-cause mortality.ConclusionsConsumption of ultra-processed foods, in particular sugar-sweetened beverages, desserts, and processed meats, is associated with a higher risk of all-cause mortality after renal transplantation, independently of low adherence to high-quality dietary patterns, such as the Mediterranean diet and the DASH diet.This trial was registered at clinicaltrials.gov as NCT02811835.

Dataset Information

Endogenous urinary glucocorticoid metabolites and mortality in prednisolone-treated renal transplant recipients.

Publications

Endogenous urinary glucocorticoid metabolites and mortality in prednisolone-treated renal transplant recipients.

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