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Published on: June 16, 2014
Reducing the Risk of Stroke in Patients with Impaired Renal Function: Nutritional Issues
1Professor of Neurology & Clinical Pharmacology, Western University, and Director, Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, London, ON, Canada.
Insights
Patients with renal failure face high stroke risk due to toxin buildup. Dietary changes, like limiting meat and eggs, and using methylcobalamin instead of cyanocobalamin can reduce this cardiovascular risk.
Area of Science:
- Nephrology and Cardiovascular Medicine
Background:
- Patients with renal failure exhibit significantly elevated cardiovascular disease (CVD) risk, with a tenfold increase in stroke incidence among dialysis patients.
- This heightened risk stems from traditional factors (diabetes, hypertension, dyslipidemia) and the accumulation of kidney-eliminated toxins.
Purpose of the Study:
- To identify key uremic toxins contributing to cardiovascular risk in renal failure patients.
- To propose dietary and therapeutic strategies for mitigating stroke risk in this population.
Main Methods:
- Review of established risk factors and accumulating uremic toxins in renal failure.
- Analysis of the origins of gut-derived uremic toxins (GDUT) and their precursors.
- Evaluation of vitamin B12 forms in renal failure.
Main Results:
- Accumulation of toxins like homocysteine, asymmetric dimethylarginine, thiocyanate, and GDUT (e.g., TMAO) is prevalent.
- GDUT are derived from dietary components, including phosphatidylcholine (egg yolk) and carnitine (red meat), as well as amino acids from meat.
- Vitamin B12 deficiency is common and linked to elevated homocysteine; however, cyanocobalamin is toxic in renal failure.
Conclusions:
- Reducing intake of red meat and egg yolk is crucial for lowering GDUT levels.
- Supplementation with methylcobalamin, not cyanocobalamin, alongside folic acid is recommended for vitamin B12-deficient renal failure patients to decrease stroke risk.
Abstract:
Patients with renal failure have extremely high cardiovascular risk; in dialysis patients the risk of stroke is increased approximately 10-fold over that in the general population. Reasons include not only a high prevalence of traditional risk factors such as diabetes, hypertension and dyslipidemia, but also the accumulation of toxic substances that are eliminated by the kidneys, so have very high levels in patients with renal failure. These include plasma total homocysteine, asymmetric dimethylarginine, thiocyanate, and toxic products of the intestinal microbiome (Gut-Derived Uremic Toxins; GDUT), which include trimethylamine N- oxide (TMAO), produced from phosphatidylcholine (largely from egg yolk) and carnitine (largely from red meat). Other GDUT are produced from amino acids, largely from meat consumption. Deficiency of vitamin B12 is very common, raises plasma tHcy, and is easily treated. However, cyanocobalamin is toxic in patients with renal failure. To reduce the risk of stroke in renal failure it is important to limit the intake of meat, avoid egg yolk, and use methylcobalamin instead of cyanocobalamin, in addition to folic acid.
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