Vascular calcification and mineral bone disorder in chronic kidney disease

Chronic Kidney Disease (CKD), osteoporosis and mild hyponatremia are all prevalent chronic conditions that may coexist and are often under-recognized. Mineral-Bone Disorder begins early in the natural history of CKD and results in complex abnormalities of bone which ultimately confers a well-established increased risk of fragility fractures in End Stage Kidney Disease. Hyponatremia is a novel, usually renal mediated metabolic perturbation, that most commonly occurs independently of the stage of renal dysfunction but which may also predispose to increased fracture risk. The extent -if any- to which either early stages of renal dysfunction or the presence of hyponatremia contribute to fracture occurrence in the general population, independently of osteoporosis, is unclear. Renal transplantation is the treatment of choice for ESKD and although it restores endogenous renal function it typically fails to normalize either the long term cardiovascular or fracture risk. One potential mechanism contributing to these elevated long-term risks and to diminished Health Related Quality of Life is persistent, post-transplant hyperparathyroidism. In this study we retrospectively examine the association of renal function and serum sodium with Bone Mineral Density and fracture occurrence in a retrospective cohort of 1930 female members of the general population who underwent routine DXA scan. We then prospectively recruited a cohort of 90 renal transplant recipients in order to examine the association of post transplant parathyroid hormone (PTH) level with measures of CKD Mineral Bone Disorder, including, DXA Bone Mineral Density, Vascular Calcification (assessed using both abdominal radiography and CT techniques, as well as indirectly by carotid-femoral Pulse Wave Velocity) and Quality of Life (using the Short Form-12 and a PTH specific symptom score). In the retrospective DXA cohort, moderate CKD (eGFR 30-59ml/min/1.73m2) and hyponatremia (<135mmol/L) were associated with fracture occurrence, independently of BMD, with an adjusted Odds Ratio (95% Confidence Interval), of 1.37 (1.0, 1.89) and 2.25 (1.24, 4.09) respectively. In the renal transplant study, PTH was independently associated with the presence of osteoporosis, adjusted Odds Ratio (95% Confidence Interval), 1.15 (per 10ng/ml increment), (1.04, 1.26). The presence of osteoporosis but not PTH was independently associated with measures of vascular calcification, adjusted ß (95% Confidence Interval), 12.45, (1.16, 23.75). Of the eight quality-of-life domains examined, post-transplant PTH (per 10ng/ml increment), was only significantly and independently associated with reduced Physical Functioning, (95% Confidence Interval), 1.12 (1.01, 1.23). CKD and hyponatremia are both common health problems that may contribute to fracture occurrence in the general population, a major on-going public health concern. PTH and decreased Bone Mineral Density may signal sub-optimal long-term outcomes post renal transplantation, influencing bone and vascular health and to a limited extent long term Health Related Quality of Life

Exploring the physicochemical basis of cheese texture, rheology and functionality, with emphasis on cation-casein interactions

The physicochemical properties of cheese and milk gels are greatly influenced by molecular interactions between the casein proteins involving calcium. Novel experiments were designed to investigate the relationship between insoluble caseinbound cations and rheological properties of Cheddar cheese and rennet-induced milk gels. Cheddar cheese and rennet-induced milk gels were supplemented with Mg2+ or Sr2+ to compare their effects on their rheological properties to those previously reported in literature for Ca2+ supplementation. Sr2+ displayed behaviour similar to Ca2+ as observed by its ability to increase the rigidity of cheese and rennet milk gels and also decrease cheese meltability. Mg+2 had no influence on cheese rheological properties and was greatly inferior to Ca2+ and Sr2+ in its ability to increase rennet milk gel elasticity. Cheddar cheese was supplemented with the calcium-chelating salts trisodium citrate, disodium hydrogen phosphate or disodium EDTA, in an attempt to reduce the CCP content of cheese and thereby modify its rheological and functional properties. TSC and EDTA were successful in decreasing cheese CCP, whereas DSP caused an initial increase in CCP content. Cheddar cheese was supplemented with chlorides of iron, copper and zinc at salting to investigate the effects of concentrations of these elements in excess of those found innately or commonly in fortification studies, with emphasis on mineral equilibria changes and resultant alteration of rheological properties. Zinc addition was the only added metal that significantly influenced cheese rheological properties, leading to an increase in cheese rigidity and decreased cheese melt at elevated temperatures. Gum tragacanth was used as a fat-replacer in the manufacture of reduced-fat Cheddar cheese, in an attempt to improve the rheological, functional and sensory properties of reduced-fat Cheddar. Overall, the experimental work reported in this thesis generated new knowledge and theories about how casein-mineral interactions influence rheological properties of casein systems.