Tuesday, November 30, 2010

Vitamin D Calcium FNB Report Ignores Science Not Dollars

Tags: Vitamin D Calcium FNB Report Ignores Science Not Dollars, Neglects Evidence, Obese Women, Heavy Sunscreen Use
I am glad such vitamin D pioneers such as Dr. John Cannell, M.D. has commented about the fraudulent advice given by experts picked by Big Pharma perhaps, who so dumb and stupid that they can't change their advice they gave 14 years ago.

Remember, just because it is on the front page of the New York Times does not mean that it is true. I am afraid many so-called smart readers will follow the so-called experts advice. It is certainly tragic that we no longer have honesty in the scientific community if big money is involved. Perhaps they are so ideological like Republicans, they can't see the truth or see the truth is not in their interest to believe.

Jim Kawakami, Nov 30, 2010, http://jimboguy.blogspot.com

... Finally, the FNB committee consulted with 14 vitamin D experts and – after reading these 14 different reports – the FNB decided to suppress their reports. Many of these 14 consultants are either famous vitamin D researchers, like Professor Robert Heaney at Creighton or, as in the case of Professor Walter Willett at Harvard, the single best-known nutritionist in the world. So, the FNB will not tell us what Professors Heaney and Willett thought of their new report? Why not? ...

Today, the FNB has failed millions...
3:00 PM PST November 30, 2010

After 13 year of silence, the quasi governmental agency, the Institute of Medicine's (IOM) Food and Nutrition Board (FNB), today recommended that a three-pound premature infant take virtually the same amount of vitamin D as a 300 pound pregnant woman.

While that 400 IU/day dose is close to adequate for infants, 600 IU/day in pregnant women will do nothing to help the three childhood epidemics most closely associated with gestational and early childhood vitamin D deficiencies: asthma, auto-immune disorders, and, as recently reported in the largest pediatric journal in the world, autism. Professor Bruce Hollis of the Medical University of South Carolina has shown pregnant and lactating women need at least 5,000 IU/day, not 600.

The FNB also reported that vitamin D toxicity might occur at an intake of 10,000 IU/day (250 micrograms/day), although they could produce no reproducible evidence that 10,000 IU/day has ever caused toxicity in humans and only one poorly conducted study indicating 20,000 IU/day may cause mild elevations in serum calcium, but not clinical toxicity.

Viewed with different measure, this FNB report recommends that an infant should take 10 micrograms/day (400 IU) and a pregnant woman 15 micrograms/day (600 IU). As a single, 30 minute dose of summer sunshine gives adults more than 10,000 IU (250 micrograms),
the FNB is apparently also warning that natural vitamin D input - as occurred from the sun before the widespread use of sunscreen - is dangerous. That is, the FNB is implying that God does not know what she is doing.

Disturbingly, this FNB committee focused on bone health, just like they did 14 years ago. They ignored the thousands of studies from the last ten years that showed higher doses of vitamin D helps: heart health, brain health, breast health, prostate health, pancreatic health, muscle health, nerve health, eye health, immune health, colon health, liver health, mood health, skin health, and especially fetal health.

Tens of millions of pregnant women and their breast-feeding infants are severely vitamin D deficient, resulting in a great increase in the medieval disease, rickets. The FNB report seems to reason that if so many pregnant women have low vitamin D blood levels then it must be OK because such low levels are so common. However, such circular logic simply represents the cave man existence (never exposed to the light of the sun) of most modern-day pregnant women.

Hence, i
f you want to optimize your vitamin D levels - not just optimize the bone effect - supplementing is crucial. But it is almost impossible to significantly raise your vitamin D levels when supplementing at only 600 IU/day (15 micrograms).

Pregnant women taking 400 IU/day have the same blood levels as pregnant women not taking vitamin D; that is, 400 IU is a meaninglessly small dose for pregnant women. Even taking 2,000 IU/day of vitamin D will only increase the vitamin D levels of most pregnant women by about 10 points, depending mainly on their weight.

Professor Bruce Hollis has shown that 2,000 IU/day does not raise vitamin D to healthy or natural levels in either pregnant or lactating women. Therefore supplementing with higher amounts - like 5000 IU/day - is crucial for those women who want their fetus to enjoy optimal vitamin D levels, and the future health benefits that go along with it.

For example, taking only two of the hundreds of recently published studies: Professor Urashima and colleagues in Japan, gave 1,200 IU/day of vitamin D3 for six months to Japanese 10-year-olds in a randomized controlled trial. They found vitamin D dramatically reduced the incidence of influenza A as well as the episodes of asthma attacks in the treated kids while the placebo group was not so fortunate.

If Dr. Urashima had followed the newest FNB recommendations, it is unlikely that 400 IU/day treatment arm would have done much of anything and some of the treated young teenagers may have come to serious harm without the vitamin D.

Likewise, a randomized controlled prevention trial of adults by Professor Joan Lappe and colleagues at Creighton University, which showed dramatic improvements in the health of internal organs, used more than twice the FNB's new adult recommendations.

Finally, the FNB committee consulted with 14 vitamin D experts and – after reading these 14 different reports – the FNB decided to suppress their reports. Many of these 14 consultants are either famous vitamin D researchers, like Professor Robert Heaney at Creighton or, as in the case of Professor Walter Willett at Harvard, the single best-known nutritionist in the world. So, the FNB will not tell us what Professors Heaney and Willett thought of their new report? Why not?

Today, the Vitamin D Council directed our attorney to file a federal Freedom of Information (FOI) request to the IOM's FNB for the release of these 14 reports.

Most of my friends, hundreds of patients, and thousands of readers of the Vitamin D Council newsletter (not to mention myself), have been taking 5,000 IU/day for up to eight years. Not only have they reported no significant side-effects, indeed, they have reported greatly improved health in multiple organ systems.

My advice, especially for pregnant women: continue taking 5,000 IU/day until your 25(OH)D is between 50-80 ng/mL (the vitamin D blood levels obtained by humans who live and work in the sun and the mid-point of the current reference ranges at all American laboratories).

Gestational vitamin D deficiency is not only associated with rickets, but a significantly increased risk of neonatal pneumonia, a doubled risk for preeclampsia, a tripled risk for gestational diabetes, and a quadrupled risk for primary cesarean section.

Today, the FNB has failed millions of pregnant women whose as yet unborn babies will pay the price. Let us hope the FNB will comply with the spirit of "transparency" by quickly responding to our Freedom of Information requests.

John Cannell, MD
The Vitamin D Council
1241 Johnson Avenue, #134

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Vitamin D Propaganda Official Said All Adults Get Enough Vitamin D Contrary View

Tags: Vitamin D for Health Expert Opinions Truth or Something Less Who Profits Are We Too Bush to Think

Re: Vitamin D Assessment Looks Like Big Pharma Propaganda: NYT Kolata Front Page Article, Nov 30, 2010



Big Pharma profits from both the use of sunscreens to cause osteoporosis and doctors benefit by treating skin diseases and other illnesses. They claim that only 20-30 nanograms/ml of non-activate 25-hydroxyvitamin D in blood is enough. Look at the above table in the article. Ten minutes in the sun produces 22,000 IU of vitamin D3 in the skin if you do not use sunscreen and have maximum exposure to 10:00 AM-2:00 PM sun depending on the Latitude you live at. I live far north in Oregon so I take 5,000 IU vitamin D3 which is perfect for me because it stopped my usually fatal autoimmune skin disease usually by infections of open sores.

For example, Clifford J. Rosen, one of the experts about vitamin D consulted in the study was involved in developing drugs to fix osteoporosis. Be aware of any study that slants the argument almost completely from one side. This article is as close to that that I can reject its main conclusions without knowing more, and I know a lot.

If it is so toxic, why do physicians including those from Harvard give 50,000 IU of vitamin D3 weekly for two to three months to bring up their patient’s vitamin D level. 40-75 nanograms/ml is the level you should achieve for optimum health.

If it is so toxic why do we make so much in such a short time. I concluded that vitamin D is for more than bones. In fact it is used by every cell in the body in the activated in the cell hormone to protect our immune system to fight cancer, colds, flu, and autoimmune diseases. Replacing bone is not as important because it is a slow process so we need vitamin D for other biological needs including saving our lives and making us healthier. It prevents the spread of cancer if used early enough.

I suspect that kidney dialysis patients may die from not getting enough vitamin D. They are told to use sunscreen all the time. My kidney doctor said he noticed no difference in cancer rates so that is one piece of information I stored in my brain. Since about two thirds get skin cancer, there must be another reason. Being indoors all the time and sunscreen use outside and not being able to have their kidneys produced activated vitamin D needed for bones presents a real problem. The front page story is bullshit. Looks like Big Pharma went shopping for doctors who would support the continued use of sunscreens all the time.

Its place on the front page instead of the science Tuesday section indicates to me that it is a propaganda piece by Big Pharma. Long studies have shown that about half of the 8 stories on the front page are propaganda.

Normally the so-called experts that no one has every heard about have ties to Big Pharma. They make sunscreens. Their comments are not lies, but they certainly do distort what recent epidemiological studies have shown. An expensive long-term direct study would take a long time and that means many more years of profits.

One mistake scientists or profiteers make is not to believe what is staring them right in front of their face. Can't believe reality without doing a long study. The Framingham heart study was epidemiological and proved extremely important. The key thing in these studies is to be able to determine the importance of other effects.

That is why I warmed my readers that these self-profit articles will come out soon. They always do. Profits are much more important than the health of the peasants. Meanwhile these experts will be taking up to 5,000 IU of vitamin D daily. It has happened in the past and will happen again and again.

My brain is extremely good in bringing disparate information to together which most scientists cannot do. These are the innovators and not the status quo scientists which there are many. Einstein's theoretical papers on relativity would have been rejected by most publications except the one run by Max Planck.

It seems that the old scientists who did not have publications and google to tell them how to think came up with many innovations and observations. Of course some like Copernicus was burned at the stake for saying that earth was not the center of the universe and revolved around the sun.

Get the test soon. When sunscreen was introduced, osteoporosis became the norm. Our mind causes the delusion of doing what is best for the people when the true benefit would be for oneself.

Of course if you read the article carefully and completely because they put the contrary opinions on the jump page do not ask the worldwide expert Dr. Holick from Boston University medical school what he thinks. His book The Vitamin C Solution is marvelous and very complete. He also answers typical questions that come up at the end of the book. Superb and well referenced books. Dr. Michael Holick, Ph.D., M.D., has published 300 papers on his vitamin d studies in peer reviewed journals and is widely respected by top scientists indicated by how many people he acknowledged helping him make his book even better.

You have an excellent mind. Whenever you read anything, always ask what benefit do the people making their "factual" statements profit themselves. It is now hard to turn on the news anymore because so much of it is propaganda. Propaganda works by giving you facts and leaving out contrary facts to make their conclusion. I remember one time the New York Times reported in 1998 that Clinton took out the inspection team because Saddam Hussein violated the weapons agreement. This was absolutely false. In 1995, Hussein's brother-in-law defected in Jordan and the CIA vetted him because he was in charge of the weapons of mass destruction. Hussein (first name) Kamal told the CIA with evidence that Saddam Hussein told him to destroy all the illegal missiles, nuclear, biological, and chemical weapons. This was hidden in the Periscope column in Newsweek with a deceptive title.

Eventually the UN inspection team found the destroyed nuclear bomb plant, destroyed missiles, and a vast store of biological and chemical weapons sent by the USA, Israel, Russians, and Germans stored in a huge underground cave. I saw the leaked video taken by the leader of the WMD group. His release may have ruined his future career. The army banned and confiscated the video from soldiers. I bought an early copy.

The murder that General Schwartzkopf might have committed was telling the troops to ignore the biological and chemical weapons detectors alarms and we can see from the video that many were wearing short sleeve shirts. Sarin nerve gas was one of the chemicals destroyed. That is why so many soldiers or at least 250,000 soldiers had to apply for disability or died most likely due to Sarin gas and Lyme disease and who knows what else. Even the Anthrax unapproved vaccine was given to all the soldiers and that made them sick too.

The team that destroyed the stuff disobeyed Schwartzkopf and wore protective gear and did not get sick being in approximately the same area as the other troops.

It is really scary how powerful and amoral the corporations have become. The Merck lawyer who were able to wear out the defendants by preventing a class action suit got a much smaller settlement than a jury would have provided. This lawyer will be the new CEO of Merck.

Jim Kawakami, Nov 30, 2010, http://jimboguy.blogspot.com

Vitamin D Propaganda Official Assessment Said All Adults Get Enough Vitamin D Gina Kolata, NY Times, Nov 29, 2010, http://www.nytimes.com/2010/11/30/health/30vitamin.html?_r=1&hpw The very high levels of vitamin D that are often recommended by doctors and testing laboratories — and can be achieved only by taking supplements — are unnecessary and could be harmful, an expert committee says. It also concludes that calcium supplements are not needed.

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The group said most people have adequate amounts of vitamin D in their blood supplied by their diets and natural sources like sunshine, the committee says in a report that is to be released on Tuesday.

“For most people, taking extra calcium and vitamin D supplements is not indicated,” said Dr. Clifford J. Rosen, a member of the panel and an osteoporosis expert at the Maine Medical Center Research Institute.

Dr. J. Christopher Gallagher, director of the bone metabolism unit at the Creighton University School of Medicine in Omaha, Neb., agreed, adding, “The onus is on the people who propose extra calcium and vitamin D to show it is safe before they push it on people.” ...

The 14-member expert committee was convened by the Institute of Medicine, an independent nonprofit scientific body, at the request of the United States and Canadian governments. It was asked to examine the available data — nearly 1,000 publications — to determine how much vitamin D and calcium people were getting, how much was needed for optimal health and how much was too much.

The two nutrients work together for bone health.

Bone health, though, is only one of the benefits that have been attributed to vitamin D, and there is not enough good evidence to support most other claims, the committee said.

Some labs have started reporting levels of less than 30 nanograms of vitamin D per milliliter of blood as a deficiency. With that as a standard, 80 percent of the population would be deemed deficient of vitamin D, Dr. Rosen said. Most people need to take supplements to reach levels above 30 nanograms per milliliter, he added.

But, the committee concluded, a level of 20 to 30 nanograms is all that is needed for bone health, and nearly everyone is in that range. ...

Monday, November 29, 2010

Media Heroes #1 and Salon’s Media Hacks Viewers Votes Maddow #1 Hero

Tags: The Nation and Salon Media Heroes and Hacks

You may note that Salon.com does not know how to spell the name of some liberals their readers called media hacks. Even though these polls are not necessarily universally accurate, they are fun to read, especially if you have your favorite heroes and hacks. Rachel Maddow picked #1 hero! Hacks include

Jim Kawakami, Nov 29, 2010, http://jimboguy.blogspot.com

Results of '30 Media Heroes' Voting Announced: Maddow Takes Top Spot!

Greg Mitchell

November 29, 2010

http://www.thenation.com/blog/156694/results-30-media-heroes-voting-announced-maddow-takes-top-spot We've been having fun since Wednesday with a response to Salon's popular "30 Biggest Media Hacks" list, sponsoring a readers' ballot to pick "30 Media Heroes." The response was overwhelming, with over 1,200 votes pouring in via Comments at the end of the original story, via e-mail to me directly and at Twitter (via @GregMitch). Votes obviously came from regular Nation readers, but also from many others.

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The Face of an American Lost Generation

About the Author


Greg Mitchell

Greg Mitchell writes the Media Fix blog for TheNation.com. A new edition of his book The Campaign of the Century: Upton...

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DAYBOOK for Monday: Special Edition—Live-blogging WikiLeaks, Day 2 (Media)

Greg Mitchell

pastedGraphic_1.pdf 7 comments

Blogging the WikiLeaks Release: Day 1

Greg Mitchell

pastedGraphic_2.pdf 10 comments

Related Topics

Amy Goodman Matt Taibbi Rachel Maddow

Now we're ready to announce the winners. But first a "trend" comment: Clearly, print got little respect in this vote, with a vast majority of top spots going to TV hosts, or very popular bloggers (who also appear on the tube a fair amount). Practically all of the MSNBC line-up, except Chris Matthews, made the Top 30 or Very Honorable Mention. Also: Jon Stewart rather comfortably topped stablemate Stephen Colbert.


Now, the drum roll please and.... congrats to Rachel Maddow, who rather easily earned the top spot in this balloting. She led from starting gate to the wire. In a close race, Amy Goodman beat out Glenn Greenwald and Matt Taibbi for the #2 slot. The venerable Bill Moyers finished fifth. Julian Assange made a late move to crack the top 30, although he also drew many critics.

See the full list below. The vote for those past the top 16 was extremely close, they could almost be placed in any order. What's most heartening: so many truly valuable people did not make the Top 30 or the Honorables list.

Also, I'd like to thank the fairly large number of people who voted for yours truly, but I decided to take myself out of the running, for obvious reasons. Feel free to erect an statue, if you'd like.

Here we go:

1. Rachel Maddow (MSNBC)

2. Amy Goodman (Democracy Now!)

3. Glenn Greenwald (Salon)

4. Matt Taibbi (Rolling Stone and more)

5. Bill Moyers (formerly PBS)

6. Jon Stewart (The Daily Show)

7. Keith Olbermann (MSNBC)

8. Jeremy Scahill (The Nation)

9. Paul Krugman (New York Times)

10. Stephen Colbert (Colbert Report)

11. Chris Hayes (The Nation, MSNBC)

12. Seymour Hersh (The New Yorker and more)

13. Chris Hedges (The Nation and more)

14. Arianna Huffington (Huffington Post)

15. Jane Hamsher (FireDogLake)

16. Cenk Uygur (The Young Turks)

17. Naomi Klein (The Nation)

18. Dylan Rattigan (MSNBC)

19. Bill Maher (HBO)

20. Frank Rich (New York Times)

21. David Sirota (syndicated columnist)

22. Thom Hartmann (radio)

23. Julian Assange (WikiLeaks)

24. Digby -- i.e. Heather Parton (blogger)

25. Greg Palast (writer)

26. Ed Schultz (MSNBC)

27. Laura Flanders (GRIT TV and more)

28. Allison Kilkenny-Jamie Kilstein (Citizen Radio team)

29. Sam Seder (Huffington Post and Majority Report)

30. Jim Hightower (The Nation and more)

Salon.com Top 30 Media Hacks: VERY HONORABLE MENTIONS: Markos Moulistas, Lawrence O'Donnell, Katrina vandenHeuvel, Eric Boehlert, Bob Herbert, Josh Marshall, Marcy Wheeler, Robert Scheer, Helen Thomas, Dean Baker, Yves Smith, Nick Kristof, Ezra Klein, Atrios, Mike Malloy, Max Blumenthal, Joe Conason. More: Robert Fisk, Melissa Harris-Perry, David Swanson, Nate Silver, Ali Abuniman, Gail Collins, Dave Wegiel, Eugene Robinson.

Greg Mitchell

You'll find some of your least favorites there, from Marty Peretz and Jonah Goldberg to, at the very top, Richard Cohen and Mark Halperin. The Washington Post grabs eight slots and the New York Times contributes David Brooks and even those alleged liberals Maureen Dowd and Thomas Friedman.

Anyway, for much-needed balance, and to remain positive (for a rare time?), allow me to propose that you, dear readers, vote for a 30 Biggest Heroes of the media, using the Comments section below, or e-mailing me at epic1934@aol.com, or filing via Twitter @GregMitch. Of course, you can and should include bloggers and social (network) misfits, plus TV hosts and satirists and pundits, and even print legends!

Raw Story Confirms Hersh’s Report WikiLeaks Israel and USA Regime Change

Tags: WikiLeaks Israel USA Regime Change Iran Propaganda Middle-East Policies Strategy Elections

Most of what is reported here has been widely suspected or reported. Unfortunately the action of Wiki Leaks will only make it even harder for all of us to determine the policies of our leaders regarding both domestic and foreign policies.

Based on comments about the closeness of Israel and the Bush administration led to comments such as Israel thinks they own the Pentagon. Israelis were not escorted during their visits often. The leading strategists at the Pentagon worked with the Israelis in their previous work to develop strategy.

With President Obama, the chumminess is now gone. The downfall of Hussein will have the unintended consequence of making Israel less critical for stability in the Middle-East. In my mind this has already started to happen with President Obama making more overtures to the Arab countries.

Our Iran policies are basically directed at helping the Arab oil states who fear Iran. Even though highly publicized almost absent danger of a nuclear Iran towards Israel, the real concern is likely Iran's increasing possible dominance of the Arab oil states. Already the Iran friendly Shiite control of Iraq which has oil reserves comparable to Saudi Arabia, and possibly much more. The need for Oil and Water will be the cause of wars in the next ten years or less.
Although not acknowledged in the press, our attack of Iraq even though all credible evidence indicated that Saddam Hussein was even thinking about attacking us, Israel wanted both the oil and water from Iraq. Deals have already been made with Jordan to allow pipelines through Jordan for water. Plans were also in place to reactivate the oil pipeline from Iraq to a port in Israel. No war is started unless there is an economic advantage of doing so, at least for the ones who will make billions of dollars such as our so-called defense and oil corporations.

Propaganda Controls the Way We Think: Starting in the 1920's the powerful corporations and our government saw the need to control information so Journalism Schools were started to wipe out the large amount of information and differing views which kept the public informed, but journalists or more likely, editors decided what should or should not be emphasized and reported. As FOX said, if we don't report it, it never happened. All news sources do select the news for us and almost always leave out information that may contradict the intention of the publishers and power brokers.

The major newspapers such as the New York Times, Wall Street Journal, and magazines such as Time magazine base their reporting on what they want us to think and normally leave out valid contrary points of view. Of course they keep us satiated from the editorials and the OpEd columns which have both conservative and more liberal points of view.

The true propaganda is in the news stories slant in the headlines and especially in the first six or so paragraphs on the front page. Many speed or skim read newspapers so most don't think very much and just absorb information to talk about with others to make conversation. Studies have shown that about half of the stories and headlines are propaganda pieces on the front page. The propaganda is directed at the elites since the lead up to World War I by the British and later the Wilson administration and top journalists. See www.prwatch.org , www.mediamatters.org .

Republicans do well in elections because they hire the best people who understand how to shape the mind of Americans and use it in campaign ads very effectively. Democrats are clueless and don't have enough money to hire the best or don't listen. Republicans repeat the same sentences many times so it imprints on the voters while Democrats often contradict each other. Independence is a steep price in elections.

Jim Kawakami, Nov 29, 2010, http://jimboguy.blogspot.com

Raw Story Confirms Seymour Hersh’s Report on WikiLeaks about Israel and USA Intentions of Regime Change in Iran Larisa Alexandrovna and Muriel Kane, The Raw Story, Monday, November 29th, 2010, http://www.rawstory.com/rs/2010/11/wikileaks-cable-reveals-israel-pushing-regime-change-iran/?utm_source=Raw+Story+Daily+Update&utm_campaign=03278b491d-Nov10Newsletter11_29_2010&utm_medium=email According to a diplomatic cable released by WikiLeaks, in August 2007 the head of Israel's intelligence agency urged US Under Secretary of State for Political Affairs, R. Nicholas Burns, to join with Israel in carrying out a five-part strategy to implement regime change in Iran.

Mossad Director Meir Dagan acknowledged at the meeting that the American analysis of Iran's alleged nuclear weapons program was different from Israel's, but he insisted that the threat from Iran was "obvious" and stated that Israel was willing to take action unilaterally.

The classified diplomatic cable outlining the meeting is part of a large cache of documents leaked to the whistleblower website Wikileaks, and released to the public on Sunday via several international newspapers, including The Guardian and The New York Times.

Dagan began the meeting by thanking the US for its support of Israel, as well as for a recent $30 billion aid package.

The Mossad chief then conceded that US analysis of Iran's alleged nuclear capabilities differed from Israel's, but remarked that such differences were essentially irrelevant and that if need be Israel would take action alone.

"The threat is obvious, even if we have a different timetable," he said. "If we want to postpone their acquisition of a nuclear capability, then we have to invest time and effort ourselves."

Philip Giraldi, a former counter-terrorism specialist and military intelligence officer and the Central Intelligence Agency, who served for eighteen years in Turkey, believes Dagan's comment that Israel will have to "invest time and effort ourselves” in dealing with Iran was, in essence, a veiled threat.

"It is essentially setting up a situation in which the threat of Israel acting alone becomes a wedge issue to force the US to do something so that it will be able to manage the situation rather than respond to Israeli initiatives," Giraldi told Raw Story on Sunday. "It pushes Washington into planning a military strike to force the Israelis to stand down on their own plans." ... http://www.rawstory.com/rs/2010/11/wikileaks-cable-reveals-israel-pushing-regime-change-iran/?utm_source=Raw+Story+Daily+Update&utm_campaign=03278b491d-Nov10Newsletter11_29_2010&utm_medium=email

Saturday, November 27, 2010

Dialysis Initiation Guide Creatinine Levels Inaccurate to Estimate GFR Kidneys

Tags: Improved GFR Test for Kidney Dialysis Initiation, Calculation with Creatinine Release Levels Inaccurate Both Creatinine and Urea Levels in Formula More Accurate

Can Plasma Creatinine Levels Guide Initiation of Dialysis?

Raymond T. Krediet; Friedo W. Dekker

Authors and Disclosures

Posted: 11/12/2010; Nat Rev Nephrol. 2010;6(10):563-564. © 2010 Nature Publishing Group


The results of a large observational study seem to confirm an association between early initiation of dialysis and increased mortality that is not fully explained by the presence of comorbidities and other confounding variables. However, this paradoxical association may be an artifact resulting from the inaccuracy of using plasma creatinine levels to estimate glomerular filtration rates in patients with severely impaired renal function.


During the past 8 years, a number of studies have explored whether a patient's estimated creatinine clearance or estimated glomerular filtration rate (eGFR) at the time of initiation of chronic dialysis treatment is associated with survival.[1–3]

In all of these studies, an increased eGFR at the start of dialysis was associated with increased mortality. The researchers tried to explain this unexpected finding by assuming that chronic dialysis was usually initiated at a higher glomerular filtration rate (GFR) in patients who had marked comorbidities as well as renal impairment than in patients who had chronic kidney failure alone, and that patients with chronic kidney failure alone were, furthermore, generally younger and healthier than those with comorbidities.

However, although adjustments for age and comorbidities attenuated the relationship between increased eGFR at dialysis initiation and increased mortality, they could not make it disappear.[1–3] An analysis of the French REIN registry data conducted in 2010 by Lassalle and colleagues[4] shows similar results with regard to both the presence of this association and its persistence despite adjustment for age and comorbidities. Lassalle et al. estimated the GFR of study participants at the start of dialysis using the Modification of Diet in Renal Disease (MDRD) equation. These researchers found that each 5 ml/min/1.73 m2 increment in eGFR at dialysis initiation was associated with a 40% increase in the unadjusted mortality risk over a median follow-up of 21.9 months. Although adjustments for a number of confounding variables, particularly age and comorbidities, substantially decreased the percentage increase in mortality risk associated with increased eGFR (to 8–20%, depending on the parameters used for the adjustment), the association remained statistically significant.

Undoubtedly, starting chronic dialysis treatment in patients who have a GFR of only a few milliliters per minute is associated with uremic complications and a high risk of mortality. Guidelines on when to start dialysis are not evidence-based, however, and in clinical practice other parameters as well as GFR are used to make this determination. These parameters include the severity of hypertension, control of fluid balance, nutritional status, and the presence of disorders of mineral metabolism.[5]

In 2001, Korevaar et al.[6] reported the results of a prospective cohort study in which participants' GFRs at the start of dialysis were not estimated but were measured as the mean of creatinine and urea clearance obtained from 24 h urine collections. After adjustment for age, sex, comorbidities and primary kidney disease, the researchers observed a mortality hazard ratio of 1.22 (P = 0.01) associated with each 1 ml/min decrement in GFR at dialysis initiation. This association resulted in a mean difference of 2.5 months in the estimated duration of survival after 3 years on dialysis in favor of prompt dialysis initiation compared with delayed initiation. However, the researchers stated that the improved survival found to be associated with prompt dialysis initiation might have been a result of lead-time bias rather than an improvement in the course of the disease; that is, that prompt starters had a shorter history of renal impairment than delayed starters.

Collecting urine over a 24 h period is difficult for many patients, especially women. Many formulas have, therefore, been developed to estimate creatinine clearance or GFR. These equations are based on plasma creatinine level and demographic parameters. The equations developed by Cockroft and Gault[7] to estimate creatinine clearance and by Levey et al.[8] to estimate GFR in the MDRD study are the most widely used.

Although both equations have been validated over a wide range of GFRs, they have never been validated in patients with very low (5–20 ml/min) GFRs. However, very little attention has been paid by the nephrology research community to the lack of validation of formulas used to estimate GFR.

Both the Cockcroft–Gault equation and the MDRD equation are vulgar fractions that have plasma creatinine level in their denominator. Thus, a low plasma creatinine level will lead to a high eGFR. The plasma concentration of creatinine is determined by the rate of release of creatinine from muscles and the rate of its removal by glomerular filtration and proximal tubular excretion.

In patients with severe renal failure, in whom the rate at which creatinine is removed is substantially decreased, the effect of muscle mass on plasma creatinine level is likely to be of increased importance. Patients with a low muscle mass, such as elderly patients with severe comorbidities and malnutrition, will release little creatinine from their muscles, which means that their plasma creatinine level will be lower (and consequently their eGFR will be higher) than that of well-nourished patients who have the same magnitude of renal impairment.

This phenomenon was first recognized by Beddhu et al.[10] in 2003, but their findings were largely ignored by the nephrology research community. Beddhu et al. found that the logarithm of plasma creatinine levels correlated positively with creatinine production, and that this association was independent of age, sex, ethnicity and plasma urea levels.

The final proof of the unreliability of eGFR estimated using serum creatinine level in individuals with very low (or indeed, very high) muscle mass would require a study investigating the relationship between eGFR and muscle mass.

The evidence so far indicates that neither plasma creatinine nor its reciprocal should be used to estimate GFR in patients at the start of dialysis, or to determine the level of kidney function at which dialysis should be started.

Instead, GFR should be determined by the measurement of creatinine and urea clearance rates in patients with severe renal failure, as was done by Korevaar and colleagues.[6] Alternatively, serum levels of another analyte that is removed from the body by glomerular filtration but is not dependent on muscle mass could be investigated. Serum cystatin C level is one such parameter.

Our research group showed that use of the serum concentration of this low-molecular-weight protein in patients on dialysis resulted in estimations of residual GFR that were more accurate and more precise than those calculated using the MDRD formula.[10] No investigations have been published, however, on whether a patient's serum cystatin C level at the start of dialysis is related to their duration of survival.

We conclude that estimations of GFR based on plasma creatinine level and demographic parameters should not be used either to determine the start of dialysis treatment or to predict outcomes in patients on dialysis.


Financials Wall Street 63 Percent GDP Controls White House, Congress, SEC, FBI?

Tags: Financial Devils Control Our Lives and Economy White House Congress SEC Greenspan Regulatory Agencies FBI CIA

Joe Nocera puts into a book what is already generally known. Wall Street controls all of our lives.

Jim Kawakami, Nov 27, 2010, http://jimboguy.blogspot.com

Joe Nocera on "All the Devils Are Here: The Hidden History of the Financial Crisis"

AMY GOODMAN: What about Obama’s record now? Where are we today?

JOE NOCERA: Ehhhhh…. ugh.

AMY GOODMAN: Any different than Bush?

JOE NOCERA: No, no, no. First of all, the creation the Consumer Protection Bureau is a big deal.

On the margins, these regulations will help, that came out of the Dodd-Frank Bill. The problem is, that if you compare it to what happened in the 1930s, in the 1930s, they forced the banks to split in two and they created the SEC. We had, pretty much fifty years of no crises before financial innovation started to poke holes in the regulations and eventually rendered them moot.

So, here we have a situation or no one is willing to take on Wall Street head-on and say, “We can’t allow certain practices to go on.” So, in fact, they’ve tried to do with these practices on the margin, but in general – $$$ …


http://www.democracynow.org/2010/11/23/joe_nocera_on_all_the_devils As federal agents raid the offices of three major hedge funds amidst news of a sweeping probe of insider trading at Wall Street firms, we speak with New York Times business columnist, Joe Nocera, about his new book, All the Devils Are Here: The Hidden History of the Financial Crisis. The book describes how most of the underlying structures and key players behind the financial crisis have emerged relatively unscathed. [includes rush transcript]

Joe Nocera, award-winning journalist and author. He’s a business columnist for the New York Times and a staff writer with the New York Times Magazine. He’s the co-author with Bethany McLean of All the Devils Are Here: The Hidden History of the Financial Crisis.

AMY GOODMAN: Federal agents have raided the offices of three major hedge funds amidst news of a sweeping probe of insider trading at Wall Street firms. On Monday, the FBI seized documents at the offices of Level Global investors, Diamondback Capital Management and Loch Capital Management in New York, Connecticut and Massachusetts. Collectively, the three firms manage nearly $10 billion in assets.

The raids come days after news broke out the federal authorities are conducting what could be the largest insider-trading investigation in U.S. history. According to The Wall Street Journal, federal prosecutors in New York, the FBI and Securities and Exchange Commission are probing a network of alleged insider trading rings involving some three dozen companies.

The probes could lead to charges against the Wall Street executives and traders but are unlikely to affect record payouts and soaring profits. According to the Journal, executive pay is set to break a record high for the second consecutive year. The top thirty-five financial firms are on pace to hand out $144 billion in compensation and benefits this year, a 4% increase from 2009.

Well, a new book has just been published that tries to explain the history of the financial crisis and how most of the underlying structures and key players behind it have emerged relatively unscathed. It’s called All the Devils Are Here: The Hidden History of the Financial Crisis.

I am joined now by one of the book’s two co-authors, Joe Nocera, a business columnist for The New York Times, a contributor to NPR’s "Weekend Edition," and former executive editor of Fortune magazine. He co-wrote the book with Vanity Fair contributing editor Bethany McLean. Joe Nocera joins us in the studio. The hidden history of the financial crises – in the moments we have, explain it, what caused it and how they’ve come out on this side, what most people don’t understand.

JOE NOCERA: Well, our key point is that it took a lot of disparate things to make this happen. If you had only Wall Street’s venality and greed, you would have had a problem, but not a crisis. If you only had the predatory lending practices of the subprime companies, you would have a problem but not a crisis. If you only had Washington’s – well, this kind of enabled everything – Washington’s deregulatory emphasis under both Democrats and Republicans, let’s be clear here, you would have had a problem. But when you combine the three of them and you watch them interact with each other.

You watch the way Wall Street gets the subprime people to make their loans worse and worse and worse and watch the way they take advantage of Wall Street to sell their loans upstream, and then you watch the way Wall Street takes advantage of investors to sell these crappy loans which are supposedly AAA and watch the government look the other way.

When you put it all together, you have a really toxic stew. So, I think most people have looked at this as the sins of Wall Street and it is absolutely the sins of Wall Street, but required awful lot more and almost a societal-wide delusion about home prices and value and what home ownership actually meant.

AMY GOODMAN: Who are the main culprits? Name them.

JOE NOCERA: Ok, in terms of institutions, we think the single worst culprits are the rating agencies because they really had to really consciously sell their soul and debase themselves, debase their integrity. They knew there were doing it, as they were doing it, in order to give all these securities AAA. The thing about it is, if you do not have a AAA rating, all of these large institutions are not allowed to buy your securities. You had to have a AAA for this to be a widespread product. So institutionally, we think it was the rating agencies. Personally, we think it’s Alan Greenspan.

AMY GOODMAN: Ok, go further into that.

JOE NOCERA: Sure. The Fed has two jobs, monetary policy and oversight over bank holding companies and other regulatory responsibilities. Alan Greenspan, as a devotee of Ayn Rand and as a libertarian goes into office saying, “I don’t believe in regulation,” and saying, “I’m going to turn my back on that part of my job and let others do it.” But he’s powerful and he is so influential that his deregulatory emphasis becomes everybody’s deregulatory emphasis.

When we get to the point in the mid-1990s when a very brave woman, named Brooks Lee Bourne, wants to of least look at the possibility of regulating derivatives, he leads the charge to beat her back and does so quite easily. (Larry Summers was deeply involved in taking down Lee Bourne. Jim)

AMY GOODMAN: Talk about Greenspan’s famous admission before Congress.

JOE NOCERA: Well, he really didn’t say, “I was wrong,” so as much as he said, “People won Nobel Prizes for this research (“conservative” Univ Chicago Economists) that led me to this belief system in the apparatus that was built up.” He – pressed by Henry Waxman, he apologized for what he had done – what had gone on in his watch. But actually, it was a halfhearted apology.

Quite recently, he’s taken to the convenient Republican line, which is to blame everything on Fannie and Freddie. As we point out in the book, Fannie and Freddie, guaranteed mortgages, which plays a hugely important role in home ownership in America and mortgages in America was, yes, they did a lot of dumb things, but the truth is, they did not lead the charge in the subprime, they followed into subprime. It’s basically a convenient excuse to blame it all on Fannie and Freddie. They did it because the Republicans are completely unwilling to say that the marketplace made mistakes too.

AMY GOODMAN: What about Obama’s record now? Where are we today?

JOE NOCERA: Ehhhhh…. ugh.

AMY GOODMAN: Any different than Bush?

JOE NOCERA: No, no, no. First of all, the creation the Consumer Protection Bureau is a big deal.

On the margins, these regulations will help, that came out of the Dodd-Frank Bill. The problem is, that if you compare it to what happened in the 1930s, in the 1930s, they forced the banks to split in two and they created the SEC. We had, pretty much fifty years of no crises before financial innovation started to poke holes in the regulations and eventually rendered them moot.

So, here we have a situation or no one is willing to take on Wall Street head-on and say, “We can’t allow certain practices to go on.” So, in fact, they’ve tried to do with these practices on the margin, but in general – $$$

AMY GOODMAN: And won’t it get worse with elections coming up? Won’t Democrats and the Republicans want the money from there big money interests?

JOE NOCERA: What’s really going to happen over the next two years with the Republicans now in charge of the House is that many of the regulations have not been written that will enforce this new law. In fact, the law itself is kind of a punt to the regulators. That’s where the battle line is and the Republicans are going to do their best to make sure these regulations are as minimal as possible and the Democrats are going to try and make them tougher.

AMY GOODMAN: What surprised you most in your research for this book?

JOE NOCERA: Here’s what surprised me most, the extent to which Wall Street was dictating to the subprime companies about their lending practices and the extent to which Wall Street knew exactly how bad these loans were and yet encouraged them to make worse and worse loans.

I’ll give you one example, we actually have an e-mail or a memo in the book where a Wall Street guy goes to visit one of the big subprime companies and he says, “You stopped lending – you won’t lend below a 620 FICO Score, you know that’s a credit score for a person who wants to buy a house – your competitor down the street, their lending at 580 FICO scores. We want you to drop your standards forty more points to be as bad as them.”

AMY GOODMAN: These federal agents who have raided the offices of three major hedge funds amidst the news of a sweeping probe of insider trading, how significant is this?

JOE NOCERA: It really looks like the biggie, the big enchilada. The problem with the FCC insider-trading cases over the past ten—

AMY GOODMAN: Goldman also looks like it is involved?

JOE NOCERA: Potentially. Although – they really, what the truth is, what they’re trying to get at is some of the really big hedge funds. They think that this is really widespread in the hedge fund community. If they go after Goldman, it would be probably, my guess would be, Goldman’s hedge funds. I don’t know that for a fact. There’s a lot of things we don’t know. But the FEC insider-trading stuff has been so on the margins for so long, going after small fry, who are meaningless small fry, at least they’re going after big targets now.

AMY GOODMAN: Finally, the title, "All the Devils Are Here". Are there any good guys?

JOE NOCERA: Yes. Not a lot, but there – one of the things we did was found a lot of people who were skeptical at the time. We found a lot of community activists, who in places like Cleveland, who were screaming to the federal government saying, “Stop this, stop this, stop this!”

We found a lot of state legislators that actually passed laws to try to get rid of some of the worst practices and the federal government basically came in and preempted those laws and that’s one of the real tragedies of this whole thing. People on the ground saw it happening and nobody in Washington would listen.

AMY GOODMAN: Joe Nocera, thanks so much for coming in. All the Devils Are Here: The Hidden History of the Financial Crisis is his book, wrote along with Bethany McLean.