801
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Mirna M, Topf A, Wernly B, Rezar R, Paar V, Jung C, Salmhofer H, Kopp K, Hoppe UC, Schulze PC, Kretzschmar D, Schneider MP, Schultheiss UT, Sommerer C, Paul K, Wolf G, Lichtenauer M, Busch M. Novel Biomarkers in Patients with Chronic Kidney Disease: An Analysis of Patients Enrolled in the GCKD-Study. J Clin Med 2020; 9:E886. [PMID: 32213894 PMCID: PMC7141541 DOI: 10.3390/jcm9030886] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Chronic kidney disease (CKD) and cardiovascular diseases (CVD) often occur concomitantly, and CKD is a major risk factor for cardiovascular mortality. Since some of the most commonly used biomarkers in CVD are permanently elevated in patients with CKD, novel biomarkers are warranted for clinical practice. Methods: Plasma concentrations of five cardiovascular biomarkers (soluble suppression of tumorigenicity (sST2), growth differentiation factor 15 (GDF-15), heart-type fatty acid-binding protein (H-FABP), insulin-like growth factor-binding protein 2 (IGF-BP2), and soluble urokinase plasminogen activator receptor) were analyzed by means of enzyme-linked immunosorbent assay (ELISA) in 219 patients with CKD enrolled in the German Chronic Kidney Disease (GCKD) study. Results: Except for sST2, all of the investigated biomarkers were significantly elevated in patients with CKD (2.0- to 4.4-fold increase in advanced CKD (estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m² body surface area (BSA)) and showed a significant inverse correlation with eGFR. Moreover, all but H-FABP and sST2 were additionally elevated in patients with micro- and macro-albuminuria. Conclusions: Based on our findings, sST2 appears to be the biomarker whose diagnostic performance is least affected by decreased renal function, thus suggesting potential viability in the management of patients with CVD and concomitant CKD. The predictive potential of sST2 remains to be proven in endpoint studies.
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Affiliation(s)
- Moritz Mirna
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - Albert Topf
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - Bernhard Wernly
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - Richard Rezar
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - Vera Paar
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany;
| | - Hermann Salmhofer
- Department of Internal Medicine I, Division of Nephrology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria;
| | - Kristen Kopp
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - Uta C. Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - P. Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Friedrich Schiller University Jena, 07743 Jena, Germany; (P.C.S.); (D.K.)
| | - Daniel Kretzschmar
- Department of Internal Medicine I, Division of Cardiology, Friedrich Schiller University Jena, 07743 Jena, Germany; (P.C.S.); (D.K.)
| | - Markus P. Schneider
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Ulla T. Schultheiss
- Department of Medicine IV – Nephrology and Primary Care, Institute of Genetic Epidemiology, Medical Center–University of Freiburg, Faculty of Medicine, 79106 Freiburg, Germany;
| | - Claudia Sommerer
- Department of Nephrology, University of Heidelberg, 69117 Heidelberg, Germany;
| | - Katharina Paul
- Department of Internal Medicine III, Friedrich Schiller University Jena, 07743 Jena, Germany; (K.P.); (G.W.); (M.B.)
| | - Gunter Wolf
- Department of Internal Medicine III, Friedrich Schiller University Jena, 07743 Jena, Germany; (K.P.); (G.W.); (M.B.)
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - Martin Busch
- Department of Internal Medicine III, Friedrich Schiller University Jena, 07743 Jena, Germany; (K.P.); (G.W.); (M.B.)
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802
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Sprague SM. Interventions for Preventing Bone Disease Following Kidney Transplantation: Is There Evidence for Specific Therapy? Am J Kidney Dis 2020; 75:809-811. [PMID: 32192784 DOI: 10.1053/j.ajkd.2019.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/21/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Stuart M Sprague
- Division of Nephrology and Hypertension, NorthShore University Health System, Evanston, IL; University of Chicago Pritzker School of Medicine, Evanston, IL.
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803
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Palmer SC, Strippoli GFM. Interventions for Preventing Bone Disease in Kidney Transplant Recipients: Editorial Summary of a Cochrane Review. Am J Kidney Dis 2020; 75:807-809. [PMID: 32192786 DOI: 10.1053/j.ajkd.2019.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/05/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Suetonia C Palmer
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Giovanni F M Strippoli
- Department of Emergency and Transplantation, University of Bari, Italy; Sydney School of Public Health, University of Sydney, Australia.
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804
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Cozzolino M, Ketteler M, Wagner CA. An expert update on novel therapeutic targets for hyperphosphatemia in chronic kidney disease: preclinical and clinical innovations. Expert Opin Ther Targets 2020; 24:477-488. [PMID: 32191548 DOI: 10.1080/14728222.2020.1743680] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: The management of hyperphosphatemia in patients with chronic kidney disease (CKD) is complicated, requiring a multidisciplinary approach that includes dietary phosphate restriction, dialysis, and phosphate binders.Areas covered: We describe key players involved in regulating inorganic phosphate homeostasis and their differential role in healthy people and different stages of CKD. The contribution of paracellular and transcellular intestinal absorptive mechanisms are also examined. Finally, we illuminate recent therapeutic approaches for hyperphosphatemia in CKD. We searched PubMed/Medline (up to November 2019) using the following terms: chronic kidney disease, dialysis, diet, hyperphosphatemia, NaPi2b, nicotinamide, phosphate binder, secondary hyperparathyroidism, tenapanor and vascular calcification.Expert opinion: The precise mechanisms regulating intestinal phosphate absorption in humans is not completely understood. However, it is now established that this process involves two independent pathways: a) active transport (i.e. transcellular route, via specific ion transporters) and inactive transport (i.e. paracellular route across tight junctions). Dietary phosphate restriction and phosphate-binder use can lead to an undesirable maladaptive increase in phosphate uptake and promote active phosphate transport by increased expression of the gastrointestinal sodium-dependent phosphate transporter, NaPi2b. Nicotinamide may overcome these limitations through the inhibition of NaPi2b, by improved efficacy and reduced phosphate binder use and better compliance.
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Affiliation(s)
- Mario Cozzolino
- Renal Division, ASST Santi Paolo E Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Markus Ketteler
- Department of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Carsten Alexander Wagner
- Institute of Physiology, University of Zurich, Zurich, Switzerland.,National Center of Competence in Research, NCCR Kidney. CH, Zurich, Switzerland
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805
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Hidden Hypocalcemia as a Risk Factor for Cardiovascular Events and All-Cause Mortality among Patients Undergoing Incident Hemodialysis. Sci Rep 2020; 10:4418. [PMID: 32157180 PMCID: PMC7064591 DOI: 10.1038/s41598-020-61459-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/26/2020] [Indexed: 12/16/2022] Open
Abstract
Lower corrected calcium (cCa) levels are associated with a better prognosis among incident dialysis patients. However, cCa frequently overestimates ionized calcium (iCa) levels. The prognostic importance of the true calcium status defined by iCa remains to be revealed. We conducted a retrospective cohort study of incident hemodialysis patients. We collected data of iCa levels immediately before the first dialysis. We divided patients into three categories: apparent hypocalcemia (low iCa; <1.15 mmol/L and low cCa; <8.4 mg/dL), hidden hypocalcemia (low iCa despite normal or high cCa), and normocalcemia (normal iCa). The primary outcome was the composite of all-cause death and cardiovascular diseases after hospital discharge. Among the enrolled 332 patients, 75% of the patients showed true hypocalcemia, defined as iCa <1.15 mmol/L, 61% of whom showed hidden hypocalcemia. In multivariate Cox models including other potential risk factors, true hypocalcemia was a significant risk factor (hazard ratio [HR], 2.34; 95% confidence interval [CI], 1.03–5.34), whereas hypocalcemia defined as corrected calcium <8.4 mg/dL was not. Furthermore, hidden hypocalcemia was significantly associated with an increased risk of the outcome compared with normocalcemia (HR, 2.56; 95% CI, 1.11–5.94), while apparent hypocalcemia was not. Patients with hidden hypocalcemia were less likely to receive interventions to correct hypocalcemia, such as increased doses of active vitamin D or administration of calcium carbonate, than patients with apparent hypocalcemia (odds ratio, 0.45; 95% CI, 0.23–0.89). Hidden hypocalcemia was a strong predictor of death and cardiovascular events, suggesting the importance of measuring iCa.
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806
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de Melo Marinho PÉ, da Rocha LG, de Araújo Filho JC, Sañudo B, Seixas A, de Andrade AD. Is whole body vibration an alternative physical training method for renal transplant recipients? PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1838. [PMID: 32124538 DOI: 10.1002/pri.1838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/23/2019] [Accepted: 02/08/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the effect of a 12-week whole-body vibration (WBV) training program on quadriceps muscle strength, quadriceps thickness, the 6-min walk test (6MWT), respiratory muscle strength and quality of life in adults with a kidney transplant. METHOD Five renal transplant recipients (age: 43-52 years; body mass: 67.1 kg; height: 1.60 m) were examined individually before and after a 12-week WBV program (two weekly sessions, 35 Hz frequency, 2-4 mm amplitude) using quadriceps strength, quadriceps thickness, 6-min walking test, inspiratory muscle strength and quality of life. RESULTS There were no complications during WBV protocol, and the program was considered safe. Two of the participants changed quadriceps muscle strength, and one increased muscle thickness. Inspiratory muscle strength improved in one participant. The distance covered on 6MWT increased for two participants. Most of the subjects (P3, P4 and P5) reported improved quality of life, mainly regarding pain and social aspects. CONCLUSION The protocol improved the physical function and quality of life in some of the patients. However, WBV training prescription should be adjusted according to individual needs. Thus, studying the use of WBV in this patient group is necessary to understand and apply the benefits for this population.
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Affiliation(s)
| | - Lívia Gomes da Rocha
- Post Graduate Program in Physical Therapy, Universidade Federal de Pernambuco, Recife, Brazil
| | | | - Borja Sañudo
- Department of Physical Education and Sport, University of Seville, Seville, Spain
| | - Adérito Seixas
- Escola Superior de Saúde, Universidade Fernando Pessoa, Porto, Portugal
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807
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Deng Y, Shu Y, Gong R. Calciphylaxis in patient with peritoneal dialysis: A case report. COGENT MEDICINE 2020. [DOI: 10.1080/2331205x.2020.1736250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Yunlei Deng
- Department of Nephrology, the Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, the Second Affiliated Chengdu Clinical College of Chongqing Medical University Chengdu China
| | - Ying Shu
- Department of Nephrology, the Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, the Second Affiliated Chengdu Clinical College of Chongqing Medical University Chengdu China
| | - Rong Gong
- Department of Nephrology, the Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, the Second Affiliated Chengdu Clinical College of Chongqing Medical University Chengdu China
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808
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Burrello J, Monticone S, Losano I, Cavaglià G, Buffolo F, Tetti M, Covella M, Rabbia F, Veglio F, Pasini B, Williams TA, Mulatero P. Prevalence of Hypokalemia and Primary Aldosteronism in 5100 Patients Referred to a Tertiary Hypertension Unit. Hypertension 2020; 75:1025-1033. [PMID: 32114853 DOI: 10.1161/hypertensionaha.119.14063] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Primary aldosteronism (PA) was considered a rare disorder almost always associated with hypokalemia. The widespread screening of patients with hypertension unveiled an increased prevalence of PA with normokalemic hypertension the prevailing phenotype. Many studies have reported the prevalence of hypokalemia in patients with PA; conversely, the prevalence of PA in patients with hypokalemia is unknown. In this retrospective observational study, we define the prevalence of hypokalemia in referred patients with hypertension and the prevalence of PA in patients with hypokalemia and hypertension. Hypokalemia was present in 15.8% of 5100 patients with hypertension, whereas 76.9% were normokalemic, and 7.3% hyperkalemic. The prevalence of PA in patients with hypokalemia was 28.1% and increased with decreasing potassium concentrations up to 88.5% of patients with spontaneous hypokalemia and potassium concentrations <2.5 mmol/L. A multivariate regression analysis demonstrated the association of hypokalemia with the occurrence of cardiovascular events independent of PA diagnosis. An association of PA with the occurrence of cardiovascular events and target organ damage independent of hypokalemia was also demonstrated. In conclusion, our results confirm that PA is a frequent cause of secondary hypertension in patients with hypokalemia, and the presence of hypertension and spontaneous hypokalemia are strong indications for PA diagnosis. Finally, we show that PA and hypokalemia are associated with an increased risk of cardiovascular events.
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Affiliation(s)
- Jacopo Burrello
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy
| | - Silvia Monticone
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy
| | - Isabel Losano
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy
| | - Giovanni Cavaglià
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy
| | - Fabrizio Buffolo
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy
| | - Martina Tetti
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy
| | - Michele Covella
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy
| | - Franco Rabbia
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy
| | - Franco Veglio
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy
| | - Barbara Pasini
- Medical Genetics Unit (B.P.), Department of Medical Sciences, University of Turin, Italy
| | - Tracy Ann Williams
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy.,Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Germany (T.A.W.)
| | - Paolo Mulatero
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy
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809
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Sola L, Levin NW, Johnson DW, Pecoits-Filho R, Aljubori HM, Chen Y, Claus S, Collins A, Cullis B, Feehally J, Harden PN, Hassan MH, Ibhais F, Kalantar-Zadeh K, Levin A, Saleh A, Schneditz D, Tchokhonelidze I, Turan Kazancioglu R, Twahir A, Walker R, Were AJ, Yu X, Finkelstein FO. Development of a framework for minimum and optimal safety and quality standards for hemodialysis and peritoneal dialysis. Kidney Int Suppl (2011) 2020; 10:e55-e62. [PMID: 32149009 PMCID: PMC7031684 DOI: 10.1016/j.kisu.2019.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/14/2019] [Accepted: 11/26/2019] [Indexed: 12/11/2022] Open
Abstract
Substantial heterogeneity in practice patterns around the world has resulted in wide variations in the quality and type of dialysis care delivered. This is particularly so in countries without universal standards of care and governmental (or other organizational) oversight. Most high-income countries have developed such oversight based on documentation of adherence to standardized, evidence-based guidelines. Many low- and lower-middle-income countries have no or only limited organized oversight systems to ensure that care is safe and effective. The implementation and oversight of basic standards of care requires sufficient infrastructure and appropriate workforce and financial resources to support the basic levels of care and safety practices. It is important to understand how these standards then can be reasonably adapted and applied in low- and lower-middle-income countries.
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Affiliation(s)
- Laura Sola
- Dialysis Unit, Centro Asistencial del Sindicato Médico del Uruguay Institución de Asistencia Médica Privada de Profesionales Sin Fines de lucro, Montevideo, Uruguay
| | - Nathan W. Levin
- Mount Sinai Icahn School of Medicine, New York, New York, USA
| | - David W. Johnson
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Roberto Pecoits-Filho
- School of Medicine, Pontificia Universidade Catolica do Paraná, Curitiba, Brazil
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Harith M. Aljubori
- Nephrology Department, Alqassimi Hospital, Sharjah, United Arab Emirates
| | - Yuqing Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Key Lab of Renal Disease, Ministry of Health of China, Beijing, China
- Key Lab of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Stefaan Claus
- Nephrology Division, Ghent University Hospital, Ghent, Belgium
| | - Allan Collins
- NxStage Medical, Inc., Lawrence, Massachusetts, USA
- Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Brett Cullis
- Renal Unit, Greys Hospital, Pietermaritzburg, South Africa
| | | | - Paul N. Harden
- Oxford Kidney Unit, Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK
| | - Mohamed H. Hassan
- Division of Nephrology, Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Fuad Ibhais
- Yatta Governmental Hospital, Yatta, Palestine
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California, USA
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Abdulkarim Saleh
- Department of Nephrology Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Daneil Schneditz
- Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Irma Tchokhonelidze
- Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia
| | | | - Ahmed Twahir
- Parklands Kidney Centre, Nairobi, Kenya
- Department of Medicine, The Aga Khan University Hospital, Nairobi, Kenya
| | - Robert Walker
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Anthony J.O. Were
- Renal Unit, Kenyatta National Hospital, Nairobi, Kenya
- School of Medicine, Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
- East African Kidney Institute, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Xueqing Yu
- Division of Nephrology, Guangdong Provincial People’s School of Medicine, South China University of Technology, Guangzhou, China
- Key Laboratory of Nephrology, Ministry of Health, Guangzhou, Guangdong, China
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810
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Hou J, Shan H, Zhang Y, Deng X, Guo B, Kang J, Wu B, Fan Y. Network meta-analysis of surgical treatment for secondary hyperparathyroidism. Am J Otolaryngol 2020; 41:102370. [PMID: 31889554 DOI: 10.1016/j.amjoto.2019.102370] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 12/02/2019] [Accepted: 12/06/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Main surgical treatments for secondary hyperparathyroidism (SHPT) include subtotal parathyroidectomy (sPTX), total parathyroidectomy with autotransplantation (tPTX+AT), and total parathyroidectomy (tPTX); however, determining the best treatment is debatable. We conducted a network meta-analysis (NMA) comparing three treatments in terms of postoperative hypocalcemia (or hypoparathyroidism), postoperative recurrence, and reoperation. METHODS We searched PubMed, Medline, the Cochrane Library, and Embase for relevant research from inception to July 30, 2019. We performed our Bayesian NMA using R 3.51 software to assess odds ratios (OR) and 95% confidence intervals (CI). Network and forest plots displayed study outputs. Potential publication bias was assessed with funnel plots using software Stata/MP 13.0. RESULTS Twenty-six articles comprising 5063 patients were included in our NMA, which showed that postoperative hypocalcemia (or hypoparathyroidism) occurred more frequently in tPTX than in sPTX (OR = 3.50, 95% CI 1.10-11.0) or tPTX+AT patients (OR = 1.80, 95% CI 0.66-5.20). Regarding postoperative hypocalcemia (or hypoparathyroidism), there was no significant difference between sPTX and tPTX+AT (OR = 0.53, 95% CI 0.24-1.10). As for recurrence rates, statistically significant differences were observed between sPTX and tPTX (OR = 25.0, 95% CI 5.1-260), tPTX+AT and tPTX (OR = 20.0, 95% CI 4.2-200), and sPTX and tPTX+AT (OR = 1.30, 95% CI 0.65-2.50). Regarding reoperation rates, sPTX experienced higher incidence compared with tPTX+AT (OR = 1.20, 95% CI 0.53-2.70) or tPTX patients (OR = 2.70, 95% CI 1.20-14.00). CONCLUSIONS TPTX+AT is recommended as the most efficient and safe surgical SHPT treatment with minimal adverse effects. Large-scale randomized controlled trials are recommended to confirm the NMA results.
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Affiliation(s)
- Jianzhong Hou
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Haojie Shan
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
| | - Yingchao Zhang
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Xianzhao Deng
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Bomin Guo
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Jie Kang
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Bo Wu
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
| | - Youben Fan
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
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811
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Kalantar-Zadeh K, Hollenbeak CS, Arguello R, Snyder S, Ashfaq A. The cost-effectiveness of extended-release calcifediol versus paricalcitol for the treatment of secondary hyperparathyroidism in stage 3-4 CKD. J Med Econ 2020; 23:308-315. [PMID: 31726882 DOI: 10.1080/13696998.2019.1693385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Aims: Patients with chronic kidney disease (CKD) not on dialysis frequently have vitamin D insufficiency (VDI) and secondary hyperparathyroidism (SHPT), which are associated with an increased risk of cardiovascular (CV) disease, fracture, CKD progression, and death. This study estimated the cost-effectiveness of extended-release calcifediol (ERC) vs paricalcitol for the treatment of patients with CKD stages 3-4 that have SHPT and VDI.Materials and methods: An economic analysis of SHPT treatments among a hypothetical cohort of 1,000 patients with CKD Stage 3 and 4 with SHPT and VDI was developed to estimate differences in the rates and costs of CV events, fractures, CKD stage progression, and mortality in patients treated with ERC and paricalcitol. A Markov model was developed with 1-year cycles and a 5-year time horizon from a US Medicare payer perspective with costs valued in 2017 US dollars.Results: The outcomes of the model were rates of clinical events, total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). Across a 1,000-person cohort, ERC was the dominant (less costly, more effective) treatment strategy when compared with paricalcitol. Treatment with ERC resulted in cost savings of $14.8 M (95% CI = -$10.0 M-$45.2 M) and an incremental gain of 340 QALYs (95% CI = 200-496) compared to treatment with paricalcitol.Limitations: Bridging biochemical levels to clinical outcomes may not represent real-world risk of the clinical events modeled. Future real-world outcomes of patients treated with ERC and paricalcitol may be used to evaluate the model results.Conclusions: This model demonstrated favorable short- and long-term clinical benefits associated with the use of ERC in patients with CKD Stage 3 and 4 with SHPT and VDI, suggesting ERC may be cost-effective from the Medicare perspective compared to paricalcitol.
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Affiliation(s)
- Kamyar Kalantar-Zadeh
- Division of Nephrology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Christopher S Hollenbeak
- Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Roy Arguello
- Health Economics and Outcomes Research, BluePath Solutions, Los Angeles, CA, USA
| | - Sophie Snyder
- Health Economics and Outcomes Research, BluePath Solutions, Los Angeles, CA, USA
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812
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Silva AP, Viegas CS, Mendes F, Macedo A, Guilherme P, Tavares N, Dias C, Rato F, Santos N, Faísca M, de Almeida E, Neves PL, Simes DC. Gla-Rich Protein (GRP) as an Early and Novel Marker of Vascular Calcification and Kidney Dysfunction in Diabetic Patients with CKD: A Pilot Cross-Sectional Study. J Clin Med 2020; 9:jcm9030635. [PMID: 32120910 PMCID: PMC7141108 DOI: 10.3390/jcm9030635] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 12/18/2022] Open
Abstract
Vascular calcification (VC) is one of the strongest predictors of cardiovascular risk in chronic kidney disease (CKD) patients. New diagnostic/prognostic tools are required for early detection of VC allowing interventional strategies. Gla-rich protein (GRP) is a cardiovascular calcification inhibitor, whose clinical utility is here highlighted. The present study explores, for the first time, correlations between levels of GRP in serum with CKD developmental stage, mineral metabolism markers, VC and pulse pressure (PP), in a cohort of 80 diabetic patients with mild to moderate CKD (stages 2–4). Spearman’s correlation analysis revealed a positive association of GRP serum levels with estimated glomerular filtration rate (eGFR) and α-Klotho, while a negative correlation with phosphate (P), fibroblast growth factor 23 (FGF-23), vascular calcification score (VCS), PP, calcium (x) phosphate (CaxP) and interleukin 6 (IL-6). Serum GRP levels were found to progressively decrease from stage 2 to stage 4 CKD. Multivariate analysis identified low levels of eGFR and GRP, and high levels of FGF-23 associated with both the VCS and PP. These results indicate an association between GRP, renal dysfunction and CKD-mineral and bone disorder. The relationship between low levels of GRP and vascular calcifications suggests a future, potential utility for GRP as an early marker of vascular damage in CKD.
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Affiliation(s)
- Ana P. Silva
- Department of Nephrology, Centro Hospitalar Universitário do Algarve, 8000-386 Faro, Portugal; (A.P.S.); (F.M.); (P.L.N.)
- Department of Biomedical Sciences and Medicine, Universidade do Algarve, 8005-139 Faro, Portugal; (A.M.); (C.D.)
| | - Carla S.B. Viegas
- Centre of Marine Sciences (CCMAR), Universidade do Algarve, 8005-139 Faro, Portugal;
- GenoGla Diagnostics, Centre of Marine Sciences (CCMAR), Universidade do Algarve, 8005-139 Faro, Portugal
| | - Filipa Mendes
- Department of Nephrology, Centro Hospitalar Universitário do Algarve, 8000-386 Faro, Portugal; (A.P.S.); (F.M.); (P.L.N.)
| | - Ana Macedo
- Department of Biomedical Sciences and Medicine, Universidade do Algarve, 8005-139 Faro, Portugal; (A.M.); (C.D.)
- Keypoint Group, 1495-190 Miraflores, Portugal
| | - Patrícia Guilherme
- Department of Cardiology, Centro Hospitalar Universitário do Algarve, 8000-386 Faro, Portugal; (P.G.); (N.T.)
| | - Nelson Tavares
- Department of Cardiology, Centro Hospitalar Universitário do Algarve, 8000-386 Faro, Portugal; (P.G.); (N.T.)
| | - Carolina Dias
- Department of Biomedical Sciences and Medicine, Universidade do Algarve, 8005-139 Faro, Portugal; (A.M.); (C.D.)
- Centre of Marine Sciences (CCMAR), Universidade do Algarve, 8005-139 Faro, Portugal;
| | - Fátima Rato
- Pathology Clinic, Centro Hospitalar Universitário do Algarve, 8000-386 Faro, Portugal; (F.R.); (N.S.); (M.F.)
| | - Nélio Santos
- Pathology Clinic, Centro Hospitalar Universitário do Algarve, 8000-386 Faro, Portugal; (F.R.); (N.S.); (M.F.)
| | - Marília Faísca
- Pathology Clinic, Centro Hospitalar Universitário do Algarve, 8000-386 Faro, Portugal; (F.R.); (N.S.); (M.F.)
| | - Edgar de Almeida
- Faculdade de Medicina da Universidade de Lisboa, 1600-190 Lisboa, Portugal;
| | - Pedro L. Neves
- Department of Nephrology, Centro Hospitalar Universitário do Algarve, 8000-386 Faro, Portugal; (A.P.S.); (F.M.); (P.L.N.)
- Department of Biomedical Sciences and Medicine, Universidade do Algarve, 8005-139 Faro, Portugal; (A.M.); (C.D.)
| | - Dina C. Simes
- Centre of Marine Sciences (CCMAR), Universidade do Algarve, 8005-139 Faro, Portugal;
- GenoGla Diagnostics, Centre of Marine Sciences (CCMAR), Universidade do Algarve, 8005-139 Faro, Portugal
- Correspondence: ; Tel.: +351-289-800-100; Fax: +351-289-800-069
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813
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Choe AR, Ryu DR, Kim HY, Lee HA, Lim J, Kim JS, Lee JK, Kim TH, Yoo K. Noninvasive indices for predicting nonalcoholic fatty liver disease in patients with chronic kidney disease. BMC Nephrol 2020; 21:50. [PMID: 32066395 PMCID: PMC7027038 DOI: 10.1186/s12882-020-01718-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/10/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Data on clinical characteristics of nonalcoholic fatty liver disease (NAFLD) in patients with chronic kidney disease (CKD) are scarce. We investigated the clinical features and risk factors of NAFLD using noninvasive serum markers in CKD patients and attempted the temporal validation of a predictive model for CKD based on NAFLD. METHODS This retrospective cross-sectional study was conducted in a single tertiary center. We enrolled 819 CKD patients and evaluated the predictive performance of relevant clinical and laboratory markers for the presence of NAFLD in both derivation (data from 2011 to 2014, n = 567) and validation (data from 2015 to 2016, n = 252) groups. RESULTS In the derivation group, NAFLD was observed in 89 patients (15.7%; mean body mass index (BMI), 24.6 kg/m2; median estimated glomerular filtration rate (eGFR), 28.0 ml/min). BMI, hemoglobin, serum alanine aminotransferase, eGFR, and triglyceride-glucose index were used to derive a prediction model for the presence of NAFLD. Using the cutoff value of 0.146, the area under the receiver operating characteristic curve (AUROC) for the prediction of NAFLD was 0.850. In the validation group, NAFLD was observed in 51 patients (20.2%; mean BMI, 25.4 kg/m2; median eGFR, 36.0 ml/min). Using the same prediction model and cutoff value, the AUROC was 0.842. NAFLD prevalence in CKD patients was comparable to that in the general population, increasing over time. CONCLUSIONS Our model using BMI, renal function, triglyceride-glucose index, serum alanine aminotransferase, and hemoglobin accurately predicted the presence of NAFLD in CKD patients.
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Affiliation(s)
- A Reum Choe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Dong-Ryeol Ryu
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Hwi Young Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
| | - Hye Ah Lee
- Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Jiyoung Lim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jin Sil Kim
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jeong Kyong Lee
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Tae Hun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Kwon Yoo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
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814
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Piccoli GB, Trabace T, Chatrenet A, Carranza de La Torre CA, Gendrot L, Nielsen L, Fois A, Santagati G, Saulnier P, Panocchia N. New Intravenous Calcimimetic Agents: New Options, New Problems. An Example on How Clinical, Economical and Ethical Considerations Affect Choice of Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1238. [PMID: 32075103 PMCID: PMC7068561 DOI: 10.3390/ijerph17041238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/10/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Dialysis treatment is improving, but several long-term problems remain unsolved, including metabolic bone disease linked to chronic kidney disease (CKD-MBD). The availability of new, efficacious but expensive drugs (intravenous calcimimetic agents) poses ethical problems, especially in the setting of budget limitations. METHODS Reasons of choice, side effects, biochemical trends were discussed in a cohort of 15 patients (13% of the dialysis population) who stared treatment with intravenous calcimimetics in a single center. All patients had previously been treated with oral calcimimetic agents; dialysis efficacy was at target in 14/15; hemodiafiltration was employed in 10/15. Median Charlson Comorbidity Index was 8. The indications were discussed according to the principlist ethics (beneficience, non maleficience, justice and autonomy). Biochemical results were analyzed to support the clinical-ethical choices. RESULTS In the context of a strict clinical and biochemical surveillance, the lack of side effects ensured "non-maleficence"; efficacy was at least similar to oral calcimimetic agents, but tolerance was better. Autonomy was respected through a shared decision-making model; all patients appreciated the reduction of the drug burden, and most acknowledged better control of their biochemical data. The ethical conflict resides in the balance between the clinical "beneficience, non-maleficience" advantage and "justice" (economic impact of treatment, potentially in attrition with other resources, since the drug is expensive and included in the dialysis bundle). The dilemma is more relevant when a patient's life expectancy is short (economic impact without clear clinical advantages), or when non-compliance is an issue (unclear advantage if the whole treatment is not correctly taken). CONCLUSIONS In a context of person-centered medicine, autonomy, beneficence and non-maleficence should weight more than economic justice. While ethical discussions are not aimed at finding "the right answer" but asking "the right questions", this example can raise awareness of the importance of including an ethical analysis in the choice of "economically relevant" drugs.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences, University of Torino, 10124 Torino, Italy
- Nephrologie, Centre Hospitalier Le Mans, 72037 Le Mans, France; (T.T.); (A.C.); (C.A.C.d.L.T.); (L.G.); (L.N.); (A.F.); (G.S.)
| | - Tiziana Trabace
- Nephrologie, Centre Hospitalier Le Mans, 72037 Le Mans, France; (T.T.); (A.C.); (C.A.C.d.L.T.); (L.G.); (L.N.); (A.F.); (G.S.)
| | - Antoine Chatrenet
- Nephrologie, Centre Hospitalier Le Mans, 72037 Le Mans, France; (T.T.); (A.C.); (C.A.C.d.L.T.); (L.G.); (L.N.); (A.F.); (G.S.)
| | | | - Lurlinys Gendrot
- Nephrologie, Centre Hospitalier Le Mans, 72037 Le Mans, France; (T.T.); (A.C.); (C.A.C.d.L.T.); (L.G.); (L.N.); (A.F.); (G.S.)
| | - Louise Nielsen
- Nephrologie, Centre Hospitalier Le Mans, 72037 Le Mans, France; (T.T.); (A.C.); (C.A.C.d.L.T.); (L.G.); (L.N.); (A.F.); (G.S.)
| | - Antioco Fois
- Nephrologie, Centre Hospitalier Le Mans, 72037 Le Mans, France; (T.T.); (A.C.); (C.A.C.d.L.T.); (L.G.); (L.N.); (A.F.); (G.S.)
| | - Giulia Santagati
- Nephrologie, Centre Hospitalier Le Mans, 72037 Le Mans, France; (T.T.); (A.C.); (C.A.C.d.L.T.); (L.G.); (L.N.); (A.F.); (G.S.)
| | - Patrick Saulnier
- Statistical laboratory, University of Angers, 49035 Angers, France;
| | - Nicola Panocchia
- Nephrology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy;
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815
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Cherfan M, Vallée A, Kab S, Salameh P, Goldberg M, Zins M, Blacher J. Unhealthy behaviors and risk of uncontrolled hypertension among treated individuals-The CONSTANCES population-based study. Sci Rep 2020; 10:1925. [PMID: 32024888 PMCID: PMC7002708 DOI: 10.1038/s41598-020-58685-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 12/19/2019] [Indexed: 11/09/2022] Open
Abstract
From an epidemiological standpoint, quantifying the individual and the combined effect of lifestyle factors on uncontrolled blood pressure (BP) deserves further evaluation. We aimed to examine the individual and combined associations between unhealthy behaviors and uncontrolled hypertension among treated hypertensive adults. Cross-sectional analysis was conducted using data from CONSTANCES, an ongoing French population-based cohort study. Uncontrolled BP was defined as mean systolic BP ≥140 mmHg and/or mean diastolic BP ≥90 mmHg. Unhealthy behaviors were considered as heavy alcohol consumption, low or medium adherence to dietary recommendations, sedentary physical activity level, and overweight. A total of 10,710 hypertensive treated volunteer participants were included and 56.1% had uncontrolled hypertension; of them, 2.0%, 24.5%, 54.0% and 19.5% exhibited 0, 1, 2 or ≥3 unhealthy behaviors respectively. In men, there was an increased odds of uncontrolled hypertension with heavy alcohol drinking compared to light-or-never (adjusted odds ratio 1.34, 95% CI 1.10-1.63), with low as well as with medium adherence to dietary recommendations compared to high (p < 0.05 for both), and with overweight or obesity compared to a normal body mass index (p ≤ 0.001 for both). In addition, men reporting a combination of ≥3 unhealthy behaviors compared to none, had an increased odds of hypertension of 1.67 (95% CI 1.09-2.53). Unhealthy behaviors described as, heavy alcohol consumption, non-adherence to dietary recommendations and overweight are associated with uncontrolled hypertension, at the individual and combined level, and particularly in men. Improvement of modifiable lifestyle factors could offer considerable benefits in the management of hypertension.
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Affiliation(s)
- Michelle Cherfan
- Nutritional Epidemiology Research Unit (EREN), Inserm U1153, Inra U1125, Cnam, Crnh, Paris 13 University Sorbonne Paris Cite, Bobigny, France
- Faculty of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Alexandre Vallée
- Faculty of Medicine, Paris-Descartes University, Paris, France
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital; AP-HP, Paris, France
| | - Sofiane Kab
- Population-based Epidemiological Cohorts Unit, Inserm, UMS011, Villejuif, France
| | - Pascale Salameh
- Faculty of Public Health, Lebanese University, Fanar, Lebanon
- Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie (INSPECT-LB), Beirut, Lebanon
| | - Marcel Goldberg
- Faculty of Medicine, Paris-Descartes University, Paris, France
- Population-based Epidemiological Cohorts Unit, Inserm, UMS011, Villejuif, France
| | - Marie Zins
- Faculty of Medicine, Paris-Descartes University, Paris, France
- Population-based Epidemiological Cohorts Unit, Inserm, UMS011, Villejuif, France
| | - Jacques Blacher
- Nutritional Epidemiology Research Unit (EREN), Inserm U1153, Inra U1125, Cnam, Crnh, Paris 13 University Sorbonne Paris Cite, Bobigny, France.
- Faculty of Medicine, Paris-Descartes University, Paris, France.
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital; AP-HP, Paris, France.
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816
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Brunerová L, Kasalický P, Verešová J, Lažanská R, Potočková J, Rychlík I. Loss of bone mineral density and trabecular bone score in elderly hemodialysis patients: a 2-year follow-up, prospective, single-centre study. Int Urol Nephrol 2020; 52:379-385. [PMID: 32016906 DOI: 10.1007/s11255-020-02378-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Low bone mineral density (BMD) and trabecular bone score (TBS) are established risk factors for fractures even in hemodialysis population and they seem to be significantly lower in comparison with general population. The aim of our study was to describe 2-year loss of BMD and TBS and their predictors in hemodialysis patients. METHODS From 59 non-selected patients (mean age 67.6 ± 13.1 years) from one dialysis centre, treated with hemodiafiltration (HDF), clinical and laboratory characteristics were obtained and densitometry examinations (with BMD and TBS results) were performed initially and at the end of 2-year follow-up. RESULTS Two-year decrease in BMD of lumbar spine reached 4.1% (ns), of proximal femur 9.1% (p = 0.004), and of femoral neck 1.3% (ns). In the co-educated cohort, BMD decrease in all the sites correlated significantly with age and only the change of BMD of lumbar spine was negatively associated with serum calcium (r = - 0.39; p = 0.04) and dialysis vintage (r = - 0.387; p = 0.062), no other predictors of BMD loss were identified. Some predictors of BMD loss were identified with regard to gender. TBS decrease was 0.05 (3.9%; p = 0.03), and similarly, it was not predicted by any of selected parameters. No differences in BMD changes or TBS were observed between the patients with and without fractures. CONCLUSIONS In patients with HDF, significant BMD and TBS annual losses were observed, and they were associated only with age and (in BMD of lumbar spine) with serum calcium and dialysis vintage.
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Affiliation(s)
- Ludmila Brunerová
- 2nd Department of Medicine, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | | | - Jana Verešová
- Dialysis Centre, Fresenius Medical Care, Prague-Vinohrady, Czech Republic
| | - Renata Lažanská
- Dialysis Centre, Fresenius Medical Care, Prague-Vinohrady, Czech Republic
| | - Jana Potočková
- 2nd Department of Medicine, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ivan Rychlík
- 1st Department of Medicine, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Šrobárova 50, 100 34, Prague 10, Czech Republic
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817
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Kim JY, Steingroever J, Lee KH, Oh J, Choi MJ, Lee J, Larkins NG, Schaefer F, Hong SH, Jeong GH, Shin JI, Kronbichler A. Clinical Interventions and All-Cause Mortality of Patients with Chronic Kidney Disease: An Umbrella Systematic Review of Meta-Analyses. J Clin Med 2020; 9:E394. [PMID: 32024136 PMCID: PMC7074128 DOI: 10.3390/jcm9020394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/12/2020] [Accepted: 01/27/2020] [Indexed: 02/07/2023] Open
Abstract
Patients with chronic kidney disease (CKD) have altered physiologic processes, which result in different treatment outcomes compared with the general population. We aimed to systematically evaluate the efficacy of clinical interventions in reducing mortality of patients with CKD. We searched PubMed, MEDLINE, Embase, and Cochrane Database of Systematic Reviews for meta-analyses of randomized controlled trials (RCT) or observational studies (OS) studying the effect of treatment on all-cause mortality of patients with CKD. The credibility assessment was based on the random-effects summary estimate, heterogeneity, 95% prediction intervals, small study effects, excess significance, and credibility ceilings. Ninety-two articles yielded 130 unique meta-analyses. Convincing evidence from OSs supported mortality reduction with three treatments: angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers for patients not undergoing dialysis, warfarin for patients with atrial fibrillation not undergoing dialysis, and (at short-term) percutaneous coronary intervention compared to coronary artery bypass grafting for dialysis patients. Two treatment comparisons were supported by highly credible evidence from RCTs in terms of all-cause mortality. These were high-flux hemodialysis (HD) versus low-flux HD as a maintenance HD method and statin versus less statin or placebo for patients not undergoing dialysis. Most significant associations identified in OSs failed to be replicated in RCTs. Associations of high credibility from RCTs were in line with current guidelines. Given the heterogeneity of CKD, it seems hard to assume mortality reductions based on findings from OSs.
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Affiliation(s)
- Jong Yeob Kim
- Yonsei University College of Medicine, Seoul 03722, Korea; (J.Y.K.); (M.J.C.)
| | - Johanna Steingroever
- Department of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany; (J.S.); (J.O.)
| | - Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul 03722, Korea;
- Division of Pediatric Nephrology, Severance Children’s Hospital, Seoul 03722, Korea
| | - Jun Oh
- Department of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany; (J.S.); (J.O.)
| | - Min Jae Choi
- Yonsei University College of Medicine, Seoul 03722, Korea; (J.Y.K.); (M.J.C.)
| | - Jiwon Lee
- Department of Pediatric Nephrology, Chungnam National University Hospital, Daejeon 35015, Korea;
| | - Nicholas G. Larkins
- Department of Nephrology, Perth Children’s Hospital, 15 Hospital Ave, Nedlands, WA 6909, Australia;
- Centre for Kidney Research, Kids Research Institute, Westmead, NSW 2031, Australia
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany;
| | - Sung Hwi Hong
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA;
| | - Gwang Hun Jeong
- College of Medicine, Gyeongsang National University, Jinju 52727, Korea;
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul 03722, Korea;
- Division of Pediatric Nephrology, Severance Children’s Hospital, Seoul 03722, Korea
| | - Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria;
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818
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Isakova T, Cai X, Lee J, Mehta R, Zhang X, Yang W, Nessel L, Anderson AH, Lo J, Porter A, Nunes JW, Negrea L, Hamm L, Horwitz E, Chen J, Scialla JJ, de Boer IH, Leonard MB, Feldman HI, Wolf M. Longitudinal Evolution of Markers of Mineral Metabolism in Patients With CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2020; 75:235-244. [PMID: 31668375 PMCID: PMC7012684 DOI: 10.1053/j.ajkd.2019.07.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/29/2019] [Indexed: 12/15/2022]
Abstract
RATIONALE & OBJECTIVE The pathogenesis of disordered mineral metabolism in chronic kidney disease (CKD) is largely informed by cross-sectional studies of humans and longitudinal animal studies. We sought to characterize the longitudinal evolution of disordered mineral metabolism during the course of CKD. STUDY DESIGN Retrospective analysis nested in a cohort study. SETTING & PARTICIPANTS Participants in the Chronic Renal Insufficiency Cohort (CRIC) Study who had up to 5 serial annual measurements of estimated glomerular filtration rate, fibroblast growth factor 23 (FGF-23), parathyroid hormone (PTH), serum phosphate, and serum calcium and who subsequently reached end-stage kidney disease (ESKD) during follow-up (n = 847). EXPOSURE Years before ESKD. OUTCOMES Serial FGF-23, PTH, serum phosphate, and serum calcium levels. ANALYTICAL APPROACH To assess longitudinal dynamics of disordered mineral metabolism in human CKD, we used "ESKD-anchored longitudinal analyses" to express time as years before ESKD, enabling assessments of mineral metabolites spanning 8 years of CKD progression before ESKD. RESULTS Mean FGF-23 levels increased markedly as time before ESKD decreased, while PTH and phosphate levels increased modestly and calcium levels declined minimally. Compared with other mineral metabolites, FGF-23 levels demonstrated the highest rate of change (velocity: first derivative of the function of concentration over time) and magnitude of acceleration (second derivative). These changes became evident approximately 5 years before ESKD and persisted without deceleration through ESKD onset. Rates of changes in PTH and phosphate levels increased modestly and without marked acceleration around the same time, with modest deceleration immediately before ESKD, when use of active vitamin D and phosphate binders increased. LIMITATIONS Individuals who entered the CRIC Study at early stages of CKD and who did not progress to ESKD were not studied. CONCLUSIONS Among patients with progressive CKD, FGF-23 levels begin to increase 5 years before ESKD and continue to rapidly accelerate until transition to ESKD.
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Affiliation(s)
- Tamara Isakova
- Division of Nephrology and Hypertension, Department of Medicine, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Xuan Cai
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jungwha Lee
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Rupal Mehta
- Division of Nephrology and Hypertension, Department of Medicine, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL; Jesse Brown Veterans Administration Medical Center, Chicago, IL
| | - Xiaoming Zhang
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Wei Yang
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Lisa Nessel
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Amanda Hyre Anderson
- Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Joan Lo
- Kaiser Permanente, Oakland, CA
| | - Anna Porter
- Section of Nephrology, Department of Medicine, University of Illinois at Chicago College of Medicine Chicago, IL
| | - Julie Wright Nunes
- Division of Nephrology, Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI
| | - Lavinia Negrea
- Division of Nephrology and Hypertension, Department of Medicine, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Lee Hamm
- Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Edward Horwitz
- Division of Nephrology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Jing Chen
- Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Julia J Scialla
- Division of Nephrology, Department of Medicine, and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Ian H de Boer
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Mary B Leonard
- Department of Pediatrics, Stanford University, Stanford, CA; Department of Medicine, Stanford University, Stanford, CA
| | - Harold I Feldman
- Jesse Brown Veterans Administration Medical Center, Chicago, IL; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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819
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Ostropolets A, Reich C, Ryan P, Shang N, Hripcsak G, Weng C. Adapting electronic health records-derived phenotypes to claims data: Lessons learned in using limited clinical data for phenotyping. J Biomed Inform 2020; 102:103363. [PMID: 31866433 PMCID: PMC7390483 DOI: 10.1016/j.jbi.2019.103363] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/20/2019] [Accepted: 12/17/2019] [Indexed: 11/23/2022]
Abstract
Algorithms for identifying patients of interest from observational data must address missing and inaccurate data and are desired to achieve comparable performance on both administrative claims and electronic health records data. However, administrative claims data do not contain the necessary information to develop accurate algorithms for disorders that require laboratory results, and this omission can result in insensitive diagnostic code-based algorithms. In this paper, we tested our assertion that the performance of a diagnosis code-based algorithm for chronic kidney disorder (CKD) can be improved by adding other codes indirectly related to CKD (e.g., codes for dialysis, kidney transplant, suspicious kidney disorders). Following the best practices from Observational Health Data Sciences and Informatics (OHDSI), we adapted an electronic health record-based gold standard algorithm for CKD and then created algorithms that can be executed on administrative claims data and account for related data quality issues. We externally validated our algorithms on four electronic health record datasets in the OHDSI network. Compared to the algorithm that uses CKD diagnostic codes only, positive predictive value of the algorithms that use additional codes was slightly increased (47.4% vs. 47.9-48.5% respectively). The algorithms adapted from the gold standard algorithm can be used to infer chronic kidney disorder based on administrative claims data. We succeeded in improving the generalizability and consistency of the CKD phenotypes by using data and vocabulary standardized across the OHDSI network, although performance variability across datasets remains. We showed that identifying and addressing coding and data heterogeneity can improve the performance of the algorithms.
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Affiliation(s)
- Anna Ostropolets
- Columbia University Medical Center, New York, NY, USA; Observational Health Data Sciences and Informatics (OHDSI), New York, NY, USA
| | - Christian Reich
- IQVIA, Cambridge, MA, USA; Observational Health Data Sciences and Informatics (OHDSI), New York, NY, USA
| | - Patrick Ryan
- Janssen Research & Development, Raritan, NJ, USA; Observational Health Data Sciences and Informatics (OHDSI), New York, NY, USA
| | - Ning Shang
- Columbia University Medical Center, New York, NY, USA; Observational Health Data Sciences and Informatics (OHDSI), New York, NY, USA
| | - George Hripcsak
- Columbia University Medical Center, New York, NY, USA; Observational Health Data Sciences and Informatics (OHDSI), New York, NY, USA.
| | - Chunhua Weng
- Columbia University Medical Center, New York, NY, USA; Observational Health Data Sciences and Informatics (OHDSI), New York, NY, USA.
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820
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Brunaud L, Zarnegar R, Frimat L. Calcimimetics: Mechanisms of persistent commercial pressures on prescription of medications. J Visc Surg 2020; 157:171-173. [PMID: 32001175 DOI: 10.1016/j.jviscsurg.2020.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- L Brunaud
- Unité de chirurgie métabolique, département de chirurgie, endocrinienne et thyroïdienne (UMET), université de Lorraine, CHRU Nancy (Brabois), 54511 Vandoeuvre-les-Nancy, France.
| | - R Zarnegar
- Department of surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, USA
| | - L Frimat
- Service de néphrologie, Université de Lorraine, CHRU Nancy (Brabois), 54511 Vandoeuvre-les-Nancy, France
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821
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Abstract
Lupus nephritis (LN) is a form of glomerulonephritis that constitutes one of the most severe organ manifestations of the autoimmune disease systemic lupus erythematosus (SLE). Most patients with SLE who develop LN do so within 5 years of an SLE diagnosis and, in many cases, LN is the presenting manifestation resulting in the diagnosis of SLE. Understanding of the genetic and pathogenetic basis of LN has improved substantially over the past few decades. Treatment of LN usually involves immunosuppressive therapy, typically with mycophenolate mofetil or cyclophosphamide and with glucocorticoids, although these treatments are not uniformly effective. Despite increased knowledge of disease pathogenesis and improved treatment options, LN remains a substantial cause of morbidity and death among patients with SLE. Within 10 years of an initial SLE diagnosis, 5-20% of patients with LN develop end-stage kidney disease, and the multiple comorbidities associated with immunosuppressive treatment, including infections, osteoporosis and cardiovascular and reproductive effects, remain a concern. Clearly, early and accurate diagnosis of LN and prompt initiation of therapy are of vital importance to improve outcomes in patients with SLE.
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822
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Carbonara CEM, dos Reis LM, Quadros KRDS, Roza NAV, Sano R, Carvalho AB, Jorgetti V, de Oliveira RB. Renal osteodystrophy and clinical outcomes: data from the Brazilian Registry of Bone Biopsies - REBRABO. J Bras Nefrol 2020; 42:138-146. [PMID: 32756862 PMCID: PMC7427645 DOI: 10.1590/2175-8239-jbn-2019-0045] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/15/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Mineral and bone disorders (MBD) are major complications of chronic kidney disease (CKD)-related adverse outcomes. The Brazilian Registry of Bone Biopsy (REBRABO) is an electronic database that includes renal osteodystrophy (RO) data. We aimed to describe the epidemiological profile of RO in a sample of CKD-MBD Brazilian patients and understand its relationship with outcomes. METHODS Between August 2015 and March 2018, 260 CKD-MBD stage 3-5D patients who underwent bone biopsy were followed for 12 to 30 months. Clinical-demographic, laboratory, and histological data were analyzed. Bone fractures, hospitalizations, and death were considered the primary outcomes. RESULTS Osteitis fibrosa, mixed uremic osteodystrophy, adynamic bone disease, osteomalacia, osteoporosis, and aluminum (Al) accumulation were detected in 85, 43, 27, 10, 77, and 65 patients, respectively. The logistic regression showed that dialysis vintage was an independent predictor of osteoporosis (OR: 1.005; CI: 1.001-1.010; p = 0.01). The multivariate logistic regression revealed that hemodialysis treatment (OR: 11.24; CI: 1.227-100; p = 0.03), previous parathyroidectomy (OR: 4.97; CI: 1.422-17.241; p = 0.01), and female gender (OR: 2.88; CI: 1.080-7.679; p = 0.03) were independent predictors of Al accumulation; 115 patients were followed for 21 ± 5 months. There were 56 hospitalizations, 14 deaths, and 7 fractures during follow-up. The COX regression revealed that none of the variable related to the RO/turnover, mineralization and volume (TMV) classification was an independent predictor of the outcomes. CONCLUSION Hospitalization or death was not influenced by the type of RO, Al accumulation, or TMV classification. An elevated prevalence of osteoporosis and Al accumulation was detected.
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Affiliation(s)
- Cinthia Esbrile Moraes Carbonara
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório para o Estudo do Distúrbio Mineral e Ósseo em Nefrologia, Campinas, SP, Brasil
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas, SP, Brasil
| | - Luciene Machado dos Reis
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Fisiopatologia Renal, São Paulo, SP, Brasil
| | - Kélcia Rosana da Silva Quadros
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório para o Estudo do Distúrbio Mineral e Ósseo em Nefrologia, Campinas, SP, Brasil
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas, SP, Brasil
| | - Noemi Angelica Vieira Roza
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório para o Estudo do Distúrbio Mineral e Ósseo em Nefrologia, Campinas, SP, Brasil
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas, SP, Brasil
| | - Rafael Sano
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório para o Estudo do Distúrbio Mineral e Ósseo em Nefrologia, Campinas, SP, Brasil
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas, SP, Brasil
| | - Aluizio Barbosa Carvalho
- Sociedade Brasileira de Nefrologia, Departamento de Distúrbios do Metabolismo Ósseo Mineral na Doença Renal Crônica, São Paulo, SP, Brasil
- Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Vanda Jorgetti
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Fisiopatologia Renal, São Paulo, SP, Brasil
- Sociedade Brasileira de Nefrologia, Departamento de Distúrbios do Metabolismo Ósseo Mineral na Doença Renal Crônica, São Paulo, SP, Brasil
| | - Rodrigo Bueno de Oliveira
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório para o Estudo do Distúrbio Mineral e Ósseo em Nefrologia, Campinas, SP, Brasil
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas, SP, Brasil
- Sociedade Brasileira de Nefrologia, Departamento de Distúrbios do Metabolismo Ósseo Mineral na Doença Renal Crônica, São Paulo, SP, Brasil
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823
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824
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Okamoto K, Fujii H, Goto S, Kono K, Watanabe K, Nishi S. Changes in the whole/intact parathyroid hormone ratio and their clinical implications in patients with chronic kidney disease. J Nephrol 2020; 33:795-802. [PMID: 31919783 DOI: 10.1007/s40620-019-00690-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/21/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although a previous study has reported the relationship between intact parathyroid hormone (iPTH) and whole parathyroid hormone (wPTH) levels in patients undergoing dialysis, the w/i PTH ratio (whole/intact PTH ratio) among predialysis chronic kidney disease (CKD) patients remains unclear. The present study therefore aimed to examine the relationship between w/i PTH ratio and kidney function and determine other factors affecting the w/i PTH ratio. METHODS An observational study including 773 predialysis CKD patients was conducted. The correlation between w/i PTH ratio and kidney function, as well as clinical factors at different CKD stages, were assessed using univariate and multivariate analyses. In addition, the relationship between w/i PTH ratio and composite renal outcome [kidney transplantation, dialysis, and 30% decline in estimated glomerular filtration rate (eGFR)] was examined. RESULTS The w/i PTH ratio decreased as the CKD stage progressed. Patients in each CKD stage (1/2, 3, 4, and 5) had a w/i PTH ratio of 0.85, 0.81, 0.78, and 0.59, respectively. The inflection point in the correlation lines between eGFR and w/i PTH ratio was 24.1 mL/min/1.73 m2. In multivariate analysis, the w/i PTH ratio was significantly correlated with serum calcium levels only in the CKD5 group and with eGFR in the CKD3, CKD4 and CKD5 group. Furthermore, w/i PTH ratio, eGFR, serum phosphate levels, and urinary protein/creatinine ratio were determined to be significant independent predictors for composite renal outcome. CONCLUSIONS Our study demonstrated that changes in the w/i PTH ratio were associated with kidney function, abnormal mineral metabolism, and renal outcome.
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Affiliation(s)
- Kohei Okamoto
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Hideki Fujii
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Shunsuke Goto
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Keiji Kono
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kentaro Watanabe
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Shinichi Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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825
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Kirmizis D, Basile C. Calcium balance in hemodialysis: More uncertainty than certainty. Semin Dial 2020; 33:103-108. [PMID: 31913542 DOI: 10.1111/sdi.12858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There is controversy about the choice of dialysate calcium concentration (DCa), with strong arguments both in favor of and against the use of a low or high DCa, as they can both be potentially harmful. Evidence suggests that calcium mass balance is positive with a DCa 3.5 mEq/L, negative or neutral with the use of DCa 2.5 mEq/L, whereas both positive and negative balances have been observed with the use of DCa 3.0 mEq/L. Overall, the use of DCa >2.5 mEq/L is usually associated with an increase in serum calcium level and a decrease in serum PTH level and use of lower vitamin D analogue dose, with the opposite effects usually observed with the use of lower DCa. Most of the available evidence is from small-sized and crossover studies; hence, evidence should be regarded with caution and applied in a patient-specific manner. As there are a lot of significant unanswered questions regarding calcium balance and the optimal DCa in hemodialysis patients, further high-quality research is needed to clarify many still unclear aspects of calcium homeostasis and balance in these patients. In conclusion, with the existing evidence the choice of DCa needs to be individualized and contextualized in the setting of each patient's calcium balance needs and homeostatic response, taking also into account oral calcium intake (dietary and medicinal), any other relevant therapy administered, such as vitamin D analogues, the type of renal mineral bone disorder, and associated cardiovascular comorbidity.
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Affiliation(s)
| | - Carlo Basile
- Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy.,Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy
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826
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Fernández-Martín JL, Dusso A, Martínez-Camblor P, Dionisi MP, Floege J, Ketteler M, London G, Locatelli F, Górriz JL, Rutkowski B, Bos WJ, Tielemans C, Martin PY, Wüthrich RP, Pavlovic D, Benedik M, Rodríguez-Puyol D, Carrero JJ, Zoccali C, Cannata-Andía JB. Serum phosphate optimal timing and range associated with patients survival in haemodialysis: the COSMOS study. Nephrol Dial Transplant 2020; 34:673-681. [PMID: 29741651 DOI: 10.1093/ndt/gfy093] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Serum phosphate is a key parameter in the management of chronic kidney disease-mineral and bone disorder (CKD-MBD). The timing of phosphate measurement is not standardized in the current guidelines. Since the optimal range of these biomarkers may vary depending on the duration of the interdialytic interval, in this analysis of the Current management of secondary hyperparathyroidism: a multicentre observational study (COSMOS), we assessed the influence of a 2- (midweek) or 3-day (post-weekend) dialysis interval for blood withdrawal on serum levels of CKD-MBD biomarkers and their association with mortality risk. METHODS The COSMOS cohort (6797 patients, CKD Stage 5D) was divided into two groups depending upon midweek or post-weekend blood collection. Univariate and multivariate Cox's models adjusted hazard ratios (HRs) by demographics and comorbidities, treatments and biochemical parameters from a patient/centre database collected at baseline and every 6 months for 3 years. RESULTS There were no differences in serum calcium or parathyroid hormone levels between midweek and post-weekend patients. However, in post-weekend patients, the mean serum phosphate levels were higher compared with midweek patients (5.5 ± 1.4 versus 5.2 ± 1.4 mg/dL, P < 0.001). Also, the range of serum phosphate with the lowest mortality risk [HR ≤ 1.1; midweek: 3.5-4.9 mg/dL (95% confidence interval, CI: 2.9-5.2 mg/dL); post-weekend: 3.8-5.7 mg/dL (95% CI: 3.0-6.4 mg/dL)] showed significant differences in the upper limit (P = 0.021). CONCLUSION Midweek and post-weekend serum phosphate levels and their target ranges associated with the lowest mortality risk differ. Thus, clinical guidelines should consider the timing of blood withdrawal when recommending optimal target ranges for serum phosphate and therapeutic strategies for phosphate control.
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Affiliation(s)
- José L Fernández-Martín
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Adriana Dusso
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Pablo Martínez-Camblor
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA.,Facultad de Ciencias de la Educación, Universidad Autónoma de Chile, Santiago, Chile
| | - Maria P Dionisi
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Jürgen Floege
- Department of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | | | | | - Francesco Locatelli
- Department of Nephrology, Dialysis and Renal Transplant, Alessandro Manzoni Hospital, Lecco, Italy
| | - José L Górriz
- Department of Nephrology, Hospital Clinico Universitario, Valencia, Spain.,Department of Medicine, Health Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - Boleslaw Rutkowski
- Department of Nephrology, Transplantology and Internal Medicine, Gdańsk Medical University, Gdańsk, Poland
| | - Willem-Jan Bos
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | | | - Drasko Pavlovic
- Department of Nephrology and Dialysis, Sestre Milosrdnice University Hospital, Zagreb, Croatia
| | - Miha Benedik
- Department of Nephrology, University Medical Centre, Ljubljana, Slovenia
| | - Diego Rodríguez-Puyol
- Department of Medicine, Universidad de Alcalá Nephrology Section and Research Unit Foundation, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain IRSIN REDinREN (Instituto de Salud Carlos III), Madrid, Spain
| | - Juan J Carrero
- Divisions of Renal Medicine and Baxter Novum (CLINTEC), Karolinska Institutet, Sweden
| | - Carmine Zoccali
- CNR National Research Council (Italy), Clinical Epidemiology and Physiopathology of Renal Disease and Hypertension and Renal and Transplantation Unit, Ospedali Riuniti, Italy
| | - Jorge B Cannata-Andía
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain
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827
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Vitamin D testing: advantages and limits of the current assays. Eur J Clin Nutr 2020; 74:231-247. [DOI: 10.1038/s41430-019-0553-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/25/2022]
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828
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Malmgren L, McGuigan FE, Christensson A, Akesson KE. Kidney function and its association to imminent, short- and long-term fracture risk-a longitudinal study in older women. Osteoporos Int 2020; 31:97-107. [PMID: 31754754 PMCID: PMC6946753 DOI: 10.1007/s00198-019-05152-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/28/2019] [Indexed: 11/27/2022]
Abstract
Reduced kidney function is associated with an increased fracture risk, although the relationship between an age-related decline and fractures needs further investigation. We followed kidney function and fracture risk for 10 years. A mild-moderate decline in kidney function was associated with fracture, but not in advanced age. INTRODUCTION With age, kidney function declines. Though well known that chronic kidney disease is associated with increased fracture risk, the extent to which the typical age-related decline contributes is unclear. In the OPRA cohort, a longitudinal study of older non-selected women, we investigated the association between kidney function and fracture. METHODS Cystatin C-based kidney function estimates were available at age 75 (n = 981) and 80 (n = 685). Women were categorized by kidney function: normal (CKD stages 1 and 2), mild-moderate (3a), poor (3b-5), and imminent, short- and long-term fracture risk investigated. BMD measurements and kidney function for risk prediction were also evaluated; women were categorized by both reduced kidney function (stages 3-5) and osteoporosis status. RESULTS In the short term, 2-3 years, mild-moderate kidney dysfunction was associated with the highest risk increase: osteoporotic fractures (2 years HRadj 2.21, 95% CI 1.27-3.87) and also up to 5 years (between 75 and 80 years) (HRadj 1.51, 1.04-2.18). Hip fracture risk was similarly increased. This association was not observed from age 80 nor for women with poorest kidney function. Reduced kidney function was associated with higher risk even without osteoporosis (osteoporotic fracture; HRadj 1.66, 1.08-2.54); risk increased by having both osteoporosis and reduced function (HRadj 2.53, 1.52-4.23). CONCLUSION Older women with mild-moderate reduction of kidney function are at increased risk of fractures, but not those with the worst function. Our findings furthermore confirm the value of osteoporosis assessment and it is possible that in this age group, age-related decline of kidney function has limited contribution compared with BMD.
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Affiliation(s)
- L Malmgren
- Department of Clinical Sciences Malmö, Lund University, 214 28, Malmö, Sweden
- Department of Geriatrics, Skåne University Hospital, 205 02, Malmö, Sweden
| | - F E McGuigan
- Department of Clinical Sciences Malmö, Lund University, 214 28, Malmö, Sweden
- Department of Orthopedics, Skåne University Hospital, 214 28, Malmö, Sweden
| | - A Christensson
- Department of Clinical Sciences Malmö, Lund University, 214 28, Malmö, Sweden
- Department of Nephrology, Skåne University Hospital, S-205 02, Malmö, Sweden
| | - K E Akesson
- Department of Clinical Sciences Malmö, Lund University, 214 28, Malmö, Sweden.
- Department of Orthopedics, Skåne University Hospital, 214 28, Malmö, Sweden.
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829
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Balcázar-Hernández L, Vargas-Ortega G, González-Virla B, Cruz-López M, Rodríguez-Gómez R, Espinoza-Pérez R, Cuevas-García C, Mendoza-Zubieta V. Biochemical Characteristics of Bone Mineral Metabolism before and throughout the First Year after Kidney Transplantation, Persistent Hyperparathyroidism, and Risk Factors in a Latin Population. Int J Endocrinol 2020; 2020:6913506. [PMID: 32256576 PMCID: PMC7085843 DOI: 10.1155/2020/6913506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/22/2020] [Accepted: 02/10/2020] [Indexed: 11/18/2022] Open
Abstract
Bone mineral metabolism disease, which included persistent hyperparathyroidism, is common after successful kidney transplantation (KT) and is related with negative outcomes in kidney transplant recipients. There is a lack of information about bone mineral metabolism, persistent hyperparathyroidism, and its risk factors in Latin kidney transplant recipients (KTRs). Material and Methods: A retrospective study was conducted in 74 patients aged 18-50 years with evolution of 12 months after KT and estimated glomerular filtration rate (eGFR) >60 ml/min; biochemical data of bone mineral metabolism before and at 1, 3, 6, and 12 months of KT were registered. Results. Age was 33 (IQR 27-37) years; 54% (n = 40) were men. Before KT, all patients had hyperparathyroidism, 40% (n = 30) hypocalcemia, 86% (n = 64) hyperphosphatemia, and 42% (n = 31) hyperphosphatasemia. After KT, an increase of calcium and a diminution of PTH, phosphorus, and alkaline phosphatase were corroborated (p=0.001). All patients had hypovitaminosis D (deficiency: 91% (n = 67); insufficiency: 9% (n = 7)); 40% (n = 30) had persistent hyperparathyroidism at 12 months. Hyperphosphatasemia before KT (OR = 4.17 (95% CI: 1.21-14.44); p=0.04), hyperparathyroidism at 6 months (OR = 1.84 (95% CI; 1.67-2.06); p=0.02), hypovitaminosis D at 6 months (OR = 3.94 (95% CI: 1.86-17.9); p=0.01), and hyperphosphatasemia at 6 months (OR = 1.47 (95% CI: 1.07-2.86); p=0.03) were risk factors for persistent hyperparathyroidism at 12 months after KT. Conclusion. Persistent hyperparathyroidism at 6 months, hypovitaminosis D, and hyperphosphatasemia are risk factors for persistent hyperparathyroidism at 1 year of KT in Latin population.
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Affiliation(s)
- Lourdes Balcázar-Hernández
- Endocrinology Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Colonia Doctores, 06720 México City, Mexico
| | - Guadalupe Vargas-Ortega
- Endocrinology Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Colonia Doctores, 06720 México City, Mexico
| | - Baldomero González-Virla
- Endocrinology Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Colonia Doctores, 06720 México City, Mexico
| | - Martha Cruz-López
- Kidney Transplant Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Colonia Doctores, 06720 México City, Mexico
| | - Raúl Rodríguez-Gómez
- Kidney Transplant Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Colonia Doctores, 06720 México City, Mexico
| | - Ramón Espinoza-Pérez
- Kidney Transplant Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Colonia Doctores, 06720 México City, Mexico
| | - Carlos Cuevas-García
- Kidney Transplant Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Colonia Doctores, 06720 México City, Mexico
| | - Victoria Mendoza-Zubieta
- Endocrinology Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Colonia Doctores, 06720 México City, Mexico
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830
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Shigematsu T, Fukagawa M, Yokoyama K, Akiba T, Fujii A, Shinoda A, Akizawa T. Influence of dialysate Ca concentrations on the therapeutic effects of etelcalcetide with concomitant drugs in patients with secondary hyperparathyroidism. Nephrology (Carlton) 2019; 25:634-643. [PMID: 31765028 PMCID: PMC7497248 DOI: 10.1111/nep.13682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 10/30/2019] [Accepted: 11/16/2019] [Indexed: 01/24/2023]
Abstract
Aim Secondary hyperparathyroidism (SHPT), a complication of haemodialysis, is commonly treated with calcimimetics. The impact of dialysates containing different calcium (Ca) concentrations on clinical efficacy of calcimimetics are unclear. We examined whether dialysate Ca concentrations influence the efficacy and dosing of etelcalcetide with concomitant drugs. Methods We performed post hoc analyses of a 52‐week, open‐label, multicentre study of etelcalcetide in Japanese SHPT patients to determine whether dialysate Ca influences the therapeutic effects of etelcalcetide with concomitant drugs. We evaluated the differences in serum intact parathyroid hormone (iPTH), corrected Ca (cCa) and phosphate levels among three dialysate Ca concentration groups (2.5, 2.75 or 3.0 mEq/L Ca). Tartrate‐resistant acid phosphatase 5b (TRACP‐5b) and bone alkaline phosphatase (BAP) levels were also compared. Since the dialysate Ca concentration may influence dose adjustment, we assessed the etelcalcetide and concomitant drug doses. Results There were no clinically meaningful differences in iPTH, cCa and phosphate levels among the 2.5, 2.75 and 3.0 mEq/L groups (n = 34, 64 and 35, respectively) over 52 weeks. At Week 52, more than 82%, 71% and 67% of patients had iPTH, cCa and phosphate levels within target ranges (60‐240 pg/mL, 8.4‐10.0 mg/dL and 3.5‐6.0 mg/dL, respectively) across the three groups. TRACP‐5b and BAP levels decreased by Week 52 regardless of dialysate Ca. Changes in etelcalcetide and concomitant drug doses were generally similar in each group. Conclusion The efficacy and dosing of etelcalcetide with concomitant drugs were essentially unaffected by the dialysate Ca concentration. Patients showed improvements in bone hypermetabolism during treatment. This is a small observational study of the effect of dialysate calcium concentrations on etelcalcetide with concomitant drugs in secondary hyperparathyroidism. No statistically significant differences were found between the different dialysate calcium groups suggesting that calcium concentrations in the dialysate do not modulate the effect of etelcalcetide.
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Affiliation(s)
- Takashi Shigematsu
- Department of Nephrology, Wakayama Medical University, Wakayama-city, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara-shi, Japan
| | - Keitaro Yokoyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Akiba
- Tokyo Next Nephrology & Dialysis Clinic, Tokyo, Japan
| | - Akifumi Fujii
- Clinical Development Planning, Ono Pharmaceutical Co., Ltd., Osaka-shi, Japan
| | - Atsushi Shinoda
- Medical Affairs, Ono Pharmaceutical Co., Ltd., Osaka-shi, Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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831
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Abdu A, Abdu A, Arogundade FA. Prevalence and pattern of chronic kidney disease-mineral bone disorders among hemodialysis patients in kano, northwest nigeria. Ann Afr Med 2019; 18:191-195. [PMID: 31823953 PMCID: PMC6918790 DOI: 10.4103/aam.aam_18_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Mineral and bone disorders (MBD) are among the important complications of chronic kidney disease (CKD) including end-stage renal disease. In addition to the higher rate of all-cause and cardiovascular-related mortality, MBD is also a cause of significant morbidity in CKD patients. Materials and Methods: This is a cross-sectional study of all consenting patients on hemodialysis at Aminu Kano Teaching Hospital, between December 2011 and June 2012. With the aid of an interviewer-administered questionnaire, the demographic profile and clinical features of the patients were obtained. After a general physical examination, blood sample was taken for the determination of calcium, phosphate, intact parathyroid hormone, 25 hydroxy (25[OH]) Vitamin D3, packed cell volume, serum creatinine, and potassium. Results: Forty-eight patients on maintenance hemodialysis were recruited for the study, 39 (81.3%) were male and 9 (18.8%) were female. The age range was 40–59 years, with a mean of 45.96 ± 13.7 years. Chronic glomerulonephritis was the predominant cause of CKD (25%). Hyperphosphatemia was noted in 19 (39.5%) of the patients, whereas 22 (46%) had hypocalcemia. In 26 (54.1%) of the patients, the calcium-phosphate product was >4.55 mmol2/L2. We found that 58% of the patients had CKD-MBD, of which 15 (31%) had secondary hyperparathyroidism, whereas 13 (27%) had features suggestive of adynamic bone disease. None of the patient had normal serum 25(OH) Vitamin D3 (mean: 43.79 ± 21 ng/ml). Conclusion: CKD-MBD is common among patients on hemodialysis in our center. Screening for CKD-MBD and appropriate use of phosphate binder and Vitamin D when indicated are highly recommended.
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Affiliation(s)
- Alhaji Abdu
- Department of Internal Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Aliyu Abdu
- Department of Internal Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Fatiu A Arogundade
- Department of Medicine, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
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832
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de Oliveira RB, Stinghen AEM, Massy ZA. Vitamin K role in mineral and bone disorder of chronic kidney disease. Clin Chim Acta 2019; 502:66-72. [PMID: 31836502 DOI: 10.1016/j.cca.2019.11.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/28/2019] [Accepted: 11/30/2019] [Indexed: 01/07/2023]
Abstract
Vitamin K is a key cofactor for the activation of proteins involved in blood coagulation, apoptosis, bone mineralization regulation, and vessel health. Scientific evidence shows an important role of activated osteocalcin and matrix-Gla protein in bone and vessels, markedly affected along the course of chronic kidney disease (CKD). In fact, CKD corresponds to an unique condition of vitamin K deficiency caused by dietary restriction, intestinal dysfunction, and impaired vitamin K recycling. Clinical data suggest that vitamin K status can be modulated and this prompts us to speculate whether patients with CKD might benefit from vitamin K supplementation. However, as important as whether the improvement in vitamin K status would be able to result in better bone quality, less vascular calcification, and lower mortality rates, several issues need to be clarified. These include better standardized methods for measuring vitamin K levels, and definition of the optimal concentration range for supplementation in different subgroups. Here, we review the literature data concerning the impact of vitamin K deficiency and supplementation on CKD-associated mineral and bone disorders (CKD-MBD). We present and discuss the available evidence from basic science and clinical studies, and highlight perspectives for further research.
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Affiliation(s)
- Rodrigo Bueno de Oliveira
- Division of Nephrology, Department of Internal Medicine, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil; Laboratory for Evaluation of Mineral and Bone Disorders in Nephrology (LEMON), School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Ziad A Massy
- Ambroise Paré University Hospital, Nephrology Division, APHP, UVSQ, France; INSERM U1018 Eq5, UVSQ, University Paris Saclay, Villejuif, France.
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833
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Infante M, Ricordi C, Padilla N, Alvarez A, Linetsky E, Lanzoni G, Mattina A, Bertuzzi F, Fabbri A, Baidal D, Alejandro R. The Role of Vitamin D and Omega-3 PUFAs in Islet Transplantation. Nutrients 2019; 11:E2937. [PMID: 31816979 PMCID: PMC6950335 DOI: 10.3390/nu11122937] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/21/2019] [Accepted: 11/26/2019] [Indexed: 12/15/2022] Open
Abstract
Recurrence of autoimmunity and allograft rejection represent major challenges that impact the success of islet transplantation. Despite the remarkable improvements achieved in immunosuppression strategies after the publication of the Edmonton protocol, long-term data of intra-hepatic islet transplantation show a gradual decline in beta-cell function. Therefore, there is a growing interest in the investigation of novel, safe and effective anti-inflammatory and immunomodulatory strategies able to promote long-term islet graft survival and notable improvements in clinical outcomes of islet transplant recipients. Vitamin D has been shown to exert anti-inflammatory and immunomodulatory effects. Pre-clinical studies investigating the use of vitamin D and its analogs (alone or in combination with immunosuppressive agents and/or other anti-inflammatory agents, such as omega-3 polyunsaturated fatty acids) showed beneficial results in terms of islet graft survival and prevention of recurrence of autoimmunity/allograft rejection in animal models of syngeneic and allogeneic islet transplantation. Moreover, epidemiologic studies demonstrated that vitamin D deficiency is highly prevalent after solid organ transplantation (e.g., heart, liver or kidney transplantation). However, studies that critically assess the prevalence of vitamin D deficiency among islet transplant recipients have yet to be conducted. In addition, prospective studies aimed to address the safety and efficacy of vitamin D supplementation as an adjuvant immunomodulatory strategy in islet transplant recipients are lacking and are therefore awaited in the future.
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Affiliation(s)
- Marco Infante
- Diabetes Research Institute (DRI) and Clinical Cell Transplant Program, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (C.R.); (N.P.); (A.A.); (G.L.); (D.B.); (R.A.)
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Camillo Ricordi
- Diabetes Research Institute (DRI) and Clinical Cell Transplant Program, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (C.R.); (N.P.); (A.A.); (G.L.); (D.B.); (R.A.)
| | - Nathalia Padilla
- Diabetes Research Institute (DRI) and Clinical Cell Transplant Program, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (C.R.); (N.P.); (A.A.); (G.L.); (D.B.); (R.A.)
| | - Ana Alvarez
- Diabetes Research Institute (DRI) and Clinical Cell Transplant Program, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (C.R.); (N.P.); (A.A.); (G.L.); (D.B.); (R.A.)
| | - Elina Linetsky
- Diabetes Research Institute (DRI) and Cell Transplant Center, cGMP Cell Processing Facility, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
| | - Giacomo Lanzoni
- Diabetes Research Institute (DRI) and Clinical Cell Transplant Program, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (C.R.); (N.P.); (A.A.); (G.L.); (D.B.); (R.A.)
| | - Alessandro Mattina
- Diabetes and Islet Transplantation Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC, 90127 Palermo, Italy;
| | | | - Andrea Fabbri
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - David Baidal
- Diabetes Research Institute (DRI) and Clinical Cell Transplant Program, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (C.R.); (N.P.); (A.A.); (G.L.); (D.B.); (R.A.)
| | - Rodolfo Alejandro
- Diabetes Research Institute (DRI) and Clinical Cell Transplant Program, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (C.R.); (N.P.); (A.A.); (G.L.); (D.B.); (R.A.)
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834
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Abstract
PURPOSE OF REVIEW To summarize the literature regarding alterations in bone health in patients with glomerular kidney disease and highlight areas in need of additional investigation. RECENT FINDINGS There is mounting evidence that children and adults with glomerular conditions, with or without compromised kidney function, comprise a distinct subgroup of patients with unique risk factors for altered bone health. Patients with glomerular kidney disease are exposed to both disease-related and treatment-related factors that affect bone structure and function. In addition to chronic kidney disease-related risk factors for impaired bone health, high rates of exposure to osteotoxic medications, varying degrees of systemic inflammation, and altered vitamin D metabolism may contribute to compromised bone health in individuals with glomerular disease. Further study is needed to better understand these risk factors and the complex interaction between the immune system and bone cells in glomerular disease.
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Affiliation(s)
- Dorey A Glenn
- UNC Kidney Center, Universirty of North Carolina at Chapel Hill, 7024 Burnett Womack Building, Chapell Hill, NC, 27599-7155, USA
| | - Michelle R Denburg
- The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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835
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Liabeuf S, McCullough K, Young EW, Pisoni R, Zee J, Reichel H, Pecoits-Filho R, Port FK, Stengel B, Csomor PA, Metzger M, Robinson B, Massy ZA. International variation in the management of mineral bone disorder in patients with chronic kidney disease: Results from CKDopps. Bone 2019; 129:115058. [PMID: 31493530 DOI: 10.1016/j.bone.2019.115058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/12/2019] [Accepted: 09/03/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Chronic kidney disease (CKD) is commonly associated with mineral and bone metabolism disorders, but these are less frequently studied in non-dialysis CKD patients than in dialysis patients. We examined and described international variation in mineral and bone disease (MBD) markers and their treatment and target levels in Stage 3-5 CKD patients. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS Prospective cohort study of 7658 adult patients with eGFR <60mL/min/1.73m2, excluding dialysis or transplant patients, participating in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) in Brazil, France, Germany, and the US. CKD-MBD laboratory markers included serum levels of phosphorus (P), calcium (Ca), intact parathyroid hormone (iPTH), and 25-hydroxyvitamin D (25-D). MBD treatment data included phosphate binders and vitamin D (nutritional and active). Nephrologist survey data were collected on target MBD marker levels. RESULTS Over two-thirds of the patients had MBD markers measured at time intervals in line with practice guidelines. P and iPTH increased and Ca decreased gradually from eGFR 60-20mL/min/1.73m2 and more sharply for eGFR<20. 25-D showed no relation to eGFR. Nephrologist survey data indicated marked variation in upper target P and iPTH levels. Among patients with P>5.5mg/dL, phosphate binder use was 14% to 43% across the four countries. Among patients with PTH >300pg/mL, use of active (calcitriol and related analogs) vitamin D was 12%-51%, and use of any (active or nutritional) vitamin D was 60%-87%. CONCLUSIONS Although monitoring of CKD-MBD laboratory markers by nephrologists in CKDopps countries is consistent with guidelines, target levels vary notably and prescription of medications to treat abnormalities in these laboratory markers is generally low in these cross-sectional analyses. While there are opportunities to increase treatment of hyperphosphatemia, hyperparathyroidism, and vitamin D deficiency in advanced CKD, the effect on longer-term complications of these conditions requires study.
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Affiliation(s)
- Sophie Liabeuf
- Pharmacology Department and Laboratory EA 7517, Amiens University Hospital, 80000 Amiens, France
| | | | - Eric W Young
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Ronald Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Jarcy Zee
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - Roberto Pecoits-Filho
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA; Pontifícia Universidade Católica Do Paraná, Nephrology, Do Paraná, Brazil
| | | | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health (CESP), UMRS 1018, UVSQ, University Paris-Saclay, Villejuif, France
| | | | - Marie Metzger
- Centre for Research in Epidemiology and Population Health (CESP), UMRS 1018, UVSQ, University Paris-Saclay, Villejuif, France
| | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Ziad A Massy
- Centre for Research in Epidemiology and Population Health (CESP), UMRS 1018, UVSQ, University Paris-Saclay, Villejuif, France; Department of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne Billancourt/Paris, France.
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836
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Could nutritional therapy take us further in our approaches to Fabry disease? Nutrition 2019; 72:110664. [PMID: 31972420 DOI: 10.1016/j.nut.2019.110664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 09/27/2019] [Accepted: 11/26/2019] [Indexed: 12/11/2022]
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder caused by mutations in the GLA gene that result in deficiency of enzyme α-galactosidase A activity. Clinical manifestation varies from mild to severe depending on the phenotype. The main clinical manifestations are cutaneous (angiokeratomas), neurologic (acroparesthesias), gastrointestinal (nausea, diarrhea, and abdominal pain), renal (proteinuria and kidney failure), cardiovascular (cardiomyopathy and arrhythmias), and cerebrovascular (stroke). Enzyme replacement therapy with recombinant human α-galactosidase is currently the therapeutic option for FD. Although enzyme replacement therapy has changed the natural history of disease, many clinical aspects of FD require an additional specific treatment. Nutritional approach is mostly indicated in case of nephropathy and gastrointestinal symptoms. Specific dietary interventions can modulate some pathogenetic mechanisms of the disease, such as the inflammation, oxidative stress, and autophagic disorders. However, to our knowledge, limited attention has been given to the nutritional aspects of FD. The aim of this review is to examine nutritional strategies that might interfere with several pathophysiologic aspects of FD, including inflammation and oxidative stress. A dietary approach should be part of the basic treatment in renal manifestations of FD. Dietary measures recommended for irritable bowel syndrome could be recommended for gastrointestinal symptoms. Dietary factors can modulate the inflammation, oxidative stress, and autophagy involved in FD. Polyphenols, ω-3 fatty acids, microbiota, and specific dietary patterns can interfere with inflammation/oxidative stress and autophagy mechanisms and could also contribute to the slowing of FD progression.
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837
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Zhang YH, Xu X, Pi HC, Yang ZK, Johnson DW, Dong J. The effects of oral vitamin D supplementation on the prevention of peritoneal dialysis-related peritonitis: study protocol for a randomized controlled clinical trial. Trials 2019; 20:657. [PMID: 31779675 PMCID: PMC6883549 DOI: 10.1186/s13063-019-3784-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Vitamin D deficiency has been shown to be closely associated with peritoneal dialysis (PD)-related peritonitis. The aim of this study is to examine the feasibility of conducting a large, powered randomized controlled trial to determine the effects of vitamin D supplementation on the risk of PD-related peritonitis in patients who have already experienced an episode of peritonitis. METHODS This prospective, open-label randomized controlled pilot trial with blinded end-points aims to determine the feasibility of oral vitamin D supplementation and to explore its effects on the risk of subsequent PD-related peritonitis among PD patients who have recovered from a recent episode of peritonitis. Eligible patients will be randomized 1:1 to either oral vitamin D supplementation (2000 IU per day; intervention group) or no vitamin D supplementation (control group) in addition to usual care according to International Society for Peritoneal Dialysis guidelines. The sample size will be 30 patients for both groups. All participants will be followed for 12 months. The primary outcome is the assessment of feasibility (recruitment success, retention, adherence, safety) and fidelity (change in serum 25-hydroxyvitamin D level during follow-up) for a large, powered randomized controlled trial to determine the effects of vitamin D on the risk of PD-related peritonitis in the future. Secondary outcomes include time to peritonitis occurrence, recovery of peritonitis, peritonitis-related transition to hemodialysis, and peritonitis-related death (defined as death within 30 days of peritonitis onset). DISCUSSION This is the first randomized controlled trail investigating the effects of vitamin D supplementation on the risk of subsequent PD-related peritonitis among patients on PD. The findings for this pilot study will determine the feasibility of conducting a full-scale randomized controlled trail, which may provide a new strategy for preventing PD-related peritonitis among PD patients. TRIAL REGISTRATION Clinicaltrails.gov, NCT03264625. Registered on 29 August 2017.
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Affiliation(s)
- Yu-Hui Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Xiao Xu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Hai-Chen Pi
- Department of Emergency Medicine, Peking University First Hospital, Beijing, China
| | - Zhi-Kai Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
- Institute of Nephrology, Peking University, Beijing, China.
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Ministry of Health, Beijing, China.
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China.
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838
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Capelli I, Cianciolo G, Gasperoni L, Galassi A, Ciceri P, Cozzolino M. Nutritional vitamin D in CKD: Should we measure? Should we treat? Clin Chim Acta 2019; 501:186-197. [PMID: 31770508 DOI: 10.1016/j.cca.2019.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 02/08/2023]
Abstract
Vitamin Ddeficiency is frequently present in patients affected by chronic kidney disease (CKD). Experimental studies demonstrated that Vitamin D may play a role in the pathophysiology of diseases beyond mineral bone disorders in CKD (CKD-MBD). Unfortunately, the lack of large and interventional studies focused on the so called "non-classic" effects of 25(OH) Vitamin D supplementation in CKD patients, doesn't permit to conclude definitely about the beneficial effects of this supplementation in clinical practice. In conclusion, treatment of nutritional vitamin D deficiency in CKD may play a central role in both bone homeostasis and cardiovascular outcomes, but there is not clear evidence to support one formulation of nutritional vitamin D over another in CKD.
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Affiliation(s)
- Irene Capelli
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giuseppe Cianciolo
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Lorenzo Gasperoni
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Andrea Galassi
- Renal Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Paola Ciceri
- Renal Research Laboratory, Department of Nephrology, Dialysis and Renal Transplant, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Mario Cozzolino
- Renal Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy.
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839
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Sprenger-Mähr H, Zitt E, Kronbichler A, Cejna M, Lhotta K. A hemodialysis patient with bone disease after pregnancy: a case report. BMC Nephrol 2019; 20:425. [PMID: 31752733 PMCID: PMC6873679 DOI: 10.1186/s12882-019-1603-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnancy is rare in women on hemodialysis. Recommendations for the treatment of secondary hyperparathyroidism (sHPT) and preservation of bone health in pregnant dialysis patients are lacking. CASE PRESENTATION We present the case of a young woman with end-stage kidney disease (ESKD) due to lupus nephritis, who developed multiple brown tumors while on hemodialysis during her second pregnancy. During her first pregnancy sHPT was well controlled and no skeletal complications occurred. Before the second pregnancy she developed severe sHPT. During pregnancy, dialysis time was increased to 24 h per week, the patient was given oral calcitriol, and the dialysate calcium concentration was set at 1.5 mmol/l. In week 20 the patient complained about bone pain in her left hip. Magnetic resonance imaging revealed a cystic lesion compatible with a brown tumor. The baby was delivered in the 36th week by cesarean section. Further assessment identified multiple brown tumors of her skeleton, including the acetabulum, tibia, ribs, skull, thoracic spine and thumb. She required multiple orthopedic surgeries. Three months after pregnancy, etelcalcetide was started, which brought about a gradual improvement in her sHPT. CONCLUSIONS This case demonstrates that the combination of pregnancy and severe sHPT in dialysis patients can have deleterious consequences for bone health.
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Affiliation(s)
- Hannelore Sprenger-Mähr
- Department of Internal Medicine III, Academic Teaching Hospital Feldkirch, Carinagasse 47, Feldkirch, Austria
| | - Emanuel Zitt
- Department of Internal Medicine III, Academic Teaching Hospital Feldkirch, Carinagasse 47, Feldkirch, Austria
| | - Andreas Kronbichler
- Department of Internal Medicine IV, Medical University of Innsbruck, Innsbruck, Austria
| | - Manfred Cejna
- Institute for Diagnostic and Interventional Radiology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Karl Lhotta
- Department of Internal Medicine III, Academic Teaching Hospital Feldkirch, Carinagasse 47, Feldkirch, Austria.
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840
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DiMarco A, Chotalia R, Bloxham R, McIntyre C, Tolley N, Palazzo FF. Autofluorescence in Parathyroidectomy: Signal Intensity Correlates with Serum Calcium and Parathyroid Hormone but Routine Clinical Use is Not Justified. World J Surg 2019; 43:1532-1537. [PMID: 30737552 DOI: 10.1007/s00268-019-04929-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The inability to identify the pathological gland at surgery results in failure to cure hyperparathyroidism in 2-5%. The poorly understood characteristic of parathyroid tissue to manifest autofluorescence (AF) under near-infrared (NIR) light has been promoted as an intraoperative adjunct in parathyroid surgery. This study sought to explore potential clinical correlates for AF and assess the clinical utility of AF in parathyroid surgery. METHODS Consecutive patients undergoing parathyroid surgery for primary and renal disease were included. NIR imaging was used intraoperatively and the degree of AF of parathyroid glands graded by the operating surgeon. Variables assessed for correlation with AF were: pre-operative serum calcium and PTH, SestaMIBI positivity, gland weight and histological composition. RESULTS Ninety-six patients underwent parathyroidectomy over an 8-month period: 49 bilateral explorations, 41 unilateral and 6 focussed lateral approaches: 284 potentially 'visualisable' glands in total. Two hundred and fifty-seven glands (90.5%) were visualised with NIR. Correlation was found between the degree of fluorescence and pre-operative serum calcium and PTH, but not between gland weight and SestaMIBI positivity. In those with renal hyperparathyroidism, a predominance of oxyphil cells correlated with increased AF. CONCLUSION Autofluorescence intensity correlates with serum calcium, PTH and gland composition. Further refinements would be required for this information to be of value in a clinical setting. Improvements allowing NIR to visualise the additional 9.5% of parathyroids and overcome the variation in signal intensity due to depth of access are required for the routine adoption of this technology. At present, its routine use in a clinical setting cannot be justified.
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Affiliation(s)
- Aimee DiMarco
- Department of Endocrine Surgery, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ravi Chotalia
- Department of Endocrine Surgery, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Ruth Bloxham
- Department of Endocrine Surgery, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Charlotte McIntyre
- Department of Endocrine Surgery, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Neil Tolley
- Department of Endocrine Surgery, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - F Fausto Palazzo
- Department of Endocrine Surgery, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK. .,Department of Surgery and Cancer, Imperial College London, London, UK.
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841
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Hu Z, Han E, Chen W, Chen J, Chen W, Guo R. Feasibility and safety of ultrasound-guided percutaneous microwave ablation for tertiary hyperparathyroidism. Int J Hyperthermia 2019; 36:1129-1136. [PMID: 31744350 DOI: 10.1080/02656736.2019.1684576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Zhian Hu
- Department of Ultrasound, Huangshi Central Hospital of Hubei Polytechnic University, Huangshi, Hubei, China
| | - Ehui Han
- Department of Ultrasound, Huangshi Central Hospital of Hubei Polytechnic University, Huangshi, Hubei, China
| | - Wei Chen
- Department of Nephrology, Huangshi Central Hospital of Hubei Polytechnic University, Huangshi, Hubei, China
| | - Jian Chen
- Department of Nephrology, Huangshi Central Hospital of Hubei Polytechnic University, Huangshi, Hubei, China
| | - Wenwei Chen
- Department of Ultrasound, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Ruiqiang Guo
- Department of Ultrasound, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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842
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Thomas A, Silver SA, Perl J, Freeman M, Slater JJ, Nash DM, Vinegar M, McArthur E, Garg AX, Harel Z, Chanchlani R, Zappitelli M, Iliescu E, Kitchlu A, Blum D, Beaubien-Souligny W, Wald R. The Frequency of Routine Blood Sampling and Patient Outcomes Among Maintenance Hemodialysis Recipients. Am J Kidney Dis 2019; 75:471-479. [PMID: 31732233 DOI: 10.1053/j.ajkd.2019.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/20/2019] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Surveillance blood work is routinely performed in maintenance hemodialysis (HD) recipients. Although more frequent blood testing may confer better outcomes, there is little evidence to support any particular monitoring interval. STUDY DESIGN Retrospective population-based cohort study. SETTING & PARTICIPANTS All prevalent HD recipients in Ontario, Canada, as of April 1, 2011, and a cohort of incident patients commencing maintenance HD in Ontario, Canada, between April 1, 2011, and March 31, 2016. EXPOSURE Frequency of surveillance blood work, monthly versus every 6 weeks. OUTCOMES The primary outcome was all-cause mortality. Secondary outcomes were major adverse cardiovascular events, all-cause hospitalization, and episodes of hyperkalemia. ANALYTICAL APPROACH Cox proportional hazards with adjustment for demographic and clinical characteristics was used to evaluate the association between blood testing frequency and all-cause mortality. Secondary outcomes were evaluated using the Andersen-Gill extension of the Cox model to allow for potential recurrent events. RESULTS 7,454 prevalent patients received care at 17 HD programs with monthly blood sampling protocols (n=5,335 patients) and at 8 programs with blood sampling every 6 weeks (n=2,119 patients). More frequent monitoring was not associated with a lower risk for all-cause mortality compared to blood sampling every 6 weeks (adjusted HR, 1.16; 95% CI, 0.99-1.38). Monthly monitoring was not associated with a lower risk for any of the secondary outcomes. Results were consistent among incident HD recipients. LIMITATIONS Unmeasured confounding; limited data for center practices unrelated to blood sampling frequency; no information on frequency of unscheduled blood work performed outside the prescribed sampling interval. CONCLUSIONS Monthly routine blood testing in HD recipients was not associated with a lower risk for death, cardiovascular events, or hospitalizations as compared with testing every 6 weeks. Given the health resource implications, the frequency of routine blood sampling in HD recipients deserves careful reassessment.
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Affiliation(s)
- Alison Thomas
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Samuel A Silver
- Division of Nephrology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada; ICES, London, Ontario, Canada
| | - Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Megan Freeman
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | | | | | | - Amit X Garg
- ICES, London, Ontario, Canada; Division of Nephrology, Western University, London, Ontario, Canada
| | - Ziv Harel
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; ICES, London, Ontario, Canada
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, McMaster University, Hamilton, Ontario, Canada
| | - Michael Zappitelli
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eduard Iliescu
- Division of Nephrology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Abhijat Kitchlu
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Daniel Blum
- Division of Nephrology, Sir Mortimer B Davis Jewish General Hospital, Quebec, Canada
| | | | - Ron Wald
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; ICES, London, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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843
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Udomkarnjananun S, Takkavatakarn K, Praditpornsilpa K, Nader C, Eiam-Ong S, Jaber BL, Susantitaphong P. Hepatitis B virus vaccine immune response and mortality in dialysis patients: a meta-analysis. J Nephrol 2019; 33:343-354. [DOI: 10.1007/s40620-019-00668-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022]
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844
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Affiliation(s)
- Emily Stonebrook
- Division of Pediatric Nephrology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
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845
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El Hussein MT, Kilfoil L. Managing End-Stage Renal Disease: An Alphabetized Mnemonic Strategy. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2019.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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846
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Cozzolino M, Ketteler M. Evaluating extended-release calcifediol as a treatment option for chronic kidney disease-mineral and bone disorder (CKD-MBD). Expert Opin Pharmacother 2019; 20:2081-2093. [PMID: 31675257 DOI: 10.1080/14656566.2019.1663826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Extended-release calcifediol (ERC) is an orally administered prohormone of active vitamin D (1,25-dihydroxyvitamin D [1,25D]) designed to safely and sufficiently increase serum total 25-hydroxyvitamin D (25D) to reduce elevated parathyroid hormone (PTH) in patients with non-dialysis-chronic kidney disease (ND-CKD). ERC is currently approved in the United States and Canada.Areas covered: Herein, key clinical data relating to the pharmacokinetics, pharmacodynamics, efficacy and safety of ERC are reviewed.Expert opinion: Currently available treatment options for secondary hyperparathyroidism (SHPT) in ND-CKD have limitations: the effectiveness of nutritional vitamin D supplements for reduction of PTH levels is unproven and active (1α-hydroxylated) vitamin D analogues elevate serum calcium, which increases the risk of hypercalcemia and vascular calcification. Clinical studies show that ERC is an effective, well tolerated treatment for SHPT in ND-CKD. ERC gradually raises serum 25D levels, resulting in physiologically regulated increases in serum 1,25D and sustained reductions in PTH, while avoiding clinically meaningful increases in serum phosphorus, calcium and fibroblast growth factor 23. ERC offers a new, effective and well tolerated treatment option for the early management of SHPT in patients with ND-CKD.
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Affiliation(s)
- Mario Cozzolino
- Renal Division and Laboratory of Experimental Nephrology, Department of Health Sciences, University of Milan, Milan, Italy
| | - Markus Ketteler
- Department of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Stuttgart, Germany.,School of Medicine, University of Split, Split, Croatia
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847
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Dang ZH, Tang C, Li GL, Luobu C, Qing D, Ma ZH, Qu JF, Suolang L, Liu LJ. Mineral and bone disorder in hemodialysis patients in the Tibetan Plateau: a multicenter cross-sectional study. Ren Fail 2019; 41:636-643. [PMID: 31269846 PMCID: PMC6610496 DOI: 10.1080/0886022x.2019.1635892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 11/28/2022] Open
Abstract
Background: Mineral and bone disorder (MBD) in hemodialysis patients is associated with increased morbidity and mortality. Studies on the MBD status of hemodialysis patients at high altitudes are extremely limited. Methods: A total of 146 hemodialysis patients from 5 local hospitals across all districts with hemodialysis centers in the Tibetan Plateau were enrolled in this cross-sectional study. Parameters related to MBD, including serum phosphorus (P), calcium (Ca), and intact parathyroid hormone (iPTH) levels, were measured. The achievement of MBD goals was compared with the achievement in the Dialysis Outcomes and Practice Study (DOPPS) 3, DOPPS 4 and a multicenter study of MBD in China. Factors associated with hyperphosphatemia were examined. Results: Altogether, 146 hemodialysis patients were recruited from the Tibetan Plateau. According to the K/DIGO guidelines, there were low achievement rates for serum Ca (40.4%), P (29.7%), and iPTH (47.1%). As for the (KDOQI) guidelines, the rates of achievement of defined targets were 38.4%, 33.7% and 16.4% for serum Ca, P and iPTH, respectively. The percentages of patients reaching the KDOQI targets for corrected Ca, P, and iPTH were significantly lower for Tibetan patients than the percentages found in DOPPS 3 (38.4% vs. 50.4%, 33.7% vs. 49.8%, and 16.4% vs. 31.4%, respectively, all p < .001) and DOPPS 4 (38.4% vs. 56.0%, 33.7% vs. 54.5%, and 16.4% vs. 35.3%, respectively, all p < .001). The percentage of patients reaching the KDOQI targets for iPTH was significantly lower in Tibet than in the plain areas of China (16.4% vs. 26.5%, p < .001). The proportion of patients with hypocalcemia was higher in Tibet than in the plain areas (44.5% vs. 19.4%, p < .001). The percentage of local patients with optimal P was significantly higher for patients with an activated vitamin D prescription than for patients without an activated vitamin D prescription (45.3% vs. 19.3%, p < .001). Age and the activated vitamin D prescription were independently associated with hyperphosphatemia. Conclusion: The MBD status of hemodialysis patients in Tibet is far from the ideal level. High altitude is one of the possible causes of the differences found, but not the principal one. It is necessary for medical staff in Tibet to improve the detection and treatment of MBD.
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Affiliation(s)
- Zong-Hui Dang
- Renal Division, The People’s Hospital of Tibet Autonomous Region, Lhasa, China
| | - Chen Tang
- Renal Division, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
| | - Guo-Liang Li
- Renal Division, The People’s Hospital of Tibet Autonomous Region, Lhasa, China
| | - Ciren Luobu
- Renal Division, The People’s Hospital of Tibet Autonomous Region, Lhasa, China
| | - De Qing
- Renal Division, The People's Hospital, Shannan, China
| | - Zhen-Hua Ma
- Renal Division, The People's Hospital, Shigatse, China
| | - Jing-Feng Qu
- Renal Division, Second People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - lamu Suolang
- Renal Division, The People's Hospital, Linzhi, China
| | - Li-Jun Liu
- Renal Division, The People’s Hospital of Tibet Autonomous Region, Lhasa, China
- Renal Division, Peking University First Hospital, Beijing, China
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848
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Bentata Y. Benefit-risk balance of native vitamin D supplementation in chronic hemodialysis: what can we learn from the major clinical trials and international guidelines? Ren Fail 2019; 41:607-615. [PMID: 31267807 PMCID: PMC6609353 DOI: 10.1080/0886022x.2019.1632719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/26/2019] [Accepted: 05/27/2019] [Indexed: 11/24/2022] Open
Abstract
For some years, there has been a great renewal of interest in native vitamin D and its major involvement in osseous and non-osseous effects in the organism. Patients in chronic hemodialysis (CHD) constitute a specific population with different physiopathologic characteristics and needs, since morbidity and mortality are strongly correlated with vitamin D insufficiency. Vitamin D supplementation raises very pertinent questions for which we have only partial answers and we lack solid scientific proof to establish certain truths. Thus, we try through this mini-review to analyze the results of the main randomized clinical trials conducted during the last decade, and to discuss international guidelines concerning native vitamin D supplementation in CHD patients. Seven double-blind randomized clinical trials have evaluated native Vitamin D supplementation in CHD patients. These clinical trials began between 2007 and 2013 and studied relatively small samples of patients with an average of 50. All of these trials are important, but do not provide sufficient scientific proof concerning the advantages, consequences, and secondary effects of native vitamin D supplementation in CHD. None of the European, American, English, Asian, Australian, or Canadian recommendations have specified the targets, doses, duration, or the molecule of vitamin D supplementation in the patient on CHD. In 2017, the long-awaited KDIGO recommendations were published and despite the results of clinical trials conducted, the recommendations on native vitamin D supplementation in CHD were very imprecise and sparse, limited to suggesting correction of any state of vitamin D insufficiency or deficiency.
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Affiliation(s)
- Yassamine Bentata
- Nephrology Unit, University Hospital Mohammed VI, Oujda, Morocco
- Laboratory of Epidemiology, Clinical Research and Public Health, Medical School of Oujda, University Mohammed The First, Oujda, Morocco
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849
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Granchi D, Baldini N, Ulivieri FM, Caudarella R. Role of Citrate in Pathophysiology and Medical Management of Bone Diseases. Nutrients 2019; 11:E2576. [PMID: 31731473 PMCID: PMC6893553 DOI: 10.3390/nu11112576] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/19/2019] [Accepted: 10/22/2019] [Indexed: 12/11/2022] Open
Abstract
Citrate is an intermediate in the "Tricarboxylic Acid Cycle" and is used by all aerobic organisms to produce usable chemical energy. It is a derivative of citric acid, a weak organic acid which can be introduced with diet since it naturally exists in a variety of fruits and vegetables, and can be consumed as a dietary supplement. The close association between this compound and bone was pointed out for the first time by Dickens in 1941, who showed that approximately 90% of the citrate bulk of the human body resides in mineralised tissues. Since then, the number of published articles has increased exponentially, and considerable progress in understanding how citrate is involved in bone metabolism has been made. This review summarises current knowledge regarding the role of citrate in the pathophysiology and medical management of bone disorders.
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Affiliation(s)
- Donatella Granchi
- Laboratory for Orthopedic Pathophysiology and Regenerative Medicine, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy;
| | - Nicola Baldini
- Laboratory for Orthopedic Pathophysiology and Regenerative Medicine, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy;
- Department of Biomedical and Neuromotor Sciences, Via Pupilli 1, University of Bologna, 40136 Bologna, Italy
| | - Fabio Massimo Ulivieri
- Nuclear Medicine, Bone Metabolic Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via F.Sforza 35, 20122 Milano, Italy;
| | - Renata Caudarella
- Maria Cecilia Hospital, GVM Care and Research, Via Corriera 1, 48033 Cotignola (RA), Italy;
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850
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Comparison of Performance of Equations for Estimated Glomerular Filtration Rate in Chinese Patients with Biopsy-Proven Diabetic Nephropathy. DISEASE MARKERS 2019; 2019:4354061. [PMID: 31636737 PMCID: PMC6766097 DOI: 10.1155/2019/4354061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/28/2019] [Indexed: 02/05/2023]
Abstract
Background The performance of various equations for estimated glomerular filtration rate (eGFR) in patients with diabetes remains controversial. We aimed to evaluate the performance of equations for eGFR in Chinese patients with diabetic nephropathy (DN). Methods This is a retrospective study included in 308 patients with type 2 diabetes and biopsy-proven DN who were followed up at least one year. eGFR was calculated using chronic kidney disease epidemiology (CKD-EPI) equations based on serum creatinine (eGFRCKD-EPI-Cr), cystatin C (eGFRCKD-EPI-CysC), and joint equations (eGFRCKD-EPI-Cr-CysC), respectively. End-stage kidney disease was defined by initiation of renal replacement therapy. The eGFR concordance between equations was assessed by Bland-Altman plots. Log-rank and multivariable logistic regression were employed to evaluate the performance of equations. Results Overall, the proportion of patients with eGFR < 60 mL/min/1.73m2 was 53%, 70%, and 61% by the equations of eGFRCKD-EPI-Cr, eGFRCKD-EPI-CysC, and eGFRCKD-EPI-Cr-CysC, respectively. Higher disconcordance was observed between equations when eGFR > 60 mL/min/1.73m2. Compared with eGFRCKD-EPI-Cr, 39% of patients were reclassified (reclassified group) from CKD 1-2 stages to CKD 3-5 stages by eGFRCKD-EPI-CysC and they presented significantly longer diabetic duration, heavier proteinuria, advanced pathological lesions, and poorer kidney outcomes. Multivariable logistic regression indicated cystatin C was independently associated with advanced glomerular classifications. Conclusion eGFR equations incorporating cystatin C are superior to eGFR based on creatinine alone for detecting kidney injury in the early stage. The independent association between cystatin C and glomerular classifications might contribute to it.
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