1
|
Characterization of Medication Trends for Chronic Kidney Disease: Mineral and Bone Disorder Treatment Using Electronic Health Record-Based Common Data Model. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5504873. [PMID: 34853790 PMCID: PMC8629641 DOI: 10.1155/2021/5504873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022]
Abstract
Chronic kidney disease–mineral bone disorder (CKD-MBD) is the most common complication in CKD patients. Although there is a consensus on treatment guidelines for CKD-MBD, it remains uncertain whether these treatment recommendations reflect actual practice. Therefore, the aim of this study was to investigate the CKD-MBD medication trend in real-world practice. This was a retrospective and observational study using a 12-year period database transformed into a common data model from three tertiary university hospitals. Study populations were subjects initially diagnosed as CKD. The date of diagnosis was designated as the index date. New patients were categorized year to year from 2008 to 2019 with a fixed observation period of 365 days to check the prescription of CKD-MBD medications including calcium-containing phosphate binder, noncalcium-containing phosphate binder, aluminium hydroxide, vitamin D receptor activator (VDRA), and cinacalcet. The numbers of CKD patients in the three hospitals were 7555, 2424, and 5351, respectively. The proportion for patients with CKD-MBD medication prescription decreased yearly regardless of hospital and CKD stage (p for trend < 0.05). The use of aluminium hydroxide disappeared steadily while the use of VDRA increased annually in all settings. Despite these changes in prescription patterns, the mean value for CKD-MBD-related serologic markers was almost within target range. The proportion of the population within the target value was not significantly changed. Irrespective of hospital and CKD stage, similar trends of prescription for CKD-MBD medications were observed in real-world practice. Further research with a distributed network study may be helpful to understand medication trends in CKD-MBD treatment.
Collapse
|
2
|
Daimon M, Fujita T, Murabayashi M, Mizushiri S, Murakami H, Nishiya Y, Tanabe J, Matsuhashi Y, Yanagimachi M, Tokuda I, Sawada K, Ihara K. Exacerbation of Hyperparathyroidism, Secondary to a Reduction in Kidney Function, in Individuals With Vitamin D Deficiency. Front Med (Lausanne) 2020; 7:221. [PMID: 32582730 PMCID: PMC7289923 DOI: 10.3389/fmed.2020.00221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/01/2020] [Indexed: 12/02/2022] Open
Abstract
Aims/Introduction: Chronic kidney disease (CKD)-mineral and bone disorders (CKD-MBD) are an adverse outcome derived from decreases in kidney function, where abnormality of serum concentrations of calcium (Ca), phosphorus, parathyroid hormone (PTH), and vitamin D can be seen simultaneously. To identify individuals at risk for CKD-MBD or secondary hyperparathyroidism, the relationships between estimated glomerular filtration rate (eGFR) and serum PTH concentration were evaluated, allowing for confounding factors, in particular vitamin D status, in a general Japanese population. Materials and Methods: Nine-hundred-and-thirty participants in the population-based Iwaki study conducted in 2016 who were not on drugs affecting mineral metabolism nor hemodialysis, were included in the study (326 men and 604 women; age: 55.4 ± 15.9 years). Results: Regression analysis showed a significant correlation between eGFR and serum intact PTH concentration, after adjustment for possible confounding factors (β = −0.122, p < 0.001). The smoothed spline curve applied for the correlation analysis revealed a biphasic correlation, with a division at an eGFR of ~60 mL/min/1.73 m2, below which the correlation coefficient was higher (β = −0.405, p < 0.001). Stratification on the basis of vitamin D status showed that the correlation was present only in participants with vitamin D deficiency (25-dihydroxyvitamin D3: <15 pg/mL) (β = −0.154, p < 0.001). Conclusions: These results indicate that a reduction in eGFR is a significant risk factor for an increase in serum PTH concentration when it is <60 mL/min/1.73 m2 and vitamin D is deficient, in the general Japanese population.
Collapse
Affiliation(s)
- Makoto Daimon
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tomoyuki Fujita
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masaya Murabayashi
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Satoru Mizushiri
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroshi Murakami
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Nishiya
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Jutaro Tanabe
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Matsuhashi
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Miyuki Yanagimachi
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Itoyo Tokuda
- Department of Oral Healthcare Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kaori Sawada
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kazushige Ihara
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
3
|
Block GA, Pergola PE, Fishbane S, Martins JG, LeWinter RD, Uhlig K, Neylan JF, Chertow GM. Effect of ferric citrate on serum phosphate and fibroblast growth factor 23 among patients with nondialysis-dependent chronic kidney disease: path analyses. Nephrol Dial Transplant 2020; 34:1115-1124. [PMID: 30380116 PMCID: PMC6603396 DOI: 10.1093/ndt/gfy318] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Indexed: 12/17/2022] Open
Abstract
Background Among patients with nondialysis-dependent chronic kidney disease (NDD-CKD) and iron-deficiency anemia (IDA), ferric citrate increases hemoglobin and iron parameters and reduces serum phosphate and fibroblast growth factor 23 (FGF23), a key phosphate-regulating hormone. We conducted post hoc analyses of a phase 3 trial to explore associations between iron replacement, serum phosphate changes and FGF23 regulation. Methods We employed multivariable regression and longitudinal mixed-effects models to identify and confirm, respectively, whether baseline demographic and laboratory variables were associated with ferric citrate-induced changes in serum phosphate or FGF23 concentrations. We employed path analyses to determine whether changes in FGF23 concentrations were mediated via changes in serum phosphate and/or transferrin saturation (TSAT). Results We analyzed a total of 117 and 115 ferric citrate-treated and placebo-treated patients, respectively. At 16 weeks, ferric citrate significantly reduced serum phosphate versus placebo (P = 0.006) only among patients with elevated baseline serum phosphate (≥4.5 mg/dL) and did not reduce serum phosphate among patients with baseline serum phosphate within the population reference range. Ferric citrate reduced intact FGF23 and C-terminal FGF23 partially via changes in TSAT (for C-terminal FGF23) and serum phosphate (for intact FGF23) and partially via unknown/unmeasured mechanisms. Conclusions Ferric citrate reduced serum FGF23 concentrations (partially via effects on serum phosphate and iron balance) and did not reduce serum phosphate among patients with baseline serum phosphate concentrations within the population reference range.
Collapse
Affiliation(s)
| | | | - Steven Fishbane
- Hofstra North Shore-Long Island Jewish School of Medicine, Great Neck, NY, USA
| | | | | | | | | | | |
Collapse
|
4
|
Bellorin-Font E, Vasquez-Rios G, Martin KJ. Controversies in the Management of Secondary Hyperparathyroidism in Chronic Kidney Disease. Curr Osteoporos Rep 2019; 17:333-342. [PMID: 31485996 DOI: 10.1007/s11914-019-00533-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Secondary hyperparathyroidism is a frequent complication of chronic kidney disease that begins early in the course of renal insufficiency as an adaptive response to maintain mineral homeostasis. This complex disorder affects the bone, leading to an increase in fracture risk and is associated with increased risks of vascular calcification and mortality. PURPOSE OF REVIEW: In this review, we examine the different strategies available to manage secondary hyperparathyroidism. Particularly, we focus on the adequate control of serum phosphorus by restricting intake and the use of phosphate binders, correction of hypocalcemia while minimizing calcium burden, and reduction in PTH levels through the use of vitamin D sterols and calcimimetics. RECENT FINDINGS: It was observed that although numerous agents directed at the correction of these abnormalities have demonstrated effectiveness on biochemical markers, there is still a relative scarcity of studies demonstrating treatment effectiveness as measured by hard clinical outcomes. In addition, most agents have side effects that may limit their use, even in patients in which the treatment has demonstrated efficacy in controlling these parameters. There is still controversy as to what therapeutic regimens to choose for a particular patient and what parameter should be used to follow their effects, including outcomes, side effects, pill burden, and costs, among others. In the present article, we analyze controversial aspects of the different therapeutic agents available. Although many tools and regimens are available, no one by itself is enough for an adequate management of the patient. But rather, combined therapy and individualization of approaches are recommended for better results. We suggest that new studies analyzing the effectiveness of therapeutic approaches to the management of secondary hyperparathyroidism should be directed not only to controlling parathyroid hormone levels but also to the evaluation of long-term outcomes, based on modification of morbidity, mortality, and end organ impact, while reducing side effects and controlling costs, among others.
Collapse
Affiliation(s)
- Ezequiel Bellorin-Font
- Division of Nephrology and Hypertension, Saint Louis University, Saint Louis, MO, 63110, USA
| | - George Vasquez-Rios
- Division of Nephrology and Hypertension, Saint Louis University, Saint Louis, MO, 63110, USA
| | - Kevin J Martin
- Division of Nephrology and Hypertension, Saint Louis University, Saint Louis, MO, 63110, USA.
| |
Collapse
|
5
|
Isakova T, Nickolas TL, Denburg M, Yarlagadda S, Weiner DE, Gutiérrez OM, Bansal V, Rosas SE, Nigwekar S, Yee J, Kramer H. KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD). Am J Kidney Dis 2017; 70:737-751. [DOI: 10.1053/j.ajkd.2017.07.019] [Citation(s) in RCA: 199] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 07/29/2017] [Indexed: 12/25/2022]
|
6
|
Katai K, Iwamoto A, Kimura Y, Oshima Y, Arioka S, Morimi Y, Omuro A, Nakasa T. Wakame (Undaria pinnatifida ) modulates hyperphosphatemia in a rat model of chronic renal failure. THE JOURNAL OF MEDICAL INVESTIGATION 2015; 62:68-74. [PMID: 25817287 DOI: 10.2152/jmi.62.68] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In chronic renal failure, inorganic phosphate (Pi) retention speeds up the progression to end-stage renal disease. The current therapy for hyperphosphatemia in patients with chronic renal failure consists of dietary Pi restriction combined with administration of Pi binders, but each therapy has practical problems. Thus, the discovery of foods or nutrients that inhibit Pi absorption may be useful for the treatment of hyperphosphatemia. In the present study, we investigated whether wakame (Undaria pinnatifida) is a useful food for the prevention of hyperphosphatemia in a rat model of renal failure. Feeding a diet containing 5% wakame significantly decreased plasma and urinary Pi levels and increased the amount of fecal Pi. In addition, wakame significantly reduced plasma blood urea nitrogen and plasma Pi levels in 5/6 nephrectomized rats fed a high-Pi diet. Biochemical analyses showed that the reduction of intestinal Pi absorption is the main reason for the decrease in plasma Pi levels in rats fed a diet containing wakame. In addition, feeding alginic acid and fucoidan, major components of wakame fiber, was effective in reducing plasma Pi levels in normal rats. Finally, we concluded that wakame may be a useful food for the prevention of hyperphosphatemia in rodents.
Collapse
Affiliation(s)
- Kanako Katai
- Department of Food science and Nutrition, Faculty of Human Life and Science, Doshisha Women's College of Liberal Arts
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Ohnishi R, Segawa H, Ohmoto T, Sasaki S, Hanazaki A, Mori A, Ikuta K, Furutani J, Kawakami E, Tatsumi S, Hamada Y, Miyamoto KI. Effect of dietary components on renal inorganic phosphate (Pi) excretion induced by a Pi-depleted diet. THE JOURNAL OF MEDICAL INVESTIGATION 2014; 61:162-70. [DOI: 10.2152/jmi.61.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ritsuko Ohnishi
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Hiroko Segawa
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Tomoyo Ohmoto
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Shohei Sasaki
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Ai Hanazaki
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Ayaka Mori
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Kayo Ikuta
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Junya Furutani
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Eri Kawakami
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Sawako Tatsumi
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Yasuhiro Hamada
- Department of Therapeutic Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Ken-ichi Miyamoto
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| |
Collapse
|
8
|
Abstract
There is growing interest in the role of fibroblast growth factor 23 (FGF23) in various diseases of disordered mineral metabolism. In chronic kidney disease (CKD), where biochemical evidence of mineral disturbances is especially common, FGF23 measurement has been advocated as an early and sensitive marker for CKD-related bone disease. In this setting, FGF23 analysis may also improve the discrimination of risk of adverse renal and cardiovascular outcomes and aid targeting of those patients that are likely to benefit from interventions. Nonetheless, while the physiological relevance of FGF23 in the control of mineral metabolism is now firmly established, relatively little attention has been paid to important preanalytical and analytical aspects of FGF23 measurement that may impact on its clinical utility. Here we review these issues and discuss the suitability of FGF23 testing strategies for routine clinical practice. The current ‘state-of-the-art’ enzyme-linked immunosorbent assay methods for FGF23 measurement show poor agreement due to differences in FGF23 fragment detection, antibody specificity and calibration. Such analytical variability does not permit direct comparison of FGF23 measurements made with different assays and is likely to at least in part account for some of the inconsistencies noted between observational studies. From a clinical perspective, the lack of concordance has implications for the development of standardized reference intervals and clinical decision limits. Finally, the inherent assay-dependent biological variability of plasma FGF23 concentration can further complicate the interpretation of results and the design of FGF23-based testing protocols. Currently, it would be premature to consider incorporating FGF23 measurements into standard testing repertoires.
Collapse
Affiliation(s)
- Edward R Smith
- Department of Renal Medicine, Eastern Health Clinical School, Faculty of Medicine Nursing and Health Sciences, Monash University, Box Hill, Victoria, Australia
| | - Lawrence P McMahon
- Department of Renal Medicine, Eastern Health Clinical School, Faculty of Medicine Nursing and Health Sciences, Monash University, Box Hill, Victoria, Australia
| | - Stephen G Holt
- Department of Renal Medicine, Eastern Health Clinical School, Faculty of Medicine Nursing and Health Sciences, Monash University, Box Hill, Victoria, Australia
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| |
Collapse
|
9
|
Ohnishi R, Segawa H, Ohmoto T, Sasaki S, Hanazaki A, Mori A, Ikuta K, Furutani J, Kawakami E, Tatsumi S, Hamada Y, Miyamoto KI. <b>Effect of dietary components on renal inorganic </b><b>phosphate (Pi) excretion induced by a Pi-depleted diet</b>. THE JOURNAL OF MEDICAL INVESTIGATION 2000. [DOI: 10.2152/jmi.40.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ritsuko Ohnishi
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Hiroko Segawa
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Tomoyo Ohmoto
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Shohei Sasaki
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Ai Hanazaki
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Ayaka Mori
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Kayo Ikuta
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Junya Furutani
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Eri Kawakami
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Sawako Tatsumi
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Yasuhiro Hamada
- Department of Therapeutic Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| | - Ken-ichi Miyamoto
- Department of Molecular Nutrition, Institution of Health Biosciences, the University of Tokushima Graduate School
| |
Collapse
|