1
|
Gifre L, Massó E, Fusaro M, Haarhaus M, Ureña P, Cozzolino M, Mazzaferro S, Calabia J, Peris P, Bover J. Vertebral fractures in patients with CKD and the general population: a call for diagnosis and action. Clin Kidney J 2024; 17:sfae191. [PMID: 39099567 PMCID: PMC11294886 DOI: 10.1093/ckj/sfae191] [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: 12/11/2023] [Indexed: 08/06/2024] Open
Abstract
Vertebral fractures (VFs) are the most common osteoporotic fractures in the general population, and they have been associated with high mortality, decreased quality of life, and high risk of subsequent fractures, especially when recent, multiple, or severe. Currently, VF diagnosis and classification determine fracture risk and the most appropriate anti-osteoporotic treatment. However, VFs are clearly underdiagnosed, especially in patients with chronic kidney disease (CKD), and CKD-associated osteoporosis has been disregarded until recently. VFs are associated with higher morbidity and mortality, and their prevalence and incidence differ depending on the grade of renal dysfunction (CKD G1-G5) and/or the type of renal replacement therapy (dialysis or transplantation). In addition to classical risk factors [such as higher age, female sex, reduced bone mineral density, diabetes and steroid use], various other factors have been associated with an increased risk of VFs in CKD, including CKD grade, haemodialysis vintage, time since renal transplantation, low or high intact parathyroid hormone and phosphate levels, and/or vitamin D and K1 deficiencies. Importantly, several clinical societies have recently modified their algorithms according to the fracture risk classification (including the presence of VFs) and determined the most appropriate anti-osteoporotic treatment for the general population. However, there are no specific guidelines addressing this topic in patients with CKD despite an important paradigm shift regarding the prognostic value of bone mineral density in 2017 after the publication of the CKD-Mineral and Bone Disorder Kidney Disease: Improving Global Outcomes guidelines. A proactive attitude towards diagnosis, treatment, and research is proposed to avoid therapeutic nihilism.
Collapse
Affiliation(s)
- Laia Gifre
- Rheumatology Department, Hospital Germans Trias i Pujol, Research Institute Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Catalonia, Spain
| | - Elisabet Massó
- Nephrology Department, University Hospital Germans Trias i Pujol, REMAR-IGTP Group, Research Institute Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Catalonia, Spain
| | - Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology, Pisa (Italy). Department of Medicine, University of Padua, Padua, Italy
| | - Mathias Haarhaus
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
- Diaverum AB, Hyllie Boulevard 53, Malmö, Sweden
| | - Pablo Ureña
- Department of Nephrology and Dialysis, AURA Nord Saint-Ouen, Saint-Ouen, Paris, France
- Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France
| | - Mario Cozzolino
- Renal Division, Department of Health Sciences, University of Milan, Milan, Italy
| | - Sandro Mazzaferro
- Department of Translation and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Jordi Calabia
- Nephrology Department, University Hospital Josep Trueta. IdIBGi Research Institute. Universitat de Girona, Catalonia, Spain
| | - Pilar Peris
- Rheumatology Department, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Jordi Bover
- Nephrology Department, University Hospital Germans Trias i Pujol, REMAR-IGTP Group, Research Institute Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Catalonia, Spain
| |
Collapse
|
2
|
Bover J, Gómez-Alonso C, Casado E, Rodríguez-García M, Lloret MJ, Castro-Alonso C, Gifre L, Henríquez-Palop F, Prior-Español Á, López de la Manzanara V, Láiz AM, Martínez-Ferrer À, Torregrosa JV, Cigarrán S, Górriz JL, Montomoli M, Panizo N, Costa E, Martínez-Laguna D, Rodríguez M, Navarro-González JF. Osteoporosis management in patients with chronic kidney disease (ERCOS Study): A challenge in nephrological care. Nefrologia 2024; 44:241-250. [PMID: 38531765 DOI: 10.1016/j.nefroe.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/07/2023] [Indexed: 03/28/2024] Open
Abstract
Fracture risk assessment in patients with chronic kidney disease (CKD) has been included in the CKD-MBD ("Chronic Kidney Disease-Mineral and Bone Disorders") complex in international and national nephrology guidelines, suggesting for the first time the assessment of bone mineral density (BMD) if the results can influence therapeutic decision-making. However, there is very little information on actual clinical practice in this population. The main objective of the ERCOS (ERC-Osteoporosis) study is to describe the profile of patients with CKD G3-5D with osteoporosis (OP) and/or fragility fractures treated in specialized nephrology, rheumatology and internal medicine clinics in Spain. Fifteen centers participated and 162 patients (mostly women [71.2%] postmenopausal [98.3%]) with a median age of 77 years were included. Mean estimated glomerular filtration rate (eGFR) was 36 mL/min/1.73 m2 and 38% of the included patients were on dialysis. We highlight the high frequency of prevalent fragility fractures [37.7%), mainly vertebral (52.5%) and hip (24.6%)], the disproportionate history of patients with glomerular disease compared to purely nephrological series (corticosteroids) and undertreatment for fracture prevention, especially in nephrology consultations. This study is an immediate call to action with the dissemination of the new, more proactive, clinical guidelines, and underlines the need to standardize a coordinated and multidisciplinary care/therapeutic approach to these patients in an efficient way to avoid current discrepancies and therapeutic nihilism.
Collapse
Affiliation(s)
- Jordi Bover
- Servicio de Nefrología, Hospital Universitari Germans Trias i Pujol, REMAR-IGTP Group, Can Ruti Campus, Badalona, Barcelona, Spain.
| | - Carlos Gómez-Alonso
- Unidad de Gestión Clínica de Metabolismo Óseo y Mineral, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Enrique Casado
- Servicio de Reumatología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Minerva Rodríguez-García
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - María Jesús Lloret
- Servicio de Nefrología, Fundació Puigvert, Institut d'Investigació Biomèdica Sant Pau (IIB-SANT PAU), Barcelona, Spain
| | - Cristina Castro-Alonso
- Servicio de Nefrología, Hospital Universitario Doctor Peset, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | - Laia Gifre
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Águeda Prior-Español
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Ana María Láiz
- Servicio de Reumatología, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - José Luis Górriz
- Servicio de Nefrología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Marco Montomoli
- Servicio de Nefrología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Nayara Panizo
- Servicio de Nefrología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Ester Costa
- Servicio de Reumatología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | | | - Mariano Rodríguez
- Servicio de Nefrología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Juan F Navarro-González
- Unidad de Investigación y Servicio de Nefrología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Islas Canarias, Spain
| |
Collapse
|
3
|
Castro-Alonso C, D’Marco L, Pomes J, Del Amo Conill M, García-Diez AI, Molina P, Puchades MJ, Valdivielso JM, Escudero V, Bover J, Navarro-González J, Ribas B, Pallardo LM, Gorriz JL. Prevalence of Vertebral Fractures and Their Prognostic Significance in the Survival in Patients with Chronic Kidney Disease Stages 3‒5 Not on Dialysis. J Clin Med 2020; 9:jcm9051604. [PMID: 32466297 PMCID: PMC7291319 DOI: 10.3390/jcm9051604] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/12/2020] [Accepted: 05/19/2020] [Indexed: 12/30/2022] Open
Abstract
Background: The prevalence of vertebral fractures (VF) and their association with clinical risk factors and outcomes are poorly documented in chronic kidney disease (CKD) cohorts. The aim of the study was to evaluate the prevalence of VF in patients with non-dialysis dependent CKD (NDD-CKD), their value in predicting mortality and its correlation with parameters of bone mineral metabolism and vascular calcification. Materials and Methods: 612 NDD 3‒5 stage CKD patients participating in the OSERCE-2 study, a prospective, multicenter, cohort study, were prospectively evaluated and categorized into two groups according to presence or absence of VF at enrollment. VF were assessed with lateral radiographs and Genant semi-quantitative method was applied. Three radiologists specialized in musculoskeletal radiology performed consensual reading of individual images obtained using a Raim DICOM Viewer and a Canon EOS 350 camera to measure with Java Image software in those who had traditional acetate X-ray. Factors related to VF were assessed by logistic regression analysis. Association between VF and death over a 3-year follow-up was assessed by Kaplan-Meier survival curves and Cox-proportional hazard models. Results: VF were detected in 110 patients (18%). Serum phosphate levels (OR 0.719, 95% CI 0.532 to 0.972, p = 0.032), ankle-brachial index < 0.9 (OR 1.694, 95% CI 1.056‒2.717, p = 0.029) and treatment with bisphosphonates (OR 5.636, 95% CI 1.876‒16.930, p = 0.002) were independently related to the presence of VF. After a median follow-up of 35 months (IQR: 17‒37 months), 62 patients (10%) died. The causes of death were cardiovascular (n = 21, 34%) and infectious (n = 11, 18%). In the crude analysis, fractured patients group had poorer survival (log-rank test, p = 0.02). After multivariate adjustment for age, MDRD, albumin, diabetes mellitus, comorbidity, Adragao Score > 3 and serum phosphate, the presence of VF (HR 1.983, 95% CI 1.009‒3.898, p = 0.047) were an independent predictor of all-cause mortality. Conclusions: In our study 18% of patients with NDD-CKD have VF. Factors associated with VF were age, low serum phosphate levels and peripheral vascular disease. The presence of VF was an independent risk factor for mortality in stages 3‒5 NDD-CKD patients. Clinical trials are needed to confirm whether this relationship is causal and reversible with treatment for osteoporosis.
Collapse
Affiliation(s)
- Cristina Castro-Alonso
- Department of Nephrology, Hospital Universitario Dr. Peset, FISABIO, Universidad de Valencia, 46017 Valencia, Spain; (C.C.-A.); (P.M.); (V.E.); (L.M.P.)
| | - Luis D’Marco
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (L.D.M.); (M.J.P.)
| | - Jaume Pomes
- Department of Radiology, Hospital Clínic, 08036 Barcelona, Spain; (J.P.); (M.D.A.C.); (A.I.G.-D.)
| | - Monserrat Del Amo Conill
- Department of Radiology, Hospital Clínic, 08036 Barcelona, Spain; (J.P.); (M.D.A.C.); (A.I.G.-D.)
| | - Ana Isabel García-Diez
- Department of Radiology, Hospital Clínic, 08036 Barcelona, Spain; (J.P.); (M.D.A.C.); (A.I.G.-D.)
| | - Pablo Molina
- Department of Nephrology, Hospital Universitario Dr. Peset, FISABIO, Universidad de Valencia, 46017 Valencia, Spain; (C.C.-A.); (P.M.); (V.E.); (L.M.P.)
| | - María Jesús Puchades
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (L.D.M.); (M.J.P.)
| | - José Manuel Valdivielso
- Vascular and Renal Translational Research Group, IRBLleida, RedinRen-ISCIII, 25198 Lleida, Spain;
| | - Verónica Escudero
- Department of Nephrology, Hospital Universitario Dr. Peset, FISABIO, Universidad de Valencia, 46017 Valencia, Spain; (C.C.-A.); (P.M.); (V.E.); (L.M.P.)
| | - Jordi Bover
- Department of Nephrology, Fundació Puigvert, IIB Sant Pau, RedinRen, 08025 Barcelona, Spain;
| | - Juan Navarro-González
- Research Unit and Nephrology Service, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife and Instituto de Tecnologías Biomédicas, Universidad de La Laguna, 38010 Tenerife, GEENDIAB REDINREN, Spain;
| | - Begoña Ribas
- Department of Nephrology, Hospital La Paz, 28046 Madrid, Spain;
| | - Luis Manuel Pallardo
- Department of Nephrology, Hospital Universitario Dr. Peset, FISABIO, Universidad de Valencia, 46017 Valencia, Spain; (C.C.-A.); (P.M.); (V.E.); (L.M.P.)
| | - José Luis Gorriz
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (L.D.M.); (M.J.P.)
- Correspondence:
| |
Collapse
|
4
|
Lin R, Toussaint ND, Gallagher M, Cass A, Kotwal S. Hospitalized fracture rates amongst patients with chronic kidney disease in Australia using data linkage. Nephrology (Carlton) 2019; 25:475-482. [PMID: 31743530 DOI: 10.1111/nep.13681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 10/27/2019] [Accepted: 11/11/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Renal osteodystrophy leading to fractures in chronic kidney disease (CKD) is associated with significant hospitalization, morbidity, mortality and health care costs. There is a paucity of data on fractures in the CKD population in Australia. AIM To describe the trends and impact of hospitalized fractures in an Australian population of non-dialysis CKD patients. METHODS Retrospective observational data derived using data linkage. Fracture rates, trends in hospital admissions, comorbidity burden and mortality were analysed in a non-dialysis CKD population between 2000 and 2010 in the Australian state of New South Wales. Hospitalized patients with CKD and fractures were compared with CKD patients without fracture. RESULTS A total of 149 839 hospitalized patients with CKD were included, of whom 9898 (6.6%) experienced one or more fractures. Patients with fracture were older, more likely to be female with a higher comorbidity burden than those without. Hospital admissions involving fracture were longer than non-fracture admissions (14.3 vs 5.9 days, P < .0001) and patients were less likely to be discharged home (28.3% vs 80.9%, P < .0001). The 12-month mortality rate was high at 41%. CONCLUSION Australian non-dialysis CKD patients with hospitalized fractures were older, had a greater burden of disease, and have similar rates of fracture and associated mortality compared to international CKD cohorts. Implications of fracture requiring hospitalization are considerable, with longer admissions, greater healthcare costs, lower likelihood of discharge home and significant mortality. As fracture prevention in the CKD population evolves, treatment algorithms should account for those at greatest risk.
Collapse
Affiliation(s)
- Raymond Lin
- Renal and Metabolic Divisions, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine (RMH), University of Melbourne, Melbourne, Victoria, Australia
| | - Martin Gallagher
- Renal and Metabolic Divisions, The George Institute for Global Health, Newtown, New South Wales, Australia.,Concord Clinical School, Faculty of Medicine & Health, University of Sydney, Sydney, New South Wales, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Sradha Kotwal
- Renal and Metabolic Divisions, The George Institute for Global Health, Newtown, New South Wales, Australia.,Department of Nephrology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
5
|
CKD, arterial calcification, atherosclerosis and bone health: Inter-relationships and controversies. Atherosclerosis 2018; 278:49-59. [DOI: 10.1016/j.atherosclerosis.2018.08.046] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 07/12/2018] [Accepted: 08/29/2018] [Indexed: 01/14/2023]
|
6
|
Marques IDB, Araújo MJCLN, Graciolli FG, Reis LMD, Pereira RM, Custódio MR, Jorgetti V, Elias RM, David-Neto E, Moysés RMA. Biopsy vs. peripheral computed tomography to assess bone disease in CKD patients on dialysis: differences and similarities. Osteoporos Int 2017; 28:1675-1683. [PMID: 28204954 DOI: 10.1007/s00198-017-3956-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/31/2017] [Indexed: 01/24/2023]
Abstract
UNLABELLED Results from bone biopsy and high-resolution peripheral quantitative computed tomography (HR-pQCT) were compared in 31 CKD patients. There was an agreement mainly for cortical compartment that may represent a perspective on the fracture risk assessment. HR-pQCT also provided some clues on the turnover status, which warrants further studies. INTRODUCTION Chronic kidney disease (CKD) patients are at high risk of bone disease. Although bone biopsy is considered the best method to evaluate bone disease, it is expensive and not always available. Here we have compared, for the first time, data obtained from bone biopsy and HR-pQCT in a sample of CKD patients on dialysis. METHODS HR-pQCT and dual-energy X-ray absorptiometry (DXA) were performed in 31 CKD patients (30 on dialysis). Biopsies were analyzed by quantitative histomorphometry, and classified according to TMV. RESULTS We have found an inverse correlation between radius cortical density measured by HR-pQCT, with serum, as well as histomorphometric bone remodeling markers. Trabecular density and BV/TV measured through HR-pQCT in the distal radius correlated with trabecular and mineralized trabecular bone volume. Trabecular number, separation, and thickness obtained from HR-pQCT and from bone biopsy correlated with each other. Patients with cortical porosity on bone histomorphometry presented lower cortical density at the distal radius. Cortical density at radius was higher while bone alkaline phosphatase was lower in patients with low turnover. Combined, these parameters could identify the turnover status better than individually. CONCLUSIONS There was an agreement between HR-pQCT and bone biopsy parameters, particularly in cortical compartment, which may point to a new perspective on the fracture risk assessment for CKD patients. Besides classical bone resorption markers, HR-pQCT provided some clues on the turnover status by measurements of cortical density at radius, although the significance of this finding warrants further studies.
Collapse
Affiliation(s)
- I D B Marques
- Renal Transplant Service, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - M J C L N Araújo
- Renal Transplant Service, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
- Nephrology Division, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - F G Graciolli
- Nephrology Division, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - L M Dos Reis
- Nephrology Division, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - R M Pereira
- Rheumatology Division, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - M R Custódio
- Renal Transplant Service, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
- Nephrology Division, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - V Jorgetti
- Nephrology Division, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - R M Elias
- Nephrology Division, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - E David-Neto
- Renal Transplant Service, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - R M A Moysés
- Nephrology Division, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.
- Universidade Nove de Julho (UNINOVE), Rua Iperoig, 690 ap 121, São Paulo, SP, 05016-000, Brazil.
| |
Collapse
|
7
|
Cupisti A, D'Alessandro C, Gesualdo L, Cosola C, Gallieni M, Egidi MF, Fusaro M. Non-Traditional Aspects of Renal Diets: Focus on Fiber, Alkali and Vitamin K1 Intake. Nutrients 2017; 9:E444. [PMID: 28468236 PMCID: PMC5452174 DOI: 10.3390/nu9050444] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/16/2017] [Accepted: 04/20/2017] [Indexed: 12/15/2022] Open
Abstract
Renal diets for advanced chronic kidney disease (CKD) are structured to achieve a lower protein, phosphate and sodium intake, while supplying adequate energy. The aim of this nutritional intervention is to prevent or correct signs, symptoms and complications of renal insufficiency, delaying the start of dialysis and preserving nutritional status. This paper focuses on three additional aspects of renal diets that can play an important role in the management of CKD patients: the vitamin K1 and fiber content, and the alkalizing potential. We examined the energy and nutrients composition of four types of renal diets according to their protein content: normal diet (ND, 0.8 g protein/kg body weight (bw)), low protein diet (LPD, 0.6 g protein/kg bw), vegan diet (VD, 0.7 g protein/kg bw), very low protein diet (VLPD, 0.3 g protein/kg bw). Fiber content is much higher in the VD and in the VLPD than in the ND or LPD. Vitamin K1 content seems to follow the same trend, but vitamin K2 content, which could not be investigated, might have a different pattern. The net endogenous acid production (NEAP) value decreases from the ND and LPD to the vegetarian diets, namely VD and VLPD; the same finding occurred for the potential renal acid load (PRAL). In conclusion, renal diets may provide additional benefits, and this is the case of vegetarian diets. Namely, VD and VLPD also provide high amounts of fibers and Vitamin K1, with a very low acid load. These features may have favorable effects on Vitamin K1 status, intestinal microbiota and acid-base balance. Hence, we can speculate as to the potential beneficial effects on vascular calcification and bone disease, on protein metabolism, on colonic environment and circulating levels of microbial-derived uremic toxins. In the case of vegetarian diets, attention must be paid to serum potassium levels.
Collapse
Affiliation(s)
- Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 56126, Italy.
| | - Claudia D'Alessandro
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 56126, Italy.
| | - Loreto Gesualdo
- Department of Emergency and Organ Transplantation-Nephrology, Dialysis and Transplantation Unit, University of Bari Aldo Moro, Bari, 70124, Italy.
| | - Carmela Cosola
- Department of Emergency and Organ Transplantation-Nephrology, Dialysis and Transplantation Unit, University of Bari Aldo Moro, Bari, 70124, Italy.
| | - Maurizio Gallieni
- San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, University of Milano, Milano, 20153, Italy.
| | - Maria Francesca Egidi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 56126, Italy.
| | - Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Pisa and Department of Medicine, University of Padua, Padua, 35122, Italy.
| |
Collapse
|
8
|
Wang J, Xu J, Liu W, Li Y, Qin L. Biodegradable Magnesium (Mg) Implantation Does Not Impose Related Metabolic Disorders in Rats with Chronic Renal Failure. Sci Rep 2016; 6:26341. [PMID: 27210744 PMCID: PMC4876325 DOI: 10.1038/srep26341] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 04/27/2016] [Indexed: 11/09/2022] Open
Abstract
Mg and its alloys have been considered as one of the most promising biodegradable medical devices, but it was still unclear whether hypermagnesemia involved health risks would occur in persons with kidney disease due to their deteriorated kidney function for Mg ions excretion from their body. In this study, we established a chronic renal failure (CRF) model in rats induced by adenine administration prior to Mg implantation, aiming to predict if CRF patients are suitable for the use of Mg implants. The results showed that Mg levels in serum, urine, feces and internal organs had no significant changes after Mg implantation for both normal and CRF rats. Biochemical indices detection and histopathological analysis in kidney, liver and heart tissue confirmed that Mg implants did not induce any extra damage in animals even with renal failure. Our study indicates that Mg based orthopaedic medical device may be considered for use in CRF patients without biosafety concerns.
Collapse
Affiliation(s)
- Jiali Wang
- Musculoskeletal Research Laboratory, Department of Orthopaedics &Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China.,Center for Translational Medicine Research and Development, Institute of Biomedical and Health Engineering, Chinese Academy of Sciences, Shenzhen 518055, P.R. China
| | - Jiankun Xu
- Musculoskeletal Research Laboratory, Department of Orthopaedics &Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China
| | - Waiching Liu
- Musculoskeletal Research Laboratory, Department of Orthopaedics &Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China
| | - Yangde Li
- Guangdong Innovation Team for Biodegradable Magnesium and Medical Implants, E-ande Dongguan 523660, P.R. China
| | - Ling Qin
- Musculoskeletal Research Laboratory, Department of Orthopaedics &Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China.,Center for Translational Medicine Research and Development, Institute of Biomedical and Health Engineering, Chinese Academy of Sciences, Shenzhen 518055, P.R. China.,Guangdong Innovation Team for Biodegradable Magnesium and Medical Implants, E-ande Dongguan 523660, P.R. China
| |
Collapse
|
9
|
Increased risks of mortality and atherosclerotic complications in incident hemodialysis patients subsequently with bone fractures: a nationwide case-matched cohort study. PLoS One 2015; 10:e0121705. [PMID: 25874794 PMCID: PMC4395346 DOI: 10.1371/journal.pone.0121705] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 02/18/2015] [Indexed: 11/19/2022] Open
Abstract
Background Hemodialysis (HD) patients with bone fractures have an increased risk for death. However, the risks for mortality and atherosclerotic complications in incident HD patients subsequently with bone fractures are unknown. Methods Data derived from the Taiwan National Health Institute Research Database between January 1997 and December 2008 was analyzed. The enrolled patients included 3,008 incident HD patients subsequently with a single long bone fracture (LB Fx) and 2,070 incident HD patients subsequently with a single non-long bone fracture (NLB Fx). These patients were matched (1:5 ratio) for age, sex, and same duration of HD with incident HD patients who had no fractures and outcomes were measured over a 3-year follow-up. Results After demographic and co-morbidity adjustment, LB Fx increased the risk for overall mortality (HR = 1.59, p < 0.001) and stroke (HR = 1.09, p = 0.028) in incident HD patients. NLB Fx increased the risk for overall mortality (HR = 1.52, p < 0.001), stroke (HR = 1.19, p < 0.001), coronary artery disease (CAD), (HR = 1.13, p = 0.003), and peripheral arterial occlusive disease (PAOD), (HR = 1.41, p < 0.001) in incident HD patients. Moreover, incident patients subsequently with NLB Fx had significantly higher risks of CAD and PAOD than those subsequently with LB Fx. Conclusions The rates of mortality and stroke were significantly higher in incident HD patients subsequently with bone fractures than in matched patients without bone fractures. Incident HD patients subsequently with NLB Fx had significantly higher risks of CAD and PAOD than those subsequently with LB Fx and without bone fractures. Thus, incident HD patients subsequently with bone fractures should be closely followed for a higher mortality and possible development of atherosclerotic complications.
Collapse
|
10
|
Allen MR, Newman CL, Chen N, Granke M, Nyman JS, Moe SM. Changes in skeletal collagen cross-links and matrix hydration in high- and low-turnover chronic kidney disease. Osteoporos Int 2015; 26:977-85. [PMID: 25466530 PMCID: PMC4512757 DOI: 10.1007/s00198-014-2978-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/24/2014] [Indexed: 12/30/2022]
Abstract
UNLABELLED Chronic kidney disease (CKD) increases fracture risk. The results of this work point to changes in bone collagen and bone hydration as playing a role in bone fragility associated with CKD. INTRODUCTION Clinical data have documented a clear increase in fracture risk associated with chronic kidney disease (CKD). Preclinical studies have shown reductions in bone mechanical properties although the tissue-level mechanisms for these differences remain unclear. The goal of this study was to assess collagen cross-links and matrix hydration, two variables known to affect mechanical properties, in animals with either high- or low-turnover CKD. METHODS At 35 weeks of age (>75% reduction in kidney function), the femoral diaphysis of male Cy/+ rats with high or low bone turnover rates, along with normal littermate (NL) controls, were assessed for collagen cross-links (pyridinoline (Pyd), deoxypyridinoline (Dpd), and pentosidine (PE)) using a high-performance liquid chromatography (HPLC) assay as well as pore and bound water per volume (pw and bw) using a (1)H nuclear magnetic resonance (NMR) technique. Material-level biomechanical properties were calculated based on previously published whole bone mechanical tests. RESULTS Cortical bone from animals with high-turnover disease had lower Pyd and Dpd cross-link levels (-21% each), lower bw (-10%), higher PE (+71%), and higher pw (+46%) compared to NL. Animals with low turnover had higher Dpd, PE (+71%), and bw (+7%) along with lower pw (-60%) compared to NL. Both high- and low-turnover animals had reduced material-level bone toughness compared to NL animals as determined by three-point bending. CONCLUSIONS These data document an increase in skeletal PE with advanced CKD that is independent of bone turnover rate and inversely related to decline in kidney function. Although hydration changes occur in both high- and low-turnover disease, the data suggest that nonenzymatic collagen cross-links may be a key factor in compromised mechanical properties of CKD.
Collapse
Affiliation(s)
- M R Allen
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, 635 Barnhill Dr., MS 5035, Indianapolis, IN, 46202, USA,
| | | | | | | | | | | |
Collapse
|