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Zaimi M, Grapsa E. Current therapeutic approach of chronic kidney disease-mineral and bone disorder. Ther Apher Dial 2024; 28:671-689. [PMID: 38898685 DOI: 10.1111/1744-9987.14177] [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: 02/29/2024] [Revised: 05/14/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024]
Abstract
Chronic kidney disease (CKD) has emerged as one of the leading noncommunicable diseases affecting >10% of the population worldwide. Bone and mineral disorders are a common complication among patients with CKD resulting in a poor life quality, high fracture risk, increased morbidity and cardiovascular mortality. According to Kidney Disease: Improving Global Outcomes, renal osteodystrophy refers to changes in bone morphology found in bone biopsy, whereas CKD-mineral and bone disorder (CKD-MBD) defines a complex of disturbances including biochemical and hormonal alterations, disorders of bone and mineral metabolism and extraskeletal calcification. As a result, the management of CKD-MBD should focus on the aforementioned parameters, including the treatment of hyperphosphatemia, hypocalcemia, abnormal PTH and vitamin D levels. Regarding the bone fragility fractures, osteoporosis and renal osteodystrophy, which constitute the bone component of CKD-MBD, anti-osteoporotic agents constitute the mainstay of treatment. However, a thorough elucidation of the CKD-MBD pathogenesis is crucial for the ideal personalized treatment approach. In this paper, we review the pathology and management of CKD-MBD based on the current literature with special attention to recent advances.
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Affiliation(s)
- Maria Zaimi
- National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Eirini Grapsa
- National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
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Ильичева ЕA, Шурыгина ИА, Дремина НН, Берсенев ГА, Григорьев ЕГ. [The role of calcium sensitive and vitamin D receptors in the pathogenesis of sporadic multiple parathyroid gland disease]. PROBLEMY ENDOKRINOLOGII 2023; 69:24-34. [PMID: 37448244 PMCID: PMC10350607 DOI: 10.14341/probl13207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/21/2023] [Accepted: 02/20/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Sporadic multiple parathyroid gland disease is ¼ cases of primary hyperparathyroidism (PHPT). However, a single tactic for diagnosing and operating volume in patients with this variant of PHPT has not yet been developed. One of the possible directions in the search for pathogenetically substantiated methods of diagnosis and treatment is the study of the molecular genetic features of the disease and associated clinical and laboratory factors. AIM To study the features of the expression of calcium sensitive (CaSR) and vitamin D (VDR) receptors on the surface of parathyroid cells in primary hyperparathyroidism with solitary and multiple lesions of the parathyroid glands, as well as its changes under the influence of a decrease in the filtration function of the kidneys. MATERIALS AND METHODS In a single center observational prospective study with retrospective data collection, there were patients who during 2019-2021. operated on for PHPT, secondary hyperparathyroidism (SHPT) and all cases of tertiary hyperparathyroidism (THPT) operated during 2014-2021. The expression of CaSR, VDR and its relationship with the main laboratory parameters, the clinical variant of hyperparathyroidism, and the morphological substrate were studied. RESULTS The study included 69 patients: 19 with multiple and 25 with solitary PTG near PHPT, 15 with SHPT, 10 with THPT. A statistically significant decrease in the frequency of detection of normal expression of CaSR and VDR receptors occurs in any morphological variant of hyperparathyroidism and is observed in 93-60% of drugs. A decrease in the normal expression of CaSR in hyperplasia is detected statistically significantly less frequently than in adenoma (p≤0.01). The median expression intensity in adenoma was 2.5 (2:3), in hyperplasia 3.5 (3-4) (p≤0.01). The difference in the molecular mechanisms of the development of hyperparathyroidism with a predominance of a morphological substrate in the form of adenoma (PHPT with solitary adenoma) or hyperplasia (SHPT and PHPT with multiple PTG lesions) is realized in the frequency of maintaining normal CaSR expression in the PTG tissue. These mechanisms are implemented at the local level, their variability does not change under the influence of RRT. A common molecular genetic mechanism for the development of hyperparathyroidism with a predominance of a morphological substrate in the form of adenoma or hyperplasia has been found to reduce the frequency of maintaining normal VDR expression in PTG (up to 7-13%), p<0.01. This mechanism is implemented at the local level, its variability changes under the influence of RRT, reaching statistically significant differences in patients with THPT. CONCLUSION The study demonstrates the features of changes in the expression of CaSR and VDR in PHPT with multiple lesions of the parathyroid glands. The relationship between the expression of these receptors and the clinical variant of hyperparathyroidism, the morphological substrate, the main laboratory parameters, and renal function was shown.
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Affiliation(s)
| | | | | | | | - Е. Г. Григорьев
- Иркутский научный центр хирургии и травматологии; Иркутский государственный медицинский университет
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Hassan A, Pollak YE, Kilav-Levin R, Silver J, London N, Nechama M, Ben-Dov IZ, Naveh-Many T. Kidney Failure Alters Parathyroid Pin1 Phosphorylation and Parathyroid Hormone mRNA-Binding Proteins, Leading to Secondary Hyperparathyroidism. J Am Soc Nephrol 2022; 33:1677-1693. [PMID: 35961788 PMCID: PMC9529182 DOI: 10.1681/asn.2022020197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/01/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Secondary hyperparathyroidism (SHP) is a common complication of CKD that increases morbidity and mortality. In experimental SHP, increased parathyroid hormone (PTH) expression is due to enhanced PTH mRNA stability, mediated by changes in its interaction with stabilizing AUF1 and destabilizing KSRP. The isomerase Pin1 leads to KSRP dephosphorylation, but in SHP parathyroid Pin1 activity is decreased and hence phosphorylated KSRP fails to bind PTH mRNA, resulting in high PTH mRNA stability and levels. The up- and downstream mechanisms by which CKD stimulates the parathyroid glands remain elusive. METHODS Adenine-rich high-phosphate diets induced CKD in rats and mice. Parathyroid organ cultures and transfected cells were incubated with Pin1 inhibitors for their effect on PTH expression. Mass spectrometry was performed on both parathyroid and PTH mRNA pulled-down proteins. RESULTS CKD led to changes in rat parathyroid proteome and phosphoproteome profiles, including KSRP phosphorylation at Pin1 target sites. Furthermore, both acute and chronic kidney failure led to parathyroid-specific Pin1 Ser16 and Ser71 phosphorylation, which disrupts Pin1 activity. Pharmacologic Pin1 inhibition, which mimics the decreased Pin1 activity in SHP, increased PTH expression ex vivo in parathyroid glands in culture and in transfected cells through the PTH mRNA-protein interaction element and KSRP phosphorylation. CONCLUSIONS Kidney failure leads to loss of parathyroid Pin1 activity by inducing Pin1 phosphorylation. This predisposes parathyroids to increase PTH production through impaired PTH mRNA decay that is dependent on KSRP phosphorylation at Pin1-target motifs. Pin1 and KSRP phosphorylation and the Pin1-KSRP-PTH mRNA axis thus drive SHP.
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Affiliation(s)
- Alia Hassan
- Minerva Center for Bone and Mineral Research, Nephrology Services, Hadassah Hebrew University Medical Center and Faculty of Medicine, Jerusalem, Israel
| | - Yael E. Pollak
- Minerva Center for Bone and Mineral Research, Nephrology Services, Hadassah Hebrew University Medical Center and Faculty of Medicine, Jerusalem, Israel
| | - Rachel Kilav-Levin
- Minerva Center for Bone and Mineral Research, Nephrology Services, Hadassah Hebrew University Medical Center and Faculty of Medicine, Jerusalem, Israel
- School of Nursing, Jerusalem College of Technology, Faculty of Life and Health Sciences, Jerusalem, Israel
| | - Justin Silver
- Minerva Center for Bone and Mineral Research, Nephrology Services, Hadassah Hebrew University Medical Center and Faculty of Medicine, Jerusalem, Israel
| | - Nir London
- Department of Chemical and Structural Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Morris Nechama
- Department of Pediatric Nephrology, Hadassah Hebrew University Medical Center and Faculty of Medicine, Jerusalem, Israel
- Wohl Institute for Translational Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Iddo Z. Ben-Dov
- Laboratory of Medical Transcriptomics, Nephrology Services, Hadassah Hebrew University Medical Center and Faculty of Medicine, Jerusalem, Israel
| | - Tally Naveh-Many
- Minerva Center for Bone and Mineral Research, Nephrology Services, Hadassah Hebrew University Medical Center and Faculty of Medicine, Jerusalem, Israel
- Wohl Institute for Translational Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Eremkina AK, Gorbacheva AM, Enenko VA, Litvinova EE, Mokrysheva NG. [Experience in using teriparatide for the treatment of postoperative hypoparathyroidism in hemodialysis patients]. PROBLEMY ENDOKRINOLOGII 2022; 68:30-39. [PMID: 36104963 DOI: 10.14341/probl13075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/18/2022] [Accepted: 05/30/2022] [Indexed: 01/01/2023]
Abstract
The frequency of chronic postoperative hypoparathyroidism after total parathyroidectomy for secondary and tertiary hyperparathyroidism in patients with end-stage renal failure, according to various authors, can reach 20% or more. Prescribing active metabolites of vitamin D and calcium it is not always sufficient for achievement of target goals. This dictates the need for replacement therapy with recombinant parathyroid hormone. Teriparatide is the only drug of this series approved by the American Food and Drug Administration (FDA) and registered in the Russian Federation. However, it is registered as an anabolic anti-osteoporotic drug and is not indicated for the treatment of chronic hypoparathyroidism. The use of teriparatide in postoperative hypoparathyroidism in patients receiving renal replacement therapy with programmed hemodialysis in the Russian Federation has not been previously studied. Data on this issue is also limited in foreign literature. However, it is a potential treatment option for hemodialysis patients with chronic hypoparathyroidism and severe bone disorders. In this article, we present 2 clinical cases of substitution and anabolic therapy with teriparatide in this cohort of patients.
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Usmani S, Ahmed N, Gnanasegaran G, Marafi F, van den Wyngaert T. Update on imaging in chronic kidney disease-mineral and bone disorder: promising role of functional imaging. Skeletal Radiol 2022; 51:905-922. [PMID: 34524489 DOI: 10.1007/s00256-021-03905-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 02/02/2023]
Abstract
Disorders of mineral metabolism and bone disease are common complications in chronic kidney disease (CKD) patients and are associated with increased morbidity and mortality. Bone biopsies, bone scintigraphy, biochemical markers, and plain films have been used to assess bone disorders and bone turnover. Of these, functional imaging is less invasive than bone/marrow sampling, more specific than serum markers and is therefore ideally placed to assess total skeletal metabolism. 18F-sodium fluoride (NaF) PET/CT is an excellent bone-seeking agent superior to conventional bone scan in CKD patients due to its high bone uptake, rapid single-pass extraction, and minimal binding to serum proteins. Due to these properties, 18F-NaF can better assess the skeletal metabolism on primary diagnosis and following treatment in CKD patients. With the increased accessibility of PET scanners, it is likely that PET scanning with bone-specific tracers such as 18F-NaF will be used more regularly for clinical assessment and quantitation of bone kinetics. This article describes the pattern of scintigraphic/functional appearances secondary to musculoskeletal alterations that might occur in patients with CKD.
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Affiliation(s)
- Sharjeel Usmani
- Department of Nuclear Medicine, Kuwait Cancer Control Centre, Kuwait City, Kuwait.
| | - Najeeb Ahmed
- Jack Brignall PET/CT Centre, Castle Hill Hospital, Cottingham, UK.,Cancer Research Group, Hull York Medical School, University of Hull, York, UK
| | | | - Fahad Marafi
- Jaber Al-Ahmad Molecular Imaging Center, Kuwait City, Kuwait
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蒋 韩, 李 珮, 柳 丽, 黄 珊, 李 俊, 吴 唯. [Identification of microRNAs targeting vitamin D receptor and their effect on parathyroid hormone secretion in secondary hyperparathyroidism]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2022; 42:509-517. [PMID: 35527486 PMCID: PMC9085591 DOI: 10.12122/j.issn.1673-4254.2022.04.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To identify the miRNAs targeting vitamin D receptor (VDR) gene and their effect on parathyroid hormone (PTH) secretion in secondary hyperparathyroidism. METHODS Primary parathyroid cells with secondary hyperparathyroidism were isolated by collagenase digestion and cultured. The miRNAs targeting VDR were screened by bioinformatics methods and full transcriptome sequencing, and dual-luciferase reporter assay was used to verify the targeting relationship between VDR and the screened miRNA. The effects of overexpression or inhibition of the candidate miRNA on VDR mRNA and protein expressions and PTH secretion were evaluated using qRT-PCR and Western blotting. The expression levels of the candidate miRNAs and VDR mRNA in clinical specimens of parathyroid tissues were verified by qRT-PCR, and the expression of VDR protein was detected by immunohistochemistry. RESULTS We successfully isolated primary parathyroid cells. Dual-luciferase reporter assay verified the targeting relationship of hsa-miR-149-5p, hsa-miR-221-5p, hsa-miR-222-3p, hsa-miR-29a-5p, hsa-miR-301a-5p, hsa-miR-873-5p, hsa-miR-93-3p with VDR, and among them, the overexpression of hsa-miR-149-5p and hsa-miR-301a-5p significantly increased PTH secretion in the parathyroid cells. In patients with secondary hyperparathyroidism, hsa-miR-149-5p was highly expressed in the parathyroid tissues (P=0.046), where the expressions of VDR mRNA (P=0.0267) and protein were both decreased. CONCLUSION The two miRNAs, hsa-miR-149-5p and hsa-miR-301a-5p, may promote the secretion of PTH in patients with secondary hyperparathyroidism by down-regulating the expression of VDR gene.
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Affiliation(s)
- 韩 蒋
- />中南大学湘雅三医院乳甲外科,湖南 长沙 410013Department of Breast and Thyroid Surgery, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - 珮婷 李
- />中南大学湘雅三医院乳甲外科,湖南 长沙 410013Department of Breast and Thyroid Surgery, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - 丽丹 柳
- />中南大学湘雅三医院乳甲外科,湖南 长沙 410013Department of Breast and Thyroid Surgery, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - 珊 黄
- />中南大学湘雅三医院乳甲外科,湖南 长沙 410013Department of Breast and Thyroid Surgery, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - 俊 李
- />中南大学湘雅三医院乳甲外科,湖南 长沙 410013Department of Breast and Thyroid Surgery, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - 唯 吴
- />中南大学湘雅三医院乳甲外科,湖南 长沙 410013Department of Breast and Thyroid Surgery, Third Xiangya Hospital of Central South University, Changsha 410013, China
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Algossy HK, Albadr F, Aloraini AY, Alsayyar MK, AlHindi AH. Uremic Leontiasis Ossea in a Pediatric Patient. Cureus 2022; 14:e23428. [PMID: 35475039 PMCID: PMC9030664 DOI: 10.7759/cureus.23428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/18/2022] Open
Abstract
Uremic leontiasis ossea (ULO) is a rare disease characterized by extensive thickening of the cranium, resulting in a characteristic, lion-like facial appearance. It is considered the most severe osseous complication of renal dystrophy. Although rare, ULO can occur even in young patients, which can be catastrophic, as it can not only lead to life-threatening conditions but also multiple complications that cause severe determent to the quality of life.
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Hanna RM, Ahdoot RS, Kalantar-Zadeh K, Ghobry L, Kurtz I. Calcium Transport in the Kidney and Disease Processes. Front Endocrinol (Lausanne) 2022; 12:762130. [PMID: 35299844 PMCID: PMC8922474 DOI: 10.3389/fendo.2021.762130] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/25/2021] [Indexed: 11/25/2022] Open
Abstract
Calcium is a key ion involved in cardiac and skeletal muscle contractility, nerve function, and skeletal structure. Global calcium balance is affected by parathyroid hormone and vitamin D, and calcium is shuttled between the extracellular space and the bone matrix compartment dynamically. The kidney plays an important role in whole-body calcium balance. Abnormalities in the kidney transport proteins alter the renal excretion of calcium. Various hormonal and regulatory pathways have evolved that regulate the renal handling of calcium to maintain the serum calcium within defined limits despite dynamic changes in dietary calcium intake. Dysregulation of renal calcium transport can occur pharmacologically, hormonally, and via genetic mutations in key proteins in various nephron segments resulting in several disease processes. This review focuses on the regulation transport of calcium in the nephron. Genetic diseases affecting the renal handling of calcium that can potentially lead to changes in the serum calcium concentration are reviewed.
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Affiliation(s)
- Ramy M. Hanna
- Division of Nephrology, Department of Medicine, University of California Irvine (UCI) School of Medicine, Orange, CA, United States
| | - Rebecca S. Ahdoot
- Division of Nephrology, Department of Medicine, University of California Irvine (UCI) School of Medicine, Orange, CA, United States
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Department of Medicine, University of California Irvine (UCI) School of Medicine, Orange, CA, United States
| | - Lena Ghobry
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ira Kurtz
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, United States
- University of California Los Angeles (UCLA) Brain Research Center, Los Angeles, CA, United States
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Hassan A, Khalaily N, Kilav-Levin R, Nechama M, Volovelsky O, Silver J, Naveh-Many T. Molecular Mechanisms of Parathyroid Disorders in Chronic Kidney Disease. Metabolites 2022; 12:metabo12020111. [PMID: 35208186 PMCID: PMC8878033 DOI: 10.3390/metabo12020111] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 01/27/2023] Open
Abstract
Secondary hyperparathyroidism (SHP) is a common complication of chronic kidney disease (CKD) that induces morbidity and mortality in patients. How CKD stimulates the parathyroid to increase parathyroid hormone (PTH) secretion, gene expression and cell proliferation remains an open question. In experimental SHP, the increased PTH gene expression is post-transcriptional and mediated by PTH mRNA–protein interactions that promote PTH mRNA stability. These interactions are orchestrated by the isomerase Pin1. Pin1 participates in conformational change-based regulation of target proteins, including mRNA-binding proteins. In SHP, Pin1 isomerase activity is decreased, and thus, the Pin1 target and PTH mRNA destabilizing protein KSRP fails to bind PTH mRNA, increasing PTH mRNA stability and levels. An additional level of post-transcriptional regulation is mediated by microRNA (miRNA). Mice with parathyroid-specific knockout of Dicer, which facilitates the final step in miRNA maturation, lack parathyroid miRNAs but have normal PTH and calcium levels. Surprisingly, these mice fail to increase serum PTH in response to hypocalcemia or uremia, indicating a role for miRNAs in parathyroid stimulation. SHP often leads to parathyroid hyperplasia. Reduced expressions of parathyroid regulating receptors, activation of transforming growth factor α-epidermal growth factor receptor, cyclooxygenase 2-prostaglandin E2 and mTOR signaling all contribute to the enhanced parathyroid cell proliferation. Inhibition of mTOR by rapamycin prevents and corrects the increased parathyroid cell proliferation of SHP. This review summarizes the current knowledge on the mechanisms that stimulate the parathyroid cell at multiple levels in SHP.
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Affiliation(s)
- Alia Hassan
- Minerva Center for Bone and Mineral Research, Nephrology Services, Hadassah—Hebrew University Medical Center, Jerusalem 91120, Israel; (A.H.); (N.K.); (R.K.-L.); (J.S.)
| | - Nareman Khalaily
- Minerva Center for Bone and Mineral Research, Nephrology Services, Hadassah—Hebrew University Medical Center, Jerusalem 91120, Israel; (A.H.); (N.K.); (R.K.-L.); (J.S.)
| | - Rachel Kilav-Levin
- Minerva Center for Bone and Mineral Research, Nephrology Services, Hadassah—Hebrew University Medical Center, Jerusalem 91120, Israel; (A.H.); (N.K.); (R.K.-L.); (J.S.)
- Nursing, Jerusalem College of Technology, Jerusalem 91160, Israel
| | - Morris Nechama
- Pediatric Nephrology, Hadassah—Hebrew University Medical Center, Jerusalem 91120, Israel; (M.N.); (O.V.)
- The Wohl Institute for Translational Medicine, Hadassah—Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Oded Volovelsky
- Pediatric Nephrology, Hadassah—Hebrew University Medical Center, Jerusalem 91120, Israel; (M.N.); (O.V.)
- The Wohl Institute for Translational Medicine, Hadassah—Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Justin Silver
- Minerva Center for Bone and Mineral Research, Nephrology Services, Hadassah—Hebrew University Medical Center, Jerusalem 91120, Israel; (A.H.); (N.K.); (R.K.-L.); (J.S.)
| | - Tally Naveh-Many
- Minerva Center for Bone and Mineral Research, Nephrology Services, Hadassah—Hebrew University Medical Center, Jerusalem 91120, Israel; (A.H.); (N.K.); (R.K.-L.); (J.S.)
- The Wohl Institute for Translational Medicine, Hadassah—Hebrew University Medical Center, Jerusalem 91120, Israel
- Correspondence:
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Goodman WG, Ward DT, Martin KJ, Drayer D, Moore C, Xu J, Lai J, Chon Y, Nemeth EF. Activation of the Calcium Receptor by Calcimimetic Agents Is Preserved Despite Modest Attenuating Effects of Hyperphosphatemia. J Am Soc Nephrol 2022; 33:201-212. [PMID: 34732508 PMCID: PMC8763177 DOI: 10.1681/asn.2021060825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/03/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Phosphorus levels in the range seen clinically among patients undergoing dialysis have been reported to attenuate calcium receptor activation and modify parathyroid hormone (PTH) release from isolated parathyroid glands in vitro. Some clinicians and providers of dialysis thus have suggested that calcimimetic agents are ineffective and should not be used to manage secondary hyperparathyroidism among those undergoing dialysis when serum phosphorus concentrations exceed certain threshold levels. METHODS To determine whether hyperphosphatemia diminishes the therapeutic response to calcimimetic agents, we used data from large clinical trials to analyze the effects of etelcalcetide and cinacalcet to lower plasma PTH levels in individuals on hemodialysis who had secondary hyperparathyroidism and varying degrees of hyperphosphatemia. RESULTS Plasma PTH levels declined progressively during 26 weeks of treatment with either etelcalcetide or cinacalcet without regard to the degree of hyperphosphatemia at baseline. However, with each calcimimetic agent, the decreases in PTH from baseline were less at each interval of follow-up during the trials among participants with serum phosphorus levels above one of three prespecified threshold values compared with those with serum phosphorus levels below these thresholds. CONCLUSIONS These in vivo findings are the first in humans to support the idea that hyperphosphatemia attenuates calcium receptor activation by calcium ions and by calcimimetic agents. The effect of hyperphosphatemia on the responsiveness to calcimimetic agents appears relatively modest, however, and unlikely to be significant therapeutically. The efficacy of treatment with calcimimetic agents for lowering plasma PTH levels among those with secondary hyperparathyroidism remains robust despite substantial elevations in serum phosphorus.
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Affiliation(s)
- William G. Goodman
- Nephrology Therapeutic Area, Global Medical Affairs, Amgen, Inc., Thousand Oaks, California
| | - Donald T. Ward
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | | | - Debra Drayer
- Nephrology Therapeutic Area, Global Medical Affairs, Amgen, Inc., Thousand Oaks, California
| | - Carol Moore
- Nephrology Therapeutic Area, Global Medical Affairs, Amgen, Inc., Thousand Oaks, California
| | - Jiahong Xu
- Nephrology Therapeutic Area, Global Medical Affairs, Amgen, Inc., Thousand Oaks, California
| | - James Lai
- Nephrology Therapeutic Area, Global Medical Affairs, Amgen, Inc., Thousand Oaks, California
| | - Yun Chon
- Nephrology Therapeutic Area, Global Medical Affairs, Amgen, Inc., Thousand Oaks, California
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Chen X, Zhao F, Pan WJ, Di JM, Xie WN, Yuan L, Liu Z. Paricalcitol in hemodialysis patients with secondary hyperparathyroidism and its potential benefits. World J Clin Cases 2021; 9:10172-10179. [PMID: 34904087 PMCID: PMC8638032 DOI: 10.12998/wjcc.v9.i33.10172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/12/2021] [Accepted: 10/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Secondary hyperparathyroidism (SHPT) is a common complication in patients with end-stage renal disease and it is also common in hemodialysis patients. SHPT can increase bone fragility and calcification of blood vessels and soft tissues, which greatly increases the risk of death. AIM To discuss the outcome, safety and other potential benefits of paricalcitol injection in hemodialysis patients with SHPT. METHODS We recruited 40 patients who received hemodialysis at our hospital for chronic renal failure with SHPT between March and December 2019. They received paricalcitol injection for 24 wk (starting dose, 0.06-0.08 μg/kg), three times per week. They were followed up at the baseline (week 0), week 4, week 12 and week 24. The primary outcome indicator was the percentage of patients with a > 30% decrease in intact parathyroid hormone (iPTH) levels at week 24 compared with the baseline. The secondary outcome indicators included percentage decrease in iPTH levels at week 24, standard-reaching rate of iPTH (percentage of patients with iPTH down to 130-585 pg/mL), changes in serum levels of calcium (Ca), phosphate (P), Ca × P product, alkaline phosphatase (ALP), creatinine (Cre), hemoglobin (Hb), and C-reactive protein (CRP), and incidence of adverse events (AEs). RESULTS After 24 wk of treatment, iPTH levels decreased significantly (598.88 ± 381.29 pg/mL vs 888.84 ± 376.88 pg/mL, P < 0.05). More than 30% decrease of iPTH was found in 21 of 36 (58.33%) patients. The average decrease in iPTH levels was 32.16 ± 4.33%; the standard-reaching rate of iPTH levels was 66.67% (24/36); and ALP levels decreased significantly compared with the baseline (113.72 ± 41.73 IU/L vs 133.45 ± 56.86 IU/L) (t = 2.798, P < 0.05). There were no significant differences in the serum levels of calcium, Hb, Cre and CRP compared with the baseline (P > 0.05). After 24 wk of treatment, serum P levels decreased compared with the baseline (1.91 ± 0.40 mmol/L vs 2.16 ± 0.66 mmol/L) (t = 2.830, P < 0.05). Ca × P product decreased significantly compared with the baseline (56.38 ± 13.22 mg2/dL2 vs 63.97 ± 20.30 mg2/dL2) (t = 2.717, P < 0.05). No serious adverse events occurred. CONCLUSION Paricalcitol was a safe and effective treatment for hemodialysis patients with SHPT. It decreased serum levels of iPTH, ALP and P and maintained stability of serum Ca levels.
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Affiliation(s)
- Xiu Chen
- Department of Nephrology, The First Affiliated Hospital of Anhui University of Science and Technology (The First People’s Hospital of Huainan), Huainan 232007, Anhui Province, China
| | - Feng Zhao
- Department of Nephrology, The First Affiliated Hospital of Anhui University of Science and Technology (The First People’s Hospital of Huainan), Huainan 232007, Anhui Province, China
| | - Wei-Juan Pan
- Department of Nephrology, The First Affiliated Hospital of Anhui University of Science and Technology (The First People’s Hospital of Huainan), Huainan 232007, Anhui Province, China
| | - Jia-Mei Di
- Department of Nephrology, The First Affiliated Hospital of Anhui University of Science and Technology (The First People’s Hospital of Huainan), Huainan 232007, Anhui Province, China
| | - Wei-Nan Xie
- Department of Nephrology, The First Affiliated Hospital of Anhui University of Science and Technology (The First People’s Hospital of Huainan), Huainan 232007, Anhui Province, China
| | - Ling Yuan
- Department of Nephrology, The First Affiliated Hospital of Anhui University of Science and Technology (The First People’s Hospital of Huainan), Huainan 232007, Anhui Province, China
| | - Zhi Liu
- Department of Nephrology, The First Affiliated Hospital of Anhui University of Science and Technology (The First People’s Hospital of Huainan), Huainan 232007, Anhui Province, China
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12
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Alonso-Perez E, Forné C, Soro M, Valls M, Manganelli AG, Valdivielso JM. Health Care Costs in Patients with and without Secondary Hyperparathyroidism in Spain. Adv Ther 2021; 38:5333-5344. [PMID: 34519948 DOI: 10.1007/s12325-021-01895-4] [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: 06/14/2021] [Accepted: 08/12/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To analyze the economic burden of secondary hyperparathyroidism (sHPT) in Spain by quantifying differences in costs of pharmacological treatments and associated cardiovascular events (CVE) between renal patients with and without sHPT. METHODS We used data collected in the NEFRONA cohort study and obtained treatment and CVE costs from the BOT PLUS database and Hospital Discharge Records in the Spanish Health System (CMBD-H), respectively. We examined data from 2445 renal patients followed during 2 years for chronic kidney disease (CKD) progression and 4 years for CVE, stratifying by presence of sHPT. Patient characteristics, administered treatments and CVE were directly extracted from NEFRONA registries. Dosage for each treatment regimen was assumed based on guidelines and multiplied by official unit costs to obtain treatment costs. Costs of CVE were based on ICD-9-CM. RESULTS Prevalence of sHPT in the cohort was 65.6% (63.6; 67.6). Average yearly pharmacological costs for patients without sHPT were 610.33€, while costs were 1483.17€ for sHPT patients (average increase of 143.0%). Two hundred three patients registered CVE, resulting in 4-year average costs of 582.57€ for non-sHPT patients compared to 941.87€ for sHPT patients (61.7% average increase). Bivariate analyses considering presence of dialysis, hypercalcemia or hyperphosphatemia and stratified by sHPT showed higher costs for sHPT patients. CONCLUSIONS These results show that sHPT is associated with substantially higher costs of both, pharmacological treatments and associated CVEs. Preventing the development of sHPT with early management in the course of CKD could possibly lead to better health outcomes and cost balance for health care systems.
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Affiliation(s)
| | - Carles Forné
- Department of Basic Medical Sciences, University of Lleida, Lleida, Spain
- Heorfy Consulting, Lleida, Spain
| | - Marco Soro
- Vifor Pharma Global HEOR, GPMA, Glattbrugg, Switzerland
| | | | | | - Jose M Valdivielso
- Vascular and Renal Translational Research Group, IRBLleida, Lleida, Spain.
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Weir MR. Managing Anemia across the Stages of Kidney Disease in Those Hyporesponsive to Erythropoiesis-Stimulating Agents. Am J Nephrol 2021; 52:450-466. [PMID: 34280923 DOI: 10.1159/000516901] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/26/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with CKD frequently have anemia that results from iron-restricted erythropoiesis and inflammation. Anemia of CKD is currently managed with iron supplements and erythropoiesis-stimulating agents (ESAs) to promote erythropoiesis and with RBC transfusion in severe cases. Hyporesponse to ESAs, or the need for larger than usual doses to attain a given hemoglobin (Hb) level, is associated with increased morbidity and mortality and presents a pressing clinical challenge, particularly for patients on dialysis. This paper reviews ESA hyporesponse and potential new therapeutic options in the management of anemia of CKD. SUMMARY The most common causes of ESA hyporesponse include iron deficiency and inflammation, and to a lesser degree, secondary hyperparathyroidism, inadequate dialysis, malnutrition, and concomitant medications. Management of ESA hyporesponse is multipronged and involves treating low level infections, ensuring adequate nutrition, and optimizing iron status and dialysis modality, although some patients can remain refractory. Inflammation directly increases production and secretion of hepcidin, contributes to an impaired response to hypoxia, and suppresses proliferation of erythroid progenitors. Coordination of renal and hepatic erythropoietin (EPO) production and iron metabolism is under the control of hypoxia-inducible factors (HIF), which are in turn regulated by HIF-prolyl hydroxylases (HIF-PHs). HIF-PHs and hepcidin are therefore attractive potential drug targets particularly in patients with ESA hyporesponse. Several oral HIF-PH inhibitors have been evaluated in patients with anemia of CKD and have been shown to increase Hb and reduce hepcidin regardless of inflammation, iron status, or dialysis modality. These sustained effects are achieved through more modest increases in endogenous EPO compared with ESAs. Key Messages: Treatments that address ESA hyporesponse remain a significant unmet clinical need in patients with anemia of CKD. New therapies such as HIF-PH inhibitors have the potential to address fundamental aspects of ESA hyporesponse and provide a new therapeutic option in these patients.
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Affiliation(s)
- Matthew R Weir
- Division of Nephrology, University of Maryland Medical Center, Baltimore, Maryland, USA
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Karaboyas A, Muenz D, Fuller DS, Desai P, Lin TC, Robinson BM, Rossetti S, Pisoni RL. Etelcalcetide Utilization, Dosing Titration, and Chronic Kidney Disease-Mineral and Bone Disease (CKD-MBD) Marker Responses in US Hemodialysis Patients. Am J Kidney Dis 2021; 79:362-373. [PMID: 34273436 DOI: 10.1053/j.ajkd.2021.05.020] [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] [Received: 07/13/2020] [Accepted: 05/23/2021] [Indexed: 01/09/2023]
Abstract
RATIONALE AND OBJECTIVE Clinical trial data have demonstrated the efficacy of etelcalcetide for reducing parathyroid hormone (PTH) levels in hemodialysis (HD) patients. We provide a real-world summary of etelcalcetide utilization, dosing, effectiveness, and discontinuation since its US introduction in April 2017. STUDY DESIGN New-user design within prospective cohort. SETTING PARTICIPANTS 2596 new users of etelcalcetide from April 2017 through August 2019 in a national sample of adult, chronic HD patients in the US Dialysis Outcomes and Practice Patterns Study (DOPPS). PREDICTORS Baseline PTH, prior cinacalcet use, initial etelcalcetide dose. OUTCOME(S) Trajectories of etelcalcetide dose, use of mineral bone disorder (MBD) medications, and levels of PTH, serum calcium, and phosphorus in the 12 months following etelcalcetide initiation. ANALYTICAL APPROACH Cumulative incidence methods for etelcalcetide discontinuation and linear generalized estimating equations for trajectory analyses. RESULTS By August 2019 etelcalcetide prescriptions increased to 6% of HD patients from their first use in April 2017. Starting etelcalcetide dose was 15 mg/week in 70% of patients and 7.5 mg/week in 27% of patients; 49% of new users were prescribed cinacalcet in the prior 3 months. Etelcalcetide discontinuation was 9%, 17%, and 27% by 3, 6, and 12 months post-initiation. One year after etelcalcetide initiation, mean PTH levels declined by 40%, from 948 to 566 pg/mL, and the proportion of patients with PTH within target (150-599 pg/mL) increased from 33% to 64% overall, from 0% to 60% among patients with baseline PTH ≥600 pg/mL, and from 30% to 63% among patients with prior cinacalcet use. The proportion of patients with serum phosphorus >5.5 mg/dL decreased from 55% to 45%, while the prevalence of albumin-corrected serum calcium <7.5 mg/dL remained at 1%-2%. Use of active vitamin D (from 77% to 87%) and Ca-based phosphate binders (from 41% to 50%) increased in the 12 months following etelcalcetide initiation. LIMITATIONS Data unavailable for provider dosing protocols, dose holds, or reasons for discontinuation. CONCLUSIONS In the 12 months following etelcalcetide initiation, patients had large and sustained reductions in PTH levels. These results support the utility of etelcalcetide as an effective therapy to achieve the KDIGO recommended guidelines for CKD-MBD markers in HD patients.
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Affiliation(s)
| | - Daniel Muenz
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
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Santos F, Díaz-Anadón L, Ordóñez FA, Haffner D. Bone Disease in CKD in Children. Calcif Tissue Int 2021; 108:423-438. [PMID: 33452890 DOI: 10.1007/s00223-020-00787-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/04/2020] [Indexed: 01/03/2023]
Abstract
This manuscript discusses mineral and bone disorders of chronic kidney disease (MBD-CKD) in pediatric patients with special emphasis on the underlying pathophysiology, the causes and clinical profile of growth retardation, the alterations in the growth plate, the strategies to optimize growth and the medical recommendations for prevention and treatment.
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Affiliation(s)
- Fernando Santos
- Division of Pediatric Nephrology, Hospital, Universitario Central de Asturias, Avda de Roma s/n, 33011, Oviedo, Asturias, Spain.
- Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain.
| | - Lucas Díaz-Anadón
- Division of Pediatric Nephrology, Hospital, Universitario Central de Asturias, Avda de Roma s/n, 33011, Oviedo, Asturias, Spain
| | - Flor A Ordóñez
- Division of Pediatric Nephrology, Hospital, Universitario Central de Asturias, Avda de Roma s/n, 33011, Oviedo, Asturias, Spain
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
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Mary A, Objois T, Brazier M, Bennis Y, Boudot C, Lenglet G, Paccou J, Bugnicourt JM, Choukroun G, Drueke TB, Massy ZA, Kamel S, Six I, Mentaverri R. Decreased monocyte calcium sensing receptor expression in patients with chronic kidney disease is associated with impaired monocyte ability to reduce vascular calcification. Kidney Int 2021; 99:1382-1391. [PMID: 33647324 DOI: 10.1016/j.kint.2021.01.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 12/23/2020] [Accepted: 01/21/2021] [Indexed: 12/31/2022]
Abstract
In chronic kidney disease (CKD), calcium-sensing receptor (CaSR) expression and function have been extensively studied in parathyroid tissue and vascular tissues. To examine whether similar changes occurred in other tissues, we measured total and surface CaSR expression in monocytes of patients with various stages of CKD and healthy volunteers respectively in cross-sectional studies. We further explored in vitro the impact of uremic serum on CaSR expression in monocytes (U937 and THP-1 cell lines), and whether human peripheral blood mononuclear cells or U937 and THP-1 monocytes might modify vascular calcium deposition in rat carotid arteries in vitro. CKD was associated with a decrease in peripheral blood mononuclear cell CaSR expression both in total and at the monocyte surface alone (43% and 34%, respectively in CKD stages 4-5). This decrease was associated with a reduction in the ability of monocytes to inhibit vascular calcification in vitro. Pretreatment with the calcimimetic NPSR568 of peripheral blood mononuclear cells isolated from patients with CKD significantly improved monocyte capacity to reduce carotid calcification in vitro. The fewer peripheral blood mononuclear cells expressing cell surface CaSR, the more calcimimetic treatment enhanced the decrease of carotid calcium content. Thus, we demonstrate that monocyte CaSR expression is decreased in patients with CKD and provide in vitro evidence for a potential role of this decrease in the promotion of vascular calcification. Hence, targeting this alteration or following monocyte CaSR expression as an accessible marker might represent a promising therapeutic strategy in CKD-associated arterial calcification.
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Affiliation(s)
- Aurélien Mary
- Research Unit 7517, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV), University of Picardie Jules Verne, Amiens, France; Clinical Pharmacy Department, Amiens University Hospital, Amiens, France.
| | - Thibaut Objois
- Research Unit 7517, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV), University of Picardie Jules Verne, Amiens, France
| | - Michel Brazier
- Research Unit 7517, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV), University of Picardie Jules Verne, Amiens, France; Human Biology Centre, Amiens University Hospital, Amiens, France
| | - Youssef Bennis
- Research Unit 7517, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV), University of Picardie Jules Verne, Amiens, France; Human Biology Centre, Amiens University Hospital, Amiens, France
| | - Cédric Boudot
- Research Unit 7517, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV), University of Picardie Jules Verne, Amiens, France
| | - Gaëlle Lenglet
- Research Unit 7517, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV), University of Picardie Jules Verne, Amiens, France
| | - Julien Paccou
- Department of Rheumatology, University Lille, Lille University Hospital, Research Unit 4490 MABLab, Lille, France; Rheumatology, Lille University Hospital, Lille, France
| | - Jean-Marc Bugnicourt
- Research Unit 7517, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV), University of Picardie Jules Verne, Amiens, France
| | - Gabriel Choukroun
- Research Unit 7517, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV), University of Picardie Jules Verne, Amiens, France; Nephrology, Amiens University Hospital, Amiens, France
| | - Tilman B Drueke
- Institut National de la Santé et de la Recherche Médicale U-1018, Research Centre in Epidemiology and Population Health, Team 5, Villejuif Hospital, France
| | - Ziad A Massy
- Institut National de la Santé et de la Recherche Médicale U-1018, Research Centre in Epidemiology and Population Health, Team 5, Villejuif Hospital, France; Nephrology, Ambroise Paré Hospital, Boulogne-Billancourt, France; Versailles Saint-Quentin-en-Yvelines University, Paris-Ile-de-France-Ouest, Versailles, France
| | - Saïd Kamel
- Research Unit 7517, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV), University of Picardie Jules Verne, Amiens, France; Human Biology Centre, Amiens University Hospital, Amiens, France
| | - Isabelle Six
- Research Unit 7517, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV), University of Picardie Jules Verne, Amiens, France
| | - Romuald Mentaverri
- Research Unit 7517, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV), University of Picardie Jules Verne, Amiens, France; Human Biology Centre, Amiens University Hospital, Amiens, France
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Bushinsky DA, Chertow GM, Cheng S, Deng H, Kopyt N, Martin KJ, Rastogi A, Ureña-Torres P, Vervloet M, Block GA. One-year safety and efficacy of intravenous etelcalcetide in patients on hemodialysis with secondary hyperparathyroidism. Nephrol Dial Transplant 2020; 35:1769-1778. [PMID: 30859218 PMCID: PMC7538239 DOI: 10.1093/ndt/gfz039] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/21/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Secondary hyperparathyroidism (sHPT), a common complication of chronic kidney disease, is characterized by elevated serum parathyroid hormone (PTH). Etelcalcetide is an intravenous calcimimetic that increases sensitivity of the calcium-sensing receptor to calcium and decreases PTH secretion. This open-label extension (OLE) trial evaluated the long-term effects of etelcalcetide for sHPT treatment in patients receiving hemodialysis. METHODS This 52-week, multicenter, single-arm OLE enrolled patients from three parent trials: two randomized, double-blind, placebo-controlled trials and one open-label, single-arm, 'switch' study from cinacalcet to etelcalcetide. The primary endpoint was to investigate the nature, frequency, severity and relation to treatment of all adverse events (AEs) reported throughout the trial. Secondary endpoints included the proportion of patients with >30% reduction from baseline in PTH and the percentage change from baseline in PTH, albumin-corrected calcium (Ca), phosphate (P) and the calcium-phosphate product (Ca × P).ClinicalTrials.gov identifier: NCT01785875; Amgen study: 20120231. RESULTS Overall, 89.8% of the patients experienced one or more treatment-emergent AE. The most common were decreased blood Ca (43.3%), diarrhea (10.8%), vomiting (10.4%) and nausea (9.6%); symptomatic hypocalcemia occurred in 3.7% of the patients. Approximately 68% of patients achieved >30% reduction in PTH, and ∼56% achieved PTH ≤300 pg/mL. Mean percent changes from baseline ranged from -25.4% to -26.1% for PTH, -8.3% to -9.1% for Ca, -3.6% to -4.1% for P and -12.0% to -12.6% for Ca × P. CONCLUSIONS Etelcalcetide effectively lowered PTH and its effect was sustained, while no new safety concerns emerged over a 1-year treatment period.
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Affiliation(s)
- David A Bushinsky
- Department of Medicine, Division of Nephrology, University of Rochester School of Medicine, Rochester, NY, USA
| | - Glenn M Chertow
- Department of Medicine, Division of Nephrology, Stanford University, Stanford, CA, USA
| | - Sunfa Cheng
- Clinical Development, Amgen Inc., Thousand Oaks, CA, USA
| | - Hongjie Deng
- Biostatistics, Amgen Inc., Thousand Oaks, CA, USA
| | - Nelson Kopyt
- Department of Medicine, Division of Nephrology, Lehigh Valley Hospital, Allentown, PA, USA
| | - Kevin J Martin
- Department of Internal Medicine, Division of Nephrology, Saint Louis University School of Medicine, St Louis, MO, USA
| | - Anjay Rastogi
- Department of Medicine, Division of Nephrology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Pablo Ureña-Torres
- Department of Nephrology and Dialysis, Ramsay-Générale de Santé, Clinique du Landy, Saint Ouen, France and Necker Hospital, University of Paris Descartes, Paris, France
| | - Marc Vervloet
- Department of Nephrology and Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, The Netherlands
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Shikida Y, Mizobuchi M, Yoshitake O, Kato T, Ogata H, Koiwa F, Honda H. Lower soluble Klotho levels in the pretransplant period are associated with an increased risk of renal function decline in renal transplant patients. Ther Apher Dial 2020; 25:331-340. [PMID: 33405323 DOI: 10.1111/1744-9987.13578] [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: 04/02/2020] [Revised: 07/15/2020] [Accepted: 08/14/2020] [Indexed: 11/28/2022]
Abstract
Serum soluble Klotho levels are associated with renal function in predialysis patients with chronic kidney disease. However, few reports exist regarding the association between soluble Klotho levels and renal function in kidney transplant (KTx) recipients. This was a retrospective observational study of 41 living KTx recipients. The serum soluble Klotho levels were classed as "high" (>456 pg/mL [i.e., high-Klotho group]) or "low" (≤456 pg/mL [i.e., low-Klotho group]). Renal function decline was defined as a decrease in the estimated glomerular filtration rate (eGFR) of 30% or more from the baseline value within 3 months after KTx. A multivariable time-to-event analysis between the groups was conducted. Among the KTx recipients, the incidence of a 30% decrease in the eGFR was significantly higher in the low-Klotho group than in the high-Klotho group (P = .036). After adjusting for donor age, donor sex, the presence of rejection, and the number of cytomegalovirus infections, multivariable Cox models revealed that low soluble Klotho levels remained associated with a higher risk of a 30% decrease in the eGFR (hazard ratio, 2.38; 95% confidence interval, 1.02-6.41). These findings suggested that lower soluble Klotho levels in the pre-KTx period are associated with an increased risk of renal function decline in KTx recipients.
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Affiliation(s)
- Yasuto Shikida
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Masahide Mizobuchi
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Osamu Yoshitake
- Division of Gastroenterological and General Surgery, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tadashi Kato
- Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Hiroaki Ogata
- Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Fumihiko Koiwa
- Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Hirokazu Honda
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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Warady BA, Ng E, Bloss L, Mo M, Schaefer F, Bacchetta J. Cinacalcet studies in pediatric subjects with secondary hyperparathyroidism receiving dialysis. Pediatr Nephrol 2020; 35:1679-1697. [PMID: 32367309 PMCID: PMC7385021 DOI: 10.1007/s00467-020-04516-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Secondary hyperparathyroidism (sHPT), a complication of chronic kidney disease (CKD) characterized by persistently elevated parathyroid hormone (PTH), alterations in calcium-phosphorus homeostasis, and vitamin D metabolism, affects 50% of children receiving dialysis. A significant proportion of these children develop CKD-mineral and bone disorder (CKD-MBD), associated with an increased risk of fractures and vascular calcification. The standard of care for sHPT in children includes vitamin D sterols, calcium supplementation, and phosphate binders. Several agents are approved for sHPT treatment in adults undergoing dialysis, including vitamin D analogs and calcimimetics, with limited information on their safety and efficacy in children. The calcimimetic cinacalcet is approved for use in adults with sHPT on dialysis, but is not approved for pediatric use outside Europe. METHODS This review provides dosing, safety, and efficacy information from Amgen-sponsored cinacalcet pediatric trials and data from non-Amgen sponsored clinical studies. RESULTS The Amgen cinacalcet pediatric clinical development program consisted of two Phase 3 randomized studies, one Phase 3 single arm extension study, one open-label Phase 2 study, and two open-label Phase 1 studies. Effects of cinacalcet on PTH varied across studies. Overall, 7.4 to 57.1% of subjects who received cinacalcet in an Amgen clinical trial attained PTH levels within recommended target ranges and 22.2 to 70.6% observed a ≥ 30% reduction in PTH. In addition, significant reductions in PTH were demonstrated in all non-Amgen-supported studies. CONCLUSIONS To help inform the pediatric nephrology community, this manuscript contains the most comprehensive review of cinacalcet usage in pediatric CKD patients to date.
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Affiliation(s)
- Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA.
| | - Eric Ng
- Amgen Inc., Thousand Oaks, CA, USA
| | | | - May Mo
- Amgen Inc., Thousand Oaks, CA, USA
| | | | - Justine Bacchetta
- Department of Pediatric Nephrology, Rheumatology and Dermatology, Femme Mère Enfant Hospital, Bron, France
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Basu C, Ma X, Mo M, Xia HA, Brundage R, Al-Kofahi M, Carlin BP. Pharmacokinetic/pharmacodynamic data extrapolation models for improved pediatric efficacy and toxicity estimation, with application to secondary hyperparathyroidism. Pharm Stat 2020; 19:882-896. [PMID: 32648333 DOI: 10.1002/pst.2043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 03/21/2020] [Accepted: 05/23/2020] [Indexed: 11/05/2022]
Abstract
In most drug development settings, the regulatory approval process is accompanied by extensive studies performed to understand the drug's pharmacokinetic (PK) and pharmacodynamic (PD) properties. In this article, we attempt to utilize the rich PK/PD data to inform the borrowing of information from adults during pediatric drug development. In pediatric settings, it is especially crucial that we are parsimonious with the patients recruited for experimentation. We illustrate our approaches in the context of clinical trials of cinacalcet for treating secondary hyperparathyroidism in pediatric and adult patients with chronic kidney disease, where we model both parathyroid hormone (efficacy endpoint) and corrected calcium levels (safety endpoint). We use population PK/PD modeling of the cinacalcet data to quantitatively assess the similarity between adults and children, and use this information in various hierarchical Bayesian adult borrowing rules whose statistical properties can then be evaluated. In particular, we simulate the bias and mean square error performance of our approaches in settings where borrowing is and is not warranted to inform guidelines for the future use of our methods.
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Affiliation(s)
| | - Xiaoye Ma
- Genentech Inc., San Francisco, California, USA
| | - May Mo
- Amgen Inc., Thousand Oaks, California, USA
| | | | - Richard Brundage
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mahmoud Al-Kofahi
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
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Naveh-Many T, Volovelsky O. Parathyroid Cell Proliferation in Secondary Hyperparathyroidism of Chronic Kidney Disease. Int J Mol Sci 2020; 21:ijms21124332. [PMID: 32570711 PMCID: PMC7352987 DOI: 10.3390/ijms21124332] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 12/12/2022] Open
Abstract
Secondary hyperparathyroidism (SHP) is a common complication of chronic kidney disease (CKD) that correlates with morbidity and mortality in uremic patients. It is characterized by high serum parathyroid hormone (PTH) levels and impaired bone and mineral metabolism. The main mechanisms underlying SHP are increased PTH biosynthesis and secretion as well as increased glandular mass. The mechanisms leading to parathyroid cell proliferation in SHP are not fully understood. Reduced expressions of the receptors for calcium and vitamin D contribute to the disinhibition of parathyroid cell proliferation. Activation of transforming growth factor-α-epidermal growth factor receptor (TGF-α-EGFR), nuclear factor kappa B (NF-kB), and cyclooxygenase 2- prostaglandin E2 (Cox2-PGE2) signaling all correlate with parathyroid cell proliferation, underlining their roles in the development of SHP. In addition, the mammalian target of rapamycin (mTOR) pathway is activated in parathyroid glands of experimental SHP rats. Inhibition of mTOR by rapamycin prevents and corrects the increased parathyroid cell proliferation of SHP. Mice with parathyroid-specific deletion of all miRNAs have a muted increase in serum PTH and fail to increase parathyroid cell proliferation when challenged by CKD, suggesting that miRNA is also necessary for the development of SHP. This review summarizes the current knowledge on the mechanisms of parathyroid cell proliferation in SHP.
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Affiliation(s)
- Tally Naveh-Many
- Minerva Center for Calcium and Bone Metabolism, Nephrology Services, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel;
- The Wohl Institute for Translational Medicine, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Oded Volovelsky
- The Wohl Institute for Translational Medicine, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel
- Pediatric Nephrology Unit and Research Lab, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel
- Correspondence: ; Tel.: +972-26777213
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22
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Cozzolino M, Shilov E, Li Z, Fukagawa M, Al-Ghamdi SMG, Pisoni R, Bieber B, Vallabh B, Chand DH. Pattern of Laboratory Parameters and Management of Secondary Hyperparathyroidism in Countries of Europe, Asia, the Middle East, and North America. Adv Ther 2020; 37:2748-2762. [PMID: 32410164 PMCID: PMC7467455 DOI: 10.1007/s12325-020-01359-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION This analysis explored laboratory mineral and bone disorder parameters and management of secondary hyperparathyroidism in patients undergoing hemodialysis in Belgium, Canada, China, France, Germany, Italy, Japan, Russia, Saudi Arabia, Spain, Sweden, the UK, and the USA. METHODS Analyses used demographic, medication, and laboratory data collected in the prospective Dialysis Outcomes and Practice Patterns Study (2012-2015). The analysis included 20,612 patients in 543 facilities. Descriptive data are presented as regional mean (standard deviation), median (interquartile range), or prevalence, weighted for facility sampling fraction. No testing of statistical hypotheses was conducted. RESULTS The frequency of serum intact parathyroid hormone levels > 600 pg/mL was lowest in Japan (1%) and highest in Russia (30%) and Saudi Arabia (27%). The frequency of serum phosphorus levels > 7.0 mg/dL was lowest in France (4%), the UK (6%), and Spain (6%), and highest in China (27%). The frequency of serum calcium levels > 10.0 mg/dL was highest in the UK (14%) and China (13%) versus 2% to 9% elsewhere. Dialysate calcium concentrations of 2.5 mEq/mL were common in the USA (78%) and Canada (71%); concentrations of 3.0-3.5 mEq/L were almost universal at facilities in Italy, France, and Saudi Arabia (each ≥ 99%). CONCLUSIONS Wide international variation in mineral and bone disorder laboratory parameters and management practices related to secondary hyperparathyroidism suggests opportunities for optimizing care.
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Affiliation(s)
- Mario Cozzolino
- Renal Division, Department of Health Sciences, University of Milan, ASST Santi Paolo E Carlo, Milan, Italy.
| | - Eugeniy Shilov
- I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Zuo Li
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Saeed M G Al-Ghamdi
- Department of Medicine, College of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Ronald Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
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Schappacher-Tilp G, Cherif A, Fuertinger DH, Bushinsky D, Kotanko P. A mathematical model of parathyroid gland biology. Physiol Rep 2020; 7:e14045. [PMID: 30927339 PMCID: PMC6440916 DOI: 10.14814/phy2.14045] [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: 10/29/2018] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/24/2022] Open
Abstract
Altered parathyroid gland biology in patients with chronic kidney disease (CKD) is a major contributor to chronic kidney disease-mineral bone disorder (CKD-MBD). This disorder is associated with an increased risk of bone disorders, vascular calcification, and cardiovascular events. Parathyroid hormone (PTH) secretion is primarily regulated by the ionized calcium concentration as well as the phosphate concentration in the extracellular fluid and vitamin D. The metabolic disturbances in patients with CKD lead to alterations in the parathyroid gland biology. A hallmark of CKD is secondary hyperparathyroidism, characterized by an increased production and release of PTH, reduced expression of calcium-sensing and vitamin D receptors on the surface of parathyroid cells, and hyperplasia and hypertrophy of these cells. These alterations happen on different timescales and influence each other, thereby triggering a cascade of negative and positive feedback loops in a highly complex manner. Due to this complexity, mathematical models are a useful tool to break down the patterns of the multidimensional cascade of processes enabling the detailed study of subsystems. Here, we introduce a comprehensive mathematical model that includes the major adaptive mechanisms governing the production, secretion, and degradation of PTH in patients with CKD on hemodialysis. Combined with models for medications targeting the parathyroid gland, it provides a ready-to-use tool to explore treatment strategies. While the model is of particular interest for use in hemodialysis patients with secondary hyperparathyroidism, it has the potential to be applicable to other clinical scenarios such as primary hyperparathyroidism or hypo- and hypercalcemia.
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Affiliation(s)
| | - Alhaji Cherif
- Renal Research Institute, New York City, New York.,School of Mathematical and Statistical Sciences, Arizona State University, Tempe, Arizona
| | - Doris H Fuertinger
- Global Research and Development, Fresenius Medical Care Germany, Bad Homburg, Germany
| | - David Bushinsky
- Division of Nephrology, Department of Medicine, University of Rochester School of Medicine, Rochester, New York
| | - Peter Kotanko
- Renal Research Institute, New York City, New York.,Icahn School of Medicine at Mount Sinai, New York City, New York
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24
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Kilav-Levin R, Hassan A, Nechama M, Shilo V, Silver J, Ben-Dov IZ, Naveh-Many T. Post-transcriptional mechanisms regulating parathyroid hormone gene expression in secondary hyperparathyroidism. FEBS J 2020; 287:2903-2913. [PMID: 32191397 DOI: 10.1111/febs.15300] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/10/2019] [Accepted: 03/17/2020] [Indexed: 12/11/2022]
Abstract
Parathyroid hormone (PTH) regulates serum calcium levels and bone strength. Secondary hyperparathyroidism (SHP) is a common complication of chronic kidney disease (CKD) that correlates with morbidity and mortality. In experimental SHP, the increased PTH gene expression is due to increased PTH mRNA stability and is mediated by protein-PTH mRNA interactions. Adenosine-uridine-rich binding factor 1 (AUF1) stabilizes and K-homology splicing regulatory protein (KSRP) destabilizes PTH mRNA. The peptidyl-prolyl cis/trans isomerase Pin1 acts on target proteins, including mRNA-binding proteins. Pin1 leads to KSRP dephosphorylation, but in SHP, parathyroid Pin1 activity is decreased and phosphorylated KSRP fails to bind PTH mRNA, leading to increased PTH mRNA stability and levels. A further level of post-transcriptional regulation occurs through microRNA (miRNA). Dicer mediates the final step of miRNA maturation. Parathyroid-specific Dicer knockout mice that lack miRNAs in the parathyroid develop normally. Surprisingly, these mice fail to increase serum PTH in response to both hypocalcemia and CKD, indicating that parathyroid Dicer and miRNAs are essential for stimulation of the parathyroid. Human and rodent parathyroids share similar miRNA profiles that are altered in hyperparathyroidism. The evolutionary conservation of abundant miRNAs and their regulation in hyperparathyroidism indicate their significance in parathyroid physiology and pathophysiology. let-7 and miR-148 antagonism modifies PTH secretion in vivo and in vitro, suggesting roles for specific miRNAs in parathyroid function. This review summarizes the current knowledge on the post-transcriptional mechanisms of PTH gene expression in SHP and the central contribution of miRNAs to the high serum PTH levels of both primary hyperparathyroidism and SHP.
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Affiliation(s)
- Rachel Kilav-Levin
- Minerva Center for Bone and Mineral Research, Nephrology Services, Hadassah - Hebrew University Medical Center, Jerusalem, Israel.,Nursing, Jerusalem College of Technology, Israel
| | - Alia Hassan
- Minerva Center for Bone and Mineral Research, Nephrology Services, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Morris Nechama
- Minerva Center for Bone and Mineral Research, Nephrology Services, Hadassah - Hebrew University Medical Center, Jerusalem, Israel.,Pediatric Nephrology, Hadassah - Hebrew University Medical Center, Jerusalem, Israel.,The Wohl Institute for Translational Medicine, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Vitali Shilo
- Minerva Center for Bone and Mineral Research, Nephrology Services, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Justin Silver
- Minerva Center for Bone and Mineral Research, Nephrology Services, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Iddo Z Ben-Dov
- Laboratory of Medical Transcriptomics, Nephrology Services, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Tally Naveh-Many
- Minerva Center for Bone and Mineral Research, Nephrology Services, Hadassah - Hebrew University Medical Center, Jerusalem, Israel.,The Wohl Institute for Translational Medicine, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
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25
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Bures C, Skachko T, Dobrindt EM, Pratschke J, Uluk D, Mogl MT. Is There a Gender Difference in Clinical Presentation of Renal Hyperparathyroidism and Outcome after Parathyroidectomy? Visc Med 2020; 36:34-40. [PMID: 32110655 DOI: 10.1159/000505501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 12/17/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Gender has been proven to influence the pathophysiology and treatment of numerous diseases, including kidney diseases and hormonal dysfunction like hyperparathyroidism. Thus, higher parathormone levels have been demonstrated in women with end-stage kidney disease, when compared to men. Objectives We questioned whether female gender is associated with an increased risk for parathyroid nodular hyperplasia and necessary parathyroidectomy in dialysis patients and assessed demographics as well as outcome data for women and men undergoing parathyroidectomy for renal hyperparathyroidism. Patients and Methods One hundred and thirty patients (men = 75, female = 55) with end-stage renal disease on chronic dialysis and advanced secondary hyperparathyroidism who underwent parathyroidectomy between 2008 and 2014 at our center were analyzed retrospectively. Perioperative characteristics and short-term outcome were evaluated with respect to biological gender. Results No differences could be demonstrated for patient demography, comorbidities and the perioperative course between males and females. Only preoperative calcium levels were lower in female than in male patients (2.3 ± 0.19 vs. 2.3 ± 0.26, p = 0.04). There were more women, however, with cerebrovascular complications during follow-up (p = 0.04). There was no postoperative mortality, and all complications and comorbidities with exception of cerebrovascular diseases were equally distributed between female and male patients. Conclusion Overall, we could not demonstrate many significant differences between male and female patients with end-stage renal diseases, chronic dialysis and operated secondary hyperparathyroidism. Only preoperative electrolyte levels were higher in male than in female patients, and cerebrovascular complications developed more often in females than in males during long-term follow-up.
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Affiliation(s)
- Claudia Bures
- Department of Surgery, Campus Charité Mitte/Campus Virchow-Klinikum, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tatjana Skachko
- Department of Surgery, Campus Charité Mitte/Campus Virchow-Klinikum, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eva M Dobrindt
- Department of Surgery, Campus Charité Mitte/Campus Virchow-Klinikum, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte/Campus Virchow-Klinikum, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Deniz Uluk
- Department of Surgery, Campus Charité Mitte/Campus Virchow-Klinikum, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martina T Mogl
- Department of Surgery, Campus Charité Mitte/Campus Virchow-Klinikum, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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26
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Pazianas M, Miller PD. Current Understanding of Mineral and Bone Disorders of Chronic Kidney Disease and the Scientific Grounds on the Use of Exogenous Parathyroid Hormone in Its Management. J Bone Metab 2020; 27:1-13. [PMID: 32190604 PMCID: PMC7064365 DOI: 10.11005/jbm.2020.27.1.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 12/31/2019] [Indexed: 12/11/2022] Open
Abstract
Chronic Kidney disease (CKD) disturbs mineral homeostasis leading to mineral and bone disorders (MBD). Serum calcium and phosphate (Pi) remain normal until the late stages of CKD at the expense of elevate fibroblast growth factor-23 (FGF-23), a phosphaturic hormone, followed by reduced 1,25-dihydroxy-vitamin D (1,25[OH]2D) and finally elevated parathyroid hormone (PTH). Pi retention is thought to be the initial cause of CKD-MBD. The management of MBD is a huge clinical challenge because the effectiveness of current therapeutic regimens to prevent and treat MBD is limited. An intermittent regimen of PTH, when administered at the early stages of CKD, through its phosphaturic action, could prevent FGF-23 increases, the drop of 1,25(OH)2D, and the development of renal osteodystrophy, including secondary hyperparathyroidism (HPT) and its catabolic effects on the skeleton. Even in more advanced stages of CKD that have not progressed to tertiary HPT, could be beneficial. Therapeutic effects could be achieved in vascular calcification as well. Limited experimental/clinical data support the effectiveness of PTH in CKD-MBD. Its safety, has been established only when it is used for the treatment of osteoporosis, including patients with CKD. The proposed intermittent PTH administration is biologically plausible but its effectiveness and safety has to be critically assessed in long term prospective studies in patients with CKD-MBD.
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Affiliation(s)
- Michael Pazianas
- Institute of Musculoskeletal Sciences, Oxford University, Oxford, United Kingdom
| | - Paul Dennis Miller
- University of Colorado Health Sciences Center, Denver, CO, USA.,Colorado Center for Bone Research, Golden, CO, USA
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Disputable Issues of Etiology and Pathogenesis of Tertiary Hyperparathyroidism. ACTA BIOMEDICA SCIENTIFICA 2019. [DOI: 10.29413/abs.2019-4.5.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Hyperparathyroidism is a clinical and laboratory syndrome characterized by high production of the chief cells of the parathyroid hormone, a calcium-phosphorus metabolism disorder and the organ failure (kidneys, bone tissue).There are primary, secondary and tertiary hyperparathyroidism.This literature review is focused on tertiary hyperparathyroidism and includes the following sections: definition of different forms of hyperparathyroidism, the role of vitamin D in the tertiary hyperparathyroidism development, the development of tertiary hyperparathyroidism in chronic kidney disease patients, the development of tertiary hyperparathyroidism in patients after kidney transplantation, differential diagnosis various forms of hyperparathyroidism, indications for surgical tertiary hyperparathyroidism treatment in patients with kidney disease, in patients with normal kidney function.Objective. The objective of this literature review is to study the current information about this definition, pathogenesis, diagnosis and treatment of tertiary hyperparathyroidism.Methodology. The literature review was taken in English data bases MEDLINE (Pubmed), Scopus, Cochlear library, using following keywords: “secondary hyperparathyroidism pathogenesis diagnosis treatment”, “tertiary hyperparathyroidism pathogenesis diagnosis treatment”, “development of tertiary hyperparathyroidism from secondary hyperparathyroidism”, “chronic vitamin D deficiency, hyperparathyroidism”, “early stages of chronic renal failure, hyperparathyroidism”. Also, search for the same keywords was completed in Russian data base Elibrary.Discussion. Both the lack of a common understanding of this problem, and the presence of diverse and contradictory data of the etiology and pathogenesis indicate the need for further study of tertiary hyperparathyroidism.
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Li L, Chen C, Cai N, Yi J, Zheng C, Feng Y, Xiong W, Luo X, Li W, Cheng Z. An improved LC–MS/MS method for determination of cinacalcet in human plasma and its application to the evaluation of food intake effect on the pharmacokinetics of cinacalcet in healthy volunteers. Biomed Chromatogr 2019; 33:e4631. [DOI: 10.1002/bmc.4631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/16/2019] [Accepted: 06/24/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Lin‐ling Li
- School of Xiangya Pharmaceutical SciencesCentral South University Changsha Hunan China
| | | | - Ning‐fang Cai
- Xiamen Key Laboratory of Neonatal Diseases, Xiamen Children's Hospital Xiamen Fujian China
| | | | - Chao Zheng
- The first affiliated hospitalSchool of Medicine, Xiamen university Xiamen Fujian China
| | - Yan Feng
- AccuBE PharmaTech Xiamen Fujian China
| | | | - Xi Luo
- The first affiliated hospitalSchool of Medicine, Xiamen university Xiamen Fujian China
| | - Wei‐hua Li
- The first affiliated hospitalSchool of Medicine, Xiamen university Xiamen Fujian China
| | - Ze‐neng Cheng
- School of Xiangya Pharmaceutical SciencesCentral South University Changsha Hunan China
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Chen P, Sohn W, Narayanan A, Gisleskog PO, Melhem M. Bridging adults and paediatrics with secondary hyperparathyroidism receiving haemodialysis: a pharmacokinetic-pharmacodynamic analysis of cinacalcet. Br J Clin Pharmacol 2019; 85:1312-1325. [PMID: 30756425 PMCID: PMC6533487 DOI: 10.1111/bcp.13900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 01/06/2023] Open
Abstract
AIMS The aims of this study were to develop a pharmacokinetic (PK) and PK-pharmacodynamic (PK/PD) model of cinacalcet in adults and paediatrics with secondary hyperparathyroidism (SHPT) on dialysis, to test covariates of interest, and to perform simulations to inform dosing in paediatrics with SHPT. METHODS Cinacalcet PK, intact parathyroid hormone (iPTH) and corrected calcium (cCa) time courses following multiple daily oral doses (1-300 mg) were modelled using a nonlinear mixed effects modelling approach using data from eight clinical studies. Model-based trial simulations, using adult or paediatric titration schemas, predicted efficacy (iPTH change from baseline and proportion achieving iPTH decrease ≥30%) and safety (cCa change from baseline and proportion achieving cCa ≤8.4 mg/dL) endpoints at 24 weeks. RESULTS Cinacalcet PK parameters were described by a two-compartment linear model with delayed first-order absorption-elimination (apparent clearance = 287.74 L h-1 ). Simulations suggested that paediatric starting doses (1, 2.5, 5, 10 and 15 mg) would provide PK exposures less than or similar to a 30 mg adult dose. The titrated dose simulations suggested that the mean (prediction interval) proportion of paediatric and adult subjects achieving ≥30% reduction in iPTH from baseline at Week 24 was 49% (36%, 62%), and 70.1% (62.5%, 77%), respectively. Additionally, the mean (confidence interval) proportion of paediatric and adult subjects achieving cCa ≤8.4 mg dL-1 at Week 24 was 8% (2%, 18%) and 23.6% (17.5%, 30.5%), respectively. CONCLUSIONS Model-based simulations showed that the paediatric cinacalcet starting dose (0.2 mg kg-1 ), titrated to effect, would provide the desired PD efficacy (PTH suppression <30%) while minimizing safety concerns (hypocalcaemia).
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MESH Headings
- Adolescent
- Adult
- Age Factors
- Biomarkers/blood
- Calcimimetic Agents/administration & dosage
- Calcimimetic Agents/adverse effects
- Calcimimetic Agents/pharmacokinetics
- Child
- Child, Preschool
- Cinacalcet/administration & dosage
- Cinacalcet/adverse effects
- Cinacalcet/pharmacokinetics
- Computer Simulation
- Drug Dosage Calculations
- Female
- Humans
- Hyperparathyroidism, Secondary/blood
- Hyperparathyroidism, Secondary/diagnosis
- Hyperparathyroidism, Secondary/drug therapy
- Hyperparathyroidism, Secondary/etiology
- Hypocalcemia/chemically induced
- Male
- Models, Biological
- Parathyroid Hormone/blood
- Renal Dialysis/adverse effects
- Renal Insufficiency, Chronic/blood
- Renal Insufficiency, Chronic/complications
- Renal Insufficiency, Chronic/diagnosis
- Renal Insufficiency, Chronic/therapy
- Treatment Outcome
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Fuller DS, Hallett D, Dluzniewski PJ, Fouqueray B, Jadoul M, Morgenstern H, Port FK, Tentori F, Pisoni RL. Predictors of cinacalcet discontinuation and reinitiation in hemodialysis patients: results from 7 European countries. BMC Nephrol 2019; 20:169. [PMID: 31088377 PMCID: PMC6518810 DOI: 10.1186/s12882-019-1355-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 04/24/2019] [Indexed: 01/17/2023] Open
Abstract
Background The putative benefits of cinacalcet therapy for management of secondary hyperparathyroidism (SHPT) are thought to be most manifested when patients are taking it consistently and as prescribed. Real-world descriptions of cinacalcet prescription discontinuation and reinitiation in European hemodialysis patients are lacking. To address this knowledge gap, we used Dialysis Outcomes and Practice Patterns Study (DOPPS) data, based on dialysis facility medical records, from seven European countries to estimate rates and predictors of cinacalcet prescription discontinuation and reinitiation in hemodialysis patients and to describe the trajectories of CKD-MBD laboratory values after discontinuation. Methods Cox regression analyses were used to predict (1) cinacalcet discontinuation among 613 patients with ≥3 consecutive months without cinacalcet prescription immediately prior to a new cinacalcet prescription and (2) cinacalcet reinitiation among 415 patients with a newly discontinued cinacalcet prescription immediately after ≥3 consecutive months of prescribed use. Results Cinacalcet was discontinued in 21 and 35% of new users after 6 and 12 months, respectively. Cinacalcet was reinitiated in 38 and 49% of newly-discontinued users after 6 and 12 months, respectively. Predictors of discontinuation included lower parathyroid hormone (PTH) in the previous month (< 150 pg/ml vs. 150–299, HR = 2.57 [95% CI: 1.52–4.33]) and lower serum calcium in the previous month (< 8.4 mg/dl vs. 8.4–10.19, HR = 1.67 [95% CI: 1.08–2.59]). Predictors of reinitiation included higher PTH in the previous month (300–599 pg/ml vs. 150–299, HR = 1.88 [95% CI = 1.19–2.97]; 600+ pg/ml, HR = 3.02 [95% CI = 1.92–4.76]). After cinacalcet discontinuation, mean serum PTH increased from 408 to 510 pg/ml, mean serum calcium briefly rose from 9.12 to 9.22 mg/dl before declining to 9.06 mg/dl, and mean serum phosphorus showed little change. Conclusions Nephrologist discontinuation of cinacalcet therapy is common in European countries. Additional research is needed to identify optimal cinacalcet treatment strategies for SHPT management, including comparisons of intermittent cinacalcet therapy versus sustained treatment with reduced dose or frequency. Electronic supplementary material The online version of this article (10.1186/s12882-019-1355-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | - Michel Jadoul
- Cliniques Universitaires St-Luc, Université catholique de Louvain, Bruxelles, Belgium
| | - Hal Morgenstern
- Departments of Epidemiology and Environmental Health Sciences, School of Public Health, and Department of Urology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | | | - Francesca Tentori
- DaVita, Inc., Minneapolis, MN, USA.,Vanderbilt University School of Medicine, Nashville, TN, USA
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Shen Q, Xiang W, Ye S, Lei X, Wang L, Jia S, Shao X, Weng C, Shen X, Wang Y, Feng S, Qu L, Wang C, Chen J, Zhang P, Jiang H. Plasma metabolite biomarkers related to secondary hyperparathyroidism and parathyroid hormone. J Cell Biochem 2019; 120:15766-15775. [PMID: 31069832 DOI: 10.1002/jcb.28846] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 02/11/2019] [Accepted: 02/14/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hyperphosphatemia, hypocalcemia, and elevation of parathyroid hormone (PTH) are typical abnormalities of uremic patients with Secondary hyperparathyroidism (SHPT). However, metabolic imbalance associated with SHPT is not well understood. METHODS A total of 15 SHPT patients with an intact parathyroid hormone (iPTH) level > 600 pg/mL were set as preoperative (PR) group, 15 age- and gender-matched controls who had undergone parathyroidectomy plus forearm transplantation because of hyperparathyroidism and achieved an iPTH level <150 pg/mL were set as postoperative (PO) group. Metabolite profiling of these 30 uremic patients and five healthy controls (HC) was performed using ultra performance liquid chromatography-mass spectrometry. RESULTS Five differential metabolites, including allyl isothiocyanate, L-phenylalanine, D-Aspartic acid, indoleacetaldehyde, and D-galactose correlated with PTH were identified in this study. Taking them as a biomarker signature, PR group can be distinguished from HC group with an area under the curve (AUC) of 0.947 (95% CI, 0.76-1) and PO group with an AUC of 0.6 (95% CI, 0.38-0.807). CONCLUSIONS The serum metabolome correlated with PTH is successfully demonstrated for a better understanding of the pathogenesis of SHPT.
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Affiliation(s)
- Qixia Shen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Nephropathy, Hangzhou, Zhejiang, China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, Zhejiang, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, Zhejiang, China.,Institute of Nephropathy, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wenyu Xiang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Nephropathy, Hangzhou, Zhejiang, China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, Zhejiang, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, Zhejiang, China.,Institute of Nephropathy, Zhejiang University, Hangzhou, Zhejiang, China
| | - Sen Ye
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Nephropathy, Hangzhou, Zhejiang, China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, Zhejiang, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, Zhejiang, China.,Institute of Nephropathy, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xin Lei
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Nephropathy, Hangzhou, Zhejiang, China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, Zhejiang, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, Zhejiang, China.,Institute of Nephropathy, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lefeng Wang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Nephropathy, Hangzhou, Zhejiang, China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, Zhejiang, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, Zhejiang, China.,Institute of Nephropathy, Zhejiang University, Hangzhou, Zhejiang, China
| | - Sha Jia
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Nephropathy, Hangzhou, Zhejiang, China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, Zhejiang, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, Zhejiang, China.,Institute of Nephropathy, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xue Shao
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Nephropathy, Hangzhou, Zhejiang, China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, Zhejiang, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, Zhejiang, China.,Institute of Nephropathy, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chunhua Weng
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Nephropathy, Hangzhou, Zhejiang, China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, Zhejiang, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, Zhejiang, China.,Institute of Nephropathy, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiujin Shen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Nephropathy, Hangzhou, Zhejiang, China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, Zhejiang, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, Zhejiang, China.,Institute of Nephropathy, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yucheng Wang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Nephropathy, Hangzhou, Zhejiang, China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, Zhejiang, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, Zhejiang, China.,Institute of Nephropathy, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shi Feng
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Nephropathy, Hangzhou, Zhejiang, China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, Zhejiang, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, Zhejiang, China.,Institute of Nephropathy, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lihui Qu
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Nephropathy, Hangzhou, Zhejiang, China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, Zhejiang, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, Zhejiang, China.,Institute of Nephropathy, Zhejiang University, Hangzhou, Zhejiang, China
| | - Cuili Wang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Nephropathy, Hangzhou, Zhejiang, China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, Zhejiang, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, Zhejiang, China.,Institute of Nephropathy, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Nephropathy, Hangzhou, Zhejiang, China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, Zhejiang, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, Zhejiang, China.,Institute of Nephropathy, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ping Zhang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Nephropathy, Hangzhou, Zhejiang, China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, Zhejiang, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, Zhejiang, China.,Institute of Nephropathy, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hong Jiang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Nephropathy, Hangzhou, Zhejiang, China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, Zhejiang, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, Zhejiang, China.,Institute of Nephropathy, Zhejiang University, Hangzhou, Zhejiang, China
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Block GA, Chertow GM, Sullivan JT, Deng H, Mather O, Tomlin H, Serenko M. An integrated analysis of safety and tolerability of etelcalcetide in patients receiving hemodialysis with secondary hyperparathyroidism. PLoS One 2019; 14:e0213774. [PMID: 30875390 PMCID: PMC6420005 DOI: 10.1371/journal.pone.0213774] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 02/11/2019] [Indexed: 01/13/2023] Open
Abstract
Background Calcimimetics have been shown to be effective and safe therapies for the treatment of secondary hyperparathyroidism (sHPT), a serious complication of disordered mineral metabolism associated with dialysis-dependent chronic kidney disease. Etelcalcetide, a recently approved intravenous calcimimetic, reduces serum parathyroid hormone (PTH), calcium, phosphorus, and fibroblast growth factor-23 concentrations. Here we report the first integrated safety profile of etelcalcetide using pooled data from five pivotal clinical trials. Methods This analysis included data from patients receiving hemodialysis with moderate to severe sHPT enrolled in two randomized, placebo-controlled trials; a randomized active-controlled (with cinacalcet) trial; and two single-arm, open-label extension trials. Patients initially received etelcalcetide intravenously 5 mg three times weekly (TIW) after hemodialysis; with potential dose increases of 2.5 or 5 mg at 4-week intervals to a maximum dose of 15 mg TIW, depending on serum PTH and calcium levels. The nature, frequency, and severity of treatment-emergent adverse events (AEs) and changes in laboratory parameters were assessed. Results Overall, we evaluated 1023 patients from the placebo-controlled trials, 683 from the active-controlled trial, and 1299 from open-label extensions. The frequency and nature of common treatment-emergent AEs reported for the etelcalcetide arm were consistent among the placebo-controlled and active-controlled trials. The most common AEs were those related to mineral metabolism (decreased blood calcium, hypophosphatemia, muscle spasms) or gastrointestinal abnormalities (diarrhea, nausea, vomiting). Hypocalcemia leading to discontinuation of either calcimimetic was experienced in ≤ 1% of patients. Conclusions This integrated safety assessment of etelcalcetide across placebo- and active-controlled trials showed an overall favorable risk/benefit profile, with safety similar to that of cinacalcet. Consistent with its mechanism of action, the most important risks associated with etelcalcetide were serum calcium reductions and hypocalcemia-related AEs; no new safety findings were identified in the pooled long-term extension trials.
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Affiliation(s)
| | - Glenn M. Chertow
- Stanford University, Stanford, California, United States of America
| | | | - Hongjie Deng
- Amgen Inc., Thousand Oaks, California, United States of America
| | - Omar Mather
- Amgen Inc., Thousand Oaks, California, United States of America
- * E-mail:
| | - Holly Tomlin
- Amgen Inc., Thousand Oaks, California, United States of America
| | - Michael Serenko
- Amgen Inc., Thousand Oaks, California, United States of America
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An open-label, single-dose study to evaluate the safety, tolerability, pharmacokinetics, and pharmacodynamics of cinacalcet in pediatric subjects aged 28 days to < 6 years with chronic kidney disease receiving dialysis. Pediatr Nephrol 2019; 34:145-154. [PMID: 30141180 PMCID: PMC6244811 DOI: 10.1007/s00467-018-4054-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/07/2018] [Accepted: 08/10/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Calcimimetics, shown to control biochemical parameters of secondary hyperparathyroidism (SHPT), have well-established safety and pharmacokinetic profiles in adult end-stage renal disease subjects treated with dialysis; however, such studies are limited in pediatric subjects. METHODS In this study, the safety, tolerability, pharmacokinetics (PK), and pharmacodynamics (PD) of cinacalcet were evaluated in children with chronic kidney disease (CKD) and SHPT receiving dialysis. Twelve subjects received a single dose of cinacalcet (0.25 mg/kg) orally or by nasogastric or gastric tube. Subjects were randomized to one of two parathyroid hormone (PTH) and serum calcium sampling sequences: [(1) 2, 8, 48 h; or (2) 2, 12, 48 h] and assessed for 72 h after dosing. RESULTS Median plasma cinacalcet tmax was 1 h (range 0.5-4.0 h); mean (SD) Cmax and AUClast were 2.83 (1.98) ng/mL and 11.8 (8.74) h*ng/mL, respectively; mean (SD) half-life (t1/2) was 3.70 (2.57) h. Dose adjustments, based upon body weight (mg/kg), minimized the effects of age, body weight, body surface area, and body mass index on cinacalcet PK. Reductions in serum PTH levels from baseline were observed at 2 to 8 h post-dose (median 10.8 and 29.6%, respectively), returned towards baseline by 12-72 h and were inversely related to changes in the plasma cinacalcet PK profile. Single-dose cinacalcet was well-tolerated with no unexpected safety findings and a PK/PD, safety profile similar to adults. CONCLUSIONS In conclusion, a single 0.25 mg/kg dose of cinacalcet was evaluated to be a safe starting dose in these children aged < 6 years.
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Kan S, Zhang W, Mao J, Wang M, Ni L, Zhang M, Zhang Q, Chen J. NF-κB activation contributes to parathyroid cell proliferation in chronic kidney disease. J Nephrol 2018; 31:941-951. [DOI: 10.1007/s40620-018-0530-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/26/2018] [Indexed: 12/20/2022]
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Beto J, Bhatt N, Gerbeling T, Patel C, Drayer D. Overview of the 2017 KDIGO CKD-MBD Update: Practice Implications for Adult Hemodialysis Patients. J Ren Nutr 2018; 29:2-15. [PMID: 30150095 DOI: 10.1053/j.jrn.2018.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/06/2018] [Accepted: 05/25/2018] [Indexed: 01/10/2023] Open
Abstract
Renal dietitians play a pivotal role in the ongoing management of chronic kidney disease in patients on hemodialysis. Awareness of changes to clinical practice guidelines that may impact laboratory parameters associated with chronic kidney disease-mineral and bone disorder is important for optimal patient care. In this article, the Kidney Disease: Improving Global Outcomes 2017 Clinical Practice Guideline Update recommendations related to the treatment of secondary hyperparathyroidism in adults on hemodialysis are reviewed and treatment implications for renal dietitians discussed. Specific attention is given to the integration of updated recommendations such as the use of calcimimetics as part of a combination approach to the existing treatment paradigm. Renal dietitians can directly apply the updated clinical recommendations in the evaluation of diet composition; food additives; medication adherence challenges with phosphate binder type and use and serial monitoring of phosphorus, calcium, and parathyroid hormone levels to inform clinical decisions on treatment options for patients.
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Affiliation(s)
- Judith Beto
- Research Associate, Division of Nephrology and Hypertension, Loyola University of Chicago, Maywood, Illinois.
| | - Nisha Bhatt
- US Medical Leader Nephrology, Medical Affairs, Amgen Inc., Thousand Oaks, California
| | - Teresa Gerbeling
- Renal Dietitian Coordinator, Dialysis Center of Lincoln, Lincoln, Nebraska
| | - Chhaya Patel
- Nutrition Program Manager, Divisional Lead RD, ORCA Division, DaVita Inc., Denver, Colorado
| | - Debra Drayer
- Senior Regional Medical Liaison Nephrology, Amgen Inc., Thousand Oaks, California
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Interrelated role of Klotho and calcium-sensing receptor in parathyroid hormone synthesis and parathyroid hyperplasia. Proc Natl Acad Sci U S A 2018; 115:E3749-E3758. [PMID: 29618612 DOI: 10.1073/pnas.1717754115] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The pathogenesis of parathyroid gland hyperplasia is poorly understood, and a better understanding is essential if there is to be improvement over the current strategies for prevention and treatment of secondary hyperparathyroidism. Here we investigate the specific role of Klotho expressed in the parathyroid glands (PTGs) in mediating parathyroid hormone (PTH) and serum calcium homeostasis, as well as the potential interaction between calcium-sensing receptor (CaSR) and Klotho. We generated mouse strains with PTG-specific deletion of Klotho and CaSR and dual deletion of both genes. We show that ablating CaSR in the PTGs increases PTH synthesis, that Klotho has a pivotal role in suppressing PTH in the absence of CaSR, and that CaSR together with Klotho regulates PTH biosynthesis and PTG growth. We utilized the tdTomato gene in our mice to visualize and collect PTGs to reveal an inhibitory function of Klotho on PTG cell proliferation. Chronic hypocalcemia and ex vivo PTG culture demonstrated an independent role for Klotho in mediating PTH secretion. Moreover, we identify an interaction between PTG-expressed CaSR and Klotho. These findings reveal essential and interrelated functions for CaSR and Klotho during parathyroid hyperplasia.
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Cozzolino M. Achieve Your Goals Together. The Easy and Reasonable Way to Treat Chronic Kidney Disease-Mineral Bone Disorder. Blood Purif 2017; 45:71-72. [PMID: 29241204 DOI: 10.1159/000485233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 11/13/2017] [Indexed: 12/26/2022]
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Waziri B, Duarte R, Dickens C, Dix Peek T, George J, Rekhviashvili V, Paget G, Naicker S. Racial Variations in the Markers of Mineral Bone Disorders in CKD Patients in South Africa. Kidney Int Rep 2017; 3:583-591. [PMID: 29854965 PMCID: PMC5976813 DOI: 10.1016/j.ekir.2017.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 11/13/2017] [Accepted: 12/06/2017] [Indexed: 01/14/2023] Open
Abstract
Introduction Several studies showed that serum intact parathyroid hormone (PTH), phosphate, and vitamin D levels differ across races. These comparative studies were largely carried out between Caucasians and black Americans. However, little is known of the existence of these associations in an African population with chronic kidney disease (CKD). Methods This cross-sectional multicenter study involved 293 CKD patients from 3 renal units in Johannesburg, South Africa. Results The 293 CKD patients (208 blacks, 85 whites) had an overall mean age of 51.1 ± 13.6 years, and black patients were significantly younger than the white patients (48.4 ± 13.6 years vs. 57.1 ± 15.5 years; P < 0.001). Compared with whites, blacks had higher median intact PTH (498 [range: 37–1084] pg/ml vs. 274 [range: 131–595] pg/ml; P = 0.03), alkaline phosphatase (122 [range: 89–192] U/L vs. 103 [range: 74–144] U/L; p = 0.03), and mean 25 OH vitamin D3 (26.8 ± 12.7 ng/ml vs. 22.7 ± 12.2 ng/ml, P = 0.01) levels, whereas their median fibroblast growth factor (FGF) level was 23 (100 [range: 34–639] pg/ml vs. 233 [range: 80–1370] pg/ml; P = 0.002), and their mean serum phosphate (1.3 ± 0.5 vs. 1.5 ± 0.5; P = 0.001) levels were significantly lower. In multivariable analyses, black race was independently associated with increased log PTH (β = 0.488, P = 0.01) and decreased log FGF-23 (β = −0.636, P = 0.02). Similarly, blacks had a 3.08 times higher likelihood (95% confidence interval: 1.51–6.30; P = 0.002) of developing severe hyperparathyroidism than whites. Conclusion This study highlighted the existence of racial differences in the circulating markers of mineral bone disorders in an African CKD population.
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Affiliation(s)
- Bala Waziri
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Raquel Duarte
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Caroline Dickens
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Therese Dix Peek
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jaya George
- Department of Chemical Pathology, National Health Laboratory Services, University of the Witwatersrand, Johannesburg, South Africa
| | - Vakhtang Rekhviashvili
- Renal Unit, Donald Gordon Medical Center, University of the Witwatersrand, Johannesburg, South Africa
| | - Graham Paget
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Saraladevi Naicker
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Yuan F, Chen X, Wang C, Li Z, Liu H. Effect of Cinacalcet Combined with Calcitriol on the Clinical Outcome and Bone Metabolism in Patients on Hemodialysis with Severe Secondary Hyperparathyroidism. Blood Purif 2017; 45:73-78. [DOI: 10.1159/000484435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 10/17/2017] [Indexed: 12/17/2022]
Abstract
Objective: To observe the clinical outcome and the effect of bone metabolism of cinacalcet combined with calcitriol in maintenance hemodialysis (MHD) patients with severe secondary hyperparathyroidism (SHPT). Methods: Thirty MHD patients with SHPT were enrolled into the study. All patients were given cinacalcet 25–75 mg and 0.5 μg calcitriol daily. Serum Ca, P, intact parathyroid hormone (iPTH), and bone metabolic markers were measured. The clinical symptoms and their changes were investigated. Results: The baseline levels of iPTH, Ca, and P were 1,787.3 ± 1,321 pg/mL, 2.54 ± 0.19 mmol/L, and 2.06 ± 0.15 mmol/L respectively. After 3 months treatment, iPTH decreased by 70%. Serum Ca and P fell to 2.39 ± 0.17 and 1.56 ± 0.50 mmol/L (p < 0.05), respectively. After 6 months, the bone-specific alkaline phosphatase, osteocalcin, and β-cross levels were decreased by 50, 37, and 49% respectively compared with corresponding values before treatment. A decline in the bone density patients was inhibited. Conclusion: Cinacalcet combined with low dose calcitriol can improve high calcium, high phosphorus, and high iPTH in MHD patients with severe SHPT and also improve bone metabolism. It can be used as a favorable choice for SHPT treatment.
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Cozzolino M, Galassi A, Conte F, Mangano M, Di Lullo L, Bellasi A. Treatment of secondary hyperparathyroidism: the clinical utility of etelcalcetide. Ther Clin Risk Manag 2017; 13:679-689. [PMID: 28615947 PMCID: PMC5461056 DOI: 10.2147/tcrm.s108490] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Secondary hyperparathyroidism (SHPT), a very frequent, severe, and worsening complication of chronic kidney disease, is characterized by high serum parathyroid hormone (PTH), parathyroid gland hyperplasia, and disturbances in mineral metabolism. Clinically, SHPT shows renal osteodystrophy, vascular calcification, cardiovascular damage, and fatal outcome. Calcium-sensing receptor (CaSR) is the main physiological regulator of PTH secretion; its activation by calcium rapidly inhibits PTH. Another important player in regulating mineral metabolism is vitamin D receptor (VDR), which is under the influence of vitamin D and influences the intestinal absorption of calcium and phosphate, PTH gene expression, and bone calcium mobilization. Serum phosphate levels influence fibroblast growth factor 23 (FGF-23) production, a phosphatonin that modulates serum phosphate reabsorption, PTH synthesis, and vitamin D production. Current therapeutic approaches consist of 1) phosphate intake control by diet or phosphate binders, 2) vitamin D by VDR activation, and 3) calcimimetic agents that activate CaSR. Recently, a new long-acting peptide (etelcalcetide) belonging to the calcimimetics class was approved for intravenous use in hemodialysis patients with SHPT. Etelcalcetide binds directly to CaSR, by a sulfide bond, inhibiting the production and secretion of PTH by parathyroid glands. After intravenous administration in rats, etelcalcetide is quickly distributed to the tissues and eliminated by kidneys, while in uremic animals the nonrenal excretion is only 1.2%. In hemodialysis patients, the treatment itself is the main route of elimination. Etelcalcetide in hemodialysis patients with SHPT was more effective than placebo and cinacalcet, with a PTH reduction of >30% in 76% of patients with etelcalcetide versus 10% with placebo. Particular attention was paid to the safety of the drug; the most common adverse event was asymptomatic blood calcium reduction, similar to cinacalcet, while gastrointestinal symptoms were less frequent. This promising new drug available for better control of SHPT will, together with drugs already in use, optimize the treatment to normalize the biochemical parameters.
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Affiliation(s)
- Mario Cozzolino
- Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan
| | - Andrea Galassi
- Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan
| | - Ferruccio Conte
- Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan
| | - Michela Mangano
- Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan
| | - Luca Di Lullo
- U.O.C. Nefrologia e Dialisi, Ospedale L. Parodi Delfino, Colleferro, Roma
| | - Antonio Bellasi
- Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan
- Sant’Anna Hospital, ASST-Lariana, Como, Italy
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Phelps KR. Tradeoff-in-the-Nephron: A Theory to Explain the Primacy of Phosphate in the Pathogenesis of Secondary Hyperparathyroidism. Nutrients 2017; 9:E427. [PMID: 28445401 PMCID: PMC5452157 DOI: 10.3390/nu9050427] [Citation(s) in RCA: 3] [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: 02/27/2017] [Revised: 04/10/2017] [Accepted: 04/17/2017] [Indexed: 02/06/2023] Open
Abstract
Chronic kidney disease (CKD) causes secondary hyperparathyroidism (SHPT). The cardinal features of SHPT are persistence of normocalcemia as CKD progresses and dependence of the parathyroid hormone concentration ([PTH]) on phosphate influx (IP). The tradeoff-in-the-nephron hypothesis integrates these features. It states that as the glomerular filtration rate (GFR) falls, the phosphate concentration ([P]CDN) rises in the cortical distal nephron, the calcium concentration ([Ca]CDN) in that segment falls, and [PTH] rises to maintain normal calcium reabsorption per volume of filtrate (TRCa/GFR). In a clinical study, we set GFR equal to creatinine clearance (Ccr) and IP equal to the urinary excretion rate of phosphorus (EP). We employed EP/Ccr as a surrogate for [P]CDN. We showed that TRCa/Ccr was high in patients with primary hyperparathyroidism (PHPT) and normal in those with SHPT despite comparably increased [PTH] in each group. In subjects with SHPT, we examined regressions of [PTH] on EP/Ccr before and after treatment with sevelamer carbonate or a placebo. All regressions were significant, and ∆[PTH] correlated with ∆EP/Ccr in each treatment cohort. We concluded that [P]CDN determines [PTH] in CKD. This inference explains the cardinal features of SHPT, much of the evidence on which other pathogenic theories are based, and many ancillary observations.
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Affiliation(s)
- Kenneth R Phelps
- Research Service, Stratton Veterans' Affairs Medical Center, Albany, NY 12208, USA.
- Department of Medicine, Division of Nephrology, Albany Medical College, Albany, NY 12208, USA.
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Associations of parathyroid hormone levels and mineral parameters with heart rate variability in patients with end-stage renal disease. Int Urol Nephrol 2017; 49:1079-1085. [PMID: 28243964 DOI: 10.1007/s11255-017-1513-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/16/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Parathormone (PTH) is a very potent uraemic toxin, which affects calcium/phosphate homeostasis in patients with end-stage renal disease (ESRD). It also plays the role in uraemic autonomic neuropathy. The aim of the study was to investigate the relationship between elevated PTH levels and cardiac autonomic neuropathy assessed by frequency-domain measures of heart rate variability. METHODS 24-h ECG was performed in 106 ESRD patients and 65 healthy controls. Very-low-frequency (VLF), low-frequency (LF) and high-frequency (HF) bands were computed. LF/HF ratio was calculated. RESULTS We found that most heart rate variability indices were lower in ESRD patients than in healthy controls. Variables including demographics (age, sex, body mass index, dialysis vintage, systolic pressure, and diastolic pressure), laboratory values (Hb, Hct, glucose, Alb, and triglyceride), and bone metabolism panel (Ca, P, ALP, and iPTH) were selected as independent variables in the multivariable models. In multivariate analysis, serum intact PTH (iPTH) was correlated with mean normal-to-normal R-R intervals, mean heart rate, and VLF, serum calcium was correlated with standard deviation of 5-min average of normal R-R intervals (SDANN), and serum phosphorus was correlated with VLF and LF/HF. Serum iPTH was independently correlated with mean normal-to-normal R-R intervals (NN), mean HR, and VLF. Serum Ca was independently correlated with SDANN, and serum P was independently correlated with VLF and LF/HF. The results remained significant after the adjustment for iPTH. CONCLUSIONS In conclusion, high PTH levels and disorders of mineral metabolism are associated with decreased heart rate variability in ESRD patients.
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Topçiu-Shufta V, Miftari R, Haxhibeqiri V, Haxhibeqiri S. Association of Beta-2 Microglobulin with Inflammation and Dislipidemia in High-Flux Membrane Hemodialysis Patients. Med Arch 2016; 70:348-350. [PMID: 27994294 PMCID: PMC5136433 DOI: 10.5455/medarh.2016.70.348-350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/05/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Higher than expected cardiovascular mortality in hemodialysis patients, has been attributed to dyslipidemia as well as inflammation. Beta2-Microglobulin (β2M) is an independent predictor of outcome for hemodialysis patients and a representative substance of middle molecules. RESULTS In 40 patients in high-flux membrane hemodialysis, we found negative correlation of β2M with high density lipoprotein (r=-0.73, p<0.001) and albumin (r= -0.53, p<0.001) and positive correlation with triglycerides (r=0.69, p<0.001), parathyroid hormone (r=0.58, p < 0.05) and phosphorus (r= 0.53, p<0.001). There was no correlation of β2M with C- reactive protein (CRP) and interleukin-6 (IL-6). During the follow-up period of three years, 6 out of 40 patients have died from cardiovascular events. CONCLUSION In high-flux membrane hemodialysis patients, we observed a significant relationship of β2M with dyslipidemia and mineral bone disorders, but there was no correlation with inflammation.
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Affiliation(s)
- Valdete Topçiu-Shufta
- Clinic of Medical Biochemistry, University Clinical Center, Pristina, Republic of Kosova; Faculty of Medicine, University of Prishtina, Republic of Kosova
| | - Ramë Miftari
- Faculty of Medicine, University of Prishtina, Republic of Kosova
| | - Valdete Haxhibeqiri
- Clinic of Medical Biochemistry, University Clinical Center, Pristina, Republic of Kosova
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Keith M, de Sequera P, Clair F, Pedersini R. Lanthanum carbonate oral powder: satisfaction, preference and adherence in French and Spanish patients with end-stage renal disease. Drugs Context 2016; 5:212300. [PMID: 27803726 PMCID: PMC5081242 DOI: 10.7573/dic.212300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Phosphate binders, such as lanthanum carbonate, control elevated serum-phosphate levels in patients with end-stage renal disease (ESRD). Lanthanum carbonate is available in oral powder and tablet form. The aim of this survey was to investigate satisfaction with, preference for, and adherence to lanthanum carbonate oral powder in patients with ESRD. SCOPE Patients from France and Spain who had been taking lanthanum carbonate powder for at least 4 weeks, and who had experience of other phosphate binders of any formulation, were asked to complete an online or telephone survey. Treatment satisfaction was measured using the Treatment Satisfaction Questionnaire for Medication-9; preference was measured using 5-point Likert scale agreement ratings; and adherence was measured using the Morisky Medication Adherence Scale-4. Data were evaluated using bivariate analyses. FINDINGS Overall, 160 patients participated (80 per country). Lanthanum carbonate powder was reported to have a higher effectiveness rating (p<0.05), be more convenient (p<0.05), and provide a higher level of satisfaction (p<0.01) than previous binders. There was an overall preference for lanthanum carbonate powder over previous binders of any formulation (p<0.001). Adherence to medication was similar for all binders analysed: 66.3% of French patients adhered to lanthanum carbonate powder, and 65.0% adhered to previous binder treatment (p=not significant); 52.5% of Spanish patients adhered to lanthanum carbonate powder, and 56.3% adhered to previous binder treatment (p=not significant). LIMITATIONS The survey enrolled patients who had already experienced phosphate binders before the study began. Information on patient preferences for and adherence to previous phosphate binders was therefore based on the patients' memories of these experiences, which may have been subject to change over time. Although most participants completed the online survey in this study, a telephone survey was used for individuals who could not access the online version; if only one method of data recording had been used, there may have been reduced variation in responses. CONCLUSION Patients with ESRD report increased satisfaction with and preference for lanthanum carbonate powder over other formulations, suggesting that lanthanum carbonate powder is more convenient and easier to use than other formulations.
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Affiliation(s)
- Michael Keith
- Global Health Economics & Outcomes Research, Shire, Lexington, MA, USA
| | | | - François Clair
- Clinique Néphrologique Maison Blanche, Vernouillet, France
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Zangeneh F, Clarke BL, Hurley DL, Watts NB, Miller PD. Chronic Kidney Disease-Mineral and Bone Disorders (CKD-MBDs): What the Endocrinologist Needs to Know. Endocr Pract 2016; 20:500-16. [PMID: 24325991 DOI: 10.4158/ep12291.ra] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Chronic kidney disease-mineral and bone disorders (CKD-MBDs) are a spectrum of abnormalities involving skeletal hormones, minerals, and bone turnover and mineralization. This paper focuses on what the endocrinologist should know about the assessment and management of skeletal and metabolic disorders in CKD-MBDs. METHODS Relevant literature was reviewed to (1) define disturbances of minerals and hormones in the course of CKD; (2) identify the variable radiographic and histomorphometric changes of CKD-MBDs; (3) review the association among CKD-MBDs, vascular calcification, cardiovascular disease (CVD), and mortality; and (4) clarify issues in CKD-MBDs therapy. RESULTS Assessment and treatment of CKD-MBDs is complicated by progressive changes in bone minerals and skeletal regulatory hormones as kidney function declines. CKD-MBDs are associated with fracture risk, and studies demonstrate that bone mineral density can be used to assess bone loss and fracture risk in these patients. Treatment of CKD-MBDs continues to evolve. Use of calcium, phosphate binders, vitamin D, vitamin D-receptor analogs, and drugs for osteoporosis and CKD-MBDs treatment are discussed in the context of safety and efficacy for patients with CKD. CONCLUSION The association of CKD with bone disease, vascular calcification, CVD, and mortality mandates earlier recognition and treatment of CKD-MBDs. Osteoporosis as a distinct entity can be diagnosed and managed in CKD, although assessment of osteoporosis becomes challenging in late (stage 4 to 5) CKD. Diabetes is common in early (stage 1 to 3) CKD. In addition, 96% of all individuals identified as having CKD have early CKD. The endocrinologist is uniquely positioned to address and treat both diabetes and many of the metabolic and skeletal disorders associated with early CKD-MBDs, including osteoporosis.
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Affiliation(s)
- Farhad Zangeneh
- Endocrine, Diabetes & Osteoporosis Clinic (EDOC), Sterling, VA
| | - Bart L Clarke
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Daniel L Hurley
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Nelson B Watts
- Mercy Health Osteoporosis and Bone Health Services, Cincinnati, Ohio
| | - Paul D Miller
- Colorado Center for Bone Research, University of Colorado Health Sciences Center
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Wei Y, Lin J, Yang F, Li X, Hou Y, Lu R, Shi X, Liu Z, Du Y. Risk factors associated with secondary hyperparathyroidism in patients with chronic kidney disease. Exp Ther Med 2016; 12:1206-1212. [PMID: 27446345 PMCID: PMC4950648 DOI: 10.3892/etm.2016.3438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/29/2016] [Indexed: 12/22/2022] Open
Abstract
Secondary hyperparathyroidism (SHPT) is common in patients with chronic kidney disease (CKD), and its development and progression are affected by various factors. The aim of the present study was to identify the risk factors for SHPT in patients with CKD. A retrospective study was performed in 498 patients (305 males and 193 females) with CKD, observed in the The First Hospital of Jilin University between January 2008 and December 2012. The demographic, clinical and laboratory data were collected. Patients were divided into the SHPT group (n=424) with elevated serum parathyroid hormone (PTH) expression levels and the control group (n=74) with normal serum PTH expression levels. Univariate and multivariate regression analyses were employed to explore the risk factors for SHPT. Serum PTH expression levels in women with CKD were significantly higher than in men (P=0.047). Serum PTH expression levels were positively correlated with the expression levels of serum creatinine (P<0.01), phosphorus (P<0.01), C-reactive protein (P<0.05), triglyceride (P<0.05), cholesterol (P<0.05) and low-density lipoprotein cholesterol (P<0.05), but were negatively correlated with the expression levels of hemoglobin (P<0.05), calcium (P<0.01) and CO2 combining power (P<0.01) in patients with CKD. Multivariate analysis showed that the serum expression levels of creatinine [µmol/l; odds radio (OR), 1.003; 95% confidence interval (CI), 1.002-1.004; P=0.001] and phosphorus (mmol/l; OR, 2.19; 95% CI, 1.254-3.826; P=0.006) in patients with CKD significantly influenced serum PTH expression levels. The SHPT risk factors include female gender, low calcium, high phosphorus, acidosis, anemia, hypertension, hyperlipidemia and micro-inflammation, with blood phosphorus and creatinine being independent risk factors.
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Affiliation(s)
- Yudan Wei
- Department of Nephrology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jing Lin
- Department of Nephrology, The First Affiliated Hospital of Luohe Medical College, Luohe, Henan 462000, P.R. China
| | - Fan Yang
- Reproductive Center of the First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xiujiang Li
- Department of Intensive Care Unit, Jilin Tumor Hospital, Changchun, Jilin 130021, P.R. China
| | - Yue Hou
- Department of Nephrology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Ronghua Lu
- Department of Nephrology, Jilin City Central Hospital, Changchun, Jilin 132000, P.R. China
| | - Xiaonv Shi
- Department of Nephrology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhi Liu
- Department of Nephrology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yujun Du
- Department of Nephrology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
- Correspondence to: Dr Yujun Du, Department of Nephrology, First Hospital of Jilin University, 71 Xinmin Street, Changchun, Jilin 130021, P.R. China, E-mail:
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Wolf M, Weir MR, Kopyt N, Mannon RB, Von Visger J, Deng H, Yue S, Vincenti F. A Prospective Cohort Study of Mineral Metabolism After Kidney Transplantation. Transplantation 2016; 100:184-93. [PMID: 26177089 PMCID: PMC4683035 DOI: 10.1097/tp.0000000000000823] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Kidney transplantation corrects or improves many complications of chronic kidney disease, but its impact on disordered mineral metabolism is incompletely understood. The prevalence of posttransplant hyperparathyroidism was 86% at 12 months (PTH >65 pg/ml) but only 40% (PTH >130 mg/dL) in the absence of cinacalcet, vitamin D sterols, or parathyroidectomy. Intact fibroblast growth factor 23 decreased rapidly to G40 pg/ml by 3 months posttransplant. Supplemental digital content is available in the text.
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Affiliation(s)
- Myles Wolf
- 1 Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. 2 Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD. 3 Lehigh Valley Hospital, Allentown, PA. 4 University of Alabama at Birmingham, Birmingham, AL. 5 The Ohio State University Medical Center, Columbus, OH. 6 Amgen Inc., Thousand Oaks, CA. 7 Kidney Transplant Service, University of California San Francisco, San Francisco, CA
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Subramanian R, Zhu X, Kerr SJ, Esmay JD, Louie SW, Edson KZ, Walter S, Fitzsimmons M, Wagner M, Soto M, Pham R, Wilson SF, Skiles GL. Nonclinical Pharmacokinetics, Disposition, and Drug-Drug Interaction Potential of a Novel D-Amino Acid Peptide Agonist of the Calcium-Sensing Receptor AMG 416 (Etelcalcetide). Drug Metab Dispos 2016; 44:1319-31. [DOI: 10.1124/dmd.115.068007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/08/2016] [Indexed: 11/22/2022] Open
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Liu H, Wang H, Liu T, Jiang J, Chen X, Gao F, Hu P. Pharmacokinetic and Pharmacodynamic Properties of Cinacalcet (KRN1493) in Chinese Healthy Volunteers: A Randomized, Open-label, Single Ascending–dose and Multiple-dose, Parallel-group Study. Clin Ther 2016; 38:348-57. [DOI: 10.1016/j.clinthera.2015.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/27/2015] [Accepted: 12/30/2015] [Indexed: 10/22/2022]
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