1
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Yang R, Ding N, Qin J, Peng H. The relationship between uric acid and bone mineral density in the intermediate stage of CKD 1-3. BMC Nephrol 2024; 25:219. [PMID: 38982346 PMCID: PMC11234712 DOI: 10.1186/s12882-024-03650-7] [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: 05/20/2023] [Accepted: 06/24/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Some studies have suggested that uric acid has antioxidant properties that can prevent bone loss, but the relationship between uric acid and bone mineral density is controversial. The aim of this study was to investigate the relationship between UA and BMD in patients with CKD stage 1-3. METHODS We extracted 13,047 participants from the NHANES database, including 7342 male subjects and 5705 female subjects. Weighted multiple linear regression analysis was used to investigate the correlation between UA and BMD in patients with CKD stages 1-3. RESULTS In patients with CKD stage 1-3, UA was significantly correlated with BMD. In the male group, UA was positively associated with BMD (β, 7.94 [95%CI, 4.95, 10.94]). In the female group, there was a negative relationship between them (β, -5.33 [95%CI, -8.77, -1.89]). The relationship between UA and BMD in male group showed an inverted U-shaped curve, and UA was positively correlated before 6.1 mg/dl and negatively correlated after 6.1 mg/dl. The relationship was basically negative in the female group. CONCLUSIONS For the patients with CKD stage 1-3, the relationship between UA and BMD showed an inverted U-shaped curve in the males, while the relationship was largely negative in the females.
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Affiliation(s)
- Ruiling Yang
- Department of Nephrology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Changsha, Hunan, 410004, China
| | - Ning Ding
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Changsha, Hunan, 410004, China.
| | - Jiao Qin
- Department of Nephrology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Changsha, Hunan, 410004, China.
| | - Hongchun Peng
- Department of Orthopedics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Changsha, Hunan, 410004, China.
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2
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Álvarez ES, Xipell M, Gallardo A, Astudillo E, Torregrosa JV. The 'Phosphorus Week': involvement of Spanish nephrologists in the control of phosphorus blood levels. Nefrologia 2023; 43:232-238. [PMID: 37442711 DOI: 10.1016/j.nefroe.2023.07.001] [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: 04/02/2021] [Accepted: 10/21/2021] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The adequate control of phosphorus levels is a major concern for professionals involved in the care of patients with chronic kidney disease (CKD), since high phosphorus levels are directly related to an increase in mortality. OBJECTIVES To know the perception and involvement of Spanish nephrologists on the control of phosphorus levels, the so-called 'Phosphorus Week' was organized (November 13-17, 2017). METHODS All members of the Spanish Society of Nephrology were invited to participate in an online survey, which included questions on aspects related to phosphorus control in patients with advanced CKD (aCKD) (glomerular filtration rate <30 ml/min/1, 73 m2) and in the different modalities of renal replacement therapies [peritoneal dialysis (PD), hemodialysis (HD) and renal transplantation (KT)]. RESULTS 72 data entries were obtained in the survey with an inclusion of 7463 patients. Of them, 35.4% were on HD, 34.8% were KT, 24.2% had aCKD and 5.5% were on PD. The serum phosphorus level target for the four groups of patients was 4.5 mg/dl, with minimal variations depending on the area of the national territory. The patients with better control of phosphataemia were patients with KT (93.3% had phosphorus values <4.5 mg/dl), followed by patients with aCKD (65.6% with phosphorus <4.5 mg/dl). Only 53.6% of the patients on HD and 39.4% of those on PD reached the phosphorus goal <4.5 mg/dl. The group of patients on dialysis was the one in whom phosphorus binders prescribed the most (73.5% and 75.6% in HD and PD, respectively), being less frequent in patients with patients with aCKD (39.9%) and only 4.5 % in KT. CONCLUSIONS The objectives of the Spanish nephrologists are in line with those recommended by the national and international clinical guidelines; however, there is still a wide room for improvement to achieve these goals, especially in HD and PD patients.
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Affiliation(s)
| | | | - Anna Gallardo
- Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
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3
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La «Semana del Fósforo»: implicación de la nefrología española en el control de los valores plasmáticos de fósforo. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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4
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Liu L, Wang L, Li L, Wang H, Yuan L, Kang L, Jiang Q, Chen G, Lv N, Cui X, Huang L, Wu H, Xu J, Li Y. Effects of triangle grass decoction on bone metabolism in rats with chronic kidney disease complicated with mineral and bone abnormalities. JOURNAL OF ETHNOPHARMACOLOGY 2021; 275:114126. [PMID: 33872749 DOI: 10.1016/j.jep.2021.114126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/08/2021] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Triangle grass is a liliaceous Chlorophytum perennial herb of ChlorophytumlaxumR.Br. It is distributed mainly in Guangdong and Guangxi Provinces of China. The initial use of triangle grass was mainly to treat bone pain and swelling caused by a fall injury. Triangle grass tablets (NO. Z20070544) are also used as a preparation in our hospital because of their analgesic, anti-inflammatory, anti-snake venom and microcirculation improvement properties and other pharmacological effects (Mei et al., 2006). Triangle grass tablets have been widely used in our hospital to treat patients with bone pain from chronic kidney disease-mineral and bone disorder (CKD-MBD). However, the effects and mechanism of triangle grass on bone metabolism in chronic kidney disease complicated with mineral and bone abnormalities are unclear. AIM OF THE STUDY The aim of the present study was to investigate the effects of a triangle grass decoction on bone metabolism in CKD-MBD rats. MATERIALS AND METHODS CKD-MBD model rats were subjected to 5/6 nephrectomy combined with 0.5 g NaH2PO4/rat. Serum blood urea nitrogen (BUN), creatinine (Cr), phosphorus (P), calcium (Ca), and intact parathyroid hormone (iPTH) levels were measured with an automatic biochemical analyser. Bone mineral density was determined with a Viva CT 40 system. Bone morphogenetic protein 7(BMP-7),runt-related transcription factor 2 (Runx2) and Osterix protein levels were measured by Western blot analysis. Kidney, vertebra and thoracic aorta tissue samples were assessed by histopathology and immunohistochemistry (IHC). RESULTS The degrees of membrane thickening, necrosis, swelling and cast deposition were significantly reduced in high-dose rats and Low-dose rats. Serum BUN levels were significantly reduced in the Pre-H group (P < 0.05). Hypocalcaemia and hyperphos phataemia were detected in triangle grass (P < 0.05, P < 0.05). In addition, iPTH levels were significantly increased in the Pre-H group (P < 0.05). Alkaline phosphatase (ALP)levels were significantly decreased in the Pre-H group (P < 0.05). The bone mineral density was improved in the Pre-H and Pre-L groups. BMP-7 protein levels were significantly increased in the Pre-H group (P < 0.05). The pathological changes in muscle fibres in the thoracic aorta middle membranes were significantly alleviated in rats in the Pre-H and Pre-L groups. Changes in SM22α and SMα-act in protein levels were significantly attenuated in the Pre-H group (P < 0.05, P < 0.05). Changes in Runx2 and Osterix protein levels were also significantly attenuated in the Pre-H and Pre-L groups (P < 0.05, P < 0.05). CONCLUSIONS Triangle grass can simultaneously ameliorate vertebral bone loss and abnormal calcification in the thoracic aorta. Triangle grass has a definite effect on bone metabolism disorder in CKD-MBD rats.
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Affiliation(s)
- Linna Liu
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, 528400, China.
| | - Lei Wang
- Cardiovascular and Cerebrovascular Drugs Research and Development Center, Tianjin Institute of Medical and Pharmaceutical Sciences, Tianjin, 300020, China.
| | - Li Li
- Second Clinical College of Traditional Chinese Medicine, University of Guangzhou, Guangzhou, 510405, China.
| | - Hong Wang
- Cardiovascular and Cerebrovascular Drugs Research and Development Center, Tianjin Institute of Medical and Pharmaceutical Sciences, Tianjin, 300020, China.
| | - Ling Yuan
- Cardiovascular and Cerebrovascular Drugs Research and Development Center, Tianjin Institute of Medical and Pharmaceutical Sciences, Tianjin, 300020, China.
| | - Li Kang
- Cardiovascular and Cerebrovascular Drugs Research and Development Center, Tianjin Institute of Medical and Pharmaceutical Sciences, Tianjin, 300020, China.
| | - Qian Jiang
- Cardiovascular and Cerebrovascular Drugs Research and Development Center, Tianjin Institute of Medical and Pharmaceutical Sciences, Tianjin, 300020, China.
| | - Guan Chen
- Cardiovascular and Cerebrovascular Drugs Research and Development Center, Tianjin Institute of Medical and Pharmaceutical Sciences, Tianjin, 300020, China.
| | - Nan Lv
- Cardiovascular and Cerebrovascular Drugs Research and Development Center, Tianjin Institute of Medical and Pharmaceutical Sciences, Tianjin, 300020, China.
| | - Xiaoxue Cui
- Cardiovascular and Cerebrovascular Drugs Research and Development Center, Tianjin Institute of Medical and Pharmaceutical Sciences, Tianjin, 300020, China.
| | - Lin Huang
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, 528400, China.
| | - Huifei Wu
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, 528400, China.
| | - Juan Xu
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, 528400, China.
| | - Yanlin Li
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, 528400, China.
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5
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Alvarenga L, Cardozo LFMF, Lindholm B, Stenvinkel P, Mafra D. Intestinal alkaline phosphatase modulation by food components: predictive, preventive, and personalized strategies for novel treatment options in chronic kidney disease. EPMA J 2020; 11:565-579. [PMID: 33240450 PMCID: PMC7680467 DOI: 10.1007/s13167-020-00228-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/30/2020] [Indexed: 12/18/2022]
Abstract
Alkaline phosphatase (AP) is a ubiquitous membrane-bound glycoprotein that catalyzes phosphate monoesters' hydrolysis from organic compounds, an essential process in cell signaling. Four AP isozymes have been described in humans, placental AP, germ cell AP, tissue nonspecific AP, and intestinal AP (IAP). IAP plays a crucial role in gut microbial homeostasis, nutrient uptake, and local and systemic inflammation, and its dysfunction is associated with persistent inflammatory disorders. AP is a strong predictor of mortality in the general population and patients with cardiovascular and chronic kidney disease (CKD). However, little is known about IAP modulation and its possible consequences in CKD, a disease characterized by gut microbiota imbalance and persistent low-grade inflammation. Mitigating inflammation and dysbiosis can prevent cardiovascular complications in patients with CKD, and monitoring factors such as IAP can be useful for predicting those complications. Here, we review IAP's role and the results of nutritional interventions targeting IAP in experimental models to prevent alterations in the gut microbiota, which could be a possible target of predictive, preventive, personalized medicine (PPPM) to avoid CKD complications. Microbiota and some nutrients may activate IAP, which seems to have a beneficial impact on health; however, data on CKD remains scarce.
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Affiliation(s)
- L. Alvarenga
- Post Graduation Program in Medical Sciences, (UFF) Federal Fluminense University Niterói-Rio de Janeiro (RJ), Niterói, Brazil
| | - L. F. M. F. Cardozo
- Post Graduation Program in Cardiovascular Sciences, Federal Fluminense University (UFF), Niterói, Rio de Janeiro (RJ) Brazil
| | - B. Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden
| | - P. Stenvinkel
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden
| | - D. Mafra
- Post Graduation Program in Medical Sciences, (UFF) Federal Fluminense University Niterói-Rio de Janeiro (RJ), Niterói, Brazil
- Post Graduation Program in Cardiovascular Sciences, Federal Fluminense University (UFF), Niterói, Rio de Janeiro (RJ) Brazil
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Zhu X, Li G, Li S, Gong Z, Liu J, Song S. Neutrophil-to-lymphocyte ratio and red blood cell distribution width-to-platelet ratio predict cardiovascular events in hemodialysis patients. Exp Ther Med 2020; 20:1105-1114. [PMID: 32742350 DOI: 10.3892/etm.2020.8756] [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: 03/19/2019] [Accepted: 07/12/2019] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular diseases are among the primary causes of decreased quality of life as well as mortality of hemodialysis patients with end-stage renal disease. The aim of the present study was to evaluate the predictive value of the red blood cell distribution width (RDW)-to-platelet ratio (RPR) and neutrophil-to-lymphocyte ratio (NLR) regarding the occurrence or development of cardiovascular events in hemodialysis patients, as well as the prognostic value of this metric. A total of 219 hemodialysis patients with cardiovascular events (HCE group) and 276 hemodialysis patients with no cardiovascular events (HNCE group) were enrolled in the present study. The clinical characteristics and laboratory parameters on admission, including RDW, as well as neutrophil, lymphocyte and platelet counts, were recorded. The NLR and RPR were increased in the HCE group compared with those in the HNCE group and there was a positive association between the NLR or RPR and the incidence of cardiovascular events in hemodialysis patients. In the receiver operating characteristics curve analysis, the area under the curve of the RPR for predicting cardiovascular events in hemodialysis patients was 0.88, while that for the NLR was 0.84. The sensitivity and specificity of the RPR for predicting cardiovascular events in hemodialysis patients were 0.87 and 0.82 respectively, and for the NLR, they were 0.75 and 0.79, respectively. The RPR was an independent risk factor for the prognosis regarding cardiovascular events in hemodialysis patients. In addition, the NLR and RPR were correlated with brain natriuretic peptide (BNP), cardiac troponin I (cTnI), creatine kinase isoenzyme-MB (CK-MB), and associated with ST segment changes in HCE patients. In conclusion, it was possible to predict the incidence of cardiovascular events in hemodialysis patients using the NLR and RPR, while the RPR had a better sensitivity and specificity than the NLR. The RPR was an independent risk factor for the prognosis regarding cardiovascular events in hemodialysis patients. These routinely available parameters should be considered as novel diagnostic markers for the occurrence and development of cardiovascular events in hemodialysis patients and their prognosis.
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Affiliation(s)
- Xiangjun Zhu
- Department of Nephrology, The First People's Hospital of Yancheng, Yancheng, Jiangsu 224005, P.R. China
| | - Gongqi Li
- Department of Clinical Laboratory, Linyi Traditional Hospital, Linyi, Shandong 276003, P.R. China
| | - Shujuan Li
- Department of Nephrology, The First People's Hospital of Yancheng, Yancheng, Jiangsu 224005, P.R. China
| | - Zhuang Gong
- Department of Nephrology, The First People's Hospital of Yancheng, Yancheng, Jiangsu 224005, P.R. China
| | - Jun Liu
- Department of Laboratory Medicine, The Fifth People's Hospital of Wuxi Affiliated to Jiangnan University, Wuxi, Jiangsu 214005, P.R. China
| | - Shu Song
- Department of Pathology, The First People's Hospital of Yancheng, Yancheng, Jiangsu 224005, P.R. China
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7
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Rodriguez RA, Spence M, Hae R, Agharazii M, Burns KD. Pharmacologic Therapies for Aortic Stiffness in End-Stage Renal Disease: A Systematic Review and Meta-Analysis. Can J Kidney Health Dis 2020; 7:2054358120906974. [PMID: 32128224 PMCID: PMC7036505 DOI: 10.1177/2054358120906974] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/09/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Increased carotid-femoral pulse wave velocity (cf-PWV), a surrogate of
increased aortic stiffness, is a risk factor for cardiovascular events and
all-cause mortality in end-stage renal disease (ESRD). To minimize the
deleterious effects of an increased aortic stiffness in ESRD patients,
several interventions have been developed and cf-PWV has been used to
monitor responses. Objective: The aim of this study was to determine the effects of pharmacologic
interventions that target aortic stiffness on cf-PWV and systolic blood
pressure (SBP) in adults with ESRD. Study design: This study implements a systematic review and meta-analysis. Data sources: MEDLINE, EMBASE, Cochrane Central, Health Technology Assessment, and EBM
databases were searched. Study eligibility, participants, and interventions: Randomized and non-randomized studies involving adults (>18 years) with
ESRD of any duration, receiving or not renal replacement therapy
(hemodialysis, peritoneal dialysis) and exposed to a pharmacologic
intervention whose effects were assessed by cf-PWV. Methods: Study screening, selection, data extraction, and quality assessments were
performed by 2 independent reviewers. Narrative synthesis and quantitative
data analysis summarized the review. Results: We included 1027 ESRD participants from 13 randomized and 5 non-randomized
studies. Most pharmacologic interventions targeted bone mineral metabolism
disorder or hypertension. Treatment with vitamin D analogues or cinacalcet
did not decrease cf-PWV or SBP over placebo or matched controls
(P > .05). Calcium-channel blockers (CCB) decreased
cf-PWV and SBP compared with placebo or standard care (P
< .05). Renin-angiotensin system inhibitors did not show any advantage
over placebo in decreasing cf-PWV (P > .05). Limitations: Quality of evidence ranged from very low to moderate. Overall evidence was
limited by the low number of studies, small sample sizes, and methodological
inconsistencies. Conclusions: Pharmacologic interventions targeting aortic stiffness in ESRD have mixed
effects on reducing cf-PWV, with some strategies suggesting potential
benefit. The quality of evidence, however, is insufficient to draw
definitive conclusions on their use to slow progression of aortic stiffness
in ESRD. Further well-designed studies are needed to confirm these
associations and their impact on cardiovascular outcomes in ESRD. Registered in PROSPERO (CRD42016033463)
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Affiliation(s)
- Rosendo A Rodriguez
- Department of Medicine, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - Matthew Spence
- Division of Nephrology, Kidney Research Centre, University of Ottawa, ON, Canada
| | - Richard Hae
- Division of Nephrology, Kidney Research Centre, University of Ottawa, ON, Canada
| | - Mohsen Agharazii
- CHU de Québec-Université Laval Research Center, Quebec City, Canada
| | - Kevin D Burns
- Department of Medicine, The Ottawa Hospital, University of Ottawa, ON, Canada.,Division of Nephrology, Kidney Research Centre, University of Ottawa, ON, Canada.,Ottawa Hospital Research Institute, ON, Canada
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8
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Choo SZ, Polkinghorne KR, Kerr PG. Biochemical comparison of 8 h haemodialysis and 4 h haemodiafiltration, and two dialysis membranes, in a randomized cross-over trial. Nephrology (Carlton) 2019; 24:542-549. [PMID: 29722110 DOI: 10.1111/nep.13397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 11/28/2022]
Abstract
AIM Extended-hours haemodialysis has long been regarded as the optimal form of dialysis for solute clearance. With emerging benefits of haemodiafiltration, we wanted to compare these two head-to-head. METHODS In this randomized cross-over trial, we recruited existing nocturnal haemodialysis patients, who had not been hospitalized in the prior 3 months. After a baseline 8 h haemodialysis session, subjects were randomized to either 2 weeks of 8 h haemodialysis or 4 h haemodiafiltration with cross-over to the alternative treatment after a 2-week washout period. Subjects were additionally randomized to the Fresenius FX80 or Nipro Elisio in a parallel design. Blood and dialysate samples were collected at baseline and at the end of both study periods. RESULTS Twelve patients completed the study. Mean (SD) age and body mass index were 55.1 ± 11.5 years and 36.4 ± 10.8, respectively. Urea and creatinine reduction ratios were higher with extended-hours haemodialysis compared to haemodiafiltration (difference 14.0%, 95% CI = 10.6, 17.3; P < 0.001 and 9.1%, 95% CI = 11.0, 7.2; P < 0.001). Fibroblast growth factor 23 (FGF23) clearance was superior with haemodiafiltration (difference 20.1%, 95% CI = 8.7, 31.6; P = 0.001). No difference was seen in reduction ratios for phosphate, retinol binding protein, alpha-1-microglobulin, beta-2-microglobulin and fetuin with both modalities. Compared to Nipro Elisio, Fresenius FX80 dialyser achieved higher beta-2-microglobulin clearance (Period 1: difference 7.8%, 95% CI = 1.3, 14.4; P = 0.02, Period 2:7.5%, 95% CI = 1.0, 14.1; P = 0.02). CONCLUSIONS Small solute clearance was superior with extended-hours haemodialysis while haemodiafiltration enhanced FGF23 clearance. Beta-2-microglobulin clearance was improved with Fresenius FX80 dialyser, but this difference is unlikely to be clinically significant.
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Affiliation(s)
- Shi Z Choo
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Monash University, Clayton, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter G Kerr
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Monash University, Clayton, Victoria, Australia
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9
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Afsar B, Sag AA, Oztosun C, Kuwabara M, Cozzolino M, Covic A, Kanbay M. The role of uric acid in mineral bone disorders in chronic kidney disease. J Nephrol 2019; 32:709-717. [DOI: 10.1007/s40620-019-00615-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/24/2019] [Indexed: 01/28/2023]
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10
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Calcium-Phosphate Metabolism Disorders in Patients with Renal Failure Clinical Significance, Diagnosis and Treatment. ACTA MEDICA BULGARICA 2019. [DOI: 10.2478/amb-2019-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Chronic kidney diseases (CKD) are commonly associated with calcium and phosphorus metabolism disorders. The general term of “renal osteodystrophy” (ROD) encompasses a complex spectrum of abnormalities in bone and mineral metabolism in CKD. This is one of the most serious and debilitating complications of CKD. It is related to disproportionately high direct and indirect costs of healthcare, thus posing a major burden on society. The development of ROD begins too early in the course of CKD. Some mechanisms involved in the pathogenesis of ROD are reduced calciferol production, calcium deficiency and hyperphosphatemia. Clinically, ROD occurs with varied manifestations – osteomalacia, osteoporosis, adynamic bone disease. The diagnosis and the treatment are a challenge for the physician and effort should be made to prolong the duration and quality of life of the affected patients.
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11
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Tallman DA, Sahathevan S, Karupaiah T, Khosla P. Egg Intake in Chronic Kidney Disease. Nutrients 2018; 10:E1945. [PMID: 30544535 PMCID: PMC6315879 DOI: 10.3390/nu10121945] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/02/2018] [Accepted: 12/06/2018] [Indexed: 12/26/2022] Open
Abstract
Patients with chronic kidney disease (CKD) are often instructed to adhere to a renal-specific diet depending on the severity and stage of their kidney disease. The prescribed diet may limit certain nutrients, such as phosphorus and potassium, or encourage the consumption of others, such as high biological value (HBV) proteins. Eggs are an inexpensive, easily available and high-quality source of protein, as well as a rich source of leucine, an essential amino acid that plays a role in muscle protein synthesis. However, egg yolk is a concentrated source of both phosphorus and the trimethylamine N-oxide precursor, choline, both of which may have potentially harmful effects in CKD. The yolk is also an abundant source of cholesterol which has been extensively studied for its effects on lipoprotein cholesterol and the risk of cardiovascular disease. Efforts to reduce dietary cholesterol to manage dyslipidemia in dialysis patients (already following a renal diet) have not been shown to offer additional benefit. There is a paucity of data regarding the impact of egg consumption on lipid profiles of CKD patients. Additionally, egg consumption has not been associated with the risk of developing CKD based on epidemiological studies. The egg yolk also contains bioactive compounds, including lutein, zeaxanthin, and vitamin D, which may confer health benefits in CKD patients. Here we review research on egg intake and CKD, discuss both potential contraindications and favorable effects of egg consumption, and describe the need for further research examining egg intake and outcomes in the CKD and end-stage renal disease population.
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Affiliation(s)
- Dina A Tallman
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA.
| | - Sharmela Sahathevan
- Dietetics Program, Faculty of Health and Medical Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 5300, Malaysia.
| | - Tilakavati Karupaiah
- School of Biosciences, Faculty of Health Sciences, Taylor's University, Subang Jaya 47500, Malaysia.
| | - Pramod Khosla
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA.
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12
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Martins JM, Aranha P. Bone turnover and bone mineral density in old persons with type 2 diabetes. J Clin Transl Endocrinol 2018; 14:12-18. [PMID: 30302313 PMCID: PMC6174825 DOI: 10.1016/j.jcte.2018.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 09/09/2018] [Accepted: 09/21/2018] [Indexed: 01/01/2023] Open
Abstract
AIMS To understand the paradox of an increased fracture risk despite increased bone mineral density (BMD) in persons with type 2 diabetes (DM2). PATIENTS AND METHODS We studied 80 old persons with DM2. Mineral metabolism, parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), bone turnover - osteocalcin, procollagen type 1 N-terminal propeptide (P1NP) and C-terminal telopeptide of type 1 collagen (CTX) - were measured and BMD was assessed at the lumbar spine (LS) and femoral neck (FN). Data was analyzed with the Statistical Package for the Social Sciences Program. RESULTS Low levels of 25OHD (84%) and high values of PTH (20%) were found. Osteocalcin was directly related to CTX, p < 0.001, with increased bone formation and increased BMD (z-score) at LS and FN. PTH was directly related to osteocalcin and CTX and inversely related to BMD at the FN, p < 0.05. Patients with dyslipidemia presented higher P1NP, p < 0.05 and patients with hypertension presented higher BMD at LS and FN, p < 0.01. CONCLUSION Old type 2 diabetics present increased bone formation, PTH-driven. Low grade secondary hyperparathyroidism may explain the paradox of an increased fracture risk despite increased BMD.
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Affiliation(s)
- João Martin Martins
- Endocrine Department, Hospital Santa Maria, 6th Floor, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Endocrine University Clinic, Lisbon Medical School, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Patrícia Aranha
- Internal Medicine Department, Hospital Santa Maria, 3rd Floor, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
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Mitsuboshi S, Yamada H, Nagai K, Okajima H. Low Continuity Rate of Sucroferric Oxyhydroxide among Japanese Hemodialysis Patients with High Phosphate Binder Pill Burden. YAKUGAKU ZASSHI 2018; 138:135-139. [DOI: 10.1248/yakushi.17-00180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Moffat AH, Chauhan P, Choudhary S, Geberhiwot T. Extreme bony pelvic deformity in a renal transplant patient. BMJ Case Rep 2017; 2017:bcr-2017-220729. [PMID: 28942400 DOI: 10.1136/bcr-2017-220729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 35-year-old female renal transplant recipient was referred to the metabolic bone clinic because of a 15 cm loss of height. She was noted to have thoracic kyphosis and vertebral X-ray confirmed a wedge fracture of the eighth thoracic vertebra. She was managed accordingly but on subsequent follow-up mentioned in passing that her gynaecologist had been unable to obtain a cervical smear for routine screening. This led to further questioning, and the patient reported intermittent urinary stress incontinence, feelings of vaginal fullness and severe dyspareunia. It became apparent that these symptoms had been ongoing for 4 years, but the patient had not brought them to the attention of a healthcare practitioner due to feelings of embarrassment and her religious beliefs. These complaints prompted radiological investigation, which revealed extensive bony pelvic deformity, thought to be an extreme manifestation of chronic kidney disease mineral and bone disorder.
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Affiliation(s)
| | - Priyesh Chauhan
- Department of Endocrinology, University of Birmingham, Birmingham, UK
| | - Surabhi Choudhary
- Radiology, University Hospital of Birmingham, Birmingham, Westmidlands
| | - Tarekegn Geberhiwot
- Department of Endocrinology, University Hospital of Birmingham, Birmingham, UK
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Gungor O, Kocyigit I, Yilmaz MI, Sezer S. Role of vascular calcification inhibitors in preventing vascular dysfunction and mortality in hemodialysis patients. Semin Dial 2017; 31:72-81. [DOI: 10.1111/sdi.12616] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Ozkan Gungor
- Department of Nephrology; Faculty of Medicine; Kahramanmaraş Sütçü İmam University; Kahramanmaras Turkey
| | - Ismail Kocyigit
- Department of Nephrology; Erciyes University Faculty of Medicine; Kayseri Turkey
| | | | - Siren Sezer
- Department of Nephrology; Faculty of Medicine; Baskent University; Ankara Turkey
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Gregorini M, Sileno G, Pattonieri EF, Corradetti V, Abelli M, Ticozzelli E, Scudeller L, Grignano MA, Esposito P, Bogliolo L, Giacomoni A, Rampino T. Understanding Bone Damage After Kidney Transplantation: A Retrospective Monocentric Cross Sectional Analysis. Transplant Proc 2017; 49:650-657. [PMID: 28457365 DOI: 10.1016/j.transproceed.2017.02.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Kidney transplantation (KT) immunosuppression may induce bone tissue damage with bone mineral density (BMD) loss increasing bone fractures risk. Steroid therapy is considered the major player, but others factors are still under review. PATIENTS AND METHODS We designed an observational retrospective cohort study to evaluate bone damage after KT. The prevalence of osteopenia, osteoporosis, bone fractures, and the associated risk factors were investigated. The following parameters were recorded before transplantation and at the last follow-up: demographic indexes, cumulative steroid dose (CSD), dialytic and transplantologic age, previous nephropathy, femoral and lumbar BMD, fractures, immunosuppressors, calcemia, phosphoremia, rejection episodes, estimated glomerular filtration rate, and parathyroid hormone and vitamin D levels. Stata software (Stata Corporation, College Station, Texas, United States) was used for the statistical analysis, to perform the Fisher's exact test, Kruskal-Wallis test, Student t test, as well as univariate and multivariate analyses. RESULTS The analyzed cohort was composed of 297 patients (65.3% males and 34.7% females). Sixty percent of KT patients had normal BMD, 24% had osteopenia, and 15% had osteoporosis. Twelve percent were victims of bone fractures (8.4% minor, 2% femoral, and 1.7% vertebral). A significant correlation (P <.05) was observed for both osteopenia and osteoporosis with menopause, transplantologic age, CSD, previous glomerulonephritis, and mammalian target of rapamycin (mTOR) inhibitors treatment (imTOR). CONCLUSION This study confirms the correlation between CSD (both before and after transplantation) and post-transplantation bone damage. It also shows that a large fraction of these patients had normal BMD related with a low steroid dose in our protocols. This correlation between imTOR assumption and osteoporosis deserves attention and warrants further in vitro analyses to be performed.
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Affiliation(s)
- M Gregorini
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - G Sileno
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - E F Pattonieri
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinic and Surgical Science, University of Pavia, Pavia, Italy.
| | - V Corradetti
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinic and Surgical Science, University of Pavia, Pavia, Italy
| | - M Abelli
- Unit of General Surgery 2, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - E Ticozzelli
- Unit of General Surgery 2, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - L Scudeller
- Clinical Epidemiology Unit, Fondazione IRCCS Policlinico San Matteo of Pavia, Pavia, Italy
| | - M A Grignano
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - P Esposito
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - L Bogliolo
- Unit of Reumatology, Fondazione IRCCS Policlinico San Matteo of Pavia, Pavia, Italy
| | - A Giacomoni
- Department of Surgery, Niguarda Transplant Center, Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - T Rampino
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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