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Hsu S, Bansal N, Denburg M, Ginsberg C, Hoofnagle AN, Isakova T, Ix JH, Robinson-Cohen C, Wolf M, Kestenbaum BR, de Boer IH, Zelnick LR. Risk factors for hip and vertebral fractures in chronic kidney disease: the CRIC study. J Bone Miner Res 2024; 39:433-442. [PMID: 38477777 PMCID: PMC11262146 DOI: 10.1093/jbmr/zjae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 03/14/2024]
Abstract
Fracture risk is high in chronic kidney disease (CKD) and underlying pathophysiology and risk factors may differ from the general population. In a cohort study of 3939 participants in the chronic renal insufficiency cohort (CRIC), we used Cox regression to test associations of putative risk factors with the composite of first hip or vertebral fracture assessed using hospital discharge codes. Mean age was 58 years, 45% were female, 42% were Black, and 13% were Hispanic. There were 82 hip and 24 vertebral fractures over a mean (SD) 11.1 (4.8) years (2.4 events per 1000 person-years [95% CI: 2.0, 2.9]). Measured at baseline, diabetes, lower body mass index (BMI), steroid use, proteinuria, and elevated parathyroid hormone (PTH) were each associated with fracture risk after adjusting for covariates. Lower time-updated estimated glomerular filtration rate (eGFR) was associated with fractures (HR 1.20 per 10 mL/min/1.73m2 lower eGFR; 95% CI: 1.04, 1.38) as were lower time-updated serum calcium and bicarbonate concentrations. Among time-updated categories of kidney function, hazard ratios (95% CI) for incident fracture were 4.53 (1.77, 11.60) for kidney failure treated with dialysis and 2.48 (0.86, 7.14) for post-kidney transplantation, compared with eGFR ≥60. Proton pump inhibitor use, dietary calcium intake, measures of vitamin D status, serum phosphate, urine calcium and phosphate, and plasma fibroblast growth factor-23 were not associated with fracture risk. In conclusion, lower eGFR in CKD is associated with higher fracture risk, which was highest in kidney failure. Diabetes, lower BMI, steroid use, proteinuria, higher serum concentrations of PTH, and lower calcium and bicarbonate concentrations were associated with fractures and may be modifiable risk factors.
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Affiliation(s)
- Simon Hsu
- Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA 98195, United States
| | - Nisha Bansal
- Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA 98195, United States
| | - Michelle Denburg
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States
- Departments of Pediatrics and Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Charles Ginsberg
- Division of Nephrology-Hypertension, University of California, San Diego, San Diego, CA 92103, United States
| | - Andrew N Hoofnagle
- Department of Laboratory Medicine, University of Washington, Seattle, WA 98195, United States
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Joachim H Ix
- Division of Nephrology-Hypertension, University of California, San Diego, San Diego, CA 92103, United States
| | - Cassianne Robinson-Cohen
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27710, United States
| | - Bryan R Kestenbaum
- Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA 98195, United States
| | - Ian H de Boer
- Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA 98195, United States
| | - Leila R Zelnick
- Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA 98195, United States
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Zhou MS, Zheng SY, Chen C, Li X, Zhang Q, Zhao YJ, Zhang W. Gene expression analysis to identify mechanisms underlying improvement of myocardial fibrosis by finerenone in SHR. Biochem Pharmacol 2024; 220:115975. [PMID: 38086490 DOI: 10.1016/j.bcp.2023.115975] [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: 09/06/2023] [Revised: 11/02/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023]
Abstract
Both spironolactone and finerenone treatments significantly reduced SBP and there was no statistical difference in their antihypertensive effects. The differences in body weight (at the end of 1/2/3/4 week) to pre-dose body weight ratio and heart rate (at the end of 1/2/3/4 week) to pre-dose heart rate ratio were not statistically significant in the vehicle, spironolactone, finerenone, and control groups.There was no statistically significant difference in mortality among the vehicle, spironolactone, and finerenone groups. The relative heart mass, ANP, BNP, CVF, Col I, TGF-β, and Casp-3 were gradually decreased in vehicle group, spironolactone group, and finerenone group. Among them, BNP, CVF, TGF-β, and Casp-3 were significantly decreased in the finerenone group compared with the vehicle group. HE and Masson staining showed that the cardiomyocytes of rats in the vehicle group and spironolactone group were disorganized, with cell hypertrophy, significantly enlarged cell gaps and a large amount of collagen deposition, whereas the cardiomyocytes of rats in the finerenone group and the control group were more neatly arranged, with smaller cell gaps and a small amount of collagen tissue deposition. RNA sequencing (RNA-seq) showed that there was a total of 119 differentially expressed genes (DEGs) between finerenone treatment and vehicle treatment. Kyoto encyclopedia of genes and genomes (KEGG) enrichment analysis showed that the signaling pathways involved were mainly in drug metabolism-cytochrome P450, chemical carcinogenesis, IL-17 signaling pathway, axon guidance, and hematopoietic cell lineage. Protein-protein interaction (PPI) analysis showed that the core genes were Oaslf, Nos2, LOC687780, Rhobtb1, Ephb3, and Rps27a.
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Affiliation(s)
- Ming-Shuang Zhou
- Fuwai Yunnan Hospital,Chinese Academy of Medical Sciences, No.528, Shahe North Road, Wuhua District, Kunming City, Yunnan Province, China.
| | - Shao-Ying Zheng
- Fuwai Yunnan Hospital,Chinese Academy of Medical Sciences, No.528, Shahe North Road, Wuhua District, Kunming City, Yunnan Province, China
| | - Cheng Chen
- Fuwai Yunnan Hospital,Chinese Academy of Medical Sciences, No.528, Shahe North Road, Wuhua District, Kunming City, Yunnan Province, China
| | - Xue Li
- Fuwai Yunnan Hospital,Chinese Academy of Medical Sciences, No.528, Shahe North Road, Wuhua District, Kunming City, Yunnan Province, China
| | - Qin Zhang
- Fuwai Yunnan Hospital,Chinese Academy of Medical Sciences, No.528, Shahe North Road, Wuhua District, Kunming City, Yunnan Province, China
| | - Ya-Jing Zhao
- Fuwai Yunnan Hospital,Chinese Academy of Medical Sciences, No.528, Shahe North Road, Wuhua District, Kunming City, Yunnan Province, China.
| | - Wen Zhang
- Fuwai Yunnan Hospital,Chinese Academy of Medical Sciences, No.528, Shahe North Road, Wuhua District, Kunming City, Yunnan Province, China.
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Cipriani C, Lauriero G, Tripepi G, Ferrari S, Bover J, Ravera M, Barbuto S, Cianciolo G, De Nicola L, Brandi ML, Minisola S, Mereu MC, Corrao G, Del Vecchio L, Fusaro M. Effect of Antidiabetic Drugs on Bone Health in Patients with Normal Renal Function and in Chronic Kidney Disease (CKD): Insight into Clinical Challenges in the Treatment of Type 2 Diabetes. J Clin Med 2023; 12:7260. [PMID: 38068310 PMCID: PMC10707671 DOI: 10.3390/jcm12237260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/29/2023] [Accepted: 11/04/2023] [Indexed: 09/14/2024] Open
Abstract
Among the metabolic changes occurring during the course of type 2 diabetes (T2DM) and diabetic kidney disease (DKD), impaired bone health with consequent increased fracture risk is one of the most complex and multifactorial complications. In subjects with diabetic kidney disease, skeletal abnormalities may develop as a consequence of both conditions. In the attempt to define a holistic approach to diabetes, potential effects of various classes of antidiabetic drugs on the skeleton should be considered in the setting of normal kidney function and in DKD. We reviewed the main evidence on these specific topics. Experimental studies reported potential beneficial and harmful effects on bone by different antidiabetics, with few data available in DKD. Clinical studies specifically designed to evaluate skeletal effects of antidiabetics have not been performed; notwithstanding, data gleaned from randomized controlled trials and intervention studies did not completely confirm observations made by basic research. In the aggregate, evidence from meta-analyses of these studies suggests potential positive effects on fracture risk by metformin and glucagon-like peptide-1 receptor agonists, neutral effects by dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter-2 inhibitors, and sulfonylureas, and negative effects by insulin and thiazolidinediones. As no clinical recommendations on the management of antidiabetic drugs currently include fracture risk assessment among the main goal of therapy, we propose an integrated approach with the aim of defining a patient-centered management of diabetes in chronic kidney disease (CKD) and non-CKD patients. Future clinical evidence on the skeletal effects of antidiabetics will help in optimizing the approach to a personalized and more effective therapy of diabetes.
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Affiliation(s)
- Cristiana Cipriani
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy;
| | - Gabriella Lauriero
- Nephrology and Dialysis Unit, Ospedale “F. Perinei”, ASL of Bari, 70022 Bari, Italy;
| | - Giovanni Tripepi
- National Research Council (CNR), Institute of Clinical Physiology, Section of Biostatistics, 89124 Reggio Calabria, Italy;
| | - Serge Ferrari
- Department of Medicine, Service of Bone Diseases, Geneva University Hospital and Faculty of Medicine, 1205 Geneva, Switzerland;
| | - Jordi Bover
- Department of Nephrology, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain;
- REMAR-IGTP Group, Research Institute Germans Trias i Pujol, Can Ruti Campus, 08916 Badalona, Spain
| | - Maura Ravera
- Nephrology, Dialysis, and Transplantation, University of Genoa and Policlinico San Martino, 16132 Genoa, Italy;
| | - Simona Barbuto
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy; (S.B.); (G.C.)
| | - Giuseppe Cianciolo
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy; (S.B.); (G.C.)
| | - Luca De Nicola
- Division of Nephrology, University of Campania “Luigi Vanvitelli”, 80137 Naples, Italy;
| | - Maria Luisa Brandi
- Fondazione Italiana Ricerca sulle Malattie dell’Osso (FIRMO Onlus), 50129 Florence, Italy;
| | - Salvatore Minisola
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy;
| | | | - Giovanni Corrao
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy;
| | - Lucia Del Vecchio
- Department of Nephrology and Dialysis, Sant’ Anna Hospital, ASST Lariana, 22042 Como, Italy;
| | - Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology, 56124 Pisa, Italy
- Department of Medicine, University of Padua, 35128 Padua, Italy
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