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Dobson R. Semaglutide and Patients Receiving Hemodialysis: Case Reports of Unexpected Benefits for Hyperphosphatemia and Hyperkalemia. Can J Hosp Pharm 2024; 77:e3534. [PMID: 38720915 PMCID: PMC11060791 DOI: 10.4212/cjhp.3534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/16/2024] [Indexed: 05/12/2024]
Affiliation(s)
- Raea Dobson
- , BSc, BScPharm, ACPR, PharmD, is with Sunnybrook Health Sciences Centre, Toronto, Ontario
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2
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Xiang X, He J, Zhang W, He Q, Liu Y. Coronary artery calcification in patients with advanced chronic kidney disease. BMC Cardiovasc Disord 2022; 22:453. [PMID: 36309659 PMCID: PMC9618197 DOI: 10.1186/s12872-022-02879-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/27/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Cardiovascular disease (CVD) is associated with higher morbidity and mortality rates in patients with chronic kidney disease (CKD). Studies have shown that vascular calcification is a major predictor of CVD. Vascular calcification in the CKD population is associated with various risk factors, and changes in bone and mineral metabolism have been linked to an increased risk of atherosclerosis. Therefore, we aimed to investigate the correlation between vascular calcification and bone metabolism, which is necessary to improve the survival and prognosis of patients with CKD. Methods We included 146 patients with CKD who received coronary artery calcification (CAC) scores at our hospital from May 2017 to November 2018. Spearman rank correlation analysis, Mann–Whitney U test, and Kaplan–Meier method were used to analyze laboratory data and all-cause mortality. Results In the 146 patients, chronic glomerulonephritis accounted for the most common cause of CKD, at approximately 39.0%. Spearman rank correlation analysis on the factors influencing vascular calcification in patients with CKD showed that CAC score was significantly and positively correlated with C-reactive protein, N-terminal/midregion osteocalcin (N-MID), N-terminal peptide of type 1 procollagen (P1NP), β-cross-linked C-telopeptide of type 1 collagen (β-CTx), and parathyroid hormone (P = 0.0423, P = 0.0432, P = 0.0235, P = 0.0061, P < 0.0001, respectively). Serum calcium levels were positively correlated with N-MID, P1NP, β-CTx, and iPTH (r = 0.19, r = 0.24, r = 0.21, r = 0.21, respectively), and serum phosphorus levels were positively correlated with N-MID, P1NP, β-CTx, and iPTH (r = 0.50, r = 0.37, r = 0.50, r = 0.55, respectively). However, no difference was found in CVC scores among patients with CKD in different stages and receiving different treatments. In the Kaplan–Meier analysis of all-cause hospitalization and mortality rates, patients with CAC > 400 had a higher risk. Conclusion We found that the primary cause of CKD is glomerulonephritis, and the CAC score is positively correlated with inflammatory and bone metabolism markers, with a higher risk of all-cause mortality and cardiovascular hospitalization when the CAC score is greater than 400.
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Gallic and Hesperidin Ameliorate Electrolyte Imbalances in AlCl3-Induced Nephrotoxicity in Wistar Rats. Biochem Res Int 2022; 2022:6151684. [PMID: 36263197 PMCID: PMC9576448 DOI: 10.1155/2022/6151684] [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] [Received: 07/09/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
Nephrotoxicity is usually characterized by inefficiency of the kidney, thereby causing disruptions to electrolyte balance and blood acidity. This study aimed to evaluate the effect of hesperidin and gallic acid on serum electrolytes and ion pumps in Wistar rats subjected to aluminum chloride (AlCl3)-induced nephrotoxicity. Thirty Wistar rats were randomly divided into six groups of five animals apiece. Group one served as the negative control and received distilled water while the study lasted. Animals in groups 2–4 received 100 mg/kg/day AlCl3 throughout the study. Animals in groups 3 and 4 were also administered 100 mg/kg/day gallic acid and 100 mg/kg/day hesperidin, respectively. Groups 5 and 6 were treated with 100 mg/kg/day gallic acid only and 100 mg/kg/day hesperidin only, respectively. Treatments were administered orally via gavage for 28 days with distilled water as the vehicle. Animals were sacrificed after which levels of potassium, calcium, magnesium, phosphate, chloride, and bicarbonate ions were evaluated in the serum, while activities of Na+/K+ and Ca2+/Mg2+ ATPases were determined in kidney homogenate. Results showed that AlCl3 significantly (p < 0.05) inhibited activities of Na+/K+ and Ca2+/Mg2+ ATPases in addition to increasing serum levels of potassium, calcium, phosphate, and chloride, with concomitant decrease in serum levels of magnesium and bicarbonate. However, coadministration of AlCl3 with either gallic acid or hesperidin ameliorated all the disruptions caused by AlCl3. It could be concluded that gallic acid and hesperidin could be relevant in managing electrolyte imbalances and acidosis occasioned by kidney dysfunction.
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4
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ICU-Admission Hyperphosphataemia Is Related to Shock and Tissue Damage, Indicating Injury Severity and Mortality in Polytrauma Patients. Diagnostics (Basel) 2021; 11:diagnostics11091548. [PMID: 34573890 PMCID: PMC8466388 DOI: 10.3390/diagnostics11091548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 01/31/2023] Open
Abstract
Hyperphosphataemia can originate from tissue ischaemia and damage and may be associated with injury severity in polytrauma patients. In this retrospective, single-centre study, 166 polytrauma patients (injury severity score (ISS) ≥ 16) primarily requiring intensive care unit (ICU) treatment were analysed within a five-year timeframe. ICU-admission phosphate levels defined a hyperphosphataemic (>1.45 mmol/L; n = 56) opposed to a non-hyperphosphataemic group (n = 110). In the hyperphosphataemic group, injury severity was increased (ISS median and IQR: 38 (30–44) vs. 26 (22–34); p < 0.001), as were signs of shock (lactate, resuscitation requirements), tissue damage (ASAT, ALAT, creatinine) and lastly in-hospital mortality (35.7% vs. 5.5%; p < 0.001). Hyperphosphataemia at ICU admission was shown to be a risk factor for mortality (1.46–2.10 mmol/L: odds ratio (OR) 3.96 (95% confidence interval (CI) 1.03–15.16); p = 0.045; >2.10 mmol/L: OR 12.81 (CI 3.45–47.48); p < 0.001) and admission phosphate levels alone performed as good as injury severity score (ISS) in predicting in-hospital mortality (area under the ROC curve: 0.811 vs. 0.770; p = 0.389). Hyperphosphataemia at ICU admission is related to tissue damage and shock and indicates injury severity and subsequent mortality in polytrauma patients. Admission phosphate levels represent an easily feasible yet strong predictor for in-hospital mortality.
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Wang Q, Wang S, Sun Z. Kidney-Specific Klotho Gene Deletion Causes Aortic Aneurysm via Hyperphosphatemia. Hypertension 2021; 78:308-319. [PMID: 34176284 DOI: 10.1161/hypertensionaha.121.17299] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Qiongxin Wang
- Department of Physiology, College of Medicine, University of Oklahoma Health Sciences Center (Q.W., S.W., Z.S.)
| | - Shirley Wang
- Department of Physiology, College of Medicine, University of Oklahoma Health Sciences Center (Q.W., S.W., Z.S.).,Department of Physiology, College of Medicine, The University of Tennessee Health Science Center, Memphis (S.W., Z.S.)
| | - Zhongjie Sun
- Department of Physiology, College of Medicine, University of Oklahoma Health Sciences Center (Q.W., S.W., Z.S.).,Department of Physiology, College of Medicine, The University of Tennessee Health Science Center, Memphis (S.W., Z.S.)
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6
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Abdulrahman MS, El-Yassin HD, Alwan NAS. Electrolytes and Nutritional Element Assessment among Iraqi Cancer Patients Receiving Chemotherapy. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION: Cancer may lead to abnormalities in electrolyte levels and acid-base disturbances in affected patients that could be induced by the tumor itself or by chemotherapy treatment. Thus, early detection is vital to improve short-term outcome and quality of life.
AIM: This study aims to assess the electrolyte and protein changes in cancer patients on chemotherapy.
MATERIALS AND METHODS: A cohort study was carried out on 100 newly diagnosed patients with cancer in Al-Amal National Radiation Oncology Hospital in Baghdad, Iraq, during the period from January 2019 to July 2019. An assessment of the studied samples was conducted as a baseline measure before receiving chemotherapy and after the third cycle of that treatment. Quantitative parameters included measurements of serum magnesium, calcium, sodium, chloride, potassium, zinc, Hb1Ac, total protein, and ferritin. Data analysis was carried out using Student’s t-test for variable levels. Level of significance of ≤0.05 was considered as significant.
RESULTS: The studied sample comprised 77 females (77%) and 23 males (23%). There were significant decreases in the levels of magnesium and zinc while no significant changes were noted in the levels of other electrolytes. On the other hand, there was a significant decrease in the level of proteins and a significant rise in HBA1c and ferritin.
CONCLUSION: Cancer patients on chemotherapy regimens suffer from major changes in the levels of vitamins, elements, and neurotransmitter that affect their lifestyle, survival, and prognosis. Frequent regular monitoring of such changes is required to harvest a positive impact on the lifestyle of cancer patients lifestyle and their outcome.
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7
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Palafox-Serdán F, Luna-Montiel OA, Pablo-Franco SE, Guillen-Tejada DL, Carreño-Vázquez SD, Silva Pereira TS, Islas Romero LM, Villaseñor López K, Ortega-Régules AE, Jiménez-Garduño AM. Nutritional Guideline for the Management of Mexican Patients with CKD and Hyperphosphatemia. Nutrients 2020; 12:E3289. [PMID: 33121062 PMCID: PMC7693767 DOI: 10.3390/nu12113289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 12/31/2022] Open
Abstract
Chronic kidney disease (CKD) represents a serious concern for the Mexican population since the main predisposing diseases (diabetes, hypertension, etc.) have a high prevalence in the country. The development of frequent comorbidities during CKD such as anemia, metabolic disorders, and hyperphosphatemia increases the costs, symptoms, and death risks of the patients. Hyperphosphatemia is likely the only CKD comorbidity in which pharmaceutical options are restricted to phosphate binders and where nutritional management seems to play an important role for the improvement of biochemical and clinical parameters. Nutritional interventions aiming to control serum phosphate levels need to be based on food tables, which should be specifically elaborated for the cultural context of each population. Until now, there are no available food charts compiling a high amount of Mexican foods and describing phosphorus content as well as the phosphate to protein ratio for nutritional management of hyperphosphatemia in CKD. In this work, we elaborate a highly complete food chart as a reference for Mexican clinicians and include charts of additives and drug phosphate contents to consider extra sources of inorganic phosphate intake. We aim to provide an easy guideline to contribute to the implementation of more nutritional interventions focusing on this population in the country.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Aura M. Jiménez-Garduño
- Health Sciences Department, Universidad de las Américas Puebla, UDLAP, Ex Hacienda Sta. Catarina Mártir S/N. Puebla, C.P. San Andrés Cholula 72810, Mexico; (F.P.-S.); (O.A.L.-M.); (S.E.P.-F.); (D.L.G.-T.); (S.D.C.-V.); (T.S.S.P.); (L.M.I.R.); (K.V.L.); (A.E.O.-R.)
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8
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Cheungpasitporn W, Thongprayoon C, Hansrivijit P, Medaura J, Chewcharat A, Bathini T, Mao MA, Erickson SB. Impact of Admission Calcium-phosphate Product on 1-year Mortality among Hospitalized Patients. Adv Biomed Res 2020; 9:14. [PMID: 32775307 PMCID: PMC7282693 DOI: 10.4103/abr.abr_249_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/12/2020] [Accepted: 02/16/2020] [Indexed: 11/04/2022] Open
Abstract
Background Calcium-phosphate product is associated with mortality among patients with end-stage kidney disease on dialysis. However, clinical evidence among hospitalized patients is limited. The objective of this study was to investigate the relationship between admission calcium-phosphate product and 1-year mortality in hospitalized patients. Materials and Methods All adult patients admitted to a tertiary referral hospital in 2009-2013 were studied. Patients who had both available serum calcium and phosphate measurement within 24 h of hospital admission were included. Admission calcium-phosphate product (calcium × phosphate) was stratified based on its distribution into six groups: <21, 21-<27, 27-<33, 33-<39, 39-<45, and ≥45 mg2/dL2. Multivariate cox proportional hazard analysis was performed to evaluate the association between admission calcium-phosphate product and 1-year mortality, using the calcium-phosphate product of 33-<39 mg2/dL2 as the reference group. Results A total of 14,772 patients were included in this study. The mean admission calcium-phosphate product was 34.4 ± 11.3 mg2/dL2. Of these patients, 3194 (22%) died within 1 year of hospital admission. In adjusted analysis, admission calcium-phosphate product of ≥45 mg2/dL2 was significantly associated with increased 1-year mortality with hazard ratio of 1.41 (95% 95% confidence interval 1.25-1.67), whereas lower admission calcium-phosphate product was not significantly associated with 1-year mortality. Conclusion Elevated calcium-phosphate product was significantly associated with increased 1-year mortality in hospitalized patients.
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Affiliation(s)
- Wisit Cheungpasitporn
- Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA.,Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Charat Thongprayoon
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Panupong Hansrivijit
- Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA, USA
| | - Juan Medaura
- Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Api Chewcharat
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA
| | - Michael A Mao
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL, USA
| | - Stephen B Erickson
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
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9
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Ratkovski GP, do Nascimento KTO, Pedro GC, Ratkovski DR, Gorza FDS, da Silva RJ, Maciel BG, Mojica-Sánchez LC, de Melo CP. Spinel Cobalt Ferrite Nanoparticles for Sensing Phosphate Ions in Aqueous Media and Biological Samples. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2020; 36:2920-2929. [PMID: 32119558 DOI: 10.1021/acs.langmuir.9b02901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Phosphate ions perform a variety of functions in metabolic processes and are essential for all living organisms. The determination of the concentration of phosphate ions is useful in clinical diagnosis of various diseases as an inadequate phosphate level could lead to many health problems. In the search for a cost-effective method of fast monitoring, we investigated the use of cobalt ferrite nanoparticles (CoFeNPs) in the selective recognition of phosphate ions dissolved in aqueous media and more complex samples, such as human blood serum. We prepared these NPs by a chemical coprecipitation route and subjected them to annealing at 600 °C for 1 h. The successful formation of the NPs was confirmed by Fourier transform infrared spectroscopy, X-ray diffraction, transmission electron microscopy, and hysteresis loop measurements. The NPs exhibited a ferrimagnetic behavior, a spinel-type crystalline structure, and hexagonal shape in the nanoscale range. We demonstrated that CoFeNPs containing immobilized fluorescent-labeled single-chain DNA (ssDNA*) probes can be applied for the fast selective detection of phosphate ions dissolved in a liquid medium. We have explored the fact that phosphate groups can displace ssDNA* probes attached to the nanoparticles, therefore causing a perceptible change in the fluorescence signal of the supernatant liquid. This detection method has been tested for the sensing of phosphate ions present both in aqueous solutions and in biological samples, with excellent selectivity and a low limit of detection (∼1.75 nM).
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Affiliation(s)
- Gabriela P Ratkovski
- Departamento de Física, Universidade Federal de Pernambuco, 50670-901 Recife, Pernambuco, Brazil
| | - Kamila T O do Nascimento
- Pós-Graduação em Ciência de Materiais, Universidade Federal de Pernambuco, 50670-901 Recife, Pernambuco, Brazil
| | - Graciela C Pedro
- Pós-Graduação em Ciência de Materiais, Universidade Federal de Pernambuco, 50670-901 Recife, Pernambuco, Brazil
| | - Danilo R Ratkovski
- Departamento de Física, Universidade Federal de Pernambuco, 50670-901 Recife, Pernambuco, Brazil
| | - Filipe D S Gorza
- Pós-Graduação em Ciência de Materiais, Universidade Federal de Pernambuco, 50670-901 Recife, Pernambuco, Brazil
| | - Romário J da Silva
- Pós-Graduação em Ciência de Materiais, Universidade Federal de Pernambuco, 50670-901 Recife, Pernambuco, Brazil
| | - Bruna G Maciel
- Pós-Graduação em Ciência de Materiais, Universidade Federal de Pernambuco, 50670-901 Recife, Pernambuco, Brazil
| | - Lizeth C Mojica-Sánchez
- Departamento de Física, Universidade Federal de Pernambuco, 50670-901 Recife, Pernambuco, Brazil
| | - Celso P de Melo
- Departamento de Física, Universidade Federal de Pernambuco, 50670-901 Recife, Pernambuco, Brazil
- Pós-Graduação em Ciência de Materiais, Universidade Federal de Pernambuco, 50670-901 Recife, Pernambuco, Brazil
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10
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Cozzolino M, Ketteler M, Wagner CA. An expert update on novel therapeutic targets for hyperphosphatemia in chronic kidney disease: preclinical and clinical innovations. Expert Opin Ther Targets 2020; 24:477-488. [PMID: 32191548 DOI: 10.1080/14728222.2020.1743680] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: The management of hyperphosphatemia in patients with chronic kidney disease (CKD) is complicated, requiring a multidisciplinary approach that includes dietary phosphate restriction, dialysis, and phosphate binders.Areas covered: We describe key players involved in regulating inorganic phosphate homeostasis and their differential role in healthy people and different stages of CKD. The contribution of paracellular and transcellular intestinal absorptive mechanisms are also examined. Finally, we illuminate recent therapeutic approaches for hyperphosphatemia in CKD. We searched PubMed/Medline (up to November 2019) using the following terms: chronic kidney disease, dialysis, diet, hyperphosphatemia, NaPi2b, nicotinamide, phosphate binder, secondary hyperparathyroidism, tenapanor and vascular calcification.Expert opinion: The precise mechanisms regulating intestinal phosphate absorption in humans is not completely understood. However, it is now established that this process involves two independent pathways: a) active transport (i.e. transcellular route, via specific ion transporters) and inactive transport (i.e. paracellular route across tight junctions). Dietary phosphate restriction and phosphate-binder use can lead to an undesirable maladaptive increase in phosphate uptake and promote active phosphate transport by increased expression of the gastrointestinal sodium-dependent phosphate transporter, NaPi2b. Nicotinamide may overcome these limitations through the inhibition of NaPi2b, by improved efficacy and reduced phosphate binder use and better compliance.
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Affiliation(s)
- Mario Cozzolino
- Renal Division, ASST Santi Paolo E Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Markus Ketteler
- Department of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Carsten Alexander Wagner
- Institute of Physiology, University of Zurich, Zurich, Switzerland.,National Center of Competence in Research, NCCR Kidney. CH, Zurich, Switzerland
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11
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Dang ZH, Tang C, Li GL, Luobu C, Qing D, Ma ZH, Qu JF, Suolang L, Liu LJ. Mineral and bone disorder in hemodialysis patients in the Tibetan Plateau: a multicenter cross-sectional study. Ren Fail 2019; 41:636-643. [PMID: 31269846 PMCID: PMC6610496 DOI: 10.1080/0886022x.2019.1635892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 11/28/2022] Open
Abstract
Background: Mineral and bone disorder (MBD) in hemodialysis patients is associated with increased morbidity and mortality. Studies on the MBD status of hemodialysis patients at high altitudes are extremely limited. Methods: A total of 146 hemodialysis patients from 5 local hospitals across all districts with hemodialysis centers in the Tibetan Plateau were enrolled in this cross-sectional study. Parameters related to MBD, including serum phosphorus (P), calcium (Ca), and intact parathyroid hormone (iPTH) levels, were measured. The achievement of MBD goals was compared with the achievement in the Dialysis Outcomes and Practice Study (DOPPS) 3, DOPPS 4 and a multicenter study of MBD in China. Factors associated with hyperphosphatemia were examined. Results: Altogether, 146 hemodialysis patients were recruited from the Tibetan Plateau. According to the K/DIGO guidelines, there were low achievement rates for serum Ca (40.4%), P (29.7%), and iPTH (47.1%). As for the (KDOQI) guidelines, the rates of achievement of defined targets were 38.4%, 33.7% and 16.4% for serum Ca, P and iPTH, respectively. The percentages of patients reaching the KDOQI targets for corrected Ca, P, and iPTH were significantly lower for Tibetan patients than the percentages found in DOPPS 3 (38.4% vs. 50.4%, 33.7% vs. 49.8%, and 16.4% vs. 31.4%, respectively, all p < .001) and DOPPS 4 (38.4% vs. 56.0%, 33.7% vs. 54.5%, and 16.4% vs. 35.3%, respectively, all p < .001). The percentage of patients reaching the KDOQI targets for iPTH was significantly lower in Tibet than in the plain areas of China (16.4% vs. 26.5%, p < .001). The proportion of patients with hypocalcemia was higher in Tibet than in the plain areas (44.5% vs. 19.4%, p < .001). The percentage of local patients with optimal P was significantly higher for patients with an activated vitamin D prescription than for patients without an activated vitamin D prescription (45.3% vs. 19.3%, p < .001). Age and the activated vitamin D prescription were independently associated with hyperphosphatemia. Conclusion: The MBD status of hemodialysis patients in Tibet is far from the ideal level. High altitude is one of the possible causes of the differences found, but not the principal one. It is necessary for medical staff in Tibet to improve the detection and treatment of MBD.
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Affiliation(s)
- Zong-Hui Dang
- Renal Division, The People’s Hospital of Tibet Autonomous Region, Lhasa, China
| | - Chen Tang
- Renal Division, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
| | - Guo-Liang Li
- Renal Division, The People’s Hospital of Tibet Autonomous Region, Lhasa, China
| | - Ciren Luobu
- Renal Division, The People’s Hospital of Tibet Autonomous Region, Lhasa, China
| | - De Qing
- Renal Division, The People's Hospital, Shannan, China
| | - Zhen-Hua Ma
- Renal Division, The People's Hospital, Shigatse, China
| | - Jing-Feng Qu
- Renal Division, Second People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - lamu Suolang
- Renal Division, The People's Hospital, Linzhi, China
| | - Li-Jun Liu
- Renal Division, The People’s Hospital of Tibet Autonomous Region, Lhasa, China
- Renal Division, Peking University First Hospital, Beijing, China
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12
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Kritmetapak K, Dumrongsukit S, Jinchai J, Wongprommek P. Pseudohyperphosphatemia in a patient with relapsed multiple myeloma after bone marrow transplantation: A case report. Clin Case Rep 2019; 7:1426-1429. [PMID: 31360504 PMCID: PMC6637355 DOI: 10.1002/ccr3.2264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/10/2019] [Accepted: 05/28/2019] [Indexed: 11/11/2022] Open
Abstract
Pseudohyperphosphatemia is a laboratory artifact characterized by falsely elevated serum phosphate mostly due to paraprotein interference on the conventional automated analyzer. Clinician recognition of this phenomenon and pre-analytical preparation, including dilution or protein precipitation, can obviate unnecessary therapy and potentially unveil the diagnosis of paraproteinemia especially related to multiple myeloma.
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Affiliation(s)
| | - Sophon Dumrongsukit
- Department of Medicine, Faculty of MedicineKhon Kaen UniversityKhon KaenThailand
| | - Jittirat Jinchai
- Department of Medicine, Faculty of MedicineKhon Kaen UniversityKhon KaenThailand
| | - Panibud Wongprommek
- Division of Nephrology, Faculty of MedicineKhon Kaen UniversityKhon KaenThailand
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13
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A Novel Heterozygous Deletion Variant in KLOTHO Gene Leading to Haploinsufficiency and Impairment of Fibroblast Growth Factor 23 Signaling Pathway. J Clin Med 2019; 8:jcm8040500. [PMID: 31013726 PMCID: PMC6517886 DOI: 10.3390/jcm8040500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 03/31/2019] [Accepted: 04/08/2019] [Indexed: 11/24/2022] Open
Abstract
Hyperphosphatemia is commonly present in end-stage renal disease. Klotho (KL) is implicated in phosphate homeostasis since it acts as obligate co-receptor for the fibroblast growth factor 23 (FGF23), a major phosphaturic hormone. We hypothesized that genetic variation in the KL gene might be associated with alterations in phosphate homeostasis resulting in hyperphosphatemia. We performed sequencing for determining KL gene variants in a group of resistant hyperphosphatemic dialysis patients. In a 67-year-old female, blood DNA sequencing revealed a heterozygous deletion of a T at position 1041 (c.1041delT) in exon 2. This variation caused a frameshift with substitution of isoleucine for phenylalanine and introduction of a premature termination codon (p.Ile348Phefs*28). cDNA sequencing showed absence of deletion-carrier transcripts in peripheral blood mononuclear cells suggesting degradation of these through a nonsense-mediated RNA decay pathway. Experiments in vitro showed that p.Ile348Phefs*28 variant impaired FGF23 signaling pathway, indicating a functional inactivation of the gene. In the patient, serum levels of KL were 2.9-fold lower than the mean level of a group of matched dialysis subjects, suggesting a compromise in the circulating protein concentration due to haploinsufficiency. These findings provide a new loss-of-function variant in the human KL gene, suggesting that genetic determinants might be associated to clinical resistant hyperphosphatemia.
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14
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Dysregulated Phosphate Metabolism, Periodontal Disease, and Cancer: Possible Global Health Implications. Dent J (Basel) 2019; 7:dj7010018. [PMID: 30754693 PMCID: PMC6473307 DOI: 10.3390/dj7010018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/31/2019] [Accepted: 02/06/2019] [Indexed: 01/08/2023] Open
Abstract
An association between periodontal disease and cancer has been established in recent studies, but no common etiology has been identified in the hopes of reducing the global burden of these non-communicable diseases. This perspective article hypothesizes that the determinant mediating the association of periodontal disease with cancer is dysregulated phosphate metabolism. Phosphate, an essential dietary micronutrient, is dysregulated in chronic kidney disease, and both cancer and periodontal disease are associated with chronic kidney disease. Reviewed evidence includes the association between phosphate toxicity and cancer development, and the association between periodontal disease and chronic kidney disease-mineral and bone disorder includes conditions such as ectopic calcification and bone resorption, which may be indirectly related to periodontal disease. Dental calculus in periodontal disease contains calcium phosphate crystals that are deposited from excess calcium and phosphate in saliva. Alveolar bone resorption may be linked systemically to release of parathyroid hormone in response to hypocalcemia induced by hyperphosphatemia. More research is needed to examine the role of dysregulated phosphate metabolism in periodontal disease.
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Lai J, Akindavyi G, Fu Q, Li ZL, Wang HM, Wen LH. Research Progress on the Relationship between Coronary Artery Calcification and Chronic Renal Failure. Chin Med J (Engl) 2018; 131:608-614. [PMID: 29483398 PMCID: PMC5850680 DOI: 10.4103/0366-6999.226066] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective: Coronary artery calcification (CAC) is thought to be a controlled metabolic process that is very similar to the formation of new bone. In patients with chronic renal failure (CRF), CAC is very common, and CAC severity correlates with the deterioration of renal function. We summarized the current understanding and emerging findings of the relationship between CAC and CRF. Data Sources: All studies were identified by systematically searching PubMed, Embase, and CNKI databases for the terms “coronary calcification”, “chronic renal failure”, “vascular smooth muscle cell”, and their synonyms until September 2017. Study Selection: We examined the titles and abstracts of all studies that met our search strategy thoroughly. The full text of relevant studies was evaluated. Reference lists of retrieved articles were also scrutinized for the additional relevant studies. Results: CRF can accelerate CAC progression. CRF increases the expression of pro-inflammatory factors, electrolyte imbalance (e.g., of calcium, phosphorus), parathyroid hormone, and uremic toxins and their ability to promote calcification. These factors, through the relevant signaling pathways, trigger vascular smooth muscle cells to transform into osteoblast-like cells while inhibiting the reduction of vascular calcification factors, thus inducing further CAC. Conclusions: Coronary heart disease in patients with CRF is due to multiple factors. Understanding the mechanism of CAC can help interventionists to protect the myocardium and reduce the prevalence of coronary heart disease and mortality.
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Affiliation(s)
- Jun Lai
- Department of Cardiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, China
| | - Gael Akindavyi
- Department of Cardiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, China
| | - Qiang Fu
- Department of Cardiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, China
| | - Zhi-Liang Li
- Department of Cardiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, China
| | - Hui-Min Wang
- Department of Cardiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, China
| | - Li-Hua Wen
- Department of Cardiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, China
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de Castro BBA, do Carmo WB, de Albuquerque Suassuna PG, Carminatti M, Brito JB, Dominguez WV, de Oliveira IB, Jorgetti V, Custodio MR, Sanders-Pinheiro H. Effect of cross-linked chitosan iron (III) on vascular calcification in uremic rats. Exp Biol Med (Maywood) 2018; 243:796-802. [PMID: 29763365 DOI: 10.1177/1535370218775035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cross-linked chitosan iron (III) is a chitin-derived polymer with a chelating effect on phosphorus, but it is untested in vascular calcification. We evaluated this compound's ability to reduce hyperphosphatemia and its effect on vascular calcification in uremic rats using an adenine-based, phosphorus-rich diet for seven weeks. We used a control group to characterize the uremia. Uremic rats were divided according the treatment into chronic kidney disease, CKD-Ch-Fe(III)CL (CKD-Ch), CKD-calcium carbonate, or CKD-sevelamer groups. We measured creatinine, phosphorus, calcium, alkaline phosphatase, phosphorus excretion fraction, parathyroid hormone, and fibroblast growth factor 23. Vascular calcification was assessed using the aortic calcium content, and a semi-quantitative analysis was performed using Von Kossa and hematoxylin-eosin staining. At week seven, rats in the chronic kidney disease group had higher creatinine, phosphorus, phosphorus excretion fraction, calcium, alkaline phosphatase, fibroblast growth factor 23, and aortic calcium content than those in the Control group. Treatments with cross-linked chitosan iron (III) and calcium carbonate prevented phosphorus increase (20%-30% reduction). The aortic calcium content was lowered by 88% and 85% in the CKD-Ch and CKD-sevelamer groups, respectively. The prevalence of vascular changes was higher in the chronic kidney disease and CKD-calcium carbonate (62.5%) groups than in the CKD-Ch group (37.5%). In conclusion, cross-linked chitosan iron (III) had a phosphorus chelating effect similar to calcium carbonate already available for clinical use, and prevented calcium accumulation in the aorta. Impact statement Vascular calcification (VC) is a common complication due to CKD-related bone and mineral disorder (BMD) and is characterized by deposition of calcium in vessels. Effective therapies are not yet available but new phosphorus chelators can prevent complications from CV. We tested the effect of chitosan, a new phosphorus chelator, on the VC of uremic animals. It has recently been proposed that chitosan treatment may be effective in the treatment of hyperphosphataemia. However, its action on vascular calcification has not been investigated yet. In this study, we demonstrated that chitosan reduced the calcium content in the aorta, suggesting that this may be a therapeutic approach in the treatment of hyperphosphatemia by preventing CV.
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Affiliation(s)
- Barbara Bruna Abreu de Castro
- 1 Laboratory of Experimental Nephrology (LABNEX) and Interdisciplinary Nucleus of Laboratory Animal Studies (NIDEAL), Reproductive Biology Center (CBR), Federal University of Juiz de Fora (UFJF), Juiz de Fora 36036900, Brazil.,2 Interdisciplinary Nucleus for Studies and Research in Nephrology (NIEPEN), Federal University of Juiz de Fora (UFJF), Juiz de Fora 36036330, Brazil
| | - Wander Barros do Carmo
- 1 Laboratory of Experimental Nephrology (LABNEX) and Interdisciplinary Nucleus of Laboratory Animal Studies (NIDEAL), Reproductive Biology Center (CBR), Federal University of Juiz de Fora (UFJF), Juiz de Fora 36036900, Brazil.,2 Interdisciplinary Nucleus for Studies and Research in Nephrology (NIEPEN), Federal University of Juiz de Fora (UFJF), Juiz de Fora 36036330, Brazil
| | - Paulo Giovani de Albuquerque Suassuna
- 1 Laboratory of Experimental Nephrology (LABNEX) and Interdisciplinary Nucleus of Laboratory Animal Studies (NIDEAL), Reproductive Biology Center (CBR), Federal University of Juiz de Fora (UFJF), Juiz de Fora 36036900, Brazil.,2 Interdisciplinary Nucleus for Studies and Research in Nephrology (NIEPEN), Federal University of Juiz de Fora (UFJF), Juiz de Fora 36036330, Brazil
| | - Moises Carminatti
- 2 Interdisciplinary Nucleus for Studies and Research in Nephrology (NIEPEN), Federal University of Juiz de Fora (UFJF), Juiz de Fora 36036330, Brazil
| | - Julia Bianchi Brito
- 1 Laboratory of Experimental Nephrology (LABNEX) and Interdisciplinary Nucleus of Laboratory Animal Studies (NIDEAL), Reproductive Biology Center (CBR), Federal University of Juiz de Fora (UFJF), Juiz de Fora 36036900, Brazil.,2 Interdisciplinary Nucleus for Studies and Research in Nephrology (NIEPEN), Federal University of Juiz de Fora (UFJF), Juiz de Fora 36036330, Brazil
| | - Wagner Vasques Dominguez
- 3 Laboratory of Renal Physiopathology, University of São Paulo Medical School, University of São Paulo, São Paulo 01246903, Brazil
| | - Ivone Braga de Oliveira
- 3 Laboratory of Renal Physiopathology, University of São Paulo Medical School, University of São Paulo, São Paulo 01246903, Brazil
| | - Vanda Jorgetti
- 3 Laboratory of Renal Physiopathology, University of São Paulo Medical School, University of São Paulo, São Paulo 01246903, Brazil
| | - Melani Ribeiro Custodio
- 3 Laboratory of Renal Physiopathology, University of São Paulo Medical School, University of São Paulo, São Paulo 01246903, Brazil
| | - Helady Sanders-Pinheiro
- 1 Laboratory of Experimental Nephrology (LABNEX) and Interdisciplinary Nucleus of Laboratory Animal Studies (NIDEAL), Reproductive Biology Center (CBR), Federal University of Juiz de Fora (UFJF), Juiz de Fora 36036900, Brazil.,2 Interdisciplinary Nucleus for Studies and Research in Nephrology (NIEPEN), Federal University of Juiz de Fora (UFJF), Juiz de Fora 36036330, Brazil
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McKee TJ, Komarova SV. Is it time to reinvent basic cell culture medium? Am J Physiol Cell Physiol 2017; 312:C624-C626. [PMID: 28228375 DOI: 10.1152/ajpcell.00336.2016] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/22/2017] [Accepted: 02/22/2017] [Indexed: 11/22/2022]
Affiliation(s)
- Turney J McKee
- Faculty of Dentistry, McGill University, Shriners Hospital for Children - Canada, Montreal, Quebec, Canada
| | - Svetlana V Komarova
- Faculty of Dentistry, McGill University, Shriners Hospital for Children - Canada, Montreal, Quebec, Canada
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Brown RB, Haq A, Stanford CF, Razzaque MS. Vitamin D, phosphate, and vasculotoxicity. Can J Physiol Pharmacol 2015; 93:1077-82. [DOI: 10.1139/cjpp-2015-0083] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Vascular calcification is a complex process that results in the ectopic deposition of calcium-phosphate hydroxyapatite. Medial and intimal vascular calcification is frequently present in patients with diabetes mellitus and chronic kidney disease (CKD), and markedly increases the morbidity and mortality of these patients. Increased serum levels of calcium and phosphate, along with the use of active vitamin D metabolites, are commonly implicated in the evolvement of vascular wall mineralization in CKD patients. Because CKD patients have lower serum levels of vitamin D, they are routinely prescribed vitamin D supplements that exert a dualistic role that is both healthful and harmful in these patients, perhaps protecting bone health, but at the expense of promoting vascular pathology. This review briefly explains how reducing the phosphate burden in CKD patients could minimize vitamin-D-associated vascular wall calcification.
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Affiliation(s)
- Ronald B. Brown
- College of Human Ecology, Kansas State University, Manhattan, KS 66506, USA
| | - Afrozul Haq
- Division of Research & Development, VPS Healthcare, Abu Dhabi, UAE
| | | | - Mohammed S. Razzaque
- Division of Research & Development, VPS Healthcare, Abu Dhabi, UAE
- Department of Applied Oral Sciences, Forsyth Institute, 245 First Street, Cambridge, MA 02142, USA
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Effects of lanthanum carbonate on vascular calcification in elderly maintenance hemodialysis patients. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s11596-015-1461-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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