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Galassi A, Ciceri P, Porata G, Iatrino R, Boni Brivio G, Fasulo E, Magagnoli L, Stucchi A, Frittoli M, Cara A, Cozzolino M. Current treatment options for secondary hyperparathyroidism in patients with stage 3 to 4 chronic kidney disease and vitamin D deficiency. Expert Opin Drug Saf 2021; 20:1333-1349. [PMID: 33993809 DOI: 10.1080/14740338.2021.1931117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Secondary hyperparathyroidism (SHPT) represents a complication of chronic kidney disease (CKD). Vitamin D system is altered since early CKD, and vitamin D deficiency is an established trigger of SHPT. Although untreated SHPT may degenerate into tertiary hyperparathyroidism with detrimental consequences in advanced CKD, best treatments for counteracting SHPT from stage 3 CKD are still debated. Enthusiasm on prescription of vitamin D receptor activators (VDRA) in non-dialysis renal patients, has been mitigated by the risk of low bone turnover and positive calcium-phosphate balance. Nutritional vitamin D is now suggested as first-line therapy to treat SHPT with low 25(OH)D insufficiency. However, no high-grade evidence supports the best choice between ergocalciferol, cholecalciferol, and calcifediol (in its immediate or extended-release formulation).Areas covered: The review discusses available data on safety and efficacy of nutritional vitamin D, VDRA and nutritional therapy in replenishing 25(OH)D deficiency and counteracting SHPT in non-dialysis CKD patients.Expert opinion: Best treatment for low 25(OH)D and SHPT remains unknown, due to incomplete understanding of the best homeostatic, as mutable, adaptation of mineral metabolism to CKD progression. Nutritional vitamin D and nutritional therapy appear safest interventions, whenever contextualized with single-patient characteristics. VDRA should be restricted to uncontrolled SHPT by first-line therapy.
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Affiliation(s)
- Andrea Galassi
- Renal and Dialysis Unit, ASST Santi Paolo E Carlo, Milan, Italy
| | - Paola Ciceri
- Renal Research Laboratory, Department of Nephrology, Dialysis and Renal Transplant, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and Fondazione D'Amico per La Ricerca Sulle Malattie Renali, Milan, Italy
| | - Giulia Porata
- Renal and Dialysis Unit, ASST Santi Paolo E Carlo, Milan, Italy
| | | | - Giulia Boni Brivio
- Renal and Dialysis Unit, ASST Santi Paolo E Carlo, Milan, Italy.,Department of Health and Science, University of Milan, Milan, Italy
| | - Eliana Fasulo
- Renal and Dialysis Unit, ASST Santi Paolo E Carlo, Milan, Italy
| | - Lorenza Magagnoli
- Renal and Dialysis Unit, ASST Santi Paolo E Carlo, Milan, Italy.,Department of Health and Science, University of Milan, Milan, Italy
| | - Andrea Stucchi
- Renal and Dialysis Unit, ASST Santi Paolo E Carlo, Milan, Italy
| | - Michela Frittoli
- Renal and Dialysis Unit, ASST Santi Paolo E Carlo, Milan, Italy.,Department of Health and Science, University of Milan, Milan, Italy
| | - Anila Cara
- Renal and Dialysis Unit, ASST Santi Paolo E Carlo, Milan, Italy.,Department of Health and Science, University of Milan, Milan, Italy
| | - Mario Cozzolino
- Renal and Dialysis Unit, ASST Santi Paolo E Carlo, Milan, Italy.,Department of Health and Science, University of Milan, Milan, Italy
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Gao JQ, Zhao FG, Huang JM, Shao FQ, Xie P. Comparative performance of FAS equation and Asian modified CKD-EPI in the determination of GFR in Chinese patients with CKD with the 99mTc-DTPA plasma clearance as the reference method. Nefrologia 2021; 41:27-33. [PMID: 36165358 DOI: 10.1016/j.nefroe.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/28/2020] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Glomerular filtration rate (GFR) is a useful index in many clinical conditions. However, very few studies have assessed the performance of full age spectrum (FAS) equation and the Asian modified Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation in the approximation of GFR in Chinese patients with chronic kidney disease. OBJECTIVE This study aimed to compare the diagnostic performance of the above two creatinine-based equations. METHODS A well designed single-center cross-sectional study was performed and the GFR was determined by 3 methods separately in the same day: technetium-99m-diethylene triamine pentaacetic acid (99mTc-DTPA) dual plasma sample clearance method (mGFR); FAS equation method; Asian modified CKD-EPI equation method. The gold standard method was the mGFR. Equations performance criteria considered correlation coefficient, bias, precision, accuracy and the ability to detect the mGFR less than 60ml/min/1.73m2. RESULTS A total of 160 patients were enrolled. The diagnostic performance of FAS showed no significant difference in the correlation coefficient (0.89 vs 0.89), precision (15.9 vs 16.1ml/min/1.73m2), accuracy (75.0% vs 76.3%) and the ability to detect the mGFR less than 60ml/min/1.73m2 (0.94 vs 0.94) compared with the Asian modified CKD-EPI equation in all participants. The FAS showed a negative bias, while the new CKD-EPI equation showed a positive bias (-1.20 vs 1.30ml/min/1.73m2, P<0.001). However, they were all near to zero. In the mGFR<60ml/min/1.73m2 subgroup and mGFR>60ml/min/1.73m2 subgroup were consistent with that in the whole cohort. The precision and accuracy decreased when GFR>60ml/min/1.73m2 in both equations. CONCLUSIONS The FAS equation and the Asian modified CKD-EPI equation had similar performance in determining the glomerular filtration rate in the Chinese patients with chronic kidney disease. Both the FAS equation and Asian modified CKD-EPI can be a satisfactory method and may be the most suitable creatinine-based equation.
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Affiliation(s)
- Jian-Qing Gao
- Department of Nuclear Medicine, The Third Hospital, Hebei Medical University, PR China
| | - Fu-Gang Zhao
- Department of Traditional Medicine, The First Hospital, Hebei Medical University, PR China
| | - Jian-Min Huang
- Department of Nuclear Medicine, The Third Hospital, Hebei Medical University, PR China
| | - Fu-Qiang Shao
- Department of Nuclear Medicine, Zigong First People's Hospital, Zigong, Sichuan, PR China
| | - Peng Xie
- Department of Nuclear Medicine, The Third Hospital, Hebei Medical University, PR China.
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Comparative performance of FAS equation and Asian modified CKD-EPI in the determination of GFR in Chinese patients with CKD with the 99mTc-DTPA plasma clearance as the reference method. Nefrologia 2020; 41:27-33. [PMID: 33153776 DOI: 10.1016/j.nefro.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/15/2020] [Accepted: 08/28/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Glomerular filtration rate (GFR) is a useful index in many clinical conditions. However, very few studies have assessed the performance of full age spectrum (FAS) equation and the Asian modified Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation in the approximation of GFR in Chinese patients with chronic kidney disease. OBJECTIVE This study aimed to compare the diagnostic performance of the above two creatinine-based equations. METHODS A well designed single-center cross-sectional study was performed and the GFR was determined by 3 methods separately in the same day: technetium-99m-diethylene triamine pentaacetic acid (99mTc-DTPA) dual plasma sample clearance method (mGFR); FAS equation method; Asian modified CKD-EPI equation method. The gold standard method was the mGFR. Equations performance criteria considered correlation coefficient, bias, precision, accuracy and the ability to detect the mGFR less than 60ml/min/1.73m2. RESULTS A total of 160 patients were enrolled. The diagnostic performance of FAS showed no significant difference in the correlation coefficient (0.89 vs 0.89), precision (15.9 vs 16.1ml/min/1.73m2), accuracy (75.0% vs 76.3%) and the ability to detect the mGFR less than 60ml/min/1.73m2 (0.94 vs 0.94) compared with the Asian modified CKD-EPI equation in all participants. The FAS showed a negative bias, while the new CKD-EPI equation showed a positive bias (-1.20 vs 1.30ml/min/1.73m2, P<0.001). However, they were all near to zero. In the mGFR<60ml/min/1.73m2 subgroup and mGFR>60ml/min/1.73m2 subgroup were consistent with that in the whole cohort. The precision and accuracy decreased when GFR>60ml/min/1.73m2 in both equations. CONCLUSIONS The FAS equation and the Asian modified CKD-EPI equation had similar performance in determining the glomerular filtration rate in the Chinese patients with chronic kidney disease. Both the FAS equation and Asian modified CKD-EPI can be a satisfactory method and may be the most suitable creatinine-based equation.
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