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Iorga C, Iorga CR, Andreiana I, Bengulescu I, Constantin T, Strambu V. Advantages of total parathyroidectomy in patients with secondary hyperparathyroidism induced by end stage renal disease. Front Endocrinol (Lausanne) 2023; 14:1191914. [PMID: 38075043 PMCID: PMC10703479 DOI: 10.3389/fendo.2023.1191914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/09/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction Secondary hyperparathyroidism, as a result of chronic kidney disease could be treated medically or surgically. When pharmacotherapy fails, patients undergo surgery - parathyroidectomy, the curative treatment of secondary hyperparathyroidism (SHPT). There are currently 3 accepted surgical techniques, each with supporters or opponents - total parathyroidectomy, subtotal parathyroidectomy and parathyroidectomy with immediate autotransplantation. Methods In this paper we described our experience on a series of 160 consecutive patients diagnosed with secondary hyperparathyroidism who underwent surgery, in 27 cases it was totalization of the intervention (patients with previously performed subtotal parathyroidectomy or with supernumerary glands and SHPT recurrence). We routinely perform total parathyroidectomy, the method that we believe offers the best results. Results The group of patients was studied according to demographic criteria, paraclinical balance, clinical symptomatology, pre- and postoperative iPTH (intact parathormone) values, SHPT recurrence, number of reinterventions. In 31 cases we found gland ectopy and in 15 cases we discovered supernumerary parathyroids. A percentage of 96.24% of patients with total parathyroidectomy did not show recurrence. Discussions After analyzing the obtained results, our conclusion was that total parathyroidectomy is the intervention of choice for patients suffering from secondary hyperparathyroidism when pharmacotherapy fails in order to prevent recurrence of the disease and to correct the metabolic parameters.
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Affiliation(s)
- Cristian Iorga
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Surgery Clinic, "Dr. Carol Davila" Clinical Nephrology Hospital, Bucharest, Romania
| | - Cristina Raluca Iorga
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Surgery Clinic, "Dr. Carol Davila" Clinical Nephrology Hospital, Bucharest, Romania
| | - Iuliana Andreiana
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Nephrology Clinic, "Dr. Carol Davila" Clinical Nephrology Hospital, Bucharest, Romania
| | - Iustinian Bengulescu
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Surgery Clinic, "Dr. Carol Davila" Clinical Nephrology Hospital, Bucharest, Romania
| | - Traian Constantin
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Urology, "Prof. Dr. Th. Burghele" Hospital, Bucharest, Romania
| | - Victor Strambu
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Surgery Clinic, "Dr. Carol Davila" Clinical Nephrology Hospital, Bucharest, Romania
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Risk Factors and Management of Osteoporosis Post-Transplant. ACTA ACUST UNITED AC 2020; 56:medicina56060302. [PMID: 32575603 PMCID: PMC7353876 DOI: 10.3390/medicina56060302] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 02/06/2023]
Abstract
Bone and mineral disorders are common after organ transplantation. Osteoporosis post transplantation is associated with increased morbidity and mortality. Pathogenesis of bone disorders in this particular sub set of the population is complicated by multiple co-existing factors like preexisting bone disease, Vitamin D deficiency and parathyroid dysfunction. Risk factors include post-transplant immobilization, steroid usage, diabetes mellitus, low body mass index, older age, female sex, smoking, alcohol consumption and a sedentary lifestyle. Immunosuppressive medications post-transplant have a negative impact on outcomes, and further aggravate osteoporotic risk. Management is complex and challenging due to the sub-optimal sensitivity and specificity of non-invasive diagnostic tests, and the underutilization of bone biopsy. In this review, we summarize the prevalence, pathophysiology, diagnostic tests and management of osteoporosis in solid organ and hematopoietic stem cell transplant recipients.
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Effects of isoflavones on bone turnover markers in peritoneal dialysis patients: a randomized controlled trial. Int Urol Nephrol 2020; 52:1367-1376. [PMID: 32488754 DOI: 10.1007/s11255-020-02523-w] [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: 01/30/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study was to investigate the effects of soy isoflavones on serum markers of bone formation and resorption in peritoneal dialysis (PD) patients. METHODS In this randomized, double-blind, placebo-controlled trial, 40 PD patients were randomly assigned to either the soy isoflavone or the placebo group. The patients in the soy isoflavone group received 100 mg soy isoflavones daily for 8 weeks, whereas the placebo group received corresponding placebos. At baseline and the end of the 8th week, 7 ml of blood was obtained from each patient after a 12- to 14-h fast and serum concentrations of bone formation markers (osteocalcin and bone alkaline phosphatase), bone resorption markers [N-telopeptide and receptor activator of nuclear factor kappa B ligand (RANKL)], and osteoprotegerin as an inhibitor of bone resorption were measured. RESULTS Serum N-telopeptide concentration decreased significantly up to 27% in the soy isoflavone group at the end of week 8 compared to baseline (P = 0.003). Also, serum RANKL concentration reduced significantly up to 17% in the soy isoflavone group at the end of week 8 compared to baseline (P = 0.03). These bone resorption markers did not significantly change in the placebo group during the study. There were no significant differences between the two groups in mean changes of serum osteocalcin, bone alkaline phosphatase, and osteoprotegerin. CONCLUSION This study indicates that daily administration of 100 mg soy isoflavone supplement to PD patients reduces serum N-telopeptide and RANKL which are two bone resorption markers. CLINICALTRIALS.GOV: NCT03773029, 2018.
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Ma X, He L. The intervention effect of zuogui pill on chronic kidney disease-mineral and bone disorder regulatory factor. Biomed Pharmacother 2018; 106:54-60. [PMID: 29957466 DOI: 10.1016/j.biopha.2018.06.092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/15/2018] [Accepted: 06/15/2018] [Indexed: 12/29/2022] Open
Abstract
Chronic kidney disease-mineral and bone disorder (CKD-MBD) play a critical role in the pathogenesis of cardiovascular complications in patients with chronic kidney disease (CKD). Zuogui pill as a traditional Chinese herbal drug has been used for nourish kidney essence improve bone malnutrition of renal bone disease by regulating the metabolism of calcium and phosphorus and participating in osteoblast metabolism. In the present study, 5/6 nephrectomy rat model was used to reveal the mechanism of zuogui pill in treatment of CKD-MBD. Compared with sham rats, the levels of serum phosphorus, PTH, iPTH and creatinine were significantly decreased, while the serum calcium level was significantly increased, and the Cbfa1 protein level was significantly decreased and FGF23 protein level was significantly increased by Zuogui pill treatment. Compared with model rats, the BMD of rat was significantly increased by Zuogui pill treatment. Histological analysis revealed that the kidney injury of rats with CKD was significantly reduced by zuogui pill treatment. Compared with model rats, the CYP27B1 mRNA level was significantly increased, and the PTH mRNA level and NaPiIIa protein level were significantly decreased in the kidney by zuogui pill treatment. We inferred that zuogui pill exhibited potential therapeutic effects on CKD-MBD in the rats by regulating bone metabolism and nourish kidney.
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Affiliation(s)
- Xiaohong Ma
- Chenxinghai Hospital of Zhongshan City, No. 18 Zhuyuan Road, Xiaolan Town, Zhongshan, Guangdong, 528415, China.
| | - Liqun He
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine and Pharmacology, No. 185 Pu'an Road, Huangpu District, Shanghai, 200021, China
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Liu Z, Su G, Guo X, Wu Y, Liu X, Zou C, Zhang L, Yang Q, Xu Y, Ma W. Dietary interventions for mineral and bone disorder in people with chronic kidney disease. Cochrane Database Syst Rev 2015; 2015:CD010350. [PMID: 26376110 PMCID: PMC9198407 DOI: 10.1002/14651858.cd010350.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a systemic dysfunction of mineral and bone metabolism in people with CKD. Recent research shows that phosphate retention plays a significant role in the development of CKD-MBD. Compared with drug therapies, dietary interventions may be simple, inexpensive and feasible for phosphate retention. However, there is little evidence to support these interventions. OBJECTIVES Our objective was to assess the benefits and harms of any dietary intervention for preventing and treating CKD-MBD. SEARCH METHODS We searched Cochrane Kidney and Transplant's Specialised Register to 27 August 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. We also searched the Chinese Biomedicine Database (CBM) (1976 to August 2015), China Knowledge Resource Integrated Database (CNKI) (1979 to August 2015), and VIP (1989 to August 2015). SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs looking at dietary interventions for prevention or treatment of CKD-MBD were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two authors independently assessed the eligibility, methodological quality, and extracted data. Continuous outcomes (serum calcium level, serum phosphorus level, calcium × phosphate product, parathyroid hormone (PTH), fibroblast growth factor 23 (FGF-23) and alkaline phosphatase) were expressed as mean difference (MD) with 95% confidence interval (CI). Dichotomous outcomes (mortality) were expressed as risk ratio (RR) with 95% CI. We used a random-effects model to meta-analyse studies. MAIN RESULTS Nine studies were included in this review which analysed 634 participants. Study duration ranged from 4 to 24 weeks. The interventions included calcium-enriched bread, low phosphorus intake, low protein intake, very low protein intake, post haemodialysis supplements and hypolipaemic diet. Only one study reported death; none of the included studies reported cardiovascular events or fractures. There was insufficient reporting of design and methodological aspects among the included studies to enable robust assessment of risk of bias.There was limited and low-quality evidence to indicate that calcium-enriched bread increased serum calcium (1 study, 53 participants: MD -0.16 mmol/L, 95% CI -0.51 to -0.31), decreased serum phosphorus (53 participants: MD -0.41 mmol/L, 95% CI -0.51 to -0.31) and decreased the calcium × phosphate product (53 participants: MD -0.62 mmol²/L², 95% CI -0.77 to -0.47).Very low protein intake was not superior to conventional low protein intake in terms of effect on serum phosphorus (2 studies, 41 participants: MD -0.12 mmol/L, 95% CI -0.50 to 0.25), serum calcium (MD 0.00 mmol/L, 95% CI -0.17 to 0.17), or alkaline phosphatase (MD -22.00 U/L, 95% CI -78.25 to 34.25). PTH was significantly lower in the very low protein intake group (2 studies, 41 participants: MD -69.64 pmol/L, 95% CI -139.83 to 0.54).One study reported no significant difference in the number of deaths between low phosphorus intake and normal diet (279 participants: RR 0.18, 95% CI 0.01 to 3.82). Low phosphorus intake decreased serum phosphorus (2 studies, 359 participants: MD -0.18 mmol/L, 95% CI -0.29 to -0.07; I(2) = 0%).One study reported post-haemodialysis supplements did not increase serum phosphorus compared to normal diet (40 participants: MD 0.12 mmol/L, 95% CI -0.24 to 0.49).One study reported low phosphorus intake plus lanthanum carbonate significantly decreased FGF-23 (19 participants: MD -333.80 RU/mL, 95% CI -526.60 to -141.00), but did not decrease serum phosphorus (19 participants: MD -0.10 mg/dL, 95% CI -0.38 to 0.58) or PTH (19 participants: MD 31.60 pg/mL, 95% CI -29.82 to 93.02). AUTHORS' CONCLUSIONS There was limited low quality evidence to indicate that dietary interventions (calcium-enriched bread or low phosphorus/protein intake) may positively affect CKD-MBD by increasing serum calcium, decreasing serum phosphorus, the calcium × phosphate product and FGF-23. Large and well-designed RCTs are needed to evaluate the effects of various interventions for people with CKD-MBD.
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Affiliation(s)
- Zhuangzhu Liu
- Guangdong Provincial Hospital of Chinese MedicineDepartment of NephrologyGuangzhouChina
- Guangdong Provincial Hospital of Chinese MedicineEmergency DepartmentNo 111 Dade RoadGuangzhouGuangdongChina510120
| | - Guobin Su
- Guangdong Provincial Hospital of Chinese MedicineDepartment of NephrologyGuangzhouChina
- Karolinska InstitutetGlobal Health ‐ Health Systems and Policy: Medicines, focusing antibiotics, Department of Public Health SciencesTomtebodavägen 18a, Widerströmska HusetStockholmStockholmSweden171 77
| | - Xinfeng Guo
- Guangdong Provincial Hospital of Chinese MedicineEvidence‐Based Medicine and Clinical Research Service Group111 Dade RoadGuangzhouGuangDongChina510120
| | - Yifan Wu
- Guangdong Provincial Hospital of Chinese MedicineNephropathy LaboratoryDade RoadGuangzhouGuang DongChina510120
| | - Xusheng Liu
- Guangdong Provincial Hospital of Chinese MedicineDepartment of NephrologyGuangzhouChina
| | - Chuan Zou
- The Second Clinical College of Guangzhou University of Chinese MedicineNephropathy LaboratoryDade RoadGuangzhouGuang DongChina510120
| | - Lei Zhang
- Guangdong Provincial Hospital of Chinese MedicineDepartment of NephrologyGuangzhouChina
| | - Qianchun Yang
- Ewha Woman's UniversityGraduate School of Pharmaceutical Sciences, College of Pharmacy52 Ewhayeodae‐gil, Seodaemun‐guSeoulKorea, South120‐750
| | - Yuan Xu
- Guangdong Provincial Hospital of Chinese MedicineDepartment of NephrologyGuangzhouChina
| | - Weizhong Ma
- Guangdong Provincial Hospital of Chinese MedicineDepartment of NephrologyGuangzhouChina
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Kessabi K, Hwas Z, Sassi A, Said K, Messaoudi I. Heavy metal accumulation and histomorphological alterations in Aphanius fasciatus (Pisces, Cyprinodontidae) from the Gulf of Gabes (Tunisia). ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2014; 21:14099-14109. [PMID: 25053282 DOI: 10.1007/s11356-014-3252-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 06/24/2014] [Indexed: 06/03/2023]
Abstract
The present study illustrates an analysis of histological changes; cadmium (Cd), copper (Cu) and zinc (Zn) accumulation; and metallothionein (MT) levels in normal and deformed Mediterranean killifish, Aphanius fasciatus (Pisces, Cyprinodontidae), collected from unpolluted (S1) and polluted areas (S2) in the Gulf of Gabes in Tunisia. Metal determination in water and sediment showed that the concentrations were significantly higher (p < 0.0001) in S2 compared to S1. Deformed fish showed a significantly higher accumulation of Cd, Cu, and Zn and high levels of MTs in their tissues compared to normal ones. Histopathological investigations revealed greater changes in gills, kidney, liver, and bone tissues of fish from the polluted area than those recorded in fish from the reference area. In comparison to normal fish of the polluted area (S2), tissue alterations were more developed in deformed specimens of this site. A possible relationship between metallic pollution, incidence of spinal deformities, and histological changes in A. fasciatus in the polluted site was discussed.
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Affiliation(s)
- Kaouthar Kessabi
- LR11ES41: Génétique, Biodiversité et Valorisation des Bioressources, Institut de Biotechnologie, Université de Monastir, Monastir, 5000, Tunisia,
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The Relationship between Intact Parathyroid Hormone Levels and Daily Physical Activity in Hemodialysis Patients. Int J Artif Organs 2014; 37:350-7. [DOI: 10.5301/ijao.5000303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2014] [Indexed: 11/20/2022]
Abstract
Purpose Poor physical activity and decreased daily activities are commonly seen in hemodialysis (HD) patients. Along with the progression of chronic kidney disease (CKD), various abnormalities of mineral and bone metabolism develop, such as osteitis fibrosa and adynamic bone disease, which are related with intact parathyroid hormone (intact-PTH). Surprisingly, scarce data exists regarding the relationship between intact-PTH and daily physical activity in HD patients. Methods Demographics, clinical parameters, laboratory data were recorded for all patients. Depressive symtoms, quality of life and daily activities of HD patients were measured by Beck Depression Inventory, SF-36, and Nottingham Extended Activities of Daily Living Scale (NEADLS), respectively. Results In total 114 patients (male/female:63/51, aged: 53.0 ± 13.8 years) were enrolled. The value of intact-PTH for <25th (Group 1), <25th-50th (Group 2), 50th-75th (Group 3) and >75th (Group 4) quartiles were <132.5 pg/ml, ≥132.5 <261.0, ≥261.0 <510.4 and ≥510.4, respectively. The NEADLS scores were 25.3 ± 10.8, 35.0 ± 9.4, 27.2 ± 13.9 and 26.4 ± 12.9 as going from Group 1 to Group 4 (p = 0.009). Post-hoc analysis of these four groups revealed that only Group 1 and Group 2 (p = 0.012), and Group 2 and Group 4 (p = 0.034) were different with respect to NEADLS scores. Conclusions Intact-PTH levels were inversely associated with daily activities in whole group. However, the post hoc analysis demonstrated that the association between intact PTH and daily activity is not linear and daily physical activity was lower only in patients with lowest and highest quartiles of intact-PTH.
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Elsurer R, Afsar B, Mercanoglu E. Bone Pain Assessment and Relationship with Parathyroid Hormone and Health-Related Quality of Life in Hemodialysis. Ren Fail 2013; 35:667-72. [DOI: 10.3109/0886022x.2013.780617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Liu Z, Su G, Guo XF, Wu Y, Liu X, Zou C, Zhang L, Yang Q, Xu Y, Ma W. Dietary interventions for mineral and bone disorder in people with chronic kidney disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Menopause is derived from the Greek words men (month) and pauses (cessation) and means permanent cessation of menstruation after the loss of ovarian activity. Chronic kidney disease (CKD) has recently been associated with cardiovascular events in several studies. CKD patients have a heavy burden of traditional cardiovascular risk factors in addition to a range of nontraditional risk factors such as inflammation and abnormal metabolism of calcium and phosphate. In this review, the association of CKD and cardiovascular disease (CVD), as well as of osteoporosis in postmenopausal women is discussed. CKD mineral and bone disorder, characterized by disturbances of calcium/phosphate/parathyroid hormone, bone abnormalities and vascular and soft tissue calcification, is highly prevalent in CKD and is a strong, independent predictor of bone fracture, CVD and death. Estrogen has been shown to: (a) decrease the expression of angiotensin type 1 receptors in vasculature and kidneys; (b) reduce the expression and activity of angiotensin-converting enzyme, and (c) cause the release of angiotensinogen substrate from the liver. However, the degree of activation or suppression of the renin-angiotensin-aldosterone system by estrogen has not been clearly established. Clinical data on the effects of estrogen therapy on bone mineral densities are extremely limited in the ESRD population. CVD is the most common cause of death in postmenopausal women with CKD and many contributing factors have been explored. Future research for prevention of CVD in postmenopausal women with CKD would focus on the biology of vascular calcification as well as bone loss.
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Affiliation(s)
- Hiromichi Suzuki
- Department of Nephrology, Saitama Medical University, Iruma gun, Saitama, Japan.
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Suzuki H. [Diagnosis and treatment for patients with chronic kidney disease]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2011; 100:777-783. [PMID: 21618812 DOI: 10.2169/naika.100.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Fukuhara S, Akizawa T, Fukagawa M, Onishi Y, Yamaguchi T, Hasegawa T, Kurokawa K. Mineral and Bone Disorders Outcomes Study for Japanese Chronic Kidney Disease Stage 5D Patients: Rationale and Study Design. Ther Apher Dial 2011; 15:169-75. [DOI: 10.1111/j.1744-9987.2010.00906.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Carrillo-López N, Román-García P, Fernández-Martín JL, Cannata-Andía JB. Parathyroid gland regulation: contribution of thein vivoandin vitromodels. Expert Opin Drug Discov 2010; 5:265-75. [DOI: 10.1517/17460441003615170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Natalia Carrillo-López
- Hospital Universitario Central de Asturias, Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Universidad de Oviedo, C/Julián Clavería s/n, Oviedo 33006, Asturias, Spain +34 985106137 ; +34 985106142 ;
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Komaba H, Moriwaki K, Kamae I, Fukagawa M. Towards cost-effective strategies for treatment of chronic kidney disease-mineral and bone disorder in Japan. Ther Apher Dial 2009; 13 Suppl 1:S28-35. [PMID: 19765256 DOI: 10.1111/j.1744-9987.2009.00771.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
There is a growing interest worldwide in making a more effective and efficient use of limited health care resources. Dialysis treatment in Japan and other countries is being confronted with increasing expenditure due to an aging population, coverage of new medical technologies, and an increase in the dialysis population. Chronic kidney disease-mineral and bone disorder (CKD-MBD) is an important issue related to the increased expenditure among dialysis patients because it is one of the main causes of morbidity and mortality, and results in a high economic burden. In recent years, several economic analyses on the treatment of CKD-MBD have been reported from Western countries. Given the longer dialysis vintage of Japanese patients, it is very important to conduct economic evaluation from a long-term viewpoint using clinical data on Japanese patients. This article reviews the recent literature on economic evaluation of CKD-MBD treatments and discusses the road ahead for cost-effectiveness analysis in Japanese dialysis patients with CKD-MBD.
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Affiliation(s)
- Hirotaka Komaba
- Division of Nephrology and Kidney Center, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2009; 16:470-80. [PMID: 19858911 DOI: 10.1097/med.0b013e3283339a46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Parathyroid scintigraphy findings in chronic kidney disease patients with recurrent hyperparathyroidism. Eur J Nucl Med Mol Imaging 2009; 37:623-34. [DOI: 10.1007/s00259-009-1313-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Accepted: 10/21/2009] [Indexed: 10/20/2022]
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Nakai K, Komaba H, Fukagawa M. Management of Mineral and Bone Disorder in Chronic Kidney Disease: Quo Vadis? Ther Apher Dial 2009; 13 Suppl 1:S2-6. [DOI: 10.1111/j.1744-9987.2009.00767.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Saidak Z, Brazier M, Kamel S, Mentaverri R. Agonists and allosteric modulators of the calcium-sensing receptor and their therapeutic applications. Mol Pharmacol 2009; 76:1131-44. [PMID: 19779033 DOI: 10.1124/mol.109.058784] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The calcium-sensing receptor (CaR) belongs to the G protein-coupled receptor superfamily, with a characteristic structure consisting of seven transmembrane helices, an intracellular C-terminal and an extracellular N terminal domain. The primary physiological function of the CaR is the maintenance of constant blood Ca2+ levels, as a result of its ability to sense very small changes in extracellular Ca2+ (Ca2+(o)). Nevertheless, in addition to being expressed in tissues involved in Ca2+(o) homeostasis, the CaR is also expressed in tissues not involved in mineral homeostasis, suggestive of additional physiological functions. Numerous agonists and modulators of the CaR are now known in addition to Ca2+(o), including various divalent and trivalent cations, aromatic l-amino acids, polyamines, and aminoglycoside antibiotics. The signaling of the CaR is also regulated by extracellular pH and ionic strength. The activated CaR couples mainly to the phospholipase Cbeta and extracellular signal-regulated kinase 1/2 signaling pathways, and it decreases intracellular cAMP levels, leading to various physiological effects. The recent identification of synthetic allosteric modulators of the CaR has opened up a new field of research possibilities. Calcimimetics and calcilytics, which increase and decrease agonist signaling via the CaR, respectively, may facilitate the manipulation of the CaR and thus aid in further investigations of its precise signaling. These allosteric modulators, as well as strontium, have been demonstrated to have therapeutic potential for the treatment of disorders involving the CaR. This review discusses the various agonists and modulators of the CaR, differences in their binding and signaling, and their roles as therapeutics in various diseases.
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Affiliation(s)
- Zuzana Saidak
- INSERM ERI-12, 1, rue des Louvels, Amiens 80037, France.
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Fukagawa M, Suzuki M. Emerging roles of cinacalcet hydrochloride in the management of CKD-MBD. Ther Apher Dial 2009; 13 Suppl 1:S1. [PMID: 19765251 DOI: 10.1111/j.1744-9987.2009.00773.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sochorová K, Budinský V, Rozková D, Tobiasová Z, Dusilová-Sulková S, Spísek R, Bartůnková J. Paricalcitol (19-nor-1,25-dihydroxyvitamin D2) and calcitriol (1,25-dihydroxyvitamin D3) exert potent immunomodulatory effects on dendritic cells and inhibit induction of antigen-specific T cells. Clin Immunol 2009; 133:69-77. [PMID: 19660988 DOI: 10.1016/j.clim.2009.06.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Revised: 06/01/2009] [Accepted: 06/30/2009] [Indexed: 12/11/2022]
Abstract
Paricalcitol (19-nor-1,25/OH(2)/D(2)), a second generation vitamin D receptor (VDR) activator, is a synthetic analogue of vitamin D3. In contrast to calcitriol, paricalcitol has a reduced effect on intestinal calcium resorption thus avoiding undesirable hypercalcemia. Information about immunomodulatory activity of paricalcitol is scarce. In this study we show that, in all investigated aspects, paricalcitol retains significant immunomodulatory activity, comparable to calcitriol. Both VDR agonists impaired differentiation of immature dendritic cells (DCs) from monocytes. The presence of VDR agonists during DC differentiation abolished their capacity to be activated and, despite potent Toll-like receptor mediated stimulation, VDR agonist-treated DCs remained in the immature state. In accordance with these findings, VDR-treated DCs produced no bioactive IL-12 and had a significantly decreased capacity to induce antigen-specific T cells while the capacity to induce functional Tregs remained unchanged when compared to control DCs. As DCs and T cells play an important role in the pathogenesis of atherosclerosis, in end-stage renal disease patients, paricalcitol should be a VDR agonist of choice for the reduction of the risk of atherosclerosis due to its immunomodulatory effect proven in this study and known limited hypercalcemic effect. The immunomodulatory potency of paricalcitol makes it a drug of interest in the therapy of chronic immune-mediated inflammatory diseases.
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Affiliation(s)
- Klára Sochorová
- Institute of Immunology, Charles University, 2nd Faculty of Medicine and University Hospital Motol, V Uvalu 84, 150 06 Prague, Czech Republic
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Clinical Practice Guideline for the Management of Secondary Hyperparathyroidism in Chronic Dialysis Patients. Ther Apher Dial 2008; 12:514-25. [DOI: 10.1111/j.1744-9987.2008.00648.x] [Citation(s) in RCA: 151] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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