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Kan C, Lu X, Zhang R. Effects of hypoxia on bone metabolism and anemia in patients with chronic kidney disease. World J Clin Cases 2021; 9:10616-10625. [PMID: 35004993 PMCID: PMC8686129 DOI: 10.12998/wjcc.v9.i34.10616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/12/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Abnormal bone metabolism and renal anemia seriously affect the prognosis of patients with chronic kidney disease (CKD). Existing studies have mostly addressed the pathogenesis and treatment of bone metabolism abnormality and anemia in patients with CKD, but few have evaluated their mutual connection. Administration of exogenous erythropoietin to CKD patients with anemia used to be the mainstay of therapeutic approaches; however, with the availability of hypoxia-inducible factor (HIF) stabilizers such as roxadustat, more therapeutic choices for renal anemia are expected in the future. However, the effects posed by the hypoxic environment on both CKD complications remain incompletely understood. AIM To summarize the relationship between renal anemia and abnormal bone metabolism, and to discuss the influence of hypoxia on bone metabolism. METHODS CNKI and PubMed searches were performed using the key words "chronic kidney disease," "abnormal bone metabolism," "anemia," "hypoxia," and "HIF" to identify relevant articles published in multiple languages and fields. Reference lists from identified articles were reviewed to extract additional pertinent articles. Then we retrieved the Abstract and Introduction and searched the results from the literature, classified the extracted information, and summarized important information. Finally, we made our own conclusions. RESULTS There is a bidirectional relationship between renal anemia and abnormal bone metabolism. Abnormal vitamin D metabolism and hyperparathyroidism can affect bone metabolism, blood cell production, and survival rates through multiple pathways. Anemia will further attenuate the normal bone growth. The hypoxic environment regulates bone morphogenetic protein, vascular endothelial growth factor, and neuropilin-1, and affects osteoblast/osteoclast maturation and differentiation through bone metabolic changes. Hypoxia preconditioning of mesenchymal stem cells (MSCs) can enhance their paracrine effects and promote fracture healing. Concurrently, hypoxia reduces the inhibitory effect on osteocyte differentiation by inhibiting the expression of fibroblast growth factor 23. Hypoxia potentially improves bone metabolism, but it still carries potential risks. The optimal concentration and duration of hypoxia remain unclear. CONCLUSION There is a bidirectional relationship between renal anemia and abnormal bone metabolism. Hypoxia may improve bone metabolism but the concentration and duration of hypoxia remain unclear and need further study.
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Affiliation(s)
- Chao Kan
- Department of Clinical Medicine, Changchun University of Chinese Medicine, Changchun 130000, Jilin Province, China
| | - Xu Lu
- Department of Clinical Medicine, Changchun University of Chinese Medicine, Changchun 130000, Jilin Province, China
| | - Rui Zhang
- Department of Nephrology, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai 519070, Guangdong Province, China
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Chen S, Sheng K, Shen Y, Jiang H, Lei X, Qu L, Xu C, Chen J, Zhang P. Impact of parathyroidectomy on left ventricular function in end stage renal disease patients. BMC Nephrol 2020; 21:479. [PMID: 33187492 PMCID: PMC7666516 DOI: 10.1186/s12882-020-02139-3] [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: 03/02/2020] [Accepted: 10/30/2020] [Indexed: 12/03/2022] Open
Abstract
Background Secondary hyperparathyroidism (SHPT) is a common complication in end-stage renal disease (ESRD) patients, and parathyroidectomy (PTX) is an effective treatment intervention of SHPT. However, the curative impact of PTX on left ventricular function still remains incompletely understood. To evaluate the impact of parathyroidectomy on left ventricular function in ESRD patients, we conducted this retrospective study. Methods Between Oct 1, 2010 and Oct 1, 2016, ESRD patients presented with SHPT who underwent parathyroidectomy were enrolled. We retrospectively collected the ultrasonic cardiogram parameter pre- and 1-year post-PTX, and analyzed the influence factor for the overturn of left ventricular hypertrophy (LVH) and the improvement of ejection fraction% (EF%). Results In all the patients (135), the main ultrasonic cardiogram parameter dramatically improved after PTX. Compared with pre-PTX, the left ventricular mass (LVM) (172.82 (135.90, 212.91) g vs. 192.76 (157.56, 237.97) g, p<0.001) and the left ventricular mass index (LVMI) (107.01 (86.79, 128.42) g/m2 vs. 123.54 (105.49, 146.64) g/m2, p<0.001) significantly declined after 1 year of the PTX. Further, 43.75% patients diagnosed with LVH before the PTX have recovered from LVH. In the subgroup analysis of 35 patients with EF% ≤ 60% pre-PTX, EF% and fractional shortening% (FS%) significantly improved after 1 year of the PTX compared with pre-PTX (EF%: 64.90 ± 7.90% vs. 55.71 ± 4.78%, p<0.001; FS% 35.48 ± 6.34% vs. 29.54 ± 2.88%, p<0.001), and 82.86% patients underwent an improvement of left ventricular systolic function post 1year of the PTX. Conclusions tPTX+AT is an effective curative intervention of secondary hyperparathyroidism and can significantly overturn the LVH and increase the left ventricular systolic function.
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Affiliation(s)
- Shaohua Chen
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, Hangzhou, China
| | - Kaixiang Sheng
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, Hangzhou, China
| | - Ying Shen
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, Hangzhou, China
| | - Hua Jiang
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, Hangzhou, China
| | - Xin Lei
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, Hangzhou, China
| | - Lihui Qu
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, Hangzhou, China
| | - Chunping Xu
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, Hangzhou, China
| | - Jianghua Chen
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, Hangzhou, China
| | - Ping Zhang
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. .,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, Hangzhou, China.
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Aktsiali M, Papachrysanthou T, Griveas I, Andriopoulos C, Sitaras P, Triantafyllopoulos IK, Lambrou GI. Treatment with Cinacalcet in Hemodialysis Patients with Severe Secondary Hyperparathyroidism, Influences Bone Mineral Metabolism and Anemia Parameters. CURRENT DRUG THERAPY 2020. [DOI: 10.2174/1574885514666190802144629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Due to the premium rate of Chronic Kidney Disease, we have increased
our knowledge with respect to diagnosis and treatment of Bone Mineral Disease (BMD) in End-
Stage Renal Disease (ESRD). Currently, various treatment options are available. The medication
used for Secondary Hyper-Parathyroidism gives promising results in the regulation of Ca, P and
Parathormone levels, improving the quality of life. The aim of the present study was to investigate
the relation of cinacalcet administration to not only parathormone, Ca and P but also to anemia
parameters such as hematocrit and hemoglobin.
Materials and Methods:
retrospective observational study was conducted in a Chronic
Hemodialysis Unit. One-hundred ESRD patients were recruited for twenty-four months and were
evaluated on a monthly rate. Biochemical parameters were related to medication prescribed and the
prognostic value was estimated. Cinacalcet was administered to 43 out of 100 patients in a dose of
30-120 mg.
Results:
Significant differences were observed in PTH, Ca and P levels with respect to Cinacalcet
administration. Ca levels appeared to be higher at 30mg as compared to 60mg cinacalcet.
Furthermore, a decreasing age-dependent pattern was observed with respect to cinacalcet dosage. A
positive correlation was observed between Dry Weight (DW) and cinacalcet dose. Finally, a
positive correlation between Hematocrit and Hemoglobin and cinacalcet was manifested.
Conclusions:
Cinacalcet, is a potential cardiovascular and bone protective agent, which is approved
for use in ESRD patients to assist SHPT. A novel information was obtained from this study,
regarding the improvement of the control of anemia.
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Affiliation(s)
- Maria Aktsiali
- Private Dialysis Unit “Nefroiatriki”, Chlois 85 Str., 14452, Metamorfosi, Athens, Greece
| | | | - Ioannis Griveas
- 417 Veterans Army Administration Hospital of Athens, Monis Petraki 10-12, 11521, Athens, Greece
| | - Christos Andriopoulos
- Private Dialysis Unit “Nefroiatriki”, Chlois 85 Str., 14452, Metamorfosi, Athens, Greece
| | - Panagiotis Sitaras
- Private Dialysis Unit “Nefroiatriki”, Chlois 85 Str., 14452, Metamorfosi, Athens, Greece
| | - Ioannis K. Triantafyllopoulos
- Graduate Program “Metabolic Bones Diseases”, National and Kapodistrian University of Athens, Medical School, Mikras Asias 75, 11527, Goudi, Athens, Greece
| | - George I. Lambrou
- Graduate Program “Metabolic Bones Diseases”, National and Kapodistrian University of Athens, Medical School, Mikras Asias 75, 11527, Goudi, Athens, Greece
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Vulpio C, Bossola M. Parathyroid Nodular Hyperplasia and Responsiveness to Drug Therapy in Renal Secondary Hyperparathyroidism: An Open Question. Ther Apher Dial 2017; 22:11-21. [PMID: 28980761 DOI: 10.1111/1744-9987.12604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/01/2017] [Accepted: 07/13/2017] [Indexed: 11/29/2022]
Abstract
The goal of the pharmacological therapy in secondary hyperparathyroidism (SHPT) is to reduce serum levels of parathyroid hormone and phosphorus, to correct those of calcium and vitamin D, to arrest or reverse the parathyroid hyperplasia. However, when nodular hyperplasia or an autonomous adenoma develops, surgery may be indicated. We reviewed the literature with the aim of defining if the echographic criteria predictive of unresponsiveness of SHPT to calcitriol therapy are valid also in the cinacalcet era and if drug therapy may reverse nodular hyperplasia of parathyroid gland (PTG). The responsiveness to therapy and regression of the nodular hyperplasia of PTG remains an open question in the calcimimetic era as well as the cutoff between medical and surgical therapy. Prospective studies are needed in order to clarify if an earlier use of cinacalcet in moderate SHPT might arrest the progression of parathyroid growth and stabilize SHPT.
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Affiliation(s)
- Carlo Vulpio
- Department of Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - Maurizio Bossola
- Department of Surgery, Catholic University of Sacred Heart, Rome, Italy
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Vulpio C, Bossola M. Parathyroid Ultrasonography in Renal Secondary Hyperparathyroidism: An Overlooked and Useful Procedure. Semin Dial 2016; 29:347-9. [PMID: 27419923 DOI: 10.1111/sdi.12521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In secondary hyperparathyroidism (SHPT), ultrasonography (US) can accurately define the size and structure of parathyroid glands as well as differentiate diffuse and nodular hyperplasia. US may be also useful to predict the response of SHPT to vitamin D analogs and cinacalcet and to assess for regression of parathyroid glands hyperplasia by measurement of parathyroid gland volume. There is increasing evidence that US can potentially identify patients who will benefit from prompt surgical intervention. Therefore, US should be part of the diagnostic armamentarium in the treatment of SHPT in the daily clinical practice.
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Affiliation(s)
- Carlo Vulpio
- Department of Surgery, Catholic University of Sacred Heart, Rome, Italy.
| | - Maurizio Bossola
- Department of Surgery, Catholic University of Sacred Heart, Rome, Italy
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