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Winkelman D, Gallant KH, Moe S, St-Jules DE. Seeing the Whole Picture: Evaluating the Contribution of Whole Grains to Phosphorus Exposure in People With Kidney Failure Undergoing Dialysis Treatment. Semin Dial 2024. [PMID: 38418258 DOI: 10.1111/sdi.13195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/29/2024] [Indexed: 03/01/2024]
Abstract
Excessive dietary phosphorus is a concern among patients with kidney failure undergoing dialysis treatment because it may contribute to hyperparathyroidism and hyperphosphatemia. A long-standing but untested component of the low-phosphorus diet is the promotion of refined grains over whole grains. This paper reviews the scientific premise for restricting whole grains in the dialysis population and estimates phosphorus exposure from grain products based on three grain intake patterns modeled from reported intakes in the general US population, adjusting for the presence of phosphorus additives and phosphorus bioavailability: (1) standard grain intake, (2) 100% refined grain intake, and (3) mixed (50/50 whole and refined grain) intake. Although estimated phosphorus exposure from grains was higher with the mixed grain pattern (231 mg/day) compared to the 100% refined grain pattern (127 mg/day), the amount of additional phosphorus from grains was relatively low. Given the lack of strong evidence for restricting whole grains in people with CKD, as well as the potential health benefits of whole grains, clinical trials are warranted to address the efficacy and health impact of this practice.
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Affiliation(s)
- Dillon Winkelman
- Department of Environmental Science and Health, University of Nevada, Reno, Nevada, USA
| | - Kathleen Hill Gallant
- Department of Food Science and Nutrition, University of Minnesota, Saint Paul, Minnesota, USA
| | - Sharon Moe
- Department of Medicine, Division of Nephrology and Hypertension, Indiana University, Indianapolis, Indiana, USA
| | - David E St-Jules
- Department of Nutrition, University of Nevada, Reno, Nevada, USA
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Hagemann R, Watanabe MT, Hueb JC, Martín LC, Silva VDS, Caramori JDSCT. Assessment of atherosclerosis and endothelial dysfunction risk factors in patients with primary glomerulonephritis. J Bras Nefrol 2024; 46:29-38. [PMID: 36638246 PMCID: PMC10962406 DOI: 10.1590/2175-8239-jbn-2022-0116en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/29/2022] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Glomerulonephritis are the third cause of chronic kidney disease (CKD) requiring dialysis in Brazil. Mineral and bone disorder (MBD) is one of the complications of CKD and is already present in the early stages. Assessment of carotid intima-media thickness (CIMT) and flow-mediated vasodilatation (FMV) are non-invasive ways of assessing cardiovascular risk. HYPOTHESIS Patients with primary glomerulonephritis (PG) have high prevalence of atherosclerosis and endothelial dysfunction, not fully explained by traditional risk factors, but probably influenced by the early onset of MBD. OBJECTIVE To evaluate the main markers of atherosclerosis in patients with PG. METHOD Clinical, observational, cross-sectional and controlled study. Patients with PG were included and those under 18 years of age, pregnants, those with less than three months of follow-up and those with secondary glomerulonephritis were excluded. Those who, at the time of exams collection, had proteinuria higher than 6 grams/24 hours and using prednisone at doses higher than 0.2 mg/kg/day were also excluded. RESULTS 95 patients were included, 88 collected the exams, 1 was excluded and 23 did not undergo the ultrasound scan. Patients with PG had a higher mean CIMT compared to controls (0.66 versus 0.60), p = 0.003. After multivariate analysis, age and values for systolic blood pressure (SBP), FMV and GFR (p = 0.02); and FMV and serum uric acid (p = 0.048) remained statistically relevant. DISCUSSION AND CONCLUSION The higher cardiovascular risk in patients with PG was not explained by early MBD. Randomized and multicentric clinical studies are necessary to better assess this hypothesis.
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Affiliation(s)
- Rodrigo Hagemann
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de
Medicina de Botucatu, Departamento de Clínica Médica, Botucatu, São Paulo,
Brazil
- Universidade Federal do Paraná, Complexo Hospital de Clínicas,
Departamento de Clínica Médica, Curitiba, Paraná, Brazil
| | - Marcela Tatiana Watanabe
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de
Medicina de Botucatu, Departamento de Clínica Médica, Botucatu, São Paulo,
Brazil
| | - João Carlos Hueb
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de
Medicina de Botucatu, Departamento de Clínica Médica, Botucatu, São Paulo,
Brazil
| | - Luis Cuadrado Martín
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de
Medicina de Botucatu, Departamento de Clínica Médica, Botucatu, São Paulo,
Brazil
| | - Vanessa dos Santos Silva
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de
Medicina de Botucatu, Departamento de Clínica Médica, Botucatu, São Paulo,
Brazil
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Szulimowska J, Zalewska A, Taranta-Janusz K, Trocka D, Żendzian-Piotrowska M, Tomasiuk R, Maciejczyk M. Association of Ischemia-Modified Albumin (IMA) in Saliva, Serum, and Urine with Diagnosis of Chronic Kidney Disease (CKD) in Children: A Case-Control Study. Med Sci Monit 2023; 29:e942230. [PMID: 38093614 PMCID: PMC10729497 DOI: 10.12659/msm.942230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Ischemia-modified albumin (IMA) is a secreted biomarker for ischemic oxidative stress. This case-control study aimed to evaluate the association of ischemia-modified albumin (IMA) in saliva, serum, and urine with diagnosis of chronic kidney disease (CKD) in 24 children. MATERIAL AND METHODS The study involved 24 children with CKD. CKD was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) diagnostic criteria. The control group consisted of 24 healthy children who were matched for age and gender to the experimental group. The concentration of IMA was determined by the colorimetric method in non-stimulated whole saliva (NWS), stimulated whole saliva (SWS), serum, and urine of children with CKD. The Mann-Whitney U test was used for inter-group comparisons. RESULTS IMA levels were significantly higher in NWS (P=0.0082) and SWS (P=0.0014) of children with CKD than in the control group. The concentration of IMA in NWS was correlated with standard indicators of kidney function, including the estimated glomerular filtration rate (r=-0.798, P≤0.0001), stage of CKD (r=0.814, P≤0.0001), and serum creatinine (r=0.711, P≤0.0001) and urea levels (r=0.738, P≤0.0001). CONCLUSIONS Salivary IMA concentration depends on renal function in children. Salivary IMA discriminates children with end-stage kidney disease from children with mild and moderate CKD and healthy children with high sensitivity and specificity. Further research is required, including assessment of the diagnostic usefulness and validation of the biomarker in a clinical diagnostic study.
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Affiliation(s)
- Julita Szulimowska
- Department of Conservative Dentistry, Medical University of Białystok, Białystok, Poland
| | - Anna Zalewska
- Department of Conservative Dentistry, Medical University of Białystok, Białystok, Poland
| | | | - Daria Trocka
- Students’ Scientific Club “Biochemistry of Civilization Diseases” at the Department of Hygiene, Epidemiology and Ergonomics, Medical University of Białystok, Białystok, Poland
| | | | - Ryszard Tomasiuk
- Department of Medicine, Faculty of Medical Sciences and Health Sciences, Kazimierz Pułaski University in Radom, Radom, Poland
| | - Mateusz Maciejczyk
- Department of Hygiene, Epidemiology and Ergonomics, Medical University of Białystok, Białystok, Białystok, Poland
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Khan BA, Qu X, Hua Y, Javaid MM. Real-World Experience of Using Etelcalcetide for Secondary Hyperparathyroidism in Community-Based Hemodialysis Centers in Singapore. Cureus 2023; 15:e48186. [PMID: 38050530 PMCID: PMC10693497 DOI: 10.7759/cureus.48186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/06/2023] Open
Abstract
Introduction Chronic kidney disease-related mineral and bone disorder (CKD-MBD), characterized by abnormalities in calcium, phosphate, and parathyroid hormone metabolism, with impaired bone turnover and extravascular calcification is a known complication of advanced chronic kidney disease (CKD). Secondary hyperparathyroidism (SHPT) develops early in the disease and its prevalence gradually increases with the disease progression, becoming almost universal in patients with end-stage renal disease (ESRD). The treatment for SHPT includes synthetic vitamin D analogs, calcitriol or calcimimetics. Recently, intravenous etelcalcetide was introduced as a second-generation calcimimetic. This article provides the real-world experience of using etelcalcetide in multiethnic Asian patients receiving hemodialysis at community-based hemodialysis centers in Singapore. Methods This study was real-world evidence, generated by a retrospective clinical audit of routine clinical care of hemodialysis patients in community-based centers in Singapore who received etelcalcetide for treating SHPT. The information on the starting and maximum dose of etelcalcetide, duration of treatment on hemodialysis, parathyroid hormone (PTH) levels, dialysate calcium, concomitant medications, and reasons for discontinuation were collected from the medical records. PTH levels were collected at four-, eight-, and twelve-month intervals. Results A total of 148 patients received etelcalcetide during the study period. Ten patients died and twenty discontinued their treatment, with 118 patients remaining on treatment. Demographically, the patients included Chinese, Malay, Indians, and those belonging to other racial groups. The starting dose of etelcalcetide ranged from 2.5 mg once per week to 7.5 mg three times a week. There was a 16.8% reduction (p=<0.001) in intact-PTH after four months of therapy. Target intact-PTH level of less than 60 pmol/L, was reported as 1.4% at baseline, with 22.3% at four months (p<0.001) and 25.9% at eight months (p=0.028). Calcium and phosphate levels were also tracked as part of the safety and efficacy measures of using etelcalcetide. No symptomatic hypocalcemia was noted and phosphate levels were noted to decline significantly. Overall, the calcium-phosphate product reduced at four months (13.2%, p=<0.001) and eight months (12.7%, p<0.05). An analysis of concomitant medication usage, dialysate calcium utilized, and the side effects of etelcalcetide were also recorded. Finally, a brief descriptive analysis of the patient's subjective feedback regarding etelcalcetide was also reported, especially regarding the reduction in pill burden and overall compliance to medications. Conclusion Etelcalcetide is safe and effective for treating SHPT in multi-ethnic Asian hemodialysis patients and can be considered an alternative to oral cinacalcet. Our study showed no side effects, which was one of the key reasons for non-compliance to traditional calcimimetics. A favorable compliance profile with reduced pill burden was noted by using this intravenous calcimimetic.
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Affiliation(s)
- Behram A Khan
- Medicine, National University of Singapore, Singapore, SGP
| | - XiaoJie Qu
- Medical Affairs, The National Kidney Foundation Singapore, Singapore, SGP
| | - Yan Hua
- Medical Affairs, The National Kidney Foundation Singapore, Singapore, SGP
| | - Muhammad M Javaid
- Medicine, Monash University, Melbourne, AUS
- Medicine, Deakin University, Warrnambool, AUS
- Nephrology, Woodlands Health, Singapore, SGP
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Shen Y. Mini review: A reevaluation of nutritional vitamin D in the treatment of chronic kidney disease. Medicine (Baltimore) 2023; 102:e35811. [PMID: 37904427 PMCID: PMC10615537 DOI: 10.1097/md.0000000000035811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/05/2023] [Indexed: 11/01/2023] Open
Abstract
Chronic kidney disease-mineral and bone disorder is a syndrome of mineral and bone metabolism abnormalities caused by chronic kidney disease. Osteoporosis is a systemic metabolic bone disease characterized by low bone mass, disruption of bone microstructure, increased brittleness, and a higher propensity for fractures. Both of these conditions significantly affect bone metabolism and substantially increase the risk of fractures. Nutritional vitamin D is an essential trace element in the human body and an important fat-soluble vitamin. One crucial physiological role of nutritional vitamin D is to achieve mineral-bone metabolism balance by regulating calcium homeostasis. This review summarized the metabolism of vitamin in normal population and its specificity in chronic kidney disease. Over the years, the understanding and application of vitamin D in patients with chronic renal failure is changing. As people pay more attention to hypercalcemia, vascular calcification, osteoporosis, nutritional vitamin D has come into people's attention again. More and more studies are discussing how to prescribe vitamin D supplementation in hemodialysis patients.
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Affiliation(s)
- Yingjing Shen
- Department of Nephrology, Shanghai Tianyou Hospital, Shanghai, China
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Wu G, Li L, Wu Z. A meta-analysis of randomized controlled trials of tonifying kidney and strengthen bone therapy on nondialysis patients with chronic kidney disease-mineral and bone disorder. Medicine (Baltimore) 2023; 102:e34044. [PMID: 37352066 PMCID: PMC10289535 DOI: 10.1097/md.0000000000034044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Correction of calcium, phosphorus, and parathyroid hormone disorders is the standard of treatment in nondialysis patients with chronic kidney disease-mineral and bone disorder (CKD-MBD). However, the side effects and adverse reactions are still the main problems. Moreover, the lack of protection of kidney function in the treatment dramatically affects patients' health. Although Traditional Chinese Medicine, specifically tonifying kidney and strengthen bone (TKSB) therapy, is wildly applied to patients with CKD-MBD in China, the evidence of TKSB therapy in the treatment of CKD-MBD is limited. Thus, we conducted this meta-analysis to evaluate the efficacy and safety of TKSB therapy combined with Western medicine (WM) for nondialysis patients with CKD-MBD. METHODS Two investigators conducted systematic research of randomized controlled trials of TKSB therapy for CKD-MBD from 7 electronic databases. Methodological quality evaluations were performed using the Cochrane collaboration tool, and data analysis was conducted by RevMan v5.3 software and STATA v15.0. RESULTS In total, 8 randomized controlled trials involving 310 patients met the criteria of meta-analysis. The complete results showed that compared with WM alone, TKSB treatment could improve the clinical efficacy rate (risk ratio = 4.49, 95% confidence interval [CI]: [2.64, 7.61], P .00001), calcium (weighted mean difference [WMD] = 0.11, 95% CI: [0.08, 0.14], P < .00001), serum creatinine (WMD = 45.58, 95% CI: [32.35, 58.8], P < .00001) phosphorus (WMD = 0.11, 95% CI: [0.08, 0.13], P < .00001), parathyroid hormone (WMD = 16.72, 95% CI: [12.89, 20.55], P < .00001), blood urea nitrogen levels (WMD = 0.95, 95% CI: [0.26, 1.64], P = .007) on nondialysis patients with CKD-MBD, which was beneficial to improve the patients' bone metabolic state and renal function. In addition, evidence shows that, compared with WM alone, TKSB treatment is safe and does not increase side effects. CONCLUSION The systematic review found that TKSB therapy combined with WM has a positive effect on improving renal function and correcting bone metabolism disorder in nondialysis patients with CKD-MBD, which shows that Traditional Chinese Medicine is effective and safe in treating CKD-MBD. However, more high-quality, large-sample, multicenter clinical trials should be conducted to assess the safety and efficacy of TKSB therapy in treating nondialysis patients with CKD-MBD.Systematic review registration: INPLASY2020120086.
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Affiliation(s)
- Guiling Wu
- Wuhan Hospital Of Traditional Chinese Medicine, Wuhan, Hubei, China
| | - Liang Li
- Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Afiliated Hospital ofHubei University of Chinese Medicine, Wuhan, China
- Hubei Province Academy of Traditional Chinese Medicine, Wuhan, China
| | - Zijian Wu
- Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Afiliated Hospital ofHubei University of Chinese Medicine, Wuhan, China
- Hubei Province Academy of Traditional Chinese Medicine, Wuhan, China
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Carbonara CE, Roza NA, dos Reis LM, Carvalho AB, Jorgetti V, de Oliveira RB. Overview of renal osteodystrophy in Brazil: a cross-sectional study. J Bras Nefrol 2023; 45:257-261. [PMID: 37158484 PMCID: PMC10627135 DOI: 10.1590/2175-8239-jbn-2022-0146en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/02/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION The epidemiologic profile of renal osteodystrophy (ROD) is changing over time and cross-sectional studies provide essential information to improve care and health policies. The Brazilian Registry of Bone Biopsy (REBRABO) is a prospective, nationalmulticenter cohort that includes patients with chronic kidney disease (CKD) undergoing bone biopsy. REBRABO aims to provide clinical information on ROD. The main objective of this subanalysis was to describe the profile of ROD, including clinically relevant associations. METHODS From Aug/2015 to Dec/2021, 511 patients with CKD who performed bone biopsy were included in the REBRABO platform. Patients with no bone biopsy report (N = 40), GFR > 90 mL/min (N = 28), without asigned consent (N = 24), bone fragments inadequate for diagnosis (N = 23), bone biopsy indicated by a specialty other than nephrology (N = 6), and < 18 years old (N = 4) were excluded. Clinical-demographic data (e.g., age, sex, ethnicity, CKD etiology, dialysis vintage, comorbidities, symptoms, and complications related to ROD), laboratory (e.g., serum levels of total calcium, phosphate, parathormone, alkaline phosphatase, 25-hydroxyvitamin D, and hemoglobin), and ROD (e.g., histological diagnosis) were analyzed. RESULTS Data from 386 individuals were considered in this subanalysis of REBRABO. Mean age was 52 (42-60) years; 198 (51%) were male; 315 (82%) were on hemodialysis. Osteitis fibrosa (OF) [163 (42%)], adynamic bone disease (ABD) [96 (25%)] and mixed uremic osteodystrophy (MUO) [83 (21%)] were the most frequent diagnosis of ROD in our sample; 203 (54%) had the diagnosis of osteoporosis, 82 (56%) vascular calcification; 138 (36%) bone aluminum accumulation, and 137 (36%) iron intoxication; patients with high turnover were prone to present a higher frequency of symptoms. CONCLUSIONS A high proportion of patients were diagnosed with OF and ABD, as well as osteoporosis, vascular calcification and clinical symptoms.
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Affiliation(s)
- Cinthia E.M. Carbonara
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas,
Divisão de Nefrologia, Campinas, SP, Brazil
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas da
Campinas, Laboratório para o Estudo do Metabolismo Mineral e Ósseo em Nefrologia,
Campinas, Campinas, SP, Brazil
| | - Noemi A.V. Roza
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas da
Campinas, Laboratório para o Estudo do Metabolismo Mineral e Ósseo em Nefrologia,
Campinas, Campinas, SP, Brazil
| | - Luciene M. dos Reis
- Universidade de São Paulo, Faculdade de Medicina, Departamento de
Medicina Interna, Laboratório de Fisiopatologia Renal, São Paulo, SP, Brazil
| | | | - Vanda Jorgetti
- Universidade de São Paulo, Faculdade de Medicina, Departamento de
Medicina Interna, Laboratório de Fisiopatologia Renal, São Paulo, SP, Brazil
| | - Rodrigo Bueno de Oliveira
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas,
Divisão de Nefrologia, Campinas, SP, Brazil
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas da
Campinas, Laboratório para o Estudo do Metabolismo Mineral e Ósseo em Nefrologia,
Campinas, Campinas, SP, Brazil
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Muacevic A, Adler JR, Singh G, Kaur G, . A, Dodda S, Patel D, Natarajan B, Maram T, Kedia A, Vempati R, Sahu S, Choubey U. Correlation of FGF-23 With Biochemical Markers and Bone Density in Chronic Kidney Disease-Bone Mineral Density Disorder. Cureus 2023; 15:e33879. [PMID: 36812096 PMCID: PMC9933891 DOI: 10.7759/cureus.33879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
Aim The purpose of this study was to determine the relationship between biochemical markers such as serum calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH), 25(OH) vitamin D, and fibroblast growth factor 23 (FGF23) in our study group, as well as to correlate dual-energy X-ray absorptiometry (DEXA) findings with these biochemical markers. Methodology An eligible group of 50 chronic hemodialysis (HD) patients, age 18 and older, who have undergone HD two times a week for at least six months participated in this retrospective cross-sectional study. We compared serum FGF23, intact parathyroid hormone (iPTH), 25(OH) vitamin D, calcium, phosphorus, and dual-energy X-ray absorptiometry scan showing bone mineral density disorder (BMD) around the femoral neck, distal radius, and lumbar spine. Human FGF23 Enzyme Linked Immuno Sorbent Assay (ELISA) Kit PicoKine® (Catalog # EK0759; Boster Biological Technology, Pleasanton, CA) was used in the optimum moisture content (OMC) lab to measure FGF23 levels. For the analysis of associations with various studied variables, the levels of FGF23 were split into two groups, which were high (group 1, FGF23 50 to 500 pg/ml), that is, up to 10 times the normal levels and extremely high (group 2, FGF23 > 500 pg/ml) FGF23 levels. All the tests were conducted for routine examination where the data obtained was analyzed in this research project. Results The mean age of patients was 39.18 ±12.84 years, of whom 35 (70%) were males and 15 (30%) were females. For the entire cohort, serum PTH levels were consistently high, and vitamin D levels were low. FGF23 levels were high in the whole cohort. The average iPTH concentration was 304.20 ± 113.18 pg/ml, while the average 25(OH) vitamin D concentration was 19.68±7.49 ng/ml. The mean FGF23 levels were 1877.36±1378.67 pg./ml. The mean calcium value was 8.23±1.05 mg /dl and the mean phosphate of 6.56±2.28 mg /dl. In the whole cohort, FGF23 showed a negative correlation with vitamin D and a positive correlation with PTH, but not statistically significant. Extremely high FGF23 levels were associated with lower bone density compared to high FGF23 values. Considering that in the whole cohort of patients, only nine had high FGF-23 and the rest of 41 patients had extremely high FGF23, we could not ascertain differences in PTH, calcium, phosphorus, and 25(OH) vitamin D levels between the two groups. The average length of time on dialysis was eight months, and there was no link between FGF-23 levels and the length of time on dialysis. Conclusion Bone demineralization and biochemical abnormalities are a hallmark in chronic kidney disease (CKD) patients. Abnormalities in serum phosphate, parathyroid hormone, calcium, and 25(OH) vitamin D play critical roles in the development of BMD in CKD patients. With the discovery of FGF-23 as a biomarker that is increased early in CKD patients, new questions arise about the effects and actions of FGF-23 in controlling bone demineralization and other biochemical markers. Our study found no statistically significant correlation to suggest an effect of FGF-23 on these parameters. But the findings need to be looked at more in prospective, controlled research, especially to find out if therapies that successfully target FGF-23 can make a big difference in how people with CKD feel about their health.
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Biruete A, Metzger CE, Chen NX, Swallow EA, Vrabec C, Clinkenbeard EL, Stacy AJ, Srinivasan S, O'Neill K, Avin KG, Allen MR, Moe SM. Effects of ferric citrate and intravenous iron sucrose on markers of mineral, bone, and iron homeostasis in a rat model of CKD-MBD. Nephrol Dial Transplant 2022; 37:1857-1867. [PMID: 35482713 PMCID: PMC9494145 DOI: 10.1093/ndt/gfac162] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Anemia and chronic kidney disease-mineral and bone disorder (CKD-MBD) are common and begin early in CKD. Limited studies have concurrently compared the effects of ferric citrate (FC) versus intravenous (IV) iron on CKD-MBD and iron homeostasis in moderate CKD. METHODS We tested the effects of 10 weeks of 2% FC versus IV iron sucrose in rats with moderate CKD (Cy/+ male rat) and untreated normal (NL) littermates. Outcomes included a comprehensive assessment of CKD-MBD, iron homeostasis and oxidative stress. RESULTS CKD rats had azotemia, elevated phosphorus, parathyroid hormone and fibroblast growth factor-23 (FGF23). Compared with untreated CKD rats, treatment with FC led to lower plasma phosphorus, intact FGF23 and a trend (P = 0.07) toward lower C-terminal FGF23. FC and IV iron equally reduced aorta and heart calcifications to levels similar to NL animals. Compared with NL animals, CKD animals had higher bone turnover, lower trabecular volume and no difference in mineralization; these were unaffected by either iron treatment. Rats treated with IV iron had cortical and bone mechanical properties similar to NL animals. FC increased the transferrin saturation rate compared with untreated CKD and NL rats. Neither iron treatment increased oxidative stress above that of untreated CKD. CONCLUSIONS Oral FC improved phosphorus homeostasis, some iron-related parameters and the production and cleavage of FGF23. The intermittent effect of low-dose IV iron sucrose on cardiovascular calcification and bone should be further explored in moderate-advanced CKD.
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Affiliation(s)
- Annabel Biruete
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Nutrition and Dietetics, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Corinne E Metzger
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Neal X Chen
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Elizabeth A Swallow
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Curtis Vrabec
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
- College of Osteopathic Medicine, Marian University, Indianapolis, IN, USA
| | - Erica L Clinkenbeard
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alexander J Stacy
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shruthi Srinivasan
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kalisha O'Neill
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Keith G Avin
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, Indiana University, Indianapolis, IN, USA
| | - Matthew R Allen
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
- Roudebush Veterans Affairs Medical Center, Indianapolis, IN, IN, USA
| | - Sharon M Moe
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
- Roudebush Veterans Affairs Medical Center, Indianapolis, IN, IN, USA
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Carmo WBD, Castro BBA, Manso LC, Carmo PAVD, Rodrigues CA, Custódio MR, Jorgetti V, Sanders-Pinheiro H. Iron-based phosphorus chelator: Risk of iron deposition and action on bone metabolism in uremic rats. Exp Biol Med (Maywood) 2021; 247:446-452. [PMID: 34861126 DOI: 10.1177/15353702211057280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Phosphate chelators are frequently used in patients with chronic kidney disease (CKD). New iron-based chelators remain understudied and offer a promising therapeutic option for the control of bone and mineral disorders of chronic kidney disease (BMD-CKD). We assessed the effect of the phosphorus chelator, chitosan-iron III (CH-FeCl), compared to calcium carbonate (CaCO3) in BMD-CKD and the potential iron overload in uremic rats. Thirty-two animals were divided into four groups, namely the control, CKD, CKD/CH-FeCl, and CKD/CaCO3 groups. CKD was induced by adding 0.75% (4 weeks) and 0.1% (3 weeks) adenine to the diet. The chelators were administered from week 3 through week 7. The renal function, BMD-CKD markers, and histomorphometry of the femur were assessed at week 7. The CKD group showed a significant increase in creatinine (83.9 ± 18.6 vs. 41.5 ± 22.1 µmol/L; P = 0.001), phosphate (3.5 ± 0.8 vs. 2.2 ± 0.2 mmol/L; P = 0.001), fractional excretion of phosphorus (FEP) (0.71 ± 0.2 vs. 0.2 ± 0.17; P = 0.0001), and FGF23 (81.36 ± 37.16 pg/mL vs. 7.42 ± 1.96; P = 0.011) compared to the control group. There was no accumulation of serum or bone iron after the use of CH-FeCl. The use of chelators reduced the FEP (control: 0.71 ± 0.20; CKD/CH-FeCl: 0.40 ± 0.16; CKD/CaCO3 0.34 ± 0.15; P = 0.001), without changes in the serum FGF23 and parathyroid hormone levels. Histomorphometry revealed the presence of bone disease with high remodeling in the uremic animals without changes with the use of chelators. The CH-FeCl chelator was efficient in reducing the FEP without iron accumulation, thereby paving the way for the use of this class of chelators in clinical settings in the future.
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Affiliation(s)
- Wander Barros do Carmo
- Laboratory of Experimental Nephrology (LABNEX), Interdisciplinary Nucleus of Laboratory Animal Studies (NIDEAL), Center for Reproductive Biology (CBR), 28113Federal University of Juiz de Fora, Juiz de Fora 36036-900, Brazil.,Interdisciplinary Center for Studies and Research in Nephrology (NIEPEN), Federal University of Juiz de Fora, Juiz de Fora 36036-330, Brazil.,Department of Internal Medicine, School of Medicine, 28113Federal University of Juiz de Fora, Juiz de Fora 36038-330, Brazil
| | - Bárbara Bruna Abreu Castro
- Laboratory of Experimental Nephrology (LABNEX), Interdisciplinary Nucleus of Laboratory Animal Studies (NIDEAL), Center for Reproductive Biology (CBR), 28113Federal University of Juiz de Fora, Juiz de Fora 36036-900, Brazil.,Interdisciplinary Center for Studies and Research in Nephrology (NIEPEN), Federal University of Juiz de Fora, Juiz de Fora 36036-330, Brazil
| | - Luísa Cardoso Manso
- Laboratory of Experimental Nephrology (LABNEX), Interdisciplinary Nucleus of Laboratory Animal Studies (NIDEAL), Center for Reproductive Biology (CBR), 28113Federal University of Juiz de Fora, Juiz de Fora 36036-900, Brazil
| | | | - Clóvis Antônio Rodrigues
- Nucleus for Chemical-Pharmaceutical Investigations (NIQFAR), University of Vale do Itajaí, Itajaí 88302-202, Brazil
| | - Melani Ribeiro Custódio
- Laboratory of Renal Physiopathology, School of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
| | - Vanda Jorgetti
- Laboratory of Renal Physiopathology, School of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
| | - Helady Sanders-Pinheiro
- Laboratory of Experimental Nephrology (LABNEX), Interdisciplinary Nucleus of Laboratory Animal Studies (NIDEAL), Center for Reproductive Biology (CBR), 28113Federal University of Juiz de Fora, Juiz de Fora 36036-900, Brazil.,Interdisciplinary Center for Studies and Research in Nephrology (NIEPEN), Federal University of Juiz de Fora, Juiz de Fora 36036-330, Brazil.,Department of Internal Medicine, School of Medicine, 28113Federal University of Juiz de Fora, Juiz de Fora 36038-330, Brazil
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11
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Lee H, Eum SH, Ko EJ, Cho HJ, Yang CW, Chung BH. Alterations in the Mineral Bone Metabolism of Living Kidney Donors After Uni-Nephrectomy: Prospective Observational Study. Front Med (Lausanne) 2021; 8:741944. [PMID: 34722580 PMCID: PMC8554047 DOI: 10.3389/fmed.2021.741944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/14/2021] [Indexed: 11/19/2022] Open
Abstract
We investigated the dynamic change of mineral bone metabolism and explored factors associated with the alteration of mineral bone metabolism in the living kidney donors (LKDs) after uni-nephrectomy. One-hundred forty-four prospective LKDs who underwent kidney donation between May 2016 and September 2018 were enrolled. Laboratory evaluation regarding mineral bone metabolism including intact parathyroid hormone (iPTH), renal fractional excretion of phosphate (FEPi), and technetium-99m diethylenetriaminepentaacetate (99mTc-DTPA) scan was performed predonation and 6 months after donation. We divided donors into two groups, the low ΔFEPi and high ΔFEPi groups, according to the change of FEPi after donation, and investigated significant risk factors associated with high ΔFEPi. At 6 months after uni-nephrectomy, estimated glomerular filtration rate (eGFR) significantly declined by 30.95 ml/min/1.73 m2 (p < 0.001), but the measured GFR (mGFR) of the remaining kidney by 99mTc-DTPA scan showed significant increase. Serum phosphorus decreased (p < 0.001), whereas FEPi (13.34–20.23%, p < 0.001) and serum iPTH (38.70–52.20 pg/ml, p < 0.001) showed significant increase. In the high ΔFEPi group, the proportion of preexisting hypertension (HTN) was higher, the baseline FEPi was lower, and the percent decline in eGFR was greater. Moreover, all of these factors were independently associated with high ΔFEPi upon multivariable logistic regression analysis. LKDs showed a significant change in mineral bone metabolism after uni-nephrectomy, especially when the donors had preexisting HTN, lower baseline FEPi, and showed greater loss of kidney function. Hence, strict monitoring of the mineral bone metabolism parameters and bone health may be required for these donors.
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Affiliation(s)
- Hanbi Lee
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Sang Hun Eum
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Eun Jeong Ko
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.,Transplant Research Center, Convergent Research Consortium for Immunologic Disease, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyuck Jin Cho
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.,Transplant Research Center, Convergent Research Consortium for Immunologic Disease, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Byung Ha Chung
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.,Transplant Research Center, Convergent Research Consortium for Immunologic Disease, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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12
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Jørgensen HS, Eide IA, Jenssen T, Åsberg A, Bollerslev J, Godang K, Hartmann A, Schmidt EB, Svensson M. Marine n-3 Polyunsaturated Fatty Acids and Bone Mineral Density in Kidney Transplant Recipients: A Randomized, Placebo-Controlled Trial. Nutrients 2021; 13:2361. [PMID: 34371870 DOI: 10.3390/nu13072361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/27/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
Kidney transplant recipients are at high risk of progressive bone loss and low-energy fractures in the years following transplantation. Marine n-3 polyunsaturated fatty acids (n-3 PUFA) supplementation may have beneficial effects on bone strength. The Omega-3 fatty acids in Renal Transplantation (ORENTRA) trial was an investigator initiated, randomized, placebo-controlled trial investigating the effects of marine n-3 PUFA supplementation after kidney transplantation. Effects of supplementation on bone mineral density (BMD) and calcium metabolism were pre-defined secondary endpoints. Adult kidney transplant recipients (n = 132) were randomized to 2.6 g marine n-3 PUFA supplement or olive oil (control) from 8 to 52 weeks post-transplant. Dual energy X-ray absorptiometry was performed to assess changes in bone mineral density of hip, spine, and forearm, as well as trabecular bone score (TBS) of the lumbar spine. Student's t test was used to assess between-group differences. There were no differences in ΔBMD between the two groups (intervention vs. control) at lumbar spine (-0.020 ± 0.08 vs. -0.007 ± 0.07 g/cm², p = 0.34), total hip (0.001 ± 0.03 vs. -0.005 ± 0.04, p = 0.38), or other skeletal sites in the intention-to-treat analyses. There was no difference in the change in TBS score (0.001 ± 0.096 vs. 0.009 ± 0.102, p = 0.62). Finally, no effect on biochemical parameters of mineral metabolism was seen. Results were similar when analyzed per protocol. In conclusion, we found no significant effect of 44 weeks of supplementation with 2.6 g of marine n-3 PUFA on BMD in kidney transplant recipients.
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13
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Gupta V, Ekundayo O, Nemeth ZK, Yang Y, Covic A, Mathe Z, Kovesdy CP, Molnar MZ, Mucsi I. Association between serum osteoprotegerin level and mortality in kidney transplant recipients - a prospective observational cohort study. Transpl Int 2021; 34:844-854. [PMID: 33606319 DOI: 10.1111/tri.13847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/07/2020] [Accepted: 02/17/2021] [Indexed: 12/13/2022]
Abstract
Paradoxically, higher serum levels of osteoprotegerin (OPG: a vascular calcification inhibitor) have been associated with increased arterial stiffness, risk of cardiovascular disease and all-cause mortality. A few studies reported that post-transplant OPG levels are associated with mortality in kidney transplant (KT) recipients. In this study, this association was assessed in a cohort of prevalent KT recipients, adjusting for previously untested potential confounders, including fibroblast growth factor 23 (FGF23) and interleukin 6 (IL-6). Socio-demographic and clinical parameters, medical and transplant history, and laboratory data were collected from 982 prevalent KT recipients. The association between serum OPG and all-cause mortality over a 6-year follow-up period was examined using Kaplan-Meier survival curves and multivariable-adjusted Cox regression models. Participants with high serum OPG were more likely female, older, deceased donor KT recipients and have more comorbidity, lower eGFR, higher FGF23, higher IL-6, and longer dialysis vintage. Each 1 pmol/l higher serum OPG level was associated with a 49% higher risk of mortality (hazard ratio (HR) [95% confidence interval (CI)]: 1.49 [1.40-1.61]). This association persisted after adjusting for confounders (HR [95% CI]: 1.20 [1.10-1.30]). In conclusion, serum OPG was associated with all-cause mortality independent of several novel confounders in prevalent KT recipients.
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Affiliation(s)
- Vardaan Gupta
- Department of Medicine, Division of Nephrology and Multiorgan Transplant Program, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Oladapo Ekundayo
- Department of Medicine, Division of Nephrology and Multiorgan Transplant Program, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Zsofia K Nemeth
- Nephrology Division, Uzsoki Teaching Hospital, Budapest, Hungary
| | - Yifan Yang
- Department of Medicine, Division of Nephrology and Multiorgan Transplant Program, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Adrian Covic
- "C.I. Parhon" University Hospital, Iasi, Romania.,Grigore T, Popa" University of Medicine, Iasi, Romania
| | - Zoltan Mathe
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Miklos Z Molnar
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.,Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Division of Nephrology & Hypertension, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Istvan Mucsi
- Department of Medicine, Division of Nephrology and Multiorgan Transplant Program, University Health Network, University of Toronto, Toronto, ON, Canada
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14
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Berner C, Marculescu R, Frommlet F, Kurnikowski A, Schairer B, Aigner C, Bieglmayer C, Hecking M. Parathyroid Hormone Concentrations in Maintenance Hemodialysis: Longitudinal Evaluation of Intact and Biointact Assays. Kidney Med 2021; 3:343-352.e1. [PMID: 34136780 PMCID: PMC8178455 DOI: 10.1016/j.xkme.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Rationale & Objective Management of chronic kidney disease mineral and bone disorder requires parathyroid hormone (PTH) concentrations. “Biointact” PTH immunoassays detect “whole” PTH (wPTH), whereas “intact” immunoassays measure PTH plus PTH fragments (iPTH). We aimed to determine whether longitudinal changes in PTH concentrations can be evaluated using biointact and intact immunoassays alike. Study Design Open noninterventional longitudinal cohort study. Setting & Participants PTH concentrations were measured quarterly up to 5 times in 102 hemodialysis patients. Predictors & Tests Compared Age, sex, phosphate levels, and others as clinical predictors for PTH trend. Tests compared were iPTH immunoassays from Siemens and Roche and wPTH immunoassays from Roche and DiaSorin. Outcomes PTH concentration trend; regression equations; test bias. Analytical Approach Predictive regression-to-the-mean model for PTH slope; Bland-Altman plots, Passing-Bablok regression, and reference change values for test comparisons. Results wPTH concentrations were similar with both immunoassays (wPTH-Roche = 11.7 + 0.97 × wPTH-DiaSorin, r = 0.99; mean ± 1.96 SD bias, 8.2 ± 43.3 pg/mL [17.5% ± 40.9%], by Bland-Altman plots). iPTH-Siemens concentrations were higher than iPTH-Roche concentrations (iPTH-Siemens = −5.4 + 1.33 × iPTH-Roche, r = 0.99; mean ± 1.96 SD bias, 84.0 ± 180.2 pg/mL [21.1% ± 29.8%], by Bland-Altman plots). iPTH-Roche and iPTH-Siemens concentrations were 2- and 2.5-fold higher than wPTH concentrations, respectively. Full agreement among all 4 immunoassays in detecting both significant and insignificant changes in PTH concentrations, upward or downward from one quarter to the next, was reached in 87% of consecutive measurements. In a predictive model, baseline PTH concentrations > 199 pg/mL (wPTH-Roche), 204 pg/mL (wPTH-DiaSorin), 386 pg/mL (iPTH-Roche), and 417 pg/mL (iPTH-Siemens) correctly predicted declining PTH concentration trend in 62% to 68% of patients, but age, sex, hemodialysis vintage, and calcium and phosphate levels were no significant predictors. Limitations Limited number of immunoassays, only 59 patients attended all quarterly samplings. Conclusions wPTH-Roche and wPTH-DiaSorin concentrations were similar, while iPTH was higher than wPTH concentrations. The iPTH-Siemens immunoassay is either higher calibrated or detects more fragments than iPTH-Roche. However, longitudinal PTH concentration changes largely coincided with all tested immunoassays.
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Affiliation(s)
- Carolin Berner
- Division of Nephrology & Dialysis, Department of Medicine III, Medical University of Vienna
- Nephrology & Dialysis, 1st Medical Department, Kaiser Franz Josef Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Rodrig Marculescu
- Clinical Institute for Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
| | - Florian Frommlet
- Center for Medical Statistics, Informatics and Intelligent Systems, Section for Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Amelie Kurnikowski
- Division of Nephrology & Dialysis, Department of Medicine III, Medical University of Vienna
| | - Benjamin Schairer
- Division of Nephrology & Dialysis, Department of Medicine III, Medical University of Vienna
| | - Christof Aigner
- Division of Nephrology & Dialysis, Department of Medicine III, Medical University of Vienna
| | - Christian Bieglmayer
- Clinical Institute for Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
| | - Manfred Hecking
- Division of Nephrology & Dialysis, Department of Medicine III, Medical University of Vienna
- Address for Correspondence: Manfred Hecking, MD, PhD, Medical University of Vienna, Medicine III, Clinical Division of Nephrology & Dialysis, Währinger Gürtel 18-20, Vienna, 1090 Austria.
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15
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Wu Z, Li L, Wu G, Xie Y, Li J, Peng R. Effects of tonifying kidney and strengthen bone therapy on non-dialysis patients with chronic kidney disease-mineral and bone disorder: A protocol for the systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e24445. [PMID: 33578537 PMCID: PMC7886426 DOI: 10.1097/md.0000000000024445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/05/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Correction of calcium (Ca), phosphorus (P), and parathyroid hormone (PTH) disorders is the standard of treatment in non-dialysis patients with chronic kidney disease-mineral and bone disorder (CKD-MBD), but the side effects and adverse reactions brought by western medicine (WM) are still the main problems. More importantly, the lack of protection of kidney function in the treatment greatly affects the health of patients. Although traditional Chinese medicine (TCM), specifically tonifying kidney and strengthen bone (TKSB) therapy is wildly applied for patients with CKD-MBD in China, the evidence of TKSB therapy in the treatment of CKD-MBD is limited. Thus, we pretent to conduct this protocol to evaluate the efficacy and safety of TKSB therapy combined with WM for non-dialysis patients with CKD-MBD. METHODS A system research of randomized controlled trials (RCTs) of TKSB therapy for CKD-MBD will be conducted by 2 investigators from 7 electronic databases. Methodological quality evaluations will be performed by using the Cochrane collaboration tool and data analysis will be conducted by RevMan V5.3 software and STATA v15.0. RESULTS The results of this paper will be submitted to a peer-reviewed journal for publication. CONCLUSION This research will determine the safety and efficacy of TKSB therapy in treating non-dialysis patients with CKD-MBD. INPLASY REGISTRATION NUMBER INPLASY2020120086.
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Affiliation(s)
- Zijian Wu
- College of Acupuncture and Orthopedics
| | - Liang Li
- Clinical College of Chinese Medicine, Hubei University of Chinese Medicine
| | - Guiling Wu
- Wuhan Hospital of Traditional Chinese Medicine
| | | | - Jia Li
- Hubei Provincial Collaborative Innovation Center of Preventive Treatment by Acupuncture and Moxibustion, Hubei University of Chinese Medicine, Wuhan, China
| | - Rui Peng
- College of Acupuncture and Orthopedics
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16
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Liu BH, Chong FL, Yuan CC, Liu YL, Yang HM, Wang WW, Fang QJ, Wu W, Wang MZ, Tu Y, Wan ZY, Wan YG, Wu GW. Fucoidan Ameliorates Renal Injury-Related Calcium-Phosphorus Metabolic Disorder and Bone Abnormality in the CKD-MBD Model Rats by Targeting FGF23-Klotho Signaling Axis. Front Pharmacol 2021; 11:586725. [PMID: 33708111 PMCID: PMC7941278 DOI: 10.3389/fphar.2020.586725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/29/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Recently, chronic kidney disease (CKD)-mineral and bone disorder (MBD) has become one of common complications occurring in CKD patients. Therefore, development of a new treatment for CKD-MBD is very important in the clinic. In China, Fucoidan (FPS), a natural compound of Laminaria japonica has been frequently used to improve renal dysfunction in CKD. However, it remains elusive whether FPS can ameliorate CKD-MBD. FGF23-Klotho signaling axis is reported to be useful for regulating mineral and bone metabolic disorder in CKD-MBD. This study thereby aimed to clarify therapeutic effects of FPS in the CKD-MBD model rats and its underlying mechanisms in vivo and in vitro, compared to Calcitriol (CTR). Methods: All male rats were divided into four groups: Sham, CKD-MBD, FPS and CTR. The CKD-MBD rat models were induced by adenine administration and uninephrectomy, and received either FPS or CTR or vehicle after induction of renal injury for 21 days. The changes in parameters related to renal dysfunction and renal tubulointerstitial damage, calcium-phosphorus metabolic disorder and bone lesion were analyzed, respectively. Furthermore, at sacrifice, the kidneys and bone were isolated for histomorphometry, immunohistochemistry and Western blot. In vitro, the murine NRK-52E cells were used to investigate regulative actions of FPS or CTR on FGF23-Klotho signaling axis, ERK1/2-SGK1-NHERF-1-NaPi-2a pathway and Klotho deficiency. Results: Using the modified CKD-MBD rat model and the cultured NRK-52E cells, we indicated that FPS and CTR alleviated renal dysfunction and renal tubulointerstitial damage, improved calcium-phosphorus metabolic disorder and bone lesion, and regulated FGF23-Klotho signaling axis and ERK1/2-SGK1-NHERF-1-NaPi-2a pathway in the kidney. In addition, using the shRNA-Klotho plasmid-transfected cells, we also detected, FPS accurately activated ERK1/2-SGK1-NHERF-1-NaPi-2a pathway through Klotho loss reversal. Conclusion: In this study, we emphatically demonstrated that FPS, a natural anti-renal dysfunction drug, similar to CTR, improves renal injury-related calcium-phosphorus metabolic disorder and bone abnormality in the CKD-MBD model rats. More importantly, we firstly found that beneficial effects in vivo and in vitro of FPS on phosphorus reabsorption are closely associated with regulation of FGF23-Klotho signaling axis and ERK1/2-SGK1-NHERF-1-NaPi-2a pathway in the kidney. This study provided pharmacological evidences that FPS directly contributes to the treatment of CKD-MBD.
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Affiliation(s)
- Bu-Hui Liu
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Nephrology Division, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Fee-Lan Chong
- The School of Pharmacy, Management and Science University, Shah Alam, Malaysia
| | - Can-Can Yuan
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ying-Lu Liu
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Hai-Ming Yang
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Wen-Wen Wang
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Qi-Jun Fang
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Wei Wu
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Mei-Zi Wang
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yue Tu
- Department of Traditional Chinese Medicine Health Preservation, Acupuncture, Moxibustion and Massage College, Health Preservation and Rehabilitation College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zi-Yue Wan
- Department of Social Work, Meiji Gakuin University, Tokyo, Japan
| | - Yi-Gang Wan
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Guo-Wen Wu
- Jilin Province Huinan Chonglong Bio-Pharmacy Co., Ltd., Huinan, China
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17
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Jia F, Wang S, Jing Y, Zhao H, Rong P, Zhang H, Lu W, Xue Y, Sun G. Osteocalcin and Abdominal Aortic Calcification in Hemodialysis Patients: An Observational Cross-Sectional Study. Front Endocrinol (Lausanne) 2021; 12:620350. [PMID: 33815281 PMCID: PMC8018234 DOI: 10.3389/fendo.2021.620350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/02/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To investigate the serum level of osteocalcin (OC), also known as bone Gla protein, in maintenance hemodialysis (MHD) patients and its correlation with abdominal aortic calcification (AAC). METHODS From July 2017 to February 2020, we enrolled 108 adult MHD patients. Routine fasting blood laboratory tests were performed before the start of the second hemodialysis in a week. Abdominal aortic calcification score (AACs) was assessed within 1 month. Pearson correlation and Logistic regression were used to analyze the data. RESULTS The OC level was 231.56 (25.92,361.33) ng/ml, elevating significantly in this group of MHD patients. It had a positive correlation with serum phosphorus (r = 0.511, P = 0.001), intact parathyroid hormone(iPTH) (r = 0.594, P = 0.0001), fibroblast growth factor 23(FGF23) (r = 0.485, P = 0.003) and a negative correlation with age(r = -0.356, P = 0.039). Based on the AACs, patients were divided into two groups. Serum OC level were higher in patients with AACs≥5 (p=0.032). A multiple logistics regression analysis revealed that age (odds ratio [OR]1.14, P=0.005) and OC(OR=1.10, P=0.008)were risk factors for high AACs(≥5). CONCLUSION The study implicated that OC elevated significantly in this group of MHD patients.OC is positively correlated with phosphorus, iPTH, FGF23, and a negative correlation with age. OC was a risk factor for vascular calcification in this study, but this study did not classify osteocalcin as c-OC and unOC. Whether unOC is associated more directly with vascular calcification requires further study.
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Affiliation(s)
- Fengyu Jia
- Department of Nephrology, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Suxia Wang
- Department of Nephrology, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Ying Jing
- Department of Nephrology, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Hanhui Zhao
- Department of Nephrology, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Peng Rong
- Department of Nephrology, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Hongbin Zhang
- Department of Nephrology, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Wenting Lu
- Department of Nephrology, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Yan Xue
- Department of Medical Imaging, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
- *Correspondence: Yan Xue, ; Gang Sun,
| | - Gang Sun
- Department of Medical Imaging, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
- *Correspondence: Yan Xue, ; Gang Sun,
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Ma H, Ouyang C, Huang Y, Xing C, Cheng C, Liu W, Yuan D, Zeng M, Yu X, Ren H, Yuan Y, Zhang L, Xu F, Cui Y, Ren W, Huang H, Qian H, Fan B, Wang N. Comparison of microwave ablation treatments in patients with renal secondary and primary hyperparathyroidism. Ren Fail 2020; 42:66-76. [PMID: 31928297 PMCID: PMC7006805 DOI: 10.1080/0886022x.2019.1707097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose Microwave ablation (MWA) is feasible for severe renal secondary hyperparathyroidism (SHPT) and primary hyperparathyroidism (PHPT) patients ineligible for parathyroidectomy (PTX). Here we compared the clinical manifestations and characteristics of parathyroid glands in these two groups, and summarized the techniques, safety and efficacy of MWA. Methods Baseline clinical characteristics, ablation-related techniques, adverse events/complications, and efficacy were recorded. Results In SHPT group, malnutrition, cardiovascular/pulmonary complications, and abnormal bone metabolism were severe. SHPT patients had more hyperplastic parathyroid glands. The volume of each gland was smaller, and the time of ablation for a single parathyroid was shorter in the SHPT group, although there were no significant differences compared with patients in the PHPT group. Three patients in both groups had recurrent laryngeal nerve injuries and all recovered, except for one SHPT patient. By the end of follow-up, serum iPTH levels had decreased from 2400.26 ± 844.26 pg/mL to 429.39 ± 407.93 pg/mL (p < .01) in SHPT and from 297.73 ± 295.32 pg/mL to 72.22 ± 36.51 pg/mL in PHPT group (p < .01). Hypocalcemia was more common (p < .001) and serum iPTH levels were prone to rebound in SHPT patients after MWA. Conclusion MWA can be reserved for those who had high surgical risks because of less invasiveness. Injuries of recurrent laryngeal nerves should be noticed. The health status, perioperative, and intraoperative procedures were more complicated and all parathyroids found by ultrasound should be ablated completely in SHPT patients.
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Affiliation(s)
- Haoyang Ma
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Chun Ouyang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Yaoyu Huang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Changying Xing
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Chen Cheng
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Wei Liu
- Department of Nuclear Medicine, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Donglan Yuan
- Department of Nuclear Medicine, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Ming Zeng
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Xiangbao Yu
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Haibin Ren
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Yanggang Yuan
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Lina Zhang
- Department of Nephrology, Henan Key Laboratory for Kidney Disease and Immunology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan, China
| | - Fangyan Xu
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Ying Cui
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Wenkai Ren
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Hui Huang
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hanyang Qian
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Boqiang Fan
- Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Ningning Wang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
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Carbonara CEM, dos Reis LM, Quadros KRDS, Roza NAV, Sano R, Carvalho AB, Jorgetti V, de Oliveira RB. Renal osteodystrophy and clinical outcomes: data from the Brazilian Registry of Bone Biopsies - REBRABO. J Bras Nefrol 2020; 42:138-146. [PMID: 32756862 PMCID: PMC7427645 DOI: 10.1590/2175-8239-jbn-2019-0045] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/15/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Mineral and bone disorders (MBD) are major complications of chronic kidney disease (CKD)-related adverse outcomes. The Brazilian Registry of Bone Biopsy (REBRABO) is an electronic database that includes renal osteodystrophy (RO) data. We aimed to describe the epidemiological profile of RO in a sample of CKD-MBD Brazilian patients and understand its relationship with outcomes. METHODS Between August 2015 and March 2018, 260 CKD-MBD stage 3-5D patients who underwent bone biopsy were followed for 12 to 30 months. Clinical-demographic, laboratory, and histological data were analyzed. Bone fractures, hospitalizations, and death were considered the primary outcomes. RESULTS Osteitis fibrosa, mixed uremic osteodystrophy, adynamic bone disease, osteomalacia, osteoporosis, and aluminum (Al) accumulation were detected in 85, 43, 27, 10, 77, and 65 patients, respectively. The logistic regression showed that dialysis vintage was an independent predictor of osteoporosis (OR: 1.005; CI: 1.001-1.010; p = 0.01). The multivariate logistic regression revealed that hemodialysis treatment (OR: 11.24; CI: 1.227-100; p = 0.03), previous parathyroidectomy (OR: 4.97; CI: 1.422-17.241; p = 0.01), and female gender (OR: 2.88; CI: 1.080-7.679; p = 0.03) were independent predictors of Al accumulation; 115 patients were followed for 21 ± 5 months. There were 56 hospitalizations, 14 deaths, and 7 fractures during follow-up. The COX regression revealed that none of the variable related to the RO/turnover, mineralization and volume (TMV) classification was an independent predictor of the outcomes. CONCLUSION Hospitalization or death was not influenced by the type of RO, Al accumulation, or TMV classification. An elevated prevalence of osteoporosis and Al accumulation was detected.
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Affiliation(s)
- Cinthia Esbrile Moraes Carbonara
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório para o Estudo do Distúrbio Mineral e Ósseo em Nefrologia, Campinas, SP, Brasil
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas, SP, Brasil
| | - Luciene Machado dos Reis
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Fisiopatologia Renal, São Paulo, SP, Brasil
| | - Kélcia Rosana da Silva Quadros
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório para o Estudo do Distúrbio Mineral e Ósseo em Nefrologia, Campinas, SP, Brasil
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas, SP, Brasil
| | - Noemi Angelica Vieira Roza
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório para o Estudo do Distúrbio Mineral e Ósseo em Nefrologia, Campinas, SP, Brasil
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas, SP, Brasil
| | - Rafael Sano
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório para o Estudo do Distúrbio Mineral e Ósseo em Nefrologia, Campinas, SP, Brasil
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas, SP, Brasil
| | - Aluizio Barbosa Carvalho
- Sociedade Brasileira de Nefrologia, Departamento de Distúrbios do Metabolismo Ósseo Mineral na Doença Renal Crônica, São Paulo, SP, Brasil
- Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Vanda Jorgetti
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Fisiopatologia Renal, São Paulo, SP, Brasil
- Sociedade Brasileira de Nefrologia, Departamento de Distúrbios do Metabolismo Ósseo Mineral na Doença Renal Crônica, São Paulo, SP, Brasil
| | - Rodrigo Bueno de Oliveira
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório para o Estudo do Distúrbio Mineral e Ósseo em Nefrologia, Campinas, SP, Brasil
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas, SP, Brasil
- Sociedade Brasileira de Nefrologia, Departamento de Distúrbios do Metabolismo Ósseo Mineral na Doença Renal Crônica, São Paulo, SP, Brasil
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Niu Q, Yang S, Gan L, Zhao H, Zuo L. Different type and dosage of heparin were not associated with the progression of coronary artery calcification in haemodialysis patients. Nephrology (Carlton) 2019; 25:551-558. [PMID: 31339604 PMCID: PMC7317585 DOI: 10.1111/nep.13632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2019] [Indexed: 12/12/2022]
Abstract
AIM Several studies have verified that unfractionated heparin (UFH) and low molecular heparin (LWMH) can induce bone loss, and bone mineral density has been inversely associated with vascular calcification in some clinical researches. But few have focused on the relationship between types and dosages of heparin and the progression of vascular calcification. We observed the progression of coronary artery calcification (CAC) in maintenance haemodialysis (MHD) patients who were treated with UFH and LMWH. METHODS This was a prospective prevalent cohort study of MHD patients. Computed tomography was performed at enrolment and 2 years after enrolment, and CAC score was obtained. Demographic and clinical data, baseline and time-average laboratory indices were collected. Multiple linear regression and logistic regression were used to estimate the influencing factors of progression of CAC. RESULTS In this study, (i) we initially enrolled 69 HD patients, and then 56 patients finished the follow-up. (ii) Among the total 56 patients, 27 patients (48.2%) were treated with UFH, 14 (25.0%) with LMWH and 15 (26.8%) with both. The median baseline CAC scores of three groups (UFH, LMWH and both users) were 91.0 (1.0, 1052.0), 134.0 (0, 1292.0) and 250.5 (27.0, 1139.0), respectively, with no significant difference (P = 0.663); the median CAC progression scores were 42.0 (0, 364.0), 172.0 (7.0, 653.0) and 118.5 (0, 434.0), respectively, with no significant difference (P = 0.660). (iii) Pearson and spearman correlation analysis shown that the progression of CAC was not associated with cumulative dosage of heparin used. (iv) After adjusted for diabetes mellitus, time-averaged intact parathyroid hormone, phosphate and alkaline phosphatase, logistic regression analysis showed using different types of heparin was not an independent risk factor for CAC progression; and multiple linear regression analysis showed that the type of heparin used was not associated with CAC progression. CONCLUSION There were no significant differences in the effects of the types and dosages of heparin on CAC progression in patients on haemodialysis.
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Affiliation(s)
- Qingyu Niu
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Shuo Yang
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Liangying Gan
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Huiping Zhao
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
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Sessa C, Galeano D, Alessandrello I, Aprile G, Distefano G, Ficara V, Giglio E, Musumeci S, Pocorobba B, Zuppardo C, Musso S, Granata A. [Osteoporosis and chronic kidney disease: review and new therapeutic strategies]. G Ital Nefrol 2019; 36:36-4-2019-4. [PMID: 31373465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Osteoporosis affects a segment of the population in which Chronic Kidney Disease is also greatly represented. Nephropathic patients may present peculiar biochemical abnormalities related to Chronic Kidney Disease, defining the Mineral and Bone Disorder. This kind of anomalies, in the worst scenarios, configure the typical histomorphology patterns of Renal Osteodystrophy. Scientific Societies of Endocrinology have established therapy guidelines for patients with osteoporosis only based on the glomerular filtration rate and recommend avoiding the use of some drugs for the more advanced classes of nephropathy. However, there is no clear therapeutic approach for patients with advanced nephropathy and bone abnormalities. In this paper we propose a systematic review of the literature and present our proposal for managing patients with advanced nephropathy, based on eGFR and on presence of Mineral and Bone Disorder.
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Affiliation(s)
- Concetto Sessa
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa
| | - Dario Galeano
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa
| | - Ivana Alessandrello
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa
| | - Giorgio Aprile
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa
| | - Giulio Distefano
- U.O. Radiologia I, Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università di Catania, Catania
| | - Vincenzo Ficara
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa
| | - Elisa Giglio
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa
| | - Stella Musumeci
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa
| | - Barbara Pocorobba
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa
| | - Carmelo Zuppardo
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa
| | - Salvatore Musso
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa
| | - Antonio Granata
- U.O.C. Nefrologia e Dialisi - P.O. "San Giovanni di Dio", Agrigento - Italia
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Xiong Y, Li J, Sun S, Han M, Liao R, Li Y, Wang L, Lin L, Liu Q, Su B. Association of mineral content outside of bone with coronary artery calcium and 1-year cardiovascular prognosis in maintenance hemodialysis patients. Artif Organs 2019; 43:988-1001. [PMID: 30932185 PMCID: PMC6850757 DOI: 10.1111/aor.13461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/12/2019] [Accepted: 03/18/2019] [Indexed: 02/05/2023]
Abstract
Coronary artery calcifications (CACs) are common among maintenance hemodialysis (MHD) patients and associated with increased morbidity and mortality due to cardiovascular events. The insight into chronic kidney disease‐mineral and bone disorder (CKD‐MBD) established a correlation between dysregulated mineral metabolism and CACs. This study aimed to identify the association of mineral content outside of bone (MCOB) with CACs and cardiovascular events in MHD patients. In the pilot prospective study with no intervention, patients underwent body composition assessment by body composition monitor after hemodialysis and computed tomography examination using the Agatston scoring method simultaneously within a week. The primary end point included cardiovascular events and cardiovascular death. Correlations and receiver operating characteristic analysis elucidated the associations of MCOB with CACs; multivariate analysis assessed the cardiovascular risk for groups with different MCOB. One hundred three eligible patients with an average age of 48 (35‐63) years old were enrolled and followed up to 12 (11‐12.5) months, among which 52.4% had detectable CACs at baseline. MCOB showed an inverse correlation with Agatston score and significantly discriminated the patients with Agatston score > 0 (AUC = 0.737; P < 0.001) and 400 (AUC = 0.733; P < 0.001). MCOB ≤ 9.2657 mg/kg was an independent risk factor for CACs (OR = 4.853; P = 0.044) and strong predictor for cardiovascular morbidity and mortality (HR = 10.108; P = 0.042), as well as rehospitalization (HR = 2.689; P = 0.004). MCOB inversely correlated with the presence and extent of CACs, and could discriminate Agatston score > 0 and 400, which also presented as an independent indicator for CKD‐MBD and 1‐year cardiovascular prognosis in adult MHD patients. Additional studies are required for identifying this issue.
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Affiliation(s)
- Yuqin Xiong
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiameng Li
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Si Sun
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Mei Han
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Ruoxi Liao
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Yupei Li
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Liya Wang
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Liping Lin
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Liu
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Baihai Su
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
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Brown RB. Dysregulated Phosphate Metabolism, Periodontal Disease, and Cancer: Possible Global Health Implications. Dent J (Basel) 2019; 7:E18. [PMID: 30754693 DOI: 10.3390/dj7010018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [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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胡 顺, 王 东, 张 芮, 曹 媛, 金 华, 茅 燕, 魏 玲, 任 克, 章 雪, 王 亿. [Effect of Ronghuang Granule on serum FGF23, FGFRs and Klotho in non-dialysis patients with CKD-MBD and kidney deficiency and damp-heat syndrome]. Nan Fang Yi Ke Da Xue Xue Bao 2018; 38:1427-1432. [PMID: 30613009 PMCID: PMC6744217 DOI: 10.12122/j.issn.1673-4254.2018.12.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To observe the effect of Ronghuang granule on serum fibroblast growth factor 23 (FGF23), fibroblast growth factor receptor (FGFRs) and Klotho protein levels in non-dialysis patients with chronic kidney disease-mineral and bone disorder (CKD-MBD) and kidney deficiency and damp heat syndrome. METHODS Seventy non-dialysis CKD-MBD patients with kidney deficiency and dampness-heat syndrome were randomized into control group (n=35) and treatment group (n=35). All the patients were given routine treatment combined with traditional Chinese medicine retention enema, and the patients in the treatment group received additional Ronghuang granule treatment (3 times a day). After the 12-week treatments, the patients were examined for changes of TCM syndromes. Serum levels of Ca, P, parathyroid hormone (iPTH), FGF23, FGFRs and Klotho proteins were detected before and after treatment. These parameters were also examined in 20 healthy volunteers. RESULTS Sixty-five patients completed the study, including 33 in the control group and 32 in the treatment group. The patients in the treatment group showed significantly better treatment responses than those in the control group (P < 0.05 or 0.01). At 4, 8, and 12 weeks of treatment, the patients in the treatment group had significantly lowered scores of TCM syndromes compared with the score before treatment (P < 0.05 or 0.01), while in the control group, significant reduction of the scores occurred only at 12 weeks (P < 0.05); at each of the time points, the treatment group had significantly greater reductions in the score than the control group (P < 0.01). Significant improvements in serum Ca, P and iPTH levels were observed at 4, 8, and 12 weeks in the treatment group (P < 0.05) but only at 12 weeks in the control group (P < 0.05). The patients in the control and treatment groups all showed elevated serum levels of FGF23, FGFRs and Klotho protein compared with the normal subjects (P < 0.01); FGF23, FGFRs and Klotho levels were significantly reduced in the treatment group (P < 0.05) but remained unchanged in the control group (P>0.05), showing significant differences between the two groups. CONCLUSIONS Ronghuang granule improves the clinical symptoms of non-dialysis CKD-MBD patients with kidney deficiency and dampness heat syndrome by reducing serum levels of FGF23, FGFRs and Klotho, improving calcium and phosphorus metabolism disorder, and inhibiting secondary hyperparathyroidism.
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Affiliation(s)
- 顺金 胡
- 安徽中医药大学 第一附属医院,安徽 合肥 230000First Affiliated Hospital, Anhui University of Chinese Medicine, Heifei 230000, China
| | - 东 王
- 安徽中医药大学 第一附属医院,安徽 合肥 230000First Affiliated Hospital, Anhui University of Chinese Medicine, Heifei 230000, China
| | - 芮 张
- 安徽中医药大学 研究生院,安徽 合肥 230000Graduate School, Anhui University of Chinese Medicine, Heifei 230000, China
| | - 媛茹 曹
- 安徽省中西医结合医院,安徽 合肥 230000Anhui Provincial Hospital of Integrated Traditional Chinese and Western Medicine Hospital, Hefei 230000, China
| | - 华 金
- 安徽中医药大学 第一附属医院,安徽 合肥 230000First Affiliated Hospital, Anhui University of Chinese Medicine, Heifei 230000, China
| | - 燕萍 茅
- 安徽中医药大学 第一附属医院,安徽 合肥 230000First Affiliated Hospital, Anhui University of Chinese Medicine, Heifei 230000, China
| | - 玲 魏
- 安徽中医药大学 第一附属医院,安徽 合肥 230000First Affiliated Hospital, Anhui University of Chinese Medicine, Heifei 230000, China
| | - 克军 任
- 安徽中医药大学 第一附属医院,安徽 合肥 230000First Affiliated Hospital, Anhui University of Chinese Medicine, Heifei 230000, China
| | - 雪莲 章
- 安徽中医药大学 第一附属医院,安徽 合肥 230000First Affiliated Hospital, Anhui University of Chinese Medicine, Heifei 230000, China
| | - 亿平 王
- 安徽中医药大学 第一附属医院,安徽 合肥 230000First Affiliated Hospital, Anhui University of Chinese Medicine, Heifei 230000, China
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de Albuquerque Suassuna PG, Sanders-Pinheiro H, de Paula RB. Uremic Cardiomyopathy: A New Piece in the Chronic Kidney Disease-Mineral and Bone Disorder Puzzle. Front Med (Lausanne) 2018; 5:206. [PMID: 30087898 PMCID: PMC6066558 DOI: 10.3389/fmed.2018.00206] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/02/2018] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular diseases are the main cause of death in chronic kidney disease (CKD) patients. In dialysis patients, sudden cardiac death accounts for 40% of all deaths. In these patients, sudden cardiac death is usually secondary to an underlying cardiomyopathy, which is clinically identified by the high prevalence of left ventricular hypertrophy and the resultant mechanical and electrical dysfunction. CKD-related cardiomyopathy has a multifactorial pathophysiology. Recent evidence has highlighted the central pathophysiological role of chronic kidney disease-mineral and bone disorder (CKD-MBD) with hyperphosphatemia and high fibroblast growth factor 23 (FGF23) levels in these patients. Further, since CKD is known to be an αKlotho deficiency state, experimental studies have demonstrated that the deleterious effects of FGF23 can be minimized by reestablishing adequate soluble Klotho levels. Herein, we present a review that addresses not only the development of the understanding of CKD-related cardiomyopathy pathophysiology, but also explores the recent data that identify the triad of hyperphosphatemia, high FGF23 levels and αKlotho deficiency as playing a central role on it. Taken together, the data suggest that the uremic cardiomyopathy can be considered a new piece in the CKD-DMO puzzle.
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Affiliation(s)
- Paulo G de Albuquerque Suassuna
- Laboratory of Experimental Nephrology and Interdisciplinary Nucleus of Laboratory Animal Studies, Federal University of Juiz de Fora, Juiz de Fora, Brazil.,Interdisciplinary Center for Studies, Research and Treatment in Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Helady Sanders-Pinheiro
- Laboratory of Experimental Nephrology and Interdisciplinary Nucleus of Laboratory Animal Studies, Federal University of Juiz de Fora, Juiz de Fora, Brazil.,Interdisciplinary Center for Studies, Research and Treatment in Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Rogério B de Paula
- Laboratory of Experimental Nephrology and Interdisciplinary Nucleus of Laboratory Animal Studies, Federal University of Juiz de Fora, Juiz de Fora, Brazil.,Interdisciplinary Center for Studies, Research and Treatment in Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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Ma L, Gao M, Wu L, Zhao X, Mao H, Xing C. The suppressive effect of soluble Klotho on fibroblastic growth factor 23 synthesis in UMR-106 osteoblast-like cells. Cell Biol Int 2018; 42:1270-1274. [PMID: 29851201 DOI: 10.1002/cbin.10997] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 05/27/2018] [Indexed: 01/03/2023]
Abstract
Fibroblastic growth factor 23 (FGF23) is a hormone secreted primarily by bone. FGF23 is elevated in the serum of chronic kidney disease (CKD) patients, but the exact mechanism is not well known. Klotho is identified as an aging suppressor, which is mainly expressed in the kidney, and the level of soluble Klotho is negatively associated with FGF23 in CKD. The aim of this study was to investigate the effect and possible mechanism of Klotho on FGF23 synthesis in osteoblast-like UMR-106 cells. UMR-106 cells were divided into five groups: (i) control group; (ii) β-glycerophosphate (β-GP) group; (iii) β-GP + Klotho group; (iv) β-GP+ lithium chloride (LiCl, a Wnt/β-catenin pathway agonist) group; and (v) β-GP + Klotho + LiCl group. Subsequently, UMR-106 cells were cultured for 72 h, and the expression of FGF23, P-glycogen synthase kinase-3β (P-GSK-3β), and glycogen synthase kinase-3β(GSK-3β) were measured with Western blot analysis. The mRNA levels of FGF23 and the Wnt/β-catenin pathway target gene c-myc were determined with RT-qPCR. The results showed that β-GP induced increased expression of FGF23 mRNA and protein. Compared with the β-GP group, expression of FGF23 mRNA and protein expression were downregulated in the β-GP + Klotho group. In addition, β-GP induced increased expression of P-GSK-3β/GSK-3β and c-myc, which were all downregulated in the β-GP + Klotho group. Moreover, the expression of FGF23, P-GSK-3β/GSK-3β, and c-myc mRNA were upregulated when treated with LiCl. These results demonstrate that soluble Klotho suppresses FGF23 synthesis in osteoblast-like UMR-106 cells. The mechanism of this suppression may be partially through the inhibition of the Wnt/β-catenin pathway.
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Affiliation(s)
- Lulu Ma
- Department of Nephrology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Min Gao
- Department of Nephrology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Lin Wu
- Department of Nephrology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiufen Zhao
- Department of Nephrology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Huijuan Mao
- Department of Nephrology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Changying Xing
- Department of Nephrology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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van Londen M, Aarts BM, Deetman PE, van der Weijden J, Eisenga MF, Navis G, Bakker SJL, de Borst MH. Post-Transplant Hypophosphatemia and the Risk of Death-Censored Graft Failure and Mortality after Kidney Transplantation. Clin J Am Soc Nephrol 2017; 12:1301-1310. [PMID: 28546442 PMCID: PMC5544514 DOI: 10.2215/cjn.10270916] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 04/25/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Hypophosphatemia is common in the first year after kidney transplantation, but its clinical implications are unclear. We investigated the relationship between the severity of post-transplant hypophosphatemia and mortality or death-censored graft failure in a large cohort of renal transplant recipients with long-term follow-up. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a longitudinal cohort study in 957 renal transplant recipients who were transplanted between 1993 and 2008 at a single center. We used a large real-life dataset containing 28,178 phosphate measurements (median of 27; first to third quartiles, 23-34) serial measurements per patient) and selected the lowest intraindividual phosphate level during the first year after transplantation. The primary outcomes were all-cause mortality, cardiovascular mortality, and death-censored graft failure. RESULTS The median (interquartile range) intraindividual lowest phosphate level was 1.58 (1.30-1.95) mg/dl, and it was reached at 33 (21-51) days post-transplant. eGFR was the main correlate of the lowest serum phosphate level (model R2 =0.32). During 9 (5-12) years of follow-up, 181 (19%) patients developed graft failure, and 295 (35%) patients died, of which 94 (32%) deaths were due to cardiovascular disease. In multivariable Cox regression analysis, more severe hypophosphatemia was associated with a lower risk of death-censored graft failure (fully adjusted hazard ratio, 0.61; 95% confidence interval, 0.43 to 0.88 per 1 mg/dl lower serum phosphate) and cardiovascular mortality (fully adjusted hazard ratio, 0.37; 95% confidence interval, 0.22 to 0.62) but not noncardiovascular mortality (fully adjusted hazard ratio, 1.33; 95% confidence interval, 0.9 to 1.96) or all-cause mortality (fully adjusted hazard ratio, 1.15; 95% confidence interval, 0.81 to 1.61). CONCLUSIONS Post-transplant hypophosphatemia develops early after transplantation. These data connect post-transplant hypophosphatemia with favorable long-term graft and patient outcomes.
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Affiliation(s)
- Marco van Londen
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
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Chao CT, Liu YP, Su SF, Yeh HY, Chen HY, Lee PJ, Chen WJ, Lee YM, Huang JW, Chiang CK, Hung KY, Chen HW. Circulating MicroRNA-125b Predicts the Presence and Progression of Uremic Vascular Calcification. Arterioscler Thromb Vasc Biol 2017; 37:1402-1414. [PMID: 28522697 DOI: 10.1161/atvbaha.117.309566] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 05/02/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Vascular calcification (VC) is a major cause of mortality in patients with end-stage renal diseases. Biomarkers to predict the progression of VC early are in urgent demand. APPROACH AND RESULTS We identified circulating, cell-free microRNAs as potential biomarkers using in vitro VC models in which both rat and human aortic vascular smooth muscle cells were treated with high levels of phosphate to mimic uremic hyperphosphatemia. Using an Affymetrix microRNA array, we found that miR-125b and miR-382 expression levels declined significantly as biomineralization progressed, but this decline was only observed for miR-125b in the culture medium. A time-dependent decrease in aortic tissue and serum miR-125b levels was also found in both ex vivo and in vivo renal failure models. We examined the levels of circulating, cell-free miR-125b in sera from patients with end-stage renal diseases (n=88) and found an inverse association between the severity of VC and the circulating miR-125b level, irrespective of age or mineral-related hormones (odds ratio, 0.71; P=0.03). Furthermore, serum miR-125b levels on enrollment can predict VC progression years later (for high versus low, odds ratio, 0.14; P<0.01; for the highest versus lowest tertile and middle versus lowest tertile, odds ratio, 0.55 and 0.13; P=0.3 and <0.01, respectively). The uremic VC prediction efficacy using circulating miR-125b levels was also observed in an independent cohort (n=135). CONCLUSIONS The results suggest that serum miR-125b levels are associated with VC severity and serve as a novel predictive marker for the risk of uremia-associated calcification progression.
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Affiliation(s)
- Chia-Ter Chao
- From the Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City (C.-T.C.); Graduate Institute of Toxicology (C.-T.C., Y.-P.L., P.-J.L., W.-J.C., Y.-M.L., C.-K.C., H.-W.C.), and Graduate Institute of Oncology (P.-J.L., W.-J.C.), College of Medicine, National Taiwan University, Taipei; Institute of Statistical Science, Academia Sinica, Taipei, Taiwan (Y.-P.L., S.-F.S., H.-Y.C., P.-J.L., W.-J.C.); School of Big Data Management, Soochow University, Taipei, Taiwan (H.-Y.Y.); Nephrology Division, Department of Internal Medicine (C.-T.C., J.-W.H., K.-Y.H.) and Department of Integrative Diagnostics and Therapeutics (C.-K.C.), National Taiwan University Hospital, Taipei; and Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu branch, Hsin-Chu County (K.-Y.H.)
| | - You-Pi Liu
- From the Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City (C.-T.C.); Graduate Institute of Toxicology (C.-T.C., Y.-P.L., P.-J.L., W.-J.C., Y.-M.L., C.-K.C., H.-W.C.), and Graduate Institute of Oncology (P.-J.L., W.-J.C.), College of Medicine, National Taiwan University, Taipei; Institute of Statistical Science, Academia Sinica, Taipei, Taiwan (Y.-P.L., S.-F.S., H.-Y.C., P.-J.L., W.-J.C.); School of Big Data Management, Soochow University, Taipei, Taiwan (H.-Y.Y.); Nephrology Division, Department of Internal Medicine (C.-T.C., J.-W.H., K.-Y.H.) and Department of Integrative Diagnostics and Therapeutics (C.-K.C.), National Taiwan University Hospital, Taipei; and Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu branch, Hsin-Chu County (K.-Y.H.)
| | - Sheng-Fang Su
- From the Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City (C.-T.C.); Graduate Institute of Toxicology (C.-T.C., Y.-P.L., P.-J.L., W.-J.C., Y.-M.L., C.-K.C., H.-W.C.), and Graduate Institute of Oncology (P.-J.L., W.-J.C.), College of Medicine, National Taiwan University, Taipei; Institute of Statistical Science, Academia Sinica, Taipei, Taiwan (Y.-P.L., S.-F.S., H.-Y.C., P.-J.L., W.-J.C.); School of Big Data Management, Soochow University, Taipei, Taiwan (H.-Y.Y.); Nephrology Division, Department of Internal Medicine (C.-T.C., J.-W.H., K.-Y.H.) and Department of Integrative Diagnostics and Therapeutics (C.-K.C.), National Taiwan University Hospital, Taipei; and Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu branch, Hsin-Chu County (K.-Y.H.)
| | - Hsiang-Yuan Yeh
- From the Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City (C.-T.C.); Graduate Institute of Toxicology (C.-T.C., Y.-P.L., P.-J.L., W.-J.C., Y.-M.L., C.-K.C., H.-W.C.), and Graduate Institute of Oncology (P.-J.L., W.-J.C.), College of Medicine, National Taiwan University, Taipei; Institute of Statistical Science, Academia Sinica, Taipei, Taiwan (Y.-P.L., S.-F.S., H.-Y.C., P.-J.L., W.-J.C.); School of Big Data Management, Soochow University, Taipei, Taiwan (H.-Y.Y.); Nephrology Division, Department of Internal Medicine (C.-T.C., J.-W.H., K.-Y.H.) and Department of Integrative Diagnostics and Therapeutics (C.-K.C.), National Taiwan University Hospital, Taipei; and Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu branch, Hsin-Chu County (K.-Y.H.)
| | - Hsuan-Yu Chen
- From the Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City (C.-T.C.); Graduate Institute of Toxicology (C.-T.C., Y.-P.L., P.-J.L., W.-J.C., Y.-M.L., C.-K.C., H.-W.C.), and Graduate Institute of Oncology (P.-J.L., W.-J.C.), College of Medicine, National Taiwan University, Taipei; Institute of Statistical Science, Academia Sinica, Taipei, Taiwan (Y.-P.L., S.-F.S., H.-Y.C., P.-J.L., W.-J.C.); School of Big Data Management, Soochow University, Taipei, Taiwan (H.-Y.Y.); Nephrology Division, Department of Internal Medicine (C.-T.C., J.-W.H., K.-Y.H.) and Department of Integrative Diagnostics and Therapeutics (C.-K.C.), National Taiwan University Hospital, Taipei; and Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu branch, Hsin-Chu County (K.-Y.H.)
| | - Pei-Jung Lee
- From the Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City (C.-T.C.); Graduate Institute of Toxicology (C.-T.C., Y.-P.L., P.-J.L., W.-J.C., Y.-M.L., C.-K.C., H.-W.C.), and Graduate Institute of Oncology (P.-J.L., W.-J.C.), College of Medicine, National Taiwan University, Taipei; Institute of Statistical Science, Academia Sinica, Taipei, Taiwan (Y.-P.L., S.-F.S., H.-Y.C., P.-J.L., W.-J.C.); School of Big Data Management, Soochow University, Taipei, Taiwan (H.-Y.Y.); Nephrology Division, Department of Internal Medicine (C.-T.C., J.-W.H., K.-Y.H.) and Department of Integrative Diagnostics and Therapeutics (C.-K.C.), National Taiwan University Hospital, Taipei; and Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu branch, Hsin-Chu County (K.-Y.H.)
| | - Wan-Jiun Chen
- From the Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City (C.-T.C.); Graduate Institute of Toxicology (C.-T.C., Y.-P.L., P.-J.L., W.-J.C., Y.-M.L., C.-K.C., H.-W.C.), and Graduate Institute of Oncology (P.-J.L., W.-J.C.), College of Medicine, National Taiwan University, Taipei; Institute of Statistical Science, Academia Sinica, Taipei, Taiwan (Y.-P.L., S.-F.S., H.-Y.C., P.-J.L., W.-J.C.); School of Big Data Management, Soochow University, Taipei, Taiwan (H.-Y.Y.); Nephrology Division, Department of Internal Medicine (C.-T.C., J.-W.H., K.-Y.H.) and Department of Integrative Diagnostics and Therapeutics (C.-K.C.), National Taiwan University Hospital, Taipei; and Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu branch, Hsin-Chu County (K.-Y.H.)
| | - Yee-Ming Lee
- From the Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City (C.-T.C.); Graduate Institute of Toxicology (C.-T.C., Y.-P.L., P.-J.L., W.-J.C., Y.-M.L., C.-K.C., H.-W.C.), and Graduate Institute of Oncology (P.-J.L., W.-J.C.), College of Medicine, National Taiwan University, Taipei; Institute of Statistical Science, Academia Sinica, Taipei, Taiwan (Y.-P.L., S.-F.S., H.-Y.C., P.-J.L., W.-J.C.); School of Big Data Management, Soochow University, Taipei, Taiwan (H.-Y.Y.); Nephrology Division, Department of Internal Medicine (C.-T.C., J.-W.H., K.-Y.H.) and Department of Integrative Diagnostics and Therapeutics (C.-K.C.), National Taiwan University Hospital, Taipei; and Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu branch, Hsin-Chu County (K.-Y.H.)
| | - Jenq-Wen Huang
- From the Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City (C.-T.C.); Graduate Institute of Toxicology (C.-T.C., Y.-P.L., P.-J.L., W.-J.C., Y.-M.L., C.-K.C., H.-W.C.), and Graduate Institute of Oncology (P.-J.L., W.-J.C.), College of Medicine, National Taiwan University, Taipei; Institute of Statistical Science, Academia Sinica, Taipei, Taiwan (Y.-P.L., S.-F.S., H.-Y.C., P.-J.L., W.-J.C.); School of Big Data Management, Soochow University, Taipei, Taiwan (H.-Y.Y.); Nephrology Division, Department of Internal Medicine (C.-T.C., J.-W.H., K.-Y.H.) and Department of Integrative Diagnostics and Therapeutics (C.-K.C.), National Taiwan University Hospital, Taipei; and Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu branch, Hsin-Chu County (K.-Y.H.)
| | - Chih-Kang Chiang
- From the Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City (C.-T.C.); Graduate Institute of Toxicology (C.-T.C., Y.-P.L., P.-J.L., W.-J.C., Y.-M.L., C.-K.C., H.-W.C.), and Graduate Institute of Oncology (P.-J.L., W.-J.C.), College of Medicine, National Taiwan University, Taipei; Institute of Statistical Science, Academia Sinica, Taipei, Taiwan (Y.-P.L., S.-F.S., H.-Y.C., P.-J.L., W.-J.C.); School of Big Data Management, Soochow University, Taipei, Taiwan (H.-Y.Y.); Nephrology Division, Department of Internal Medicine (C.-T.C., J.-W.H., K.-Y.H.) and Department of Integrative Diagnostics and Therapeutics (C.-K.C.), National Taiwan University Hospital, Taipei; and Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu branch, Hsin-Chu County (K.-Y.H.)
| | - Kuan-Yu Hung
- From the Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City (C.-T.C.); Graduate Institute of Toxicology (C.-T.C., Y.-P.L., P.-J.L., W.-J.C., Y.-M.L., C.-K.C., H.-W.C.), and Graduate Institute of Oncology (P.-J.L., W.-J.C.), College of Medicine, National Taiwan University, Taipei; Institute of Statistical Science, Academia Sinica, Taipei, Taiwan (Y.-P.L., S.-F.S., H.-Y.C., P.-J.L., W.-J.C.); School of Big Data Management, Soochow University, Taipei, Taiwan (H.-Y.Y.); Nephrology Division, Department of Internal Medicine (C.-T.C., J.-W.H., K.-Y.H.) and Department of Integrative Diagnostics and Therapeutics (C.-K.C.), National Taiwan University Hospital, Taipei; and Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu branch, Hsin-Chu County (K.-Y.H.)
| | - Huei-Wen Chen
- From the Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City (C.-T.C.); Graduate Institute of Toxicology (C.-T.C., Y.-P.L., P.-J.L., W.-J.C., Y.-M.L., C.-K.C., H.-W.C.), and Graduate Institute of Oncology (P.-J.L., W.-J.C.), College of Medicine, National Taiwan University, Taipei; Institute of Statistical Science, Academia Sinica, Taipei, Taiwan (Y.-P.L., S.-F.S., H.-Y.C., P.-J.L., W.-J.C.); School of Big Data Management, Soochow University, Taipei, Taiwan (H.-Y.Y.); Nephrology Division, Department of Internal Medicine (C.-T.C., J.-W.H., K.-Y.H.) and Department of Integrative Diagnostics and Therapeutics (C.-K.C.), National Taiwan University Hospital, Taipei; and Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu branch, Hsin-Chu County (K.-Y.H.).
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Vikrant S, Parashar A. Prevalence and severity of disordered mineral metabolism in patients with chronic kidney disease: A study from a tertiary care hospital in India. Indian J Endocrinol Metab 2016; 20:460-467. [PMID: 27366711 PMCID: PMC4911834 DOI: 10.4103/2230-8210.183457] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Disordered mineral metabolism is common complications of chronic kidney disease (CKD). However, there are limited data on the pattern of these disturbances in Indian CKD population. MATERIALS AND METHODS This was a prospective observational study of CKD-mineral and bone disorder (CKD-MBD) over a period of 3 years. The biochemical markers of CKD-MBD, namely, calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone (iPTH), and 25-hydoxyvitamin Vitamin D3 (25OHD), were measured in newly diagnosed CKD Stage 3-5 and prevalent CKD Stage 5D adult patients. RESULTS A total of 462 patients of CKD Stage 3-5D were studied. The frequency of various biochemical abnormalities was hypocalcemia (23.8%), hypercalcemia (5.4%), hypophosphatemia (2.8%), hyperphosphatemia (55.4%), raised alkaline phosphatase (56.9%), secondary hyperparathyroidism (82.7%), and hypoparathyroidism (1.5%). 25OHD was done in 335 (72.5%) patients and 90.4% were found to have Vitamin D deficiency. About 70.6% of the patients had iPTH levels were above kidney disease outcomes quality initiative (KDOQI) target range. Nondiabetic CKD as compared to diabetic CKD had a higher alkaline phosphatase (P = 0.016), a higher iPTH (P = 0.001) a higher proportion of patients with iPTH above KDOQI target range (P = 0.09), and an elevated alkaline phosphatase (P = 0.004). The 25OHD levels were suggestive of severe Vitamin D deficiency in 33.7%, Vitamin D deficiency in 45.4%, and Vitamin D insufficiency in 11.3% patients. There was a significant positive correlation between iPTH with alkaline phosphatase (r = 0.572, P = 0.001), creatinine (r = 0.424, P = 0.001), and phosphorus (r = 0.241, P = 0.001) and a significant negative correlation with hemoglobin (r = -0.325, 0.001), age (r = -0.169, P = 0.002), and 25OHD (r = -0.126, P = 0.021). On multivariate logistic regression analysis, an elevated alkaline phosphatase was a significant predictor of hyperparathyroidism (odds ratio 9.7, 95% confidence interval 4.9-19.2, P = 0.001). CONCLUSIONS There was a high prevalence of CKD-MBD in Indian CKD patients. CKD-MBD is more common and more severe and has an early onset as compared to the western populations.
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Affiliation(s)
- Sanjay Vikrant
- Department of Nephrology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Anupam Parashar
- Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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Abstract
INTRODUCTION Secondary hyperparathyroidism (SHPT), a common, serious, and progressive complication of chronic kidney disease (CKD), is characterized by elevated serum parathyroid hormone (PTH), parathyroid gland hyperplasia, and mineral metabolism abnormalities. These disturbances may result in CKD-mineral and bone disorder (CKD-MBD), which is associated with poor quality of life and short life expectancy. AREAS COVERED The goal of SHPT treatment is to maintain PTH, calcium, and phosphorus within accepted targeted ranges. This review highlights the pathogenesis of SHPT and current SHPT therapeutic approaches, including the use of low-phosphate diets, phosphate binders, 1,25-dihydroxyvitamin D3 (calcitriol) and its analogs, calcimimetics, and parathyroidectomy in addition to discussing emerging drugs in development for SHPT. EXPERT OPINION Numerous studies indicate that mineral abnormalities occur early in the course of CKD, are prevalent by the time patients enter dialysis, and foreshadow a risk of cardiovascular and all-cause mortality. Several newly developed compounds may potentially overcome the limitations of current SHPT therapies. If emerging therapies can reduce PTH, normalize mineral metabolism, promote treatment adherence, and reduce the risk of side effects, they may provide the requisite features for improving long-term outcomes in patients with SHPT receiving dialysis and reduce the risks of CKD-MBD.
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Affiliation(s)
- Mario Cozzolino
- University of Milan, San Paolo Hospital, School of Medicine, Renal Division, Department of Health Sciences , Milan , Italy +39 02 81844381 ;
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