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Mineral bone disease of CKD

J Aleksova, K W Ng, C Jung, H Zeimer, K M Dwyer, F Milat, R J MacIsaac
The metabolic abnormalities affecting bone in the setting of chronic kidney disease (CKD) are complex with over-lapping and inter-acting aetiologies and have challenging diagnostic and management strategies. Disturbances in calcium, phosphate, fibroblast growth factor 23, parathyroid hormone (PTH) concentrations and vitamin D deficiency are commonly encountered and contribute to the clinical syndromes of bone disorders in CKD including hyperparathyroidism, osteomalacia, osteoporosis and adynamic bone disease...
October 9, 2018: Internal Medicine Journal
Yi-Chou Hou, Chien-Lin Lu, Kuo-Cheng Lu
As the GFR loss aggravates, the disturbed mineral metabolism worsens the bone microstructure and remodelling - scenario, which is known as CKD-mineral bone disease (MBD). CKD-MBD is characterized by : (i) abnormal metabolism of calcium, phosphorus, parathyroid hormone (PTH), or vitamin D; (ii) abnormalities in bone turnover, mineralization, volume linear growth or strength; (iii) soft-tissue calcifications, either vascular or extra-osseous. Uremic vascular calcification and osteoporosis are the most common complications related to CKD-MBD...
October 2018: Nephrology
Denis Fouque, Hubert Roth, Bernadette Darné, Jean-Louis Bouchet, Eric Daugas, Tilman B Drüeke, Thierry Hannedouche, Guillaume Jean, Gérard M London
Background: The aim of the third French Phosphorus and Calcium Observatory (Photo-Graphe® 3) was to assess the achievement of international Kidney Disease: Improving Global Outcomes (KDIGO) recommendations on optimal serum phosphate, calcium and parathyroid hormone (PTH) levels and possible associations with mortality in patients with chronic kidney disease (CKD). Methods: This was a prospective, observational study conducted with nephrologists in France who were selected using a clustering approach...
October 2018: Clinical Kidney Journal
Yogendranath Purrunsing, Jingjing Zhang, Ying Cui, Wei Liu, Yi Xu, Xunning Hong, Changying Xing, Xiaoming Zha, Ningning Wang
Secondary hyperparathyroidism (SHPT) is a long-term complication of chronic kidney disease-mineral and bone disorder (CKD-MBD). SHPT is characterized by hyperplasia of the parathyroid glands and abnormal secretion of parathyroid hormones (PTH), calcium and phosphorous metabolic disorders, renal osteodystrophy, vascular and soft tissue calcification, malnutrition, and other multiple system complications, which can seriously affect the quality of life of the patient and increase the risk of cardiovascular disease and mortality rate...
July 2018: JBMR Plus
Mariana P Cardoso, Luciano A L Pereira
Chronic kidney disease patients have a high prevalence of vitamin D insufficiency/deficiency. Vitamin D deficiency has been associated with a variety of bone, metabolic and cardiovascular disorders. However, the role of native vitamin D supplementation (ergocalciferol, cholecalciferol or calcifediol) remains unclear in chronic kidney disease (CKD), particularly in the pre-dialytic phase. Several international guidelines have been developed on CKD-Mineral and Bone Disorder, but the optimal strategy for native vitamin D supplementation and its clinical benefit remains a subject of debate in the scientific community...
September 28, 2018: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Allison B Reiss, Nobuyuki Miyawaki, Jane Moon, Lora J Kasselman, Iryna Voloshyna, Robert D'Avino, Joshua De Leon
Mineral bone disease (MBD) is a common complication of chronic kidney disease (CKD) characterized by disruption of normal mineral homeostasis within the body. One or more of the following may occur: hypocalcemia, hyperphosphatemia, secondary hyperparathyroidism (SHPT), decreased vitamin D and vascular calcification (VC). The greater the decrease in renal function, the worse the progression of CKD-MBD. These abnormalities may lead to bone loss, osteoporosis and fractures. CKD-MBD is a major contributor to the high morbidity and mortality among patients with CKD...
August 30, 2018: Atherosclerosis
Elizabeth R Stremke, Kathleen M Hill Gallant
Chronic kidney disease (CKD) affects approximately 10% of adults worldwide. Dysregulation of phosphorus homeostasis which occurs in CKD leads to development of CKD-Mineral Bone Disorder (CKD-MBD) and contributes to increased morbidity and mortality in these patients. Phosphorus is regulated by multiple hormones (parathyroid hormone (PTH), 1,25-dihyxdroxyvitamin D (1,25D), and fibroblast growth factor 23 (FGF23)) and tissues (kidney, intestine, parathyroid glands, and bone) to maintain homeostasis. In health, the kidneys are the major site of regulation for phosphorus homeostasis...
September 23, 2018: Nutrients
Guibao Ke, Junlin Huang, Yue Zhu, Jia Yang, Yamei Zhang, Lvlin Chen, Juan Hu, Shaoqiang Tao, Yao Hu, Dehua Yang, Shuangxin Liu
BACKGROUND/AIMS: Hemodialysis (HD) patients often have inadequate nutrition, especially with respect to ascorbic acid (AA). It is reported that every HD session may cause a 50%- 75% decrease in plasma AA levels. Some studies have shown that supplementation of AA can change the outcome of chronic kidney disease-mineral bone disorders (CKD-MBD), but the effect of AA on HD patients with CKD-MBD remains controversial. Consequently, we decided to perform a meta-analysis to evaluate the efficacy of AA supplementation in CKD-MBD patients requiring dialysis...
September 24, 2018: Kidney & Blood Pressure Research
James O Burton, David J Goldsmith, Nicki Ruddock, Rukshana Shroff, Mandy Wan
This report comments on the relevance and utility of the recently published (2017) KDIGO Clinical Practice Guideline Update for the diagnosis, evaluation, prevention and treatment of mineral bone disease in patients with chronic kidney disease (CKD-MBD) with respect to UK clinical practice. This document replaces all previously published Renal Association guidelines on the topic.
September 20, 2018: BMC Nephrology
Jason Ge Zelt, Bruno A Svajger, Kieran Quinn, Mandy E Turner, Kimberly J Laverty, Bonnie Shum, Rachel M Holden, Michael A Adams
Pathogenic accumulation of calcium (Ca) and phosphate (PO4 ) in vasculature is a sentinel of advancing cardiovascular disease in chronic kidney disease (CKD). This study sought to characterize acute distribution patterns of radiolabeled 33 PO4 and 45 Ca in cardiovascular tissues of rats with CKD (0.25% dietary adenine). The disposition of 33 PO4 and 45 Ca was assessed in blood and 36 tissues after a 10-minute intravenous infusion of one of the following: (i) PO4  pulse + tracer 33 PO4 ; (ii) PO4  pulse + tracer 45 Ca; or (iii) saline + tracer 45 Ca in CKD and non-CKD animals...
September 14, 2018: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
Liwen Cui, Jinsheng Xu, Junxia Zhang, Muqing Zhang, Shenglei Zhang, Yaling Bai
Vascular calcification (VC) caused by chronic kidney disease (CKD)-mineral and bone disorder is a common complication of CKD. Recent studies have demonstrated that menaquinone-4 (MK-4) is negativly associated with VC in patients with CKD. Furthermore, we have previously shown that runt-related transcription factor 2 (Runx2) is important in the phenotypic transformation process of rat vascular smooth muscle cells (VSMCs), which is the key step for the development of VC. The present study investigated the influence of MK-4 on the phenotypic transformation process of rat VSMCs in order to illustrate its role in the process of VC...
October 2018: Experimental and Therapeutic Medicine
D Miyaoka, Y Imanishi, M Ohara, N Hayashi, Y Nagata, S Yamada, K Mori, M Emoto, M Inaba
Denosumab treatment of osteoporotic patients, except those with severe renal insufficiency, reduced cCa levels. Low baseline cCa, low estimated glomerular filtration rate, and high bone turnover increased the risk of lower cCa, while increasing bone mineral density. Pretreatment with antiresorptive agents was beneficial in reducing the risk of hypocalcemia. INTRODUCTION: Although denosumab-induced hypocalcemia has been frequently observed in patients with chronic kidney disease (CKD) stages 4-5D being treated with denosumab for osteoporosis, few studies have assessed the risk factors for serum-corrected calcium (cCa) reductions in patients with non-severe renal insufficiency...
September 5, 2018: Osteoporosis International
Junichi Ishigami, Kunihiro Matsushita
Infectious disease is recognized as an important complication among patients with end-stage renal disease, contributing to excess morbidity and health care costs. However, recent epidemiological studies have revealed that even mild to moderate stages of chronic kidney disease (CKD) substantially increase risk of infection. Regarding underlying mechanisms, evidence suggests various aspects of altered immune response in patients with CKD including impaired function of T cells, B cells and neutrophil. Multiple conditions surrounding CKD, such as older age, diabetes, and cardiovascular disease are important contributors in the increased susceptibility to infection in this population...
September 3, 2018: Clinical and Experimental Nephrology
Luca Neri, Ursula Kreuzberg, Francesco Bellocchio, Diego Brancaccio, Carlo Barbieri, Bernard Canaud, Stefano Stuard, Markus Ketteler
Background: The clinical management of chronic kidney disease-mineral bone disorder (CKD-MBD) remains extremely challenging, partially due to difficulties in defining high-risk phenotypes based on serum biomarkers. We evaluated the prevalence and outcomes of 27 mutually exclusive CKD-MBD phenotypes in a large, multi-national cohort of chronic dialysis patients over a 5-year follow-up study. Methods: In this historical cohort study, we enrolled all haemodialysis patients registered in EuCliD® on 1 July 2011 across 28 Europe, the Middle East and Africa (EMEA) and South American countries...
August 27, 2018: Nephrology, Dialysis, Transplantation
Judith Beto, Nisha Bhatt, Teresa Gerbeling, Chhaya Patel, Debra Drayer
Renal dietitians play a pivotal role in the ongoing management of chronic kidney disease in patients on hemodialysis. Awareness of changes to clinical practice guidelines that may impact laboratory parameters associated with chronic kidney disease-mineral and bone disorder is important for optimal patient care. In this article, the Kidney Disease: Improving Global Outcomes 2017 Clinical Practice Guideline Update recommendations related to the treatment of secondary hyperparathyroidism in adults on hemodialysis are reviewed and treatment implications for renal dietitians discussed...
August 24, 2018: Journal of Renal Nutrition
Toshifumi Sugatani
The high cardiovascular mortality associated with chronic kidney disease (CKD) is caused in part by the CKD-mineral bone disorder (CKD-MBD) syndrome. The CKD-MBD consists of skeletal, vascular and cardiac pathology caused by metabolic derangements produced by kidney disease. The prevalence of osteopenia/osteoporosis resulting from the skeletal component of the CKD-MBD, renal osteodystrophy (ROD), in patients with CKD exceeds that of the general population and is a major public health concern. That CKD is associated with compromised bone health is widely accepted, yet the mechanisms underlying impaired bone metabolism in CKD are not fully understood...
August 23, 2018: International Journal of Molecular Sciences
Silvio Borrelli, Paolo Chiodini, Luca De Nicola, Roberto Minutolo, Michele Provenzano, Carlo Garofalo, Giuseppe Remuzzi, Claudio Ronco, Mario Gennaro Cozzolino, Carlo Manno, Anna Maria Costanzo, Giuliana Gualberti, Giuseppe Conte
International Guidelines for mineral bone disorders recommend that in Non Dialytic-Chronic Kidney Disease (ND-CKD) clinical decisions should be based on the trend of serum PTH changes over time rather than on a single value. However, the prognostic impact of these changes in ND-CKD patients remains unknown. We performed a multicenter cohort study in ND-CKD patients (stage 1-5) followed for 36 months in 24 Italian Nephrology Units. PTH changes (ΔPTH) were defined as the absolute differences between all available PTH measurements following the first control and basal value...
2018: PloS One
Marinella Ruospo, Suetonia C Palmer, Patrizia Natale, Jonathan C Craig, Mariacristina Vecchio, Grahame J Elder, Giovanni Fm Strippoli
BACKGROUND: Phosphate binders are used to reduce positive phosphate balance and to lower serum phosphate levels for people with chronic kidney disease (CKD) with the aim to prevent progression of chronic kidney disease-mineral and bone disorder (CKD-MBD). This is an update of a review first published in 2011. OBJECTIVES: The aim of this review was to assess the benefits and harms of phosphate binders for people with CKD with particular reference to relevant biochemical end-points, musculoskeletal and cardiovascular morbidity, hospitalisation, and death...
August 22, 2018: Cochrane Database of Systematic Reviews
Yoshiko Iwasaki, Hideyuki Yamato, Masafumi Fukagawa
Transforming growth factor (TGF)-β signaling is not only important in skeletal development, but also essential in bone remodeling in adult bone. The bone remodeling process involves integrated cell activities induced by multiple stimuli to balance bone resorption and bone formation. TGF-β plays a role in bone remodeling by coordinating cell activities to maintain bone homeostasis. However, mineral metabolism disturbance in chronic kidney disease (CKD) results in abnormal bone remodeling, which leads to ectopic calcification in CKD...
August 10, 2018: International Journal of Molecular Sciences
J Ramalho, I D B Marques, Didier Hans, David Dempster, Hua Zhou, Parth Patel, R M R Pereira, V Jorgetti, R M A Moyses, Thomas L Nickolas
The trabecular bone score (TBS) is a novel tool using grayscale variograms of the lumbar spine bone mineral density (BMD) to assess trabecular bone microarchitecture. Studies in patients with chronic kidney disease (CKD) suggest it may be helpful in assessing fracture risk. However, TBS has not been validated as a measure of trabecular architecture against transiliac bone biopsy with histomorphometry in CKD patients. We hypothesized that TBS would reflect trabecular architecture at the iliac crest in CKD patients...
November 2018: Bone
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