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Mineral bone disease of CKD

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...
August 8, 2018: Bone
Paulo G de Albuquerque Suassuna, Helady Sanders-Pinheiro, Rogério B de Paula
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...
2018: Frontiers in Medicine
Jamil Ibrahim, Azzour D Hazzan, Anna T Mathew, Vipul Sakhiya, Meng Zhang, Candice Halinski, Steven Fishbane
Background: Late-stage chronic kidney disease (LS-CKD) can be defined by glomerular filtration rate (GFR) 0-30 mL/min. It is a period of risk for medication discrepancies because of frequent hospitalizations, fragmented medical care, inadequate communication and polypharmacy. In this study, we sought to characterize medication discrepancies in LS-CKD. Methods: We analyzed all patients enrolled in Northwell Health's Healthy Transitions in LS-CKD program. All patients had estimated GFR 0-30 mL/min, not on dialysis...
August 2018: Clinical Kidney Journal
Anna Jovanovich, Jessica Kendrick
Chronic kidney disease mineral bone disorder (CKD-MBD) is common in end-stage renal disease and is associated with an increased risk of cardiovascular morbidity and mortality. Mainstays of treatment include decreasing serum phosphorus level toward the normal range with dietary interventions and phosphate binders and treating increased parathyroid hormone levels with activated vitamin D and/or calcimimetics. There is significant variation in serum levels of mineral metabolism markers, intestinal absorption of phosphorus, and therapeutic response among individual patients and subgroups of patients with end-stage renal disease...
July 2018: Seminars in Nephrology
Hyang Ki Min, Su Ah Sung, Yun Kyu Oh, Yeong Hoon Kim, Wookyung Chung, Sue K Park, Curie Ahn, Sung Woo Lee
Background: Few studies have examined the association between hepcidin, iron indices and bone mineral metabolism in non-dialysis chronic kidney disease (CKD) patients. Methods: We reviewed the data of 2238 patients from a large-scale multicenter prospective Korean study (2011-16) and excluded 214 patients with missing data on markers and related medications of iron and bone mineral metabolism, hemoglobin, blood pressure and causes of CKD. Multivariate linear regression analysis was used to identify the association between iron and bone mineral metabolism...
July 23, 2018: Nephrology, Dialysis, Transplantation
Eri Kobari, Junichiro James
In dialysis patiants, Chronic Kidney Disease-Mineral and Bone Disorder;CKD-MBD is the most important complication associated with vital prognosis. From the view of vital prognosis, the Medical Guidelines of CKD-MBD references the treatment and adjusting the medicine to keep the serum P, Ca, and PTH level. In the patients undergoing hemodialysis, composition of dialysate influences bone and Ca metabolism. Ca concentrations of dialysate is recommended 2.5-3.0 mEq/L in Japan, but it is important that we select the dialysate considering presence of complications and the meal and the medicines...
2018: Clinical Calcium
Suguru Yamamoto
Uremic toxins are increased with deterioration of kidney function and the levels are associated with progression of uremic syndrome. Uremic toxins are associated with various chronic kidney disease(CKD)-related systemic disease, and bone is one of major targets. Recent clinical and basic studies show that protein-bound uremic toxins, such as indoxyl sulfate(IS)and p-crecyl sulfate(PCS), parathyroid hormone, and renin-angiotensin-aldosterone system(RAAS)are associated with bone fragilities. IS and PCS induce skeletal resistance to PTH in osteoblasts and osteoclasts as well as impairment of bone quality...
2018: Clinical Calcium
Akiko Tajiri, Taketo Uchiyama, Ichiro Ohkido
The relationship between renal dysfunction and bone fragility is well known. Bone fragility, which is associated with an increased risk of bone fracture, affects quality of life and prognosis in patients with chronic kidney disease(CKD). The bone of patients with CKD is more fragile than the risk estimated by measurement of bone mineral density. Bone quality, which is defined by many factors including bone turnover, microarchitecture, collagen crosslinking, and matrix composition, is considered to be major cause of bone fragility of the patients with CKD...
2018: Clinical Calcium
Anna Walder, Martin Müller, Suzan Dahdal, Daniel Sidler, Vasilios Devetzis, Alexander B Leichtle, Martin G Fiedler, Albrecht W Popp, Kurt Lippuner, Bruno Vogt, Dominik Uehlinger, Uyen Huynh-Do, Spyridon Arampatzis
BACKGROUND: Accelerated bone loss occurs rapidly following renal transplantation due to intensive immunosuppression and persistent hyperparathyroidism. In renal transplant recipients (RTRs) due to the hyperparathyroidism the non-dominant forearm is often utilized as a peripheral measurement site for dual-energy x-ray absorptiometry (DXA) measurements. The forearm is also the site of previous created distal arteriovenous fistulas (AVF). Although AVF remain patent long after successful transplantation, there are no data available concerning their impact on radial bone DXA measurements...
2018: PloS One
Andreja Figurek, Goce Spasovski
PURPOSE: The complexity of chronic kidney disease-mineral and bone disorder (CKD-MBD) led to many preclinical and clinical trials. The role of sclerostin in renal pathophysiology remained unresolved, and question whether sclerostin is related to cardiovascular (CV) outcome in patients with CKD is still open. Our aim was to evaluate the possible association between serum sclerostin levels and carotid intima-media thickness (CIMT) in CV pathophysiology through various CKD stages. METHODS: Eighty-eight patients in various CKD stages were involved in this analysis...
July 20, 2018: International Urology and Nephrology
Akira Mima, Kosuke Tansho, Dai Nagahara, Kenji Watase
Objective Secondary hyperparathyroidism (SHPT) is a major complication in patients with chronic kidney disease (CKD). SHPT is related to chronic kidney disease-mineral bone disorder, leading to increased morbidity and mortality. Etelcalcetide is intravenously administered at the end of hemodialysis (HD). Etelcalcetide differs from the oral calcimimetic cinacalcet because it reduces gastrointestinal adverse events, thereby improving therapeutic effects. Etelcalcetide has only been approved by the U.S. Food and Drug Administration for several months...
January 1, 2018: Journal of International Medical Research
Mario Cozzolino, Piergiorgio Bolasco, Claudio Ronco, Giuseppe Conte, Paolo Menè, Maria Cristina Mereu, Marina Di Luca, Dario Roccatello, Alberto Rosati, Claudio Jommi, Anna Maria Costanzo, Giuliana Gualberti, Umberto di Luzio Paparatti, Giuseppe Remuzzi
BACKGROUND: Lack of adequate management of chronic kidney disease (CKD) often results in delayed diagnosis and inadequate treatment. This study assessed the clinical management and outcome of stages 1-5 CKD patients. METHODS: Patients were prospectively followed for 3 years in 25 nephrology centers across Italy. Clinical characteristics were measured at baseline and every 6 months. Outcome measures included CKD staging, presence of comorbidities, treatment, mineral bone disorder (MBD) parameters, and patient outcomes...
July 17, 2018: Nephron
Robert Stöhr, Alexander Schuh, Gunnar H Heine, Vincent Brandenburg
Fibroblast growth factor-23 (FGF23) is a mainly osteocytic hormone which increases renal phosphate excretion and reduces calcitriol synthesis. These renal actions are mediated via alpha-klotho as the obligate co-receptor. Beyond these canonical "mineral metabolism" actions, FGF23 has been identified as an independent marker for cardiovascular risk in various patient populations. Previous research has linked elevated FGF23 predominantly to left-ventricular dysfunction and consecutive morbidity and mortality...
2018: Frontiers in Endocrinology
Michelle C Lamarche, Wilma M Hopman, Jocelyn S Garland, Christine A White, Rachel M Holden
Background: Patients with chronic kidney disease (CKD) have higher levels of coronary artery calcification (CAC) compared with the general population. The role of CAC in renal function decline is not well understood. Methods: In this prospective cohort study of Stages 3-5 CKD patients with CAC scores kidney function decline, development of end-stage kidney disease (ESKD) and all-cause mortality were determined at 5 and 10 years. Baseline variables included markers of CKD and chronic kidney disease mineral and bone disorder (CKD-MBD), demographics and comorbidities...
July 16, 2018: Nephrology, Dialysis, Transplantation
Kyubok Jin, Tae Hyun Ban, Ji Yong Jung, Ae Jin Kim, Yaerim Kim, So-Young Lee, Dong Ho Yang, Bum Soon Choi, Kook-Hwan Oh, Jieun Kim, Young Joo Kwon, Jong Wook Choi, Gheun-Ho Kim
Background: The aim of this study is to narrow the gap between global guidelines and local practices, we recently established domestic recommendations by adapting the international guidelines for management of chronic kidney disease-mineral bone disorder (CKD-MBD) in patients on maintenance hemodialysis (MHD). This study was undertaken to determine whether application of this guideline adaptation was associated with improved serum mineral profiles in patients with CKD-MBD. Methods: A total of 355 patients on MHD were enrolled from seven dialysis units...
June 2018: Kidney Research and Clinical Practice
Xiaohong Ma, Liqun He
Chronic kidney disease-mineral and bone disorder (CKD-MBD) play a critical role in the pathogenesis of cardiovascular complications in patients with chronic kidney disease (CKD). Zuogui pill as a traditional Chinese herbal drug has been used for nourish kidney essence improve bone malnutrition of renal bone disease by regulating the metabolism of calcium and phosphorus and participating in osteoblast metabolism. In the present study, 5/6 nephrectomy rat model was used to reveal the mechanism of zuogui pill in treatment of CKD-MBD...
June 24, 2018: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
H Chen, P Lips, M G Vervloet, N M van Schoor, R T de Jongh
Early renal dysfunction is associated with a 38% increased fracture risk in individuals aged 65 years and older. In men but not women, early renal dysfunction is associated with decreased femoral neck bone mineral density (BMD) which can be partially explained by increased parathyroid hormone (PTH) concentrations. INTRODUCTION: It is uncertain whether early renal dysfunction is associated with osteoporosis and increased fracture risk. The aim of this study was to determine the relationship of decreased renal function with BMD and fracture risk and the role of PTH therein...
June 15, 2018: Osteoporosis International
Olena Andrukhova, Christiane Schüler, Claudia Bergow, Alexandra Petric, Reinhold G Erben
Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a systemic disorder of mineral and bone metabolism caused by CKD. Impaired bone mineralization together with increased bony secretion of fibroblast growth factor-23 (FGF23) are hallmarks of CKD-MBD. We recently showed that FGF23 suppresses the expression of tissue nonspecific alkaline phosphatase (TNAP) in bone cells by a Klotho-independent, FGF receptor-3-mediated signaling axis, leading to the accumulation of the mineralization inhibitor pyrophosphate...
2018: Frontiers in Endocrinology
Yvette Sophie van den Berkhof, Christina Maria Gant, Ronald Maatman, Albert De Graaf, Gerjan J Navis, Stephan J L Bakker, Gozewijn Dirk Laverman
BACKGROUND: Renal function decline in diabetic kidney disease is accompanied by calcium and phosphate metabolism alterations. Whereas strontium (Sr2+ ) has many similarities with calcium, little is known about Sr2+ in this respect. We studied the association of plasma Sr2+ concentration and parameters associated with an altered calcium and phosphate metabolism in diabetic kidney disease. MATERIALS AND METHODS: Plasma Sr2+ concentration was measured in 450 patients included in the DIAbetes and LifEstyle Cohort Twente-1...
June 21, 2018: European Journal of Clinical Investigation
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