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Mineral bone disease of CKD

Geuza Dutra Dos Santos, Rosilene Motta Elias, Maria Aparecida Dalboni, Giovânio Vieira da Silva, Rosa Maria Affonso Moysés
INTRODUCTION: Mineral and bone metabolism disorders in chronic kidney disease (CKD-MBD) constitute a syndrome defined by changes in calcium, phosphorus (P), vitamin D and parathormone, fibroblast growth factor 23 (FGF-23) and its specific cofactor, Klotho. CKD-MBD, as well as smoking, are associated with an increased risk of cardiovascular disease. However, it is not known whether or not smoking impacts the cardiovascular risk in CKD- MBD. OBJECTIVE: To analyze the relationship between smoking and CKD-MBD markers...
December 10, 2018: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
Toshitsugu Sugimoto, Daisuke Inoue, Masayuki Maehara, Ichiro Oikawa, Takashi Shigematsu, Yoshiki Nishizawa
Limited data are available on the safety and efficacy of anti-resorptive agents, particularly once-monthly bisphosphonates, for use in osteoporotic patients with chronic kidney disease (CKD). We conducted a post hoc analysis of data from a 12-month, randomized, double-blind, phase III study to evaluate the safety and efficacy of once-monthly risedronate (RIS-OM) 75 mg tablets in Japanese osteoporosis patients with mild-to-moderate CKD. Patients who received RIS-OM 75 mg were stratified by baseline estimated glomerular filtration rate (eGFR; ≥ 90, ≥ 60 to < 90, or ≥ 30 to < 60 mL/min/1...
December 6, 2018: Journal of Bone and Mineral Metabolism
Mariano Rodriguez, Escolastico Aguilera-Tejero
The aim of this paper is to review current knowledge about the interactions of energy-dense diets and mineral metabolism in the context of chronic kidney disease⁻metabolic bone disease (CKD-MBD). Energy dense-diets promote obesity and type II diabetes, two well-known causes of CKD. Conversely, these diets may help to prevent weight loss, which is associated with increased mortality in advanced CKD patients. Recent evidence indicates that, in addition to its nephrotoxic potential, energy-dense food promotes changes in mineral metabolism that are clearly detrimental in the context of CKD-MBD, such as phosphorus (P) retention, increased concentrations of fibroblast growth factor 23, decreased levels of renal klotho, and reduction in circulating concentrations of calcitriol...
December 1, 2018: Nutrients
Keith C Norris, Opeyemi Olabisi, M Edwina Barnett, Yuan-Xiang Meng, David Martins, Chamberlain Obialo, Jae Eun Lee, Susanne B Nicholas
Chronic kidney disease (CKD) is a major non-communicable disease associated with high rates of premature morbidity and mortality. The prevalence of hypovitaminosis D (deficiency of 25(OH)D or 25D) is greater in racial/ethnic minorities and in patients with CKD than the general population. Low 25D is associated with bone and mineral disorders as well as immune, cardiometabolic and cardiovascular (CV) diseases. Thus, it has been suggested that low 25D contributes to the poor outcomes in patients with CKD. The prevalence of hypovitaminosis D rises progressively with advancing severity of kidney disease with over 30% of patients with CKD stage 3 and 70% patients with CKD stage 5 estimated to have low levels of 25D...
November 30, 2018: International Journal of Environmental Research and Public Health
Yosuke Nakagawa, Hirotaka Komaba
In patients with chronic kidney disease(CKD), mineral metabolism abnormalities such as hyperphosphatemia, decreased 1,25-dihydroxyvitamin D, and elevated parathyroid hormone develop as kidney function declines, which lead to vascular calcification and a variety of skeletal abnormalities, collectively termed renal osteodystrophy. Because CKD patients have increased risk of bone fractures, it is important to assess fracture risk by measuring bone mineral density and bone metabolism markers. In addition to management of secondary hyperparathyroidism, medications for osteoporosis could be a reasonable option for preventing fracture...
2018: Clinical Calcium
Matthew J Damasiewicz, Thomas L Nickolas
Renal osteodystrophy (ROD) is the bone component of chronic kidney disease mineral and bone disorder (CKD-MBD). ROD affects bone quality and strength through the numerous hormonal and metabolic disturbances that occur in patients with kidney disease. Collectively these disorders in bone quality increase fracture risk in CKD patients compared with the general population. Fractures are a serious complication of kidney disease and are associated with higher morbidity and mortality compared with the general population...
November 2018: JBMR plus
Shinya Nakatani, Keiko Yasukawa, Eiji Ishimura, Ayumi Nakatani, Norikazu Toi, Hideki Uedono, Akihiro Tsuda, Shinsuke Yamada, Hitoshi Ikeda, Katsuhito Mori, Masanori Emoto, Yutaka Yatomi, Masaaki Inaba
Oxidative stress plays a major role in development of cardiovascular disease in patients with chronic kidney disease (CKD). Human mercaptalbumin (HMA), a reduced form of serum albumin, and non-mercaptalbumin (HNA), an oxidized form of serum albumin, are known as indicators for evaluating oxidative stress in systemic circulation, including end-stage renal disease cases. We investigated factors associated with fraction of HNA [f(HNA)] in 112 pre-dialysis CKD patients (63.6 ± 14.0 years old; 59 males, 53 females) using a newly established anion-exchange column packed with hydrophilic polyvinyl alcohol gel as well as high performance liquid chromatography...
November 14, 2018: Scientific Reports
Emily S Andrews, Loni Perrenoud, Kristen L Nowak, Zhiying You, Andreas Pasch, Michel Chonchol, Jessica Kendrick, Diana Jalal
BACKGROUND: Chronic kidney disease (CKD)-mineral and bone disorder (MBD) is a systemic disorder that leads to vascular calcification and accelerated atherosclerosis. Uric acid has been shown to associate with vascular calcification and with carotid intima-media thickness (CIMT) and to suppress the 1 α-hydroxylase enzyme leading to lower 1,25-dihydroxyvitamin D (1,25(OH)2D) and higher intact parathyroid hormone (iPTH) levels. We hypothesized that lowering serum uric acid would reduce CIMT, calcification propensity, and circulating markers of CKD-MBD in CKD...
2018: PloS One
Mark R Hanudel, Marciana Laster, Isidro B Salusky
PURPOSE OF REVIEW: We will review non-renal-related mechanisms of fibroblast growth factor 23 (FGF23) pathophysiology. RECENT FINDINGS: FGF23 production and metabolism may be affected by many bone, mineral, and kidney factors. However, it has recently been demonstrated that other factors, such as iron status, erythropoietin, and inflammation, also affect FGF23 production and metabolism. As these non-mineral factors are especially relevant in the setting of chronic kidney disease (CKD), they may represent emerging determinants of CKD-associated elevated FGF23 levels...
December 2018: Current Osteoporosis Reports
Renata C Pereira, Isidro B Salusky, Paul Roschger, Klaus Klaushofer, Ora Yadin, Earl G Freymiller, Richard Bowen, Anne M Delany, Nadja Fratzl-Zelman, Katherine Wesseling-Perry
Pediatric renal osteodystrophy is characterized by skeletal mineralization defects, but the role of osteoblast and osteocyte maturation in the pathogenesis of these defects is unknown. We evaluated markers of osteocyte maturation and programmed cell death in iliac crest biopsy samples from pediatric dialysis patients and healthy controls. We evaluated the relationship between numbers of fibroblast growth factor 23 (FGF23)-expressing osteocytes and histomorphometric parameters of skeletal mineralization. We confirmed that chronic kidney disease (CKD) causes intrinsic changes in bone cell maturation using an in vitro model of primary osteoblasts from patients with CKD and healthy controls...
November 2018: Kidney International
Di Zou, Wen Wu, Yan He, Sichao Ma, Ji Gao
Chronic kidney disease (CKD) is an inherently systemic disease that refers to a long-term loss of kidney function. The progression of CKD has repercussions for other organs, leading to many kinds of extrarenal complications. Intensive studies are now being undertaken to reveal the risk factors and pathophysiological mechanism of this disease. During the past 20 years, increasing evidence from clinical and basic studies has indicated that klotho, which was initially known as an anti-aging gene and is mainly expressed in the kidney, is significantly correlated with the development and progression of CKD and its complications...
October 22, 2018: BMC Nephrology
Kunitoshi Iseki, Lisa L Henn, Takanobu Nomura, Eiichiro Kanda, Kazuhiko Tsuruya, Hideki Hirakata, Friedrich K Port, Ronald L Pisoni, Francesca Tentori, Bruce M Robinson
BACKGROUND: Abnormal chronic kidney disease-mineral and bone disorder (CKD-MBD) markers have been associated with adverse outcomes in hemodialysis (HD) patients. Dialysate calcium concentration (D-Ca) likely influences serum calcium and phosphorus levels. Optimal D-Ca level remains unclear. We hypothesized that higher D-Ca is associated with cardiovascular events and mortality among Japanese HD patients. METHODS: Enrollment data of chronic HD patients in the prospective observational study JDOPPS, phases 1-5 (1999-2015), provided exposures and covariates...
October 19, 2018: Nephron
Marina A Aleksinskaya, Matthieu Monge, Michiel Siebelt, Edith M Slot, Karin M Koekkoek, Ruben G de Bruin, Ziad A Massy, Harrie Weinans, Ton J Rabelink, Willem E Fibbe, Anton Jan van Zonneveld, Melissa van Pel
In chronic kidney disease (CKD), endothelial injury, is associated with disease progression and an increased risk for cardiovascular complications. Circulating cells with vascular reparative functions are hematopoietic and also reduced in CKD. To explore the mechanistic basis behind these observations, we have investigated hematopoietic stem cell (HSC) homeostasis in a mouse model for non-progressive CKD-mineral and bone disorder with experimentally induced chronic renal failure (CRF). In mice subjected to 12 weeks of CRF, bone marrow HSC frequencies were decreased and transplantation of bone marrow cells from CRF donors showed a decrease in long-term HSC repopulation compared to controls...
October 18, 2018: Scientific Reports
Jasna Aleksova, Alexander J Rodriguez, Robert McLachlan, Peter Kerr, Frances Milat, Peter R Ebeling
PURPOSE OF REVIEW: Patients with chronic kidney disease (CKD) have a greatly increased fracture risk compared with the general population. Gonadal hormones have an important influence on bone mineral density (BMD) and fracture risk, and hormone therapies can significantly improve these outcomes. Gonadal dysfunction is a frequent finding in patients with CKD; yet, little is known about the impact of gonadal hormones in the pathogenesis and treatment of bone health in patients with CKD...
December 2018: Current Osteoporosis Reports
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...
November 2018: Atherosclerosis
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