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CKD-MBD

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https://www.readbyqxmd.com/read/27913900/bone-mineral-density-of-extremities-is-associated-with-coronary-calcification-and-biopsy-verified-vascular-calcification-in-living-donor-renal-transplant-recipients
#1
Zhimin Chen, Jia Sun, Mathias Haarhaus, Peter Barany, Lars Wennberg, Jonaz Ripsweden, Torkel B Brismar, Bengt Lindholm, Annika Wernerson, Magnus Söderberg, Peter Stenvinkel, Abdul Rashid Qureshi
Chronic kidney disease (CKD) mineral and bone disorders (CKD-MBD) may lead to low bone mineral density (BMD) and vascular calcification (VC), but links to the latter are unclear. Here we investigated associations between BMD, coronary artery calcium (CAC) scores, and histological signs of VC in end-stage renal disease (ESRD) patients undergoing living-donor kidney transplantation (LD-Rtx). In 66 ESRD patients (median age 45 years, 68% males), BMD (by dual-energy X-ray absorptiometry, DXA), CAC score (by computed tomography, CT; n = 54), and degree of VC score (graded by histological examination of epigastric artery specimens collected at LD-Rtx; n = 55) were assessed at the time of LD-Rtx...
December 2, 2016: Journal of Bone and Mineral Metabolism
https://www.readbyqxmd.com/read/27896453/management-of-phosphorus-load-in-ckd-patients
#2
REVIEW
Yutaka Taketani, Fumihiko Koiwa, Keitaro Yokoyama
Disturbances in mineral and bone metabolism play a critical role in the pathogenesis of cardiovascular complications in patients with chronic kidney disease (CKD). The term "renal osteodystrophy" has recently been replaced with "CKD-mineral and bone disorder (CKD-MBD)", which includes vascular calcification as well as bone abnormalities. In Japan, proportions of the aged and long-term dialysis patients are increasing which makes management of vascular calcification and parathyroid function increasingly more important...
November 28, 2016: Clinical and Experimental Nephrology
https://www.readbyqxmd.com/read/27890549/novel-functions-of-circulating-klotho
#3
REVIEW
Julia M Hum, Linda O'Bryan, Rosamund C Smith, Kenneth E White
A significant portion of the key biological functions of αKlotho (αKL) and its cognate ligand Fibroblast growth factor-23 (FGF23) have been revealed through the study of rare diseases of mineral metabolism. These findings have far reaching implications for common disorders such as chronic kidney disease-mineral bone disorder (CKD-MBD). αKL's predominant effect on mineral homeostasis is through its actions in the kidney as a co-receptor for FGF23, however emerging data has shed light on its capacity to act as a circulating factor through the cleavage of the transmembrane form of αKL ('mKL') to produce 'cleaved KL' or 'cKL'...
November 23, 2016: Bone
https://www.readbyqxmd.com/read/27847254/vascular-calcification-in-ckd-mbd-roles-for-phosphate-fgf23-and-klotho
#4
REVIEW
Shunsuke Yamada, Cecilia M Giachelli
Vascular calcification (VC) is highly prevalent in aging, diabetes mellitus, and chronic kidney disease (CKD). VC is a strong predictor of cardiovascular morbidity and mortality in the CKD population. Complex pathological mechanisms are involved in the development of VC, including osteochondrogenic differentiation and apoptosis of vascular smooth muscle cells, instability and release of extracellular vesicles loaded calcium and phosphate, and elastin degradation. Elevated serum phosphate is a late manifestation of CKD, and has been shown to accelerate mineral deposition in both the vessel wall and heart valves...
November 12, 2016: Bone
https://www.readbyqxmd.com/read/27818277/comparison-of-the-effects-of-novel-vitamin-d-receptor-analog-vs-105-and-paricalcitol-on-chronic-kidney-disease-mineral-bone-disorder-in-an-experimental-model-of-chronic-kidney-disease
#5
Hideki Fujii, Yuriko Yonekura, Kentaro Nakai, Keiji Kono, Shunsuke Goto, Shinichi Nishi
When using vitamin D, the most important clinical problems are hypercalcemia, hyperphosphatemia, and vascular calcification. VS-105 is a novel vitamin D receptor (VDR) analog. In the present study, we compared the effects of VS-105 and paricalcitol on chronic kidney disease-mineral bone disorder (CKD-MBD) in a CKD rat model. We used male Sprague-Dawley (SD) rats and performed 5/6 nephrectomy at 8-9 weeks. At 10 weeks, the rats were classified into five groups and administered vehicle, low-dose paricalcitol (LP, 0...
November 3, 2016: Journal of Steroid Biochemistry and Molecular Biology
https://www.readbyqxmd.com/read/27814753/facility-level-ckd-mbd-composite-score-and-risk-of-adverse-clinical-outcomes-among-patients-on-hemodialysis
#6
Geoffrey A Block, Akeem A Yusuf, Mark D Danese, Heidi S Wirtz, Yan Hu, Thy P Do, Kerry Cooper, David T Gilbertson, Brian D Bradbury, Allan J Collins
BACKGROUND: Patients receiving hemodialysis with values outside of target levels for parathyroid hormone (PTH: 150-600 pg/mL), calcium (Ca: 8.4-10.2 mg/dL), and phosphate (P: 3.5-5.5 mg/dL) are at elevated morbidity and mortality risk. We examined whether patients receiving care in dialysis facilities where greater proportions of patients have at least two values out of target have a higher risk of adverse clinical outcomes. METHODS: The study cohort consisted of 39,085 prevalent hemodialysis patients in 1298 DaVita dialysis facilities as of September 1, 2009, followed from January 1, 2010, until an outcome, a censoring event, or December 31, 2010...
November 4, 2016: BMC Nephrology
https://www.readbyqxmd.com/read/27806914/micrornas-in-the-pathophysiology-of-ckd-mbd-biomarkers-and-innovative-drugs
#7
REVIEW
Valérie Metzinger-Le Meuth, Stéphane Burtey, Pierre Maitrias, Ziad A Massy, Laurent Metzinger
microRNAs comprise a novel class of endogenous small non-coding RNAs that have been shown to be implicated in both vascular damage and bone pathophysiology. Chronic kidney disease-mineral bone disorder (CKD-MBD) is characterized by vessel and bone damage secondary to progressive loss of kidney function. In this review, we will describe how several microRNAs have been implicated, in recent years, in cellular and animal models of CKD-MBD, and have been very recently shown to be deregulated in patients with CKD...
October 30, 2016: Biochimica et Biophysica Acta
https://www.readbyqxmd.com/read/27804080/a-critical-appraisal-of-chronic-kidney-disease-mineral-and-bone-disorders-clinical-practice-guidelines-using-the-agree-ii-instrument
#8
REVIEW
Nigar Sekercioglu, Reem Al-Khalifah, Joycelyne Efua Ewusie, Rosilene M Elias, Lehana Thabane, Jason W Busse, Noori Akhtar-Danesh, Alfonso Iorio, Tetsuya Isayama, Juan Pablo Díaz Martínez, Ivan D Florez, Gordon H Guyatt
BACKGROUND: Patients with chronic kidney disease mineral and bone disorders (CKD-MBD) suffer high rates of morbidity and mortality, in particular related to bone and cardiovascular outcomes. The management of CKD-MBD remains challenging. The objective of this systematic survey is to critically appraise clinical practice guidelines (CPGs) addressing CKD-MBD. METHODS/DESIGN: Data sources included MEDLINE, EMBASE, the National Guideline Clearinghouse, Guideline International Network and Turning Research into Practice up to May 2016...
November 1, 2016: International Urology and Nephrology
https://www.readbyqxmd.com/read/27719736/regression-of-vascular-calcification-in-a-parathyroidectomized-patient-on-dialysis-with-untreated-hypocalcemia-over-12-year-follow-up%C3%A2
#9
Pablo Molina, José L Górriz, Sandra Beltrán, Belén Vizcaino, Luis M Pallardó
Although some experimental targets involved in calcium deposition are emerging, no intervention has been described to reliably reverse vascular calcification (VC). We report a case of severe VC regression in a parathyroidectomized patient on hemodialysis over 12-year follow-up, highlighting the use of calcium-free phosphate binders and a 2.5 mEq/L calcium dialysate for reducing calcium loading, despite persistent asymptomatic hypocalcemia occurrences. This case suggests that phosphate-binder choice and calcium dialysate concentration could be influenced by other components of CKD-MBD besides biochemical parameters, such as the presence of VC, so concluding that asymptomatic hypocalcemia may not be as harmful as once supposed, and conferring greater prognostic weight to the presence of VC than to calcium levels...
October 10, 2016: Clinical Nephrology
https://www.readbyqxmd.com/read/27679712/fgf23-in-kidney-transplant-the-strange-case-of-doctor-jekyll-and-mister-hyde
#10
Giuseppe Cianciolo, Mario Cozzolino
During the last decade, a new view into the molecular mechanisms of chronic kidney disease-mineral bone disorder (CKD-MBD) has been proposed, with fibroblast growth factor 23 (FGF23) as a novel player in the field. Enhanced serum FGF23 levels cause a reduction in serum phosphate, together with calcitriol suppression and consequent hyperparathyroidism (HPT). In contrast, reduced serum FGF23 levels are associated with hyperphosphatemia, higher calcitriol levels and parathyroid hormone (PTH) suppression. In addition, serum FGF23 levels are greatly increased and positively correlated with serum phosphate levels in CKD patients...
October 2016: Clinical Kidney Journal
https://www.readbyqxmd.com/read/27647184/mineral-and-bone-disorder-and-its-association-with-cardiovascular-parameters-in-chinese-patients-with-chronic-kidney-disease
#11
Chu Zhou, Fang Wang, Jin-Wei Wang, Lu-Xia Zhang, Ming-Hui Zhao
BACKGROUND: Mineral and bone disorder (MBD), especially hyperphosphatemia, is an independently risk factor for adverse prognosis in patients with chronic kidney disease (CKD). However, CKD-MBD among Chinese population was poorly studied. This study aimed to investigate the status of MBD and its association with cardiovascular parameters in Chinese patients with predialysis CKD. METHODS: Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE) is a prospective multicenter cohort study involving predialysis CKD patients in China...
2016: Chinese Medical Journal
https://www.readbyqxmd.com/read/27598394/parathyroidectomy-increases-heart-rate-variability-and-leptin-levels-in-patients-with-stage-5-chronic-kidney-disease
#12
Yao Jiang, Zhixiang Shen, Jingjing Zhang, Changying Xing, Xiaoming Zha, Chong Shen, Ming Zeng, Guang Yang, Huijuan Mao, Bo Zhang, Xiangbao Yu, Bin Sun, Chun Ouyang, Yifei Ge, Lina Zhang, Chen Cheng, Jing Zhang, Caixia Yin, Huimin Chen, Ningning Wang
BACKGROUND: In chronic kidney disease (CKD) patients, decreased heart rate variability (HRV) reflects impaired cardiac automatic nervous function and high risk of cardiovascular disease (CVD). Lower HRV in patients with severe secondary hyperparathyroidism (SHPT), a clinical manifestation of CKD-mineral and bone disorder (CKD-MBD), could be reversed by parathyroidectomy (PTX). It has been proved that leptin interacts with the autonomic nervous function. However, the associations between leptin and HRV in CKD patients and their longitudinal changes in SHPT patients after PTX are still unknown...
2016: American Journal of Nephrology
https://www.readbyqxmd.com/read/27595517/cardiovascular-calcifications-in-chronic-kidney-disease-potential-therapeutic-implications
#13
Jordi Bover, Pablo Ureña-Torres, José Luis Górriz, María Jesús Lloret, Iara da Silva, César Ruiz-García, Pamela Chang, Mariano Rodríguez, José Ballarín
Cardiovascular (CV) calcification is a highly prevalent condition at all stages of chronic kidney disease (CKD) and is directly associated with increased CV and global morbidity and mortality. In the first part of this review, we have shown that CV calcifications represent an important part of the CKD-MBD complex and are a superior predictor of clinical outcomes in our patients. However, it is also necessary to demonstrate that CV calcification is a modifiable risk factor including the possibility of decreasing (or at least not aggravating) its progression with iatrogenic manoeuvres...
November 2016: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
https://www.readbyqxmd.com/read/27576942/calcium-as-a-cardiovascular-toxin-in-ckd-mbd
#14
Sharon M Moe
Disordered calcium balance and homeostasis are common in patients with chronic kidney disease. Such alterations are commonly associated with abnormal bone remodeling, directly and indirectly. Similarly, positive calcium balance may also be a factor in the pathogenesis of extra skeletal soft tissue and arterial calcification. Calcium may directly affect cardiac structure and function through direct effects to alter cell signaling due to abnormal intracellular calcium homeostasis 2) extra-skeletal deposition of calcium and phosphate in the myocardium and small cardiac arterioles, 3) inducing cardiomyocyte hypertrophy through calcium and hormone activation of NFAT signaling mechanisms, and 4) increased aorta calcification resulting in chronic increased afterload leading to hypertrophy...
August 27, 2016: Bone
https://www.readbyqxmd.com/read/27561349/-the-efficacy-and-safety-of-activated-vitamin-d-for-ckd-mbd
#15
Nobuki Hayakawa, Atsushi Suzuki
Metabolic bone disorders that are represented by secondary hyperparathyroidism occur with the progression of chronic kidney disease(CKD). The administration of activated vitamin D is expected to improve high-turnover bone disorders and is widely used for the management of bone mineral diseases in patients with CKD and end-stage renal disease. CKD is an underlying disease of secondary osteoporosis and coexists with primary osteoporosis at a high rate. With regard to osteoporosis patients with renal insufficiency, the administration of activated vitamin D is also thought to reduce the fracture incidence by both increasing bone mass and reducing falls...
September 2016: Clinical Calcium
https://www.readbyqxmd.com/read/27561346/-is-denosmab-really-effective-and-safe-in-the-care-of-ckd-mbd
#16
Takayuki Hamano, Chikako Nakano
The authors of Freedom study enrolling primary osteoporosis patients argued that the anti-fracture effect of denosmab is not dependent on baseline estimated glomerular filtration rate(eGFR)by showing the non-significant interaction term between treatment and CKD stage. However, given disproportionate numbers of patients in each subgroup(4069, 2817, and only 73 patients, in CKD stage 2, 3, and, 4, respectively), this study seems to lack the statistical power to reach a definite conclusion on the effect modification by CKD stage...
September 2016: Clinical Calcium
https://www.readbyqxmd.com/read/27561345/-teriparatide-benefit-and-safety-for-bone-disease-in-ckd-patients-undergoing-hemodialysis
#17
Suguru Yamamoto, Isei Ei, Ichiei Narita
Teriparatide, 1-34 parathyroid hormone, is one of effective treatments for osteoporosis. Teriparatide shows an anabolic effect for bone formation, as a result, increases bone mineral density as well as prevention of fractures in the general population. On the other hand, there are a few report about the effect of teriparatide on increase of bone mineral density in maintenance hemodialysis patients. In addition to CKD-MBD, osteoporosis is also an important pathological change in ESRD patients, therefore its safety and efficacy should be discussed in more detail...
September 2016: Clinical Calcium
https://www.readbyqxmd.com/read/27561339/-the-expanding-concept-of-ckd-mbd
#18
Hirotaka Komaba
Almost seven years have passed since the publication of the KDIGO clinical practice guideline on chronic kidney disease-mineral and bone disorder(CKD-MBD). During this period, several new medications for osteoporosis that may be applicable to patients with CKD have become available. Clinical studies have also shown the utility of bone mineral density to assess fracture risk in CKD. These new data charges us with the task of reconciling the concept of renal osteodystrophy(ROD)and osteoporosis in CKD. This review summarize the recent advances in the management of bone disease in CKD and the key points raised during the discussion for the KDIGO guideline revision, and address the problems to be solved in future...
September 2016: Clinical Calcium
https://www.readbyqxmd.com/read/27547867/recent-changes-in-chronic-kidney-disease-mineral-and-bone-disorders-ckd-mbd-and-associated-fractures-after-kidney-transplantation
#19
Peggy Perrin, Clotilde Kiener, Rose-Marie Javier, Laura Braun, Noelle Cognard, Gabriela Gautier-Vargas, Francoise Heibel, Clotilde Muller, Jerome Olagne, Bruno Moulin, Sophie Caillard
BACKGROUND: The management of chronic kidney disease-mineral and bone disorders (CKD-MBD) has recently changed. We investigated the modifications of CKD-MBD with a special focus on the incidence of fractures in the first year after kidney transplantation (KT). METHODS: We retrospectively compared 2 groups of patients who consecutively underwent transplantation at our center 5 years from each other. Group 1 consisted of patients (n=152) transplanted between 2004 and 2006, whereas patients in group 2 (n=137) underwent KT between 2009 and 2011...
August 19, 2016: Transplantation
https://www.readbyqxmd.com/read/27545626/-phosphate-binders-in-renal-patients-a-point-estimate-from-rationale-through-evidences-to-the-real-world-setting
#20
Andrea Galassi, Maria Enrica Giovenzana, Eleonora Galbiati, Sara Auricchio, Sara Colzani, Renzo Scanziani
Phosphate binders represent a common intervention in renal patients affected by chronic kidney disease and mineral bone disorder (CKD-MBD). Although counteracting P overload through binders adoption is argued by a physiology-driven approach, the efficacy of this intervention on hard endpoints remains poorly evident. The inconsistencies between rationale and methodological weakness, concerning the clinical relevance of P binding in chronic kidney disease, will be herein discussed with special focus on the need of a multi-factorial treatment against CKD-MBD, which is currently more achievable due to the variety of P binders and the rapid evolution of nutritional therapy, dialysis techniques and nursing science...
July 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
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