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Hyperphosphatemia in CKD

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https://www.readbyqxmd.com/read/28064444/phosphate-binders-and-targets-over-decades-do-we-have-it-right-now
#1
Morgan Marcuccilli, Michel Chonchol, Anna Jovanovich
In advanced renal disease, the kidney is unable to maintain phosphate balance due to decreased urinary excretion as well as the imbalance of the bone metabolic axis. It is well established that hyperphosphatemia is associated with increased cardiovascular events and mortality in patients with chronic kidney disease (CKD). However, there are no randomized controlled trials that demonstrate a clear benefit on hard outcomes in lowering serum phosphate levels to recommended targets in the CKD or dialysis population...
January 8, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28045952/predictive-factors-of-one-year-mortality-in-a-cohort-of-patients-undergoing-urgent-start-hemodialysis
#2
Luciene P Magalhães, Luciene M Dos Reis, Fabiana G Graciolli, Benedito J Pereira, Rodrigo B de Oliveira, Altay A L de Souza, Rosa M Moyses, Rosilene M Elias, Vanda Jorgetti
BACKGROUND: Chronic kidney disease (CKD) affects 10-15% of adult population worldwide. Incident patients on hemodialysis, mainly those on urgent-start dialysis at the emergency room, have a high mortality risk, which may reflect the absence of nephrology care. A lack of data exists regarding the influence of baseline factors on the mortality of these patients. The aim of this study was to evaluate the clinical and laboratory characteristics of this population and identify risk factors that contribute to their mortality...
2017: PloS One
https://www.readbyqxmd.com/read/28009416/sleep-quality-and-risk-factors-of-atherosclerosis-in-predialysis-chronic-kidney-disease
#3
Ibrahim Guney, Yavuz Sultan Selim Akgul, Vedat Gencer, Harun Aydemir, Uysaler Aslan, Samil Ecirli
INTRODUCTION: Chronic kidney disease (CKD) patients have more frequent sleep disorders and cardiovascular disease than normals. Since arterial stiffness as a risk factor of atherosclerosis can be evaluated with pulse wave velocity (PWV), we aimed to investigate the prevalance of sleep quality (SQ) and the relationship between SQ and risk factors of atherosclerosis and whether there is a relationship between SQ and PWV (the indicator of arterial stiffness) in predialysis CKD patients. METHODS: This cross-sectional study was carried out in CKD patients followed at the Nephrology Department in Konya, Turkey, between November 2014 and March 2015...
December 19, 2016: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/27966564/habitual-dietary-phosphorus-intake-and-urinary-excretion-in-chronic-kidney-disease-patients-a-3-day-observational-study
#4
L Salomo, A-L Kamper, G M Poulsen, S K Poulsen, A Astrup, M Rix
Hyperphosphatemia in chronic kidney disease (CKD) is associated with vascular calcification, cardiovascular morbidity and mortality. The aim of this study was to estimate the daily dietary phosphorus intake compared with recommendations in CKD patients and to evaluate the reproducibility of the 24-h urinary phosphorus excretion. Twenty CKD patients stage 3-4 from the outpatient clinic, collected 24-h urine and kept dietary records for 3 consecutive days. The mean daily phosphorus intake was 1367±499, 1642±815 and 1426±706 mg/day, respectively (P=0...
December 14, 2016: European Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/27951564/preventive-strategies-for-vascular-calcification-in-patients-with-chronic-kidney-disease
#5
Takashi Shigematsu, Tomohiro Sonou, Masaki Ohya, Keitaro Yokoyama, Hiraku Yoshida, Takashi Yokoo, Kouji Okuda, Asuka R Masumoto, Yuko Iwashita, Keiko Iseki, Satoko Kunimoto, Yukiko Yamano
BACKGROUND: Vascular calcification is significant because of the close association between the degree of vascular calcification and cardiovascular mortality in chronic kidney disease (CKD) patients. SUMMARY: There are 2 types of vascular calcification in CKD patients. One is endothelial vascular calcification, a common type of vascular calcification. Another is medial vascular calcification, a specific type that is common in CKD patients. The former is mainly associated with atherosclerosis due to hyperlipidemia, especially hypercholesterolemia...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27933339/efficacy-and-safety-of-osteoporosis-medications-in-a-rat-model-of-late-stage-chronic-kidney-disease-accompanied-by-secondary-hyperparathyroidism-and-hyperphosphatemia
#6
M Ota, M Takahata, T Shimizu, Y Kanehira, H Kimura-Suda, Y Kameda, H Hamano, S Hiratsuka, D Sato, N Iwasaki
: This study showed that bisphosphonate was safe and effective for the treatment of bone disorders in stage 4 chronic kidney disease (CKD) rats. Intermittent teriparatide therapy showed an anabolic action on bone even under secondary hyperparathyroidism conditions without having an adverse effect on mineral metabolism in late-stage CKD. INTRODUCTION: Patients with late-stage CKD are at high risk for fragility fractures. However, there are no consensus on the efficacy and safety of osteoporosis medications for patients with late-stage CKD...
December 8, 2016: Osteoporosis International
https://www.readbyqxmd.com/read/27928449/severe-asymptomatic-coronary-obstruction-in-chronic-hemodialysed-patient-a-case-report
#7
Voiculeț C, Zara O, Văcăroiu I, Bogeanu C, Tiron T, Turcu F, Aron G, Ciocâlteu A
Introduction. Arterial stiffness and vascular calcifications are independent predictors of cardiovascular morbidity and mortality in the chronic kidney disease (CKD) stage 5D population. According to the guidelines, patients on renal replacement therapy represent a very high cardiovascular risk class. Case report. We report the case of a 67-year-old hypertensive male patient, known with CKD stage 5D on hemodialysis (three times per week), secondary bone mineral disease, admitted for progressive right leg pain...
October 2016: Journal of Medicine and Life
https://www.readbyqxmd.com/read/27900568/control-of-phosphate-balance-by-the-kidney-and-intestine
#8
REVIEW
Ichiro Kaneko, Sawako Tatsumi, Hiroko Segawa, Ken-Ichi Miyamoto
The prevention and correction of hyperphosphatemia are major goals of the treatment of chronic kidney disease (CKD)-bone mineral disorders, and thus, Pi balance requires special attention. Pi balance is maintained by intestinal absorption, renal excretion, and bone accretion. The kidney is mainly responsible for the plasma Pi concentration. In CKD, reduced glomerular filtration rate leads to various Pi metabolism abnormalities, and Pi absorption in the small intestine also has an important role in Pi metabolism...
November 30, 2016: Clinical and Experimental Nephrology
https://www.readbyqxmd.com/read/27837149/chronic-hyperphosphatemia-and-vascular-calcification-are-reduced-by-stable-delivery-of-soluble-klotho
#9
Julia M Hum, Linda M O'Bryan, Arun K Tatiparthi, Taryn A Cass, Erica L Clinkenbeard, Martin S Cramer, Manoj Bhaskaran, Robert L Johnson, Jonathan M Wilson, Rosamund C Smith, Kenneth E White
αKlotho (αKL) regulates mineral metabolism, and diseases associated with αKL deficiency are characterized by hyperphosphatemia and vascular calcification (VC). αKL is expressed as a membrane-bound protein (mKL) and recognized as the coreceptor for fibroblast growth factor-23 (FGF23) and a circulating soluble form (cKL) created by endoproteolytic cleavage of mKL. The functions of cKL with regard to phosphate metabolism are unclear. We tested the ability of cKL to regulate pathways and phenotypes associated with hyperphosphatemia in a mouse model of CKD-mineral bone disorder and αKL-null mice...
November 11, 2016: Journal of the American Society of Nephrology: JASN
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
#10
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/27803315/inhibition-of-gsk-3%C3%AE-increases-trabecular-bone-volume-but-not-cortical-bone-volume-in-adenine-induced-uremic-mice-with-severe-hyperparathyroidism
#11
Narihito Tatsumoto, Masaki Arioka, Shunsuke Yamada, Fumi Takahashi-Yanaga, Masanori Tokumoto, Kazuhiko Tsuruya, Takanari Kitazono, Toshiyuki Sasaguri
Patients with chronic kidney disease (CKD) are at increased risk for bone fractures compared with the general population. Repression of the Wnt/β-catenin signaling pathway is associated with bone abnormalities. Inhibition of glycogen synthase kinase (GSK)-3β, a critical component of the Wnt/β-catenin signaling pathway, increases bone volume through accumulation of β-catenin. It remains unknown whether inhibition of GSK-3β increases bone volume in CKD The present in vivo study examined the effects of GSK-3β inhibition on bone volume in CKD mice...
November 2016: Physiological Reports
https://www.readbyqxmd.com/read/27737388/effectiveness-and-safety-of-a-6-month-treatment-with-paricalcitol-in-patients-on-hemodialysis-with-secondary-hyperparathyroidism
#12
Inés Olaizola, Hena Caorsi, Laura Fajardo, Alejandro Ferreiro, Nieves Campistrus, Deyanira Dolinsky, Alicia Petraglia, Pablo Ambrosoni
Introduction: The mineral bone disorder, particularly secondary hyperparathyroidism, in chronic kidney disease (CKD) has a systemic impact affecting not only bone metabolism. Therefore its correction is important to prevent cardiovascular, inflammatory and immune diseases. Objective: To assess the effectiveness and safety of intravenous paricalcitol administered over a 6 month period for the treatment of secondary hyperparathyroidism (SHPT) in patients undergoing conventional hemodialysis, with close follow-up of treatment response...
July 2016: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
https://www.readbyqxmd.com/read/27679712/fgf23-in-kidney-transplant-the-strange-case-of-doctor-jekyll-and-mister-hyde
#13
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/27666759/ligand-trap-of-the-activin-receptor-type-iia-inhibits-osteoclast-stimulation-of-bone-remodeling-in-diabetic-mice-with-chronic-kidney-disease
#14
Toshifumi Sugatani, Olga A Agapova, Yifu Fang, Alycia G Berman, Joseph M Wallace, Hartmut H Malluche, Marie-Claude Faugere, William Smith, Victoria Sung, Keith A Hruska
Dysregulation of skeletal remodeling is a component of renal osteodystrophy. Previously, we showed that activin receptor signaling is differentially affected in various tissues in chronic kidney disease (CKD). We tested whether a ligand trap for the activin receptor type 2A (RAP-011) is an effective treatment of the osteodystrophy of the CKD-mineral bone disorder. With a 70% reduction in the glomerular filtration rate, CKD was induced at 14 weeks of age in the ldlr-/- high fat-fed mouse model of atherosclerotic vascular calcification and diabetes...
January 2017: Kidney International
https://www.readbyqxmd.com/read/27651467/the-efficacy-and-safety-of-sevelamer-and-lanthanum-versus-calcium-containing-and-iron-based-binders-in-treating-hyperphosphatemia-in-patients-with-chronic-kidney-disease-a-systematic-review-and-meta-analysis
#15
Steven Habbous, Sebastian Przech, Rey Acedillo, Sisira Sarma, Amit X Garg, Janet Martin
BACKGROUND: It remains unclear which phosphate binders should be preferred for hyperphosphatemia management in chronic kidney disease (CKD). METHODS: We performed a systematic review and meta-analysis of randomized trials comparing sevelamer or lanthanum with other phosphate binders in CKD. RESULTS: Fifty-one trials (8829 patients) were reviewed. Compared with calcium-based binders, all-cause mortality was nonsignificantly lower with sevelamer {risk ratio [RR] 0...
September 20, 2016: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/27647184/mineral-and-bone-disorder-and-its-association-with-cardiovascular-parameters-in-chinese-patients-with-chronic-kidney-disease
#16
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/27643443/treating-hyperphosphatemia-current-and-advancing-drugs
#17
Markus Ketteler, Orfeas Liangos, Patrick H Biggar
INTRODUCTION: Hyperphosphatemia is a hallmark of advanced chronic kidney disease (CKD) and associated with adverse outcomes. Preclinical and epidemiological studies strongly support a causal relationship between hyperphosphatemia and mortality as well as cardiovascular complications, especially including vascular, valvular and soft-tissue calcifications. Thus, appropriate phosphate lowering is considered to play a major role in health and longevity of CKD patients. In this respect, phosphate binders are the most powerful therapeutic option, while dietary phosphate restriction and intensified dialysis are valuable supportive approaches...
October 2016: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/27628245/the-cerebrovascular-chronic-kidney-disease-connection-perspectives-and-mechanisms
#18
Wei Ling Lau, Branko N Huisa, Mark Fisher
Chronic kidney disease (CKD) is an independent risk factor for the development of cerebrovascular disease, particularly small vessel disease which can manifest in a variety of phenotypes ranging from lacunes to microbleeds. Small vessel disease likely contributes to cognitive dysfunction in the CKD population. Non-traditional risk factors for vascular injury in uremia include loss of calcification inhibitors, hyperphosphatemia, increased blood pressure variability, elastinolysis, platelet dysfunction, and chronic inflammation...
September 14, 2016: Translational Stroke Research
https://www.readbyqxmd.com/read/27600818/nutritional-support-in-the-tertiary-care-of-patients-affected-by-chronic-renal-insufficiency-report-of-a-step-wise-personalized-pragmatic-approach
#19
Adamasco Cupisti, Claudia D'Alessandro, Biagio Di Iorio, Anna Bottai, Claudia Zullo, Domenico Giannese, Massimiliano Barsotti, Maria Francesca Egidi
BACKGROUND: Dietary treatment is helpful in CKD patients, but nutritional interventions are scarcely implemented. The main concern of the renal diets is its feasibility with regards to daily clinical practice especially in the elderly and co-morbid patients. This study aimed to evaluate the effects of a pragmatic, step-wise, personalized nutritional support in the management of CKD patients on tertiary care. METHODS: This is a case-control study. It included 823 prevalent out-patients affected by CKD stage 3b to 5 not-in-dialysis, followed by tertiary care in nephrology clinics; 305 patients (190 males, aged 70 ± 12 years) received nutritional support (nutritional treatment Group, NTG); 518 patients (281 males, aged 73 ± 13 years) who did not receive any dietary therapy, formed the control group (CG)...
September 6, 2016: BMC Nephrology
https://www.readbyqxmd.com/read/27588942/effectiveness-of-cinacalcet-in-patients-with-chronic-kidney-disease-and-secondary-hyperparathyroidism-not-receiving-dialysis
#20
Ariadna Pérez-Ricart, Maria Galicia-Basart, Maria Alcalde-Rodrigo, Alfons Segarra-Medrano, Josep-Maria Suñé-Negre, José-Bruno Montoro-Ronsano
BACKGROUND: Secondary hyperparathyroidism (SHPT) is a common complication in chronic kidney disease (CKD) patients. Cinacalcet could be a therapeutic option although its use is controversial in patients not receiving dialysis. Thus, the aim of this study is to assess the effectiveness and safety of cinacalcet in patients with CKD and SHPT without renal replacement treatment (RRT) and without renal transplantation (RT). METHODS: A retrospective observational study was conducted...
2016: PloS One
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