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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
Camiel L M de Roij van Zuijdewijn, Dinky E de Haseth, Bastiaan van Dam, Willem A Bax, Muriel P C Grooteman, Michiel L Bots, Peter J Blankestijn, Menso J Nubé, Marinus A van den Dorpel, Pieter M Ter Wee, Erik L Penne
BACKGROUND/AIMS: In hemodialysis (HD) patients, the bromcresol green (BCG) assay overestimates, whereas the bromcresol purple (BCP) assay underestimates albumin concentration. Since corrected calcium concentrations depend on albumin, the albumin assay may have implications for the management of bone mineral disorders. METHODS: A subset of patients from CONTRAST, a cohort of prevalent HD patients, was analyzed. Bone mineral parameters and prescription of medication were compared between patients in whom albumin was assessed by BCP versus BCG...
September 13, 2018: Nephron
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
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
Chandan Vangala, Jenny Pan, Ronald T Cotton, Venkat Ramanathan
The risk of mineral and bone disorders among patients with chronic kidney disease is substantially elevated, owing largely to alterations in calcium, phosphorus, vitamin D, parathyroid hormone, and fibroblast growth factor 23. The interwoven relationship among these minerals and hormones results in maladaptive responses that are differentially affected by the process of kidney transplantation. Interpretation of conventional labs, imaging, and other fracture risk assessment tools are not standardized in the post-transplant setting...
2018: Frontiers in Medicine
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
Ebele M Umeukeje, Amanda S Mixon, Kerri L Cavanaugh
Objectives: This review summarizes factors relevant for adherence to phosphate-control strategies in dialysis patients, and discusses interventions to overcome related challenges. Methods: A literature search including the terms "phosphorus", "phosphorus control", "hemo-dialysis", "phosphate binder medications", "phosphorus diet", "adherence", and "nonadherence" was undertaken using PubMed, PsycInfo, CINAHL, and Embase...
2018: Patient Preference and Adherence
Noriko Ide, Rui Ye, Marie Courbebaisse, Hannes Olauson, Michael J Densmore, Tobias Larsson, Jun-Ichi Hanai, Beate Lanske
Phosphate homeostasis is primarily maintained in the renal proximal tubules where the expression of sodium/phosphate co-transporters (Npt2a and Npt2c) is modified by the endocrine actions of both FGF23 and PTH. However, the specific contribution of each regulatory pathway in the proximal tubules has not been fully elucidated in vivo. We have previously demonstrated that proximal tubule-specific deletion of the FGF23 co-receptor Klotho results in mild hyperphosphatemia with little to no change in serum levels of FGF23, 1,25(OH)2D3, and PTH...
July 11, 2018: American Journal of Physiology. Renal Physiology
Csaba P Kovesdy, Jun Ling Lu, Barry M Wall, Geeta Gyamlani, Adnan Naseer, Angela Wallick, Zhongji Han, Fridtjof Thomas, L Darryl Quarles, Nabil Jarmukli
Introduction: Abnormal phosphorus homeostasis develops early in chronic kidney disease (CKD). It is unclear if its correction results in improved clinical outcomes in non-dialysis dependent CKD. Methods: We conducted a randomized controlled, parallel design clinical trial in 120 patients with estimated glomerular filtration rate 15 to 59 ml/min per 1.73 m2 and abnormal phosphorus homeostasis (serum phosphorus >4.6 mg/dl, parathyroid hormone [PTH] >70 pg/ml or tubular reabsorption of phosphorus [TRP] <80%)...
July 2018: KI Reports
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
L-C Desbiens, A Sidibé, R-V Ung, C Fortier, M Munger, Y-P Wang, S-K Bisson, K Marquis, M Agharazii, F Mac-Way
We performed a case-control study on 130 age- and sex-matched hemodialysis patients. In multivariate analysis, we observed that FGF23 levels were associated with fracture incidence and that soluble α-klotho levels were associated with the aortic-brachial arterial stiffness ratio. INTRODUCTION: New bone markers such as sclerostin, Dickkopf-related protein 1 (DKK1), fibroblast growth factor-23 (FGF23), and α-klotho have been identified as potential key players in bone and vascular abnormalities of chronic kidney disease...
October 2018: Osteoporosis International
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...
September 2018: European Journal of Clinical Investigation
Berthold Hocher, Andreas Pasch
BACKGROUND: Chronic kidney disease-mineral and bone disorder (CKD-MBD) patients have a huge morbidity and mortality. Only relatively minor progress in therapeutic strategies has been made in the past decades. This is at least partially due to a lack of predictive diagnostic tools allowing personalized treatment of CKD-MBD patients. SUMMARY: In this review we describe recent progress in the diagnosis of disturbances of calcium and phosphate metabolism in patients with CKD-MBD, measuring biological active nonoxidized parathyroid hormone as well as the overall likelihood of a patient to get calcified...
July 2017: Kidney Diseases
Takayuki Hamano
Despite the advent of cinacalcet and noncalcium-containing phosphate binders, controlling the progression of vascular calcification (VC) is still challenging. Recent reports demonstrate that carbamylation driven by high urea concentration aggravates VC, suggesting the importance of adequate dialysis in retarding its progression. Theoretically, other promising measures include the use of iron-based phosphate binders, vitamin K, and magnesium supplements, which should be investigated in future randomized controlled trials (RCTs), ideally with hard outcomes...
June 13, 2018: Seminars in Dialysis
Georg Lorenz, Christopher C Mayer, Quirin Bachmann, Sarah Stryeck, Matthias C Braunisch, Bernhard Haller, Javier Carbajo-Lozoya, Alina Schmidt, Simon Witthauer, Jasmin Abuzahu, Stephan Kemmner, Susanne Angermann, Naresh Koneru, Siegfried Wassertheurer, Richard Bieber, Uwe Heemann, Tobias Madl, Andreas Pasch, Christoph Schmaderer
Background: A novel in vitro test (T50 test) assesses ex vivo serum calcification propensity and predicts mortality in chronic kidney disease and haemodialysis (HD) patients. For the latter, a time-dependent decline of T50 was shown to relate to mortality. Here we assessed whether a 3-month switch to acetate-free, citrate-acidified, standard bicarbonate HD (CiaHD) sustainably improves calcification propensity. Methods: T50 values were assessed in paired midweek pre-dialysis sera collected before and 3 months after CiaHD in 78 prevalent European HD patients...
May 30, 2018: Nephrology, Dialysis, Transplantation
Maria Lerche Mace, Klaus Ølgaard, Eva Lewin
Calcium and phosphate levels are regulated by a complex interplay between parathyroid hormone (PTH), calcitriol, fibroblast growth factor 23 (FGF23) and its co-receptor αKlotho. Kidney failure causes severe disturbances in the mineral and bone homeostasis resulting in phosphate retention, hypocalcaemia and high plasma levels of FGF23 and PTH, and the patients develop fragile bones and vascular calcifications. Today's treatments aim to lower the levels of phosphate and PTH. Future studies need to clarify, if lowering the FGF23 level or supplementation with αKlotho will improve survival for patients with chronic kidney disease...
May 21, 2018: Ugeskrift for Laeger
Marzia Pasquali, Antonio Bellasi, Giuseppe Cianciolo, Carlo Massimetti, Maria Cristina Mereu, Luigi Morrone, Vincenzo Panuccio
Guidelines for the assessment, diagnosis and therapy of the alterations that characterize the CKD-MBD are an important support in the clinical practice of the nephrologist. Compared to the KDIGO guidelines published in 2009, the 2017 update made changes on some topics on which there was previously no strong evidence both in terms of diagnosis and therapy. The recommendations include the diagnosis of bone anomalies in CKD-MBD and the treatment of mineral metabolism abnormalities with particular regard to hyperphosphataemia, calcium levels, secondary hyperparathyroidism and anti-resorptive therapies...
May 2018: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
David C Grossman, Susan J Curry, Douglas K Owens, Michael J Barry, Aaron B Caughey, Karina W Davidson, Chyke A Doubeni, John W Epling, Alex R Kemper, Alex H Krist, Martha Kubik, Seth Landefeld, Carol M Mangione, Michael Silverstein, Melissa A Simon, Chien-Wen Tseng
Importance: Because of the aging population, osteoporotic fractures are an increasingly important cause of morbidity and mortality in the United States. Approximately 2 million osteoporotic fractures occurred in the United States in 2005, and annual incidence is projected to increase to more than 3 million fractures by 2025. Within 1 year of experiencing a hip fracture, many patients are unable to walk independently, more than half require assistance with activities of daily living, and 20% to 30% of patients will die...
April 17, 2018: JAMA: the Journal of the American Medical Association
Marc G Vervloet, Adriana J van Ballegooijen
Hyperphosphatemia has consistently been shown to be associated with dismal outcome in a wide variety of populations, particularly in chronic kidney disease (CKD). Compelling evidence from basic and animal studies elucidated a range of mechanisms by which phosphate may exert its pathological effects and motivated interventions to treat hyperphosphatemia. These interventions consisted of dietary modifications and phosphate binders. However, the beneficial effects of these treatment methods on hard clinical outcomes have not been convincingly demonstrated in prospective clinical trials...
May 2018: Kidney International
Jürgen Floege, Kate Tsirtsonis, Jan Iles, Tilman B Drueke, Glenn M Chertow, Patrick Parfrey
The calcimimetic cinacalcet is used to treat secondary hyperparathyroidism in patients receiving dialysis, and asymptomatic hypocalcemia is often observed following its initiation. Here we investigated the incidence, predictors and therapeutic consequences of hypocalcemia by a post hoc analysis of the randomized, double-blind, placebo-controlled EValuation Of Cinacalcet Hydrochloride Therapy to Lower CardioVascular Events (EVOLVE) trial. Hypocalcemia was classified as mild (total serum calcium 8.0-8.39 mg/dL), moderate (7...
June 2018: Kidney International
Yuhui Zhang, Darsy Darssan, Elaine M Pascoe, David W Johnson, Haichen Pi, Jie Dong
Background: Vitamin D deficiency is highly prevalent in patients on dialysis. Although vitamin D deficiency is closely associated with cardiovascular disease (CVD) and high mortality in the general population, the relationship between serum 25-hydroxyvitamin D [25(OH)D] and all-cause and cardiovascular mortality in dialysis patients is uncertain. We aim to explore the relationship between serum 25(OH)D levels and all-cause and cardiovascular mortality in dialysis patients. Methods: This is a systematic review and meta-analysis of clinical studies among patients receiving maintenance dialysis...
February 21, 2018: Nephrology, Dialysis, Transplantation
2018-02-28 06:55:02
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