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CKD-MBD

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69 papers 100 to 500 followers
By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
https://www.readbyqxmd.com/read/28717990/iron-based-phosphate-binders-a-paradigm-shift-in-the-treatment-of-hyperphosphatemic-anemic-ckd-patients
#1
REVIEW
Francesco Locatelli, Lucia Del Vecchio
The partial correction of anemia and the normalization of phosphate and blood pressure are the mainstay of treatment of patients with chronic kidney disease (CKD). Available anti-hypertensive drugs, erythropoiesis stimulating agents (ESAs) and iron supplements have resolved quite satisfactorily the goal of controlling hypertension and partially correcting anemia. Unfortunately, the treatment of hyperphosphatemia is still far from resolved. Phosphate binders have poor tolerability and/or limited efficacy, leading to the prescription of many tablets that achieve only a mild-to-moderate effect...
July 17, 2017: Journal of Nephrology
https://www.readbyqxmd.com/read/28644425/significance-of-parathyroid-scintigraphy-and-correlation-of-findings-with-parathyroid-hormone-values-in-patients-undergoing-hemodialysis
#2
Nermana Ahmetbegović, Nadira Suljagić, Vahidin Katica
Aim To compare finding of thyroid gland scintigraphy with serum concentration of parathyroid hormone in patients undergoing hemodialysis. Methods This retrospective-prospective study included 50 patients undergoing hemodialysis with established hyperparathyroidism who were treated at Cantonal Hospital Zenica in the period 2009 - 2014. Besides anthropological data, concentration of parathyroid hormone in serum of patients was monitored too. Scintigraphy was performed at the Department of Nuclear Medicine using two-headed gamma camera Prism 2000xp...
August 1, 2017: Medicinski Glasnik
https://www.readbyqxmd.com/read/28584909/a-review-of-phosphate-binders-in-chronic-kidney-disease-incremental-progress-or-just-higher-costs
#3
REVIEW
Wendy L St. Peter, Lori D Wazny, Eric Weinhandl, Katie E Cardone, Joanna Q Hudson
As kidney disease progresses, phosphorus retention also increases, and phosphate binders are used to treat hyperphosphatemia. Clinicians prescribe phosphate binders thinking that reducing total body burden of phosphorus may decrease risks of mineral and bone disorder, fractures, cardiovascular disease, progression of kidney disease, and mortality. Recent meta-analyses suggest that sevelamer use results in lower mortality than use of calcium-containing phosphate binders. However, studies included in meta-analyses show significant heterogeneity, and exclusion or inclusion of specific studies alters results...
July 2017: Drugs
https://www.readbyqxmd.com/read/28577750/-strategies-aiming-to-control-hyperphosphatemia-in-chronic-kidney-disease
#4
Pablo Antonio Ureña Torres
Chronic kidney disease is known to be associated with phosphate retention. The mechanisms are complex and the early increase in serum phosphate levels in chronic kidney disease is not strictly related to the dietary phosphate load or to the degree of phosphate retention. It also implicates the activity of intestinal sodium-phosphate cotransporters, the degree of bone turnover and the retention and/or phosphate release from the skeleton, and the feedback mechanisms regulating the phosphaturia. Indeed, the increase in serum phosphate levels is only a reflection of underlying complex mechanisms, and many important factors play a role including parathyroid hormone, vitamin D, fibroblast growth factor 23 (FGF23), and others...
April 2017: Néphrologie & Thérapeutique
https://www.readbyqxmd.com/read/28619127/bone-mineral-disturbances-in-patients-with-chronic-kidney-disease-stage-5-not-yet-on-dialysis
#5
Andreja Marn Pernat, Matej Zrimšek
AIMS: This retrospective study evaluates the success of a treatment strategy for secondary hyperparathyroidism in our cohort of patients with chronic kidney disease stage 5 who were not yet on dialysis. MATERIALS AND METHODS: 81 predialysis patients from the outpatient clinic of the Department of Nephrology, University Medical Center Ljubljana were reviewed. We focused on serum markers for bone mineral metabolism including intact parathyroid hormone (PTH), phosphate, corrected calcium, and the usage of phosphate-binding agents and vitamin D analogs...
June 16, 2017: Clinical Nephrology
https://www.readbyqxmd.com/read/28531397/most-consumed-processed-foods-by-patients-on-hemodialysis-alert-for-phosphate-containing-additives-and-the-phosphate-to-protein-ratio
#6
Marcela T Watanabe, Raphael M Araujo, Barbara P Vogt, Pasqual Barretti, Jacqueline C T Caramori
BACKGROUND AND AIMS: Hyperphosphatemia is common in patients with chronic kidney disease (CKD) stages IV and V because of decreased phosphorus excretion. Phosphatemia is closely related to dietary intake. Thus, a better understanding of sources of dietary phosphate consumption, absorption and restriction, particularly inorganic phosphate found in food additives, is key to prevent consequences of this complication. Our aims were to investigate the most commonly consumed processed foods by patients with CKD on hemodialysis, to analyze phosphate and protein content of these foods using chemical analysis and to compare these processed foods with fresh foods...
August 2016: Clinical Nutrition ESPEN
https://www.readbyqxmd.com/read/28445887/use-of-phosphorus-binders-among-non-dialysis-chronic-kidney-disease-patients-and-mortality-outcomes
#7
Simran K Bhandari, In-Lu A Liu, Dean A Kujubu, Trung Huynh, Hind Behayaa, Csaba P Kovesdy, Kamyar Kalantar-Zadeh, Steven J Jacobsen, John J Sim
BACKGROUND: Whether the benefits of phosphorus binders extend to those without end stage renal disease is uncertain. Among a large diverse non-dialysis chronic kidney disease (CKD) population with hyperphosphatemia, we sought to evaluate phosphorus binder use and compare mortality risk between patients prescribed and not prescribed binders. METHODS: A retrospective cohort study within an integrated health system (January 1, 1998 - December 31, 2012) among CKD patients (age ≥18) was performed...
2017: American Journal of Nephrology
https://www.readbyqxmd.com/read/28429550/parathyroid-hormone-targets-in-chronic-kidney-disease-and-managing-severe-hyperparathyroidism
#8
Carmel M Hawley, Stephen G Holt
Appropriate targets for parathyroid hormone (PTH) in patients with chronic kidney disease (CKD) stages 3-5D are controversial, as are the means by which these targets might be achieved. Secondary hyperparathyroidism is linked to symptoms like bone pain and itch, in addition to less clinically overt issues like bone fragility as well as vascular and soft tissue calcification which may lead to adverse hard endpoints, particularly fracture and death. Recognized therapies for managing a rising PTH include vitamin D analogues, with or without calcimimetic (where available), in addition to management of serum mineral concentrations with diet, binders and dialysis...
March 2017: Nephrology
https://www.readbyqxmd.com/read/28429549/is-there-a-practical-role-for-a-virtual-bone-biopsy-using-high-resolution-imaging-of-bone-in-patients-with-chronic-kidney-disease
#9
Ashish K Sharma, Nigel D Toussaint
Renal osteodystrophy (ROD) refers to alterations in bone turnover, mineralisation, mass and microarchitecture in patients with chronic kidney disease (CKD) and represents the skeletal component of 'CKD-mineral and bone disorder'. Changes in bone structure lead to impaired bone quality, compromised bone strength and increased susceptibility to fractures with associated significant morbidity, mortality and financial cost. Diagnosis and management of ROD is hindered by the inadequacy of currently available diagnostic methods to interpret the complex pathophysiology...
March 2017: Nephrology
https://www.readbyqxmd.com/read/28384171/the-shift-from-high-to-low-turnover-bone-disease-after-parathyroidectomy-is-associated-with-the-progression-of-vascular-calcification-in-hemodialysis-patients-a-12-month-follow-up-study
#10
Fabiana Rodrigues Hernandes, Maria Eugênia Fernandes Canziani, Fellype Carvalho Barreto, Rodrigo Oliveira Santos, Valéria de Melo Moreira, Carlos Eduardo Rochitte, Aluizio Barbosa Carvalho
Parathyroidectomy (PTX) may cause low levels of PTH, leading to an excessive reduction of bone turnover, which is associated with poor outcomes in dialysis patients, including vascular calcification (VC). We aimed to prospectively investigate the impact of PTX on bone remodeling and its potential consequence on the progression of VC in hemodialysis patients. In this prospective study, 19 hemodialysis patients with severe secondary hyperparathyroidism (sHPT) were evaluated. All patients underwent laboratorial tests and coronary tomography at baseline and, 6 and 12 months after PTX; bone biopsy was performed at baseline and 12-month...
2017: PloS One
https://www.readbyqxmd.com/read/28375869/hungry-bone-syndrome
#11
Nishank Jain, Robert F Reilly
PURPOSE OF REVIEW: In the United States, the number of parathyroidectomies among patients with chronic dialysis has remained stable in the last decade. A fall in serum calcium concentration is common postparathyroidectomy in patients with hyperparathyroidism, which usually resolves in 2-4 days. A severe drop in serum total calcium concentration less than 2.1 mmol/L and/or prolonged hypocalcemia for more than 4 days postparathyroidectomy is called hungry bone syndrome (HBS). Concomitant hypophosphatemia, hypomagnesemia, and hyperkalemia can be seen...
July 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/28318623/the-complexity-of-chronic-kidney-disease-mineral-and-bone-disorder-across-stages-of-chronic-kidney%C3%A2-disease
#12
Fabiana G Graciolli, Katia R Neves, Fellype Barreto, Daniela V Barreto, Luciene M Dos Reis, Maria E Canziani, Yves Sabbagh, Aluizio B Carvalho, Vanda Jorgetti, Rosilene M Elias, Susan Schiavi, Rosa M A Moysés
Chronic Kidney Disease (CKD)-Mineral and Bone Disorder (CKD-MBD) is a complex disease that is not completely understood. However, some factors secreted by the osteocytes might play an important role in its pathophysiology. Therefore, we evaluated the bone expression of proteins in a group of patients with CKD 2-3, CKD 4, and CKD 5 on dialysis and healthy individuals. We also tested several bone remodeling markers, and correlated these levels with bone biopsy findings. As expected, as serum calcium decreased, serum phosphate, alkaline phosphatase, fibroblast growth factor-23 (FGF-23), parathyroid hormone, and osteoprotegerin increased, as CKD progressed...
June 2017: Kidney International
https://www.readbyqxmd.com/read/28290186/phosphorus-and-other-aspects-of-ckd-mbd-in-the-conservative-management-of-chronic-kidney-disease
#13
REVIEW
Anuja Shah
As the prevalence of chronic kidney disease (CKD) increases and the population ages, there is an imperative to offer cost effective and patient specific therapeutic options for the management of advanced CKD. In cases where there is a desire to avoid or delay renal replacement therapy, conservative options need to be defined and strategies for delaying the need for renal replacement therapy should be offered. CKD-mineral bone disorders (MBD) refers to the constellation of disturbances in abnormal bone and soft tissue calcification along with abnormalities, in phosphorus, calcium, parathyroid hormone, vitamin D, and FGF-23...
June 2017: Panminerva Medica
https://www.readbyqxmd.com/read/28044233/management-of-secondary-hyperparathyroidism-how-and-why
#14
REVIEW
Hirotaka Komaba, Takatoshi Kakuta, Masafumi Fukagawa
Secondary hyperparathyroidism (SHPT) is a common complication in chronic kidney disease. Currently, various treatment options are available, including vitamin D receptor activators, cinacalcet hydrochloride, and parathyroidectomy. These treatment options have contributed to the successful control of SHPT, and recent clinical studies have provided evidence suggesting that effective treatment of SHPT leads to improved survival. Although bone disease is the most widely recognized consequence of SHPT and remains a major target for treatment of SHPT, there is increasing evidence that parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23), both of which are markedly elevated in SHPT, have multiple adverse effects on extraskeletal tissues...
March 2017: Clinical and Experimental Nephrology
https://www.readbyqxmd.com/read/27867189/the-role-of-phosphate-in-kidney-disease
#15
REVIEW
Marc G Vervloet, Siren Sezer, Ziad A Massy, Lina Johansson, Mario Cozzolino, Denis Fouque
The importance of phosphate homeostasis in chronic kidney disease (CKD) has been recognized for decades, but novel insights - which are frequently relevant to everyday clinical practice - continue to emerge. Epidemiological data consistently indicate an association between hyperphosphataemia and poor clinical outcomes. Moreover, compelling evidence suggests direct toxicity of increased phosphate concentrations. Importantly, serum phosphate concentration has a circadian rhythm that must be considered when interpreting patient phosphate levels...
January 2017: Nature Reviews. Nephrology
https://www.readbyqxmd.com/read/26951967/phosphate-homeostasis-parathyroid-hormone-and-fibroblast-growth-factor-23-in-stages-3-and-4-chronic-kidney-disease
#16
Kenneth R Phelps, Darius L Mason, Kim S Stote
AIMS: Increased concentrations of parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) often coincide with normal serum phosphorus ([P]s) in chronic kidney disease (CKD). We hypothesized that the phosphate concentration ([P]f) in the cortical distal nephron (CDN) determines [PTH] and [FGF23] in this circumstance. METHODS: We studied 29 patients with CKD at 4 visits and 28 controls at 1 visit. Assuming GFR = creatinine clearance (Ccr), we examined the following regressions: [P]s on its determinants, EP/Ccr and TRP/Ccr (P excretion and reabsorption per volume of filtrate); [PTH] and [FGF23] on [P]s and EP/Ccr; and TRP/Ccr on [PTH] and [FGF23]...
May 2016: Clinical Nephrology
https://www.readbyqxmd.com/read/26914677/association-between-hemodialysis-patient-outcomes-and-compliance-with-kdoqi-and-kdigo-targets-for-mineral-and-bone-metabolism
#17
MULTICENTER STUDY
Ljubica Djukanović, Nada Dimković, Jelena Marinković, Živka Djurić, Violeta Knežević, Tatjana Lazarević, Stanimir Ljubenović, Rodoljub Marković, Violeta Rabrenović
BACKGROUND: Increased mortality of hemodialysis (HD) patients is associated with chronic kidney disease-mineral and bone disorders (CKD-MBD), and therefore, their correction may improve patient survival. Differences in targets recommended by KDOQI and KDIGO CKD-MBD guidelines directed us to compare the relative numbers of patients achieving these targets and to examine possible associations between compliance with the targets and patient outcome. METHODS: A total of 1,744 patients (61...
2016: Nephron
https://www.readbyqxmd.com/read/26806832/changing-bone-patterns-with-progression-of-chronic-kidney-disease
#18
REVIEW
Tilman B Drüeke, Ziad A Massy
It is commonly held that osteitis fibrosa and mixed uremic osteodystrophy are the predominant forms of renal osteodystrophy in patients with chronic kidney disease. Osteitis fibrosa is a high-turnover bone disease resulting mainly from secondary hyperparathyroidism, and mixed uremic osteodystrophy is in addition characterized by a mineralization defect most often attributed to vitamin D deficiency. However, there is ancient and more recent evidence that in early chronic kidney disease stages adynamic bone disease characterized by low bone turnover occurs first, at least in a significant proportion of patients...
February 2016: Kidney International
https://www.readbyqxmd.com/read/26785065/optimal-management-of-bone-mineral-disorders-in-chronic-kidney-disease-and-end-stage-renal-disease
#19
REVIEW
Andrew L Lundquist, Sagar U Nigwekar
PURPOSE OF REVIEW: The review summarizes recent studies on chronic kidney disease-mineral bone disorders, with a focus on new developments in disease management. RECENT FINDINGS: The term chronic kidney disease-mineral bone disorder has come to describe an increasingly complex network of alterations in minerals and skeletal disorders that contribute to the significant cardiovascular morbidity and mortality seen in patients with chronic kidney disease and end stage renal disease...
March 2016: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/26759046/targeting-serum-calcium-in-chronic-kidney-disease-and-end-stage-renal-disease-is-normal-too-high
#20
REVIEW
W Charles O'Neill
Hypocalcemia is common in advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD), and it is standard practice to correct this back to the normal range, presumably to prevent symptomatic hypocalcemia and help control hyperparathyroidism. However, there are few studies to support this approach, and recent data suggest that this promotes vascular calcification and adynamic bone disease. Whether setting a lower target will improve outcomes has not been tested, but existing data suggest that this may have minimal risks and substantial potential benefits and should be explored...
January 2016: Kidney International
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