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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
Stephen A Strugnell, Stuart M Sprague, Akhtar Ashfaq, Martin Petkovich, Charles W Bishop
BACKGROUND: Vitamin D repletion is recommended for secondary hyperparathyroidism (SHPT) and associated vitamin D insufficiency (VDI) in chronic kidney disease (CKD), but optimal levels of serum total 25-hydroxyvitamin D remain undefined. Clinical practice guidelines target sufficiency, whereas recent data indicate that higher levels are required to control the elevation of intact parathyroid hormone (iPTH) as CKD advances. This secondary analysis of 2 randomized controlled trials seeks to identify the minimum level of mean serum 25-hydroxyvitamin D required to control SHPT arising from VDI in stage 3 or 4 CKD...
March 15, 2019: American Journal of Nephrology
Marko Baralić, Voin Brković, Vesna Stojanov, Sanja Stanković, Nataša Lalić, Petar Đurić, Ljubica Đukanović, Milorad Kašiković, Milan Petrović, Marko Petrović, Milan Stošović, Višnja Ležaić
Background: Vascular calcification (VC) is highly prevalent in dialysis (HD) patients, and its mechanism is multifactorial. Most likely that systemic or local inhibitory factor is overwhelmed by promoters of VC in these patients. VC increased arterial stiffness, and left ventricular hypertrophy. Thus, the present study aimed to investigate the association of VC and myocardial remodeling and to analyze their relationship with VC promoters (fibroblast growth factor 23-FGF23, Klotho, intact parathormon-iPTH, vitamin D) in 56 prevalent HD patients (median values: age 54 yrs, HD vintage 82 months)...
April 2019: Journal of Medical Biochemistry
Chia-Liang Wang, Kuan-Pin Lin, Guoo-Shyng W Hsu, Kai-Li Liu, Chih-Hung Guo
Patients undergoing long-term hemodialysis (HD) are known to have abnormal blood concentrations of antioxidant minerals; concurrent oxidative stress can contribute to increased vascular calcification. This study aims to evaluate the associations between circulating antioxidant minerals and clinical biomarkers of vascular calcification in HD patients. Blood biochemical parameters, antioxidant minerals (selenium (Se), zinc (Zn), copper (Cu), and magnesium (Mg)), and several promoters and inhibitors of calcification (matrix Gla protein (MGP), fibroblast growth factor-23 (FGF-23), matrix metalloproteinases (MMP-2 and -9), and tissue inhibitors of metalloproteinase (TIMP-1 and -2)) were determined in HD patients (n = 62) and age- and sex-matched healthy individuals (n = 30)...
March 7, 2019: Biological Trace Element Research
Jordi Bover, Pablo Ureña-Torres, Ana María Laiz Alonso, Josep-Vicens Torregrosa, Minerva Rodríguez-García, Cristina Castro-Alonso, José Luis Górriz, Silvia Benito, Víctor López-Báez, María Jesús Lloret Cora, Secundino Cigarrán, Iara DaSilva, Maya Sánchez-Bayá, Silvia Mateu Escudero, Lluis Guirado, Jorge Cannata-Andía
Osteoporosis (OP) and chronic kidney disease (CKD) both independently affect bone health. A significant number of patients with CKD have decreased bone mineral density (BMD), are at high risk of fragility fractures and have an increased morbidity and mortality risk. With an ageing population, these observations are not only dependent on "renal osteodystrophy" but also on the associated OP. As BMD predicts incident fractures in CKD patients (partI), we now aim to analyse the potential therapeutic consequences...
February 20, 2019: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Zhongyan Liu, Hao Zhou, Xiaoying Chen, Hong Chen, Yi Wang, Ting Wang, Luyan Cai, Yanyan Hong, Hailun Ke, Jing Zheng
PURPOSE: To characterize the relationship between the cFGF23/Klotho ratio and phosphate level in patients with chronic kidney disease (CKD). METHODS: A total of 152 patients with CKD stage 3-5 (CKD stage 3: n = 74; CKD stage 4: n = 60; CKD stage 5: n = 18) were included in the study. Thirty healthy volunteers served as controls. Intact-FGF23, cFGF23, Klotho, serum calcium, serum phosphate, and serum creatinine were measured, and estimated glomerular filtration rate (eGFR) was calculated...
January 28, 2019: International Urology and Nephrology
Hironobu Fujisawa, Yosuke Nakayama, Kaoru Ueda, Kei Fukami
Abnormalities, such as hyperparathyroidism, vascular calcification, and osteoporosis, are devastating complications in patients with end-stage renal disease(ESRD). These abnormalities significantly affect the quality of life and prognosis. Therefore, controlling the abnormalities of chronic kidney disease-mineral and bone metabolism play an important role in these patients. Conventionally, calcium and phosphorus metabolism abnormalities have been mainly attributed to the development of vascular calcification, but preventing vascular calcification is still difficult even if calcium and phosphorus levels are controlled...
2019: Clinical Calcium
(no author information available yet)
No abstract text is available yet for this article.
July 2017: Kidney International Supplements
Francesca Sassi, Cristina Tamone, Patrizia D'Amelio
The classical functions of vitamin D are to regulate calcium-phosphorus homeostasis and control bone metabolism. However, vitamin D deficiency has been reported in several chronic conditions associated with increased inflammation and deregulation of the immune system, such as diabetes, asthma, and rheumatoid arthritis. These observations, together with experimental studies, suggest a critical role for vitamin D in the modulation of immune function. This leads to the hypothesis of a disease-specific alteration of vitamin D metabolism and reinforces the role of vitamin D in maintaining a healthy immune system...
November 3, 2018: Nutrients
Qing-Ya Zeng, Zhi-Yin Xia, Yan-Shan Tong, Liang Sun, Hong-Bin Mou, Rui Chen, Guang-Yu Bi, Chang-Hua Liu
BACKGROUND: Klotho G-395-A gene polymorphism is associated with several diseases; however, its association with calcium-phosphate metabolism disorders in end-stage renal disease (ESRD) is unknown. METHODS: 137 patients with ESRD and 80 healthy adults (control) were enrolled in the study. Patients with ESRD were divided into three subgroups: hemodialysis (A1, n=52), peritoneal dialysis (A2, n=30), and non-dialysis (A3, n=55). The Klotho G-395-A genotype was detected by TaqMan PCR assay, and ELISA was used to detect the soluble Klotho protein (sKL) and fibroblast growth factor (FGF23)...
December 8, 2018: Nephrology
Chien-Lin Lu, Dong-Feng Yeih, Yi-Chou Hou, Guey-Mei Jow, Zong-Yu Li, Wen-Chih Liu, Cai-Mei Zheng, Yuh-Feng Lin, Jia-Fwu Shyu, Remy Chen, Chung-Yu Huang, Kuo-Cheng Lu
In chronic kidney disease (CKD), hyperphosphatemia induces fibroblast growth factor-23 (FGF-23) expression that disturbs renal 1,25-dihydroxy vitamin D (1,25D) synthesis; thereby increasing parathyroid hormone (PTH) production. FGF-23 acts on the parathyroid gland (PTG) to increase 1α-hydroxylase activity and results in increase intra-gland 1,25D production that attenuates PTH secretion efficiently if sufficient 25D are available. Interesting, calcimimetics can further increase PTG 1α-hydroxylase activity that emphasizes the demand for nutritional vitamin D (NVD) under high PTH status...
December 3, 2018: Nutrients
Florian Lang, Christina Leibrock, Aleksandra A Pandyra, Christos Stournaras, Carsten A Wagner, Michael Föller
Fibroblast growth factor 23 (FGF23) is released primarily from osteoblasts/osteocytes in bone. In cooperation with the transmembrane protein Klotho, FGF23 is a powerful inhibitor of 1α 25OH Vitamin D Hydroxylase (Cyp27b1) and thus of the formation of 1,25-dihydroxyvitamin D3 (1,25(OH)2D3). As 1,25(OH)2D3 up-regulates intestinal calcium and phosphate absorption, the downregulation of 1,25(OH)2D3 synthesis counteracts phosphate excess and tissue calcification. FGF23 also directly inhibits renal phosphate reabsorption...
2018: Kidney & Blood Pressure Research
Ming Chang Hu, Mingjun Shi, Orson W Moe
Alpha-Klotho is a member of the Klotho family consisting of two other single-pass transmembrane proteins: βKlotho and γKlotho; αKlotho has been shown to circulate in the blood. Fibroblast growth factor (FGF)23 is a member of the FGF superfamily of 22 genes/proteins. αKlotho serves as a co-receptor with FGF receptors (FGFRs) to provide a receptacle for physiological FGF23 signaling including regulation of phosphate metabolism. The extracellular domain of transmembrane αKlotho is shed by secretases and released into blood circulation (soluble αKlotho)...
December 1, 2018: Pflügers Archiv: European Journal of Physiology
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
Thierry Hannedouche, Denis Fouque, Dominique Joly
Metabolic complications of chronic kidney disease (CKD) are frequent; the aims of this review are to present a 2018 update for hyperkalemia, hyperphosphatemia and anemia. Hyperkalemia is defined by a plasma level above 5.0 mmol/L, after ruling out pre-analytical problems such as hemolysis. It is frequent in CKD, most often due to drugs and notably renin/ angiotensin blockers. Chronic hyperkalemia is deleterious, with an increased risk of mortality. Therapeutic strategies to decrease the incidence and severity of hyperkalemia are therefore crucial in nephrology: experts recommend to maintain the renin/angiotensin blockers as long as possible, whilst associating diuretics and potassium binders...
November 2018: Néphrologie & Thérapeutique
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
Makoto Kuro-O
The Klotho proteins, αKlotho and βKlotho, are essential components of endocrine fibroblast growth factor (FGF) receptor complexes, as they are required for the high-affinity binding of FGF19, FGF21 and FGF23 to their cognate FGF receptors (FGFRs). Collectively, these proteins form a unique endocrine system that governs multiple metabolic processes in mammals. FGF19 is a satiety hormone that is secreted from the intestine on ingestion of food and binds the βKlotho-FGFR4 complex in hepatocytes to promote metabolic responses to feeding...
January 2019: Nature Reviews. Nephrology
Varvara Chatzipetrou, Maude Gerbaix, Serge Ferrari, Andrea Trombetti
The management of osteoporosis in patients with mild to moderate chronic kidney disease (CKD) can be established as in general population. In severe or terminal CKD, bone densitometry is indicated. Bone-specific alkaline phosphatase is considered a useful marker for distinguishing among the histologic types of renal osteodystrophy. In ambiguous cases, bone biopsy together with quantitative histomorphometry will be necessary. As far as the treatment is concerned, the bisphosphonates, which had been avoided due to their renal excretion as well as the official warnings against using them in case of renal clearance lower than 30 ml/min, seem to be effective even in advanced stages of renal disease...
November 7, 2018: Revue Médicale Suisse
Joseph Lunyera, Julia J Scialla
Chronic kidney disease mineral and bone disorder (MBD) encompasses changes in mineral ion and vitamin D metabolism that are widespread in the setting of chronic kidney disease and end-stage renal disease. MBD components associate with cardiovascular disease in many epidemiologic studies. Through impacts on hypertension, activation of the renin-angiotensin-aldosterone system, vascular calcification, endothelial function, and cardiac remodeling and conduction, MBD may be a direct and targetable cause of cardiovascular disease...
November 2018: Seminars in Nephrology
David A Bushinsky, David M Spiegel, Jinwei Yuan, Suzette Warren, Jeanene Fogli, Pablo E Pergola
BACKGROUND AND OBJECTIVES: Patiromer is a sodium-free, nonabsorbed, potassium-binding polymer that uses calcium as the counter-exchange ion and is approved for treatment of hyperkalemia. The 4-week TOURMALINE study in patients with hyperkalemia previously demonstrated that patiromer administered once daily reduces serum potassium similarly when given with or without food. We report a prespecified exploratory efficacy analysis as well as a post hoc efficacy and safety analysis of the TOURMALINE study on circulating markers of mineral metabolism...
October 31, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Yan Yang, Shi Qiu, Linghui Deng, Xi Tang, Xinrui Li, Qiang Wei, Ping Fu
BACKGROUND: Mineral bone disease constitutes a common complication of post-kidney transplantation, leading to great disability. As there is no consensus on the optimal treatment for post-kidney transplant recipients (KTRs), we aimed to evaluate the efficacy and safety of bisphosphonate and its combined therapies. METHODS: We incorporated relevant trials to perform a network meta-analysis from direct and indirect comparisons. We searched PubMed, Embase and the CENTRAL and the reference lists of relevant articles up to August 1, 2017, for randomized controlled trials...
October 19, 2018: BMC Nephrology
2018-10-22 12:55:28
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