Adynamic Bone Disease: From Bone to Vessels in Chronic Kidney Disease

Bover, Jordi; Ureña, Pablo; Brandenburg, Vincent; Goldsmith, David; Ruiz, César; daSilva, Iara; Bosch, Ricardo J.

doi:10.1016/j.semnephrol.2014.09.008

Cited by 107 publications

(85 citation statements)

References 186 publications

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“…All of our cases with low serum PTH had serum ALP levels >100 IU/L. The prevalence of ABD in dialysis patients is increasing (39,40) due to over suppression of PTH and skeletal resistance to its actions (41). In our series, high frequency (2/3 of cases) of hypoparathyroidism in males, who majority were used HD modality and dialyzed with low dialysate Ca solutions, suggest that factors other than Ca concentrations in dialysis solutions play role in inducing PTH suppressions.…”

Section: Discussionmentioning

confidence: 60%

Hypoparathyroidism versus hyperparathyroidism in pediatric dialysis patients; a single center study

Naseri¹

2017

J Nephropathol

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Background: Abnormalities in calcium, phosphorous and parathyroid hormone (PTH) metabolisms are common in dialysis patients. Reaching target levels for these serologic factors and calcium × phosphorous products is recommended to minimize cardiovascular events. Objectives: The aim of this study was to examine calcium, phosphorous and intact PTH (iPTH) abnormalities in a group of dialysis patients. Patients and Methods: Bone minerals status and iPTH levels were assessed in 46 dialysis patients aged 19-300 (165.2 ± 75.73) months. Low and high Ca dialysate solutions routinely were used for hemodialysis (63%) and peritoneal dialysis (30.4%) patients respectively. Comparisons between groups were performed with considering age (≤5, 6-10, and > 10 years), gender and modality of dialysis. Results: Serum calcium and corrected calcium levels were significantly higher in peritoneal dialysis (PD) patients. Hypoparathyroidism was the most frequent iPTH abnormality (58.7%). It was more prevalent in males. Hyperparathyroidism was more frequent in females. Conclusions: We found that hypoparathyroidism is the most prevalent PTH abnormality. We also noted that patients on peritoneal dialysis are more prone to develop this form of PTH abnormality. We found that phosphate control is better in peritoneal dialysis vs. hemodialysis cases.

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Section: Discussionmentioning

confidence: 60%

Hypoparathyroidism versus hyperparathyroidism in pediatric dialysis patients; a single center study

Naseri¹

2017

J Nephropathol

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“…However, these therapies are limited by the occurrence of hyperphosphatemia and hypercalcemia, by a lack of specificity, and by limited long-term efficacy. On the other hand, surgical parathyroidectomy is not exempt from important, sometimes neglected, risks, as recently reported (5,28). Fortunately, with the advent of calcimimetics, enormous progress has been made in extending the armamentarium against SHPT, although we acknowledge that there is insufficient high-grade evidence on whether any treatment or a combination thereof should be preferred to control SHPT in dialysis patients (29,30).…”

Section: Cinacalcet As a Treatment For Shptmentioning

confidence: 90%

“…However, in other situations, the initial increase in PTH and bone remodeling may be excessively slowed by a multitude of factors leading to low bone turnover or adynamic bone disease (ABD) (5). Both high and low bone turnover bone diseases are associated with a high risk of skeletal fractures and poor clinical outcomes (3,25).…”

Section: Bone Abnormalitiesmentioning

confidence: 99%

“…Other studies and metaanalyses have confirmed that cinacalcet has a significant beneficial effect in preventing parathyroidectomy and hypercalcemia (13,49,59,(65)(66)(67)(68)(69), but these studies also found that cinacalcet increases nausea, vomiting, and hypocalcemia, with relative risks of 2.02 (95% CI, 1.45 to 2.81), 1.97 (95% CI, 1.73 to 2.24), and 6.98 (95% CI, 5.10 to 9.53), respectively (59). Therefore, these are the problems that nephrologists encounter more frequently with the clinical use of cinacalcet, together with PTH oversuppression (5).…”

Section: Cinacalcet Use In Patients With Ckd Treated By Dialysismentioning

confidence: 99%

“…Multiple CKD-related derangements may account for the extremely high mortality observed in these patients (1) and, among these disturbances, CKD-related mineral and bone disorders (CKD-MBDs) seem to play an important role (1)(2)(3). Classic biochemical alterations of calcium (Ca), phosphate (P), Ca 3 P product, parathyroid hormone (PTH), and other bone-related biomarkers have been increasingly associated, although not uniformly, with prediction of bone disease and also with CV events and survival (2)(3)(4)(5). On the other hand, it has been suggested that patients with CKD stages 3-5D, with known vascular or valvular calcifications, should be considered at the highest CV risk; therefore, it seems reasonable to use this information to guide the management of CKD-MBD (3,(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical and Practical Use of Calcimimetics in Dialysis Patients With Secondary Hyperparathyroidism

Bover

Ureña

Ruiz-García

et al. 2016

Clinical Journal of the American Society of Nephrology

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CKD and CKD-related mineral and bone disorders (CKD-MBDs) are associated with high cardiovascular and mortality risks. In randomized clinical trials (RCTs), no single drug intervention has been shown to reduce the high mortality risk in dialysis patients, but several robust secondary analyses point toward important potential beneficial effects of controlling CKD-MBD-related factors and secondary hyperparathyroidism. The advent of cinacalcet, which has a unique mode of action at the calcium-sensing receptor, represented an important step forward in controlling CKD-MBD. In addition, new RCTs have conclusively shown that cinacalcet improves achievement of target levels for all of the metabolic abnormalities associated with CKD-MBD and may also attenuate the progression of vascular and valvular calcifications in dialysis patients. However, a final conclusion on the effect of cinacalcet on hard outcomes remains elusive. Tolerance of cinacalcet is limited by frequent secondary side effects such as nausea, vomiting, hypocalcemia and oversuppression of parathyroid hormone, which may cause some management difficulties, especially for those lacking experience with the drug. Against this background, this review aims to summarize the results of studies on cinacalcet, up to and including the publication of the recent ADVANCE and EVOLVE RCTs, as well as recent post hoc analyses, and to offer practical guidance on how to improve the clinical management of the most frequent adverse events associated with cinacalcet, based on both currently available information and personal experience. In addition, attention is drawn to less common secondary effects of cinacalcet treatment and advisable precautions.

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Pathophysiology and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder

Hanudel

Moe

Salusky

2018

Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism

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Adynamic Bone Disease: From Bone to Vessels in Chronic Kidney Disease

Cited by 107 publications

References 186 publications

Hypoparathyroidism versus hyperparathyroidism in pediatric dialysis patients; a single center study

Hypoparathyroidism versus hyperparathyroidism in pediatric dialysis patients; a single center study

Clinical and Practical Use of Calcimimetics in Dialysis Patients With Secondary Hyperparathyroidism

Pathophysiology and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder

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